Chapter 3 - Assessment of Posture.ppt

Basic Hukman Posture and its assessment

1. Chapter 3
Assessment of Posture

2. Introduction
Posture is the position of the body at a given
point in time
Correct posture can:
–improve performance
–decrease abnormal stresses
–reduce the development of pathological
conditions

3. Introduction
Faulty posture:
–Deviates from ideal posture
–Requires an increased amount of muscular
activity
–Places an increased amount of stress on the
joints and surrounding tissues
Restrictions in normal movement patterns
may cause compensatory postures
–Overtime can result in muscle imbalances and
soft tissue dysfunction

4. Introduction
Pain related to postural deviations is a
common clinical occurrence
–Many do not seek help until pain is experienced
Postural assessment is used to determine if
postural deviations are contributing factors
in patient’s pain or dysfunction
Posture must be evaluated in functional and
nonfunctional positions

5. Clinical Anatomy
Musculoskeletal system is designed to
function in a mechanically and
physiologically efficient manner to use the
least possible amount of energy
Postural deviations or skeletal malalignment
cause other joints in kinetic chain to undergo
compensatory motions or postures to allow
body to move as efficiently as possible

6. The Kinetic Chain
Closed kinetic chain
–Weight-bearing
–Lower extremity
–Distal segment meets resistance or is fixated
–Interdependency of each joint = predictable changes in
position
–Figure 3-1A, page 53
Open kinetic chain
–Non-weight-bearing
–Upper extremity
–Distal segment moves freely in space

7. The Kinetic Chain
A dysfunction occurring in one area may
affect the proximal or distal associated joints
and soft tissue structures
–Causing a specific postural deviation
The body compensates for these deviations
to maintain as much efficiency as possible in
movement and function
Table 3-1, page 54

8. Muscular Function
Muscles produce joint motion and provide
dynamic joint stability
Muscles must be of adequate length and
function in a proper manner
–If too short or too long
Adverse stress on joints
Work inefficiently
Create need for compensatory motions
Table 3-2, page 55

9. Muscular Length-Tension
Relationships
Describes how a muscle is capable of
producing different amounts of tension
(force), depending on its length
Active insufficiency
–Muscle is shortened and maximum tension
cannot be produced
Passive insufficiency
–Muscle is lengthened and cannot generate
sufficient tension to be effective
Figure 3-4, page 56

10. Agonist and Antagonist
Relationships
Agonist
–Muscle that contracts to perform the primary movement
of a joint
Antagonist
–Performs opposite movement of agonist and must relax
to allow agonist’s motion to occur
–Reciprocal inhibition
Bicep/triceps example
Co-contraction
–Used for dynamic stability of joint

11. Muscular Imbalances
Impaired relationship between a muscle that
is overactivated, subsequently shortened
and tightened and another that is inhibited
and weakened
–Table 3-3, page 57
Postural vs. phasic muscles
–Table 3-4, page 57
–Table 3-5, page 57

12. Soft Tissue Imbalances
Joint’s capsule and surrounding ligaments
undergo adaptive changes from prolonged
overstressing or understressing of structure
Faulty posture can alter the position of
joints, causing an increase in stress on
different portions of the joint capsule and
surrounding ligaments

13. Clinical Evaluation of Posture
Not an exact science
–Radiographs, photographs, computer analysis
–Clinical tools –plumb lines, goniometers,
flexible rulers, inclinometers (fig. 3-5, page 58)
Subjective vs. objective methods
–Normal, mild, moderate, severe posture
–Quantifiable measurements can assess
treatment plan

14. Clinical Evaluation of Posture
Commonly assessed in various positions
–Standing and sitting
–Sport-specific and ADLs
Orthoposition
–Normal or properly aligned posture
–4 movements to perform before assessment
Page 58

15. History
To determine if a postural dysfunction is
contributing to the patient’s pathology
Identify any routine repetitive motions
IF injury is chronic
–Explore day to day tasks and posture
If injury is acute
–Determine factors that may have predisposed
athlete to the injury

16. History
Mechanism of injury
–Common responses
Insidious onset
Pain worsening as day progresses
Posture-specific pain
Intermittent, vague , or generalized pain
Starting as an ache and progressing
Type, location, and severity of symptoms
Side of dominance
Activities of daily living
–Table 3-7, pages 60-61

17. History
Driving, sitting, and sleeping postures
–Table 3-8, page 62
Specific postures causing discomfort
Level and intensity of exercise
Medical History

18. Inspection
Considerations
–Area being used is private, comfortable
–Patient preparedness
–Do not inform patient you are assessing posture
–Use systematic approach
Start at feet and work superiorly or vice versa
–Compare bilaterally for symmetry
–Your eyes should be at level of region you are
observing

19. Overall Impression
Determine patient’s general body type
–Ectomorph, mesomorph, endomorph
–Inherited
–Can indicate a person’s natural abilities and
disabilities
–Does not necessarily dictate how they may
function
–Box 3-1, page 64

20. Views of Postural Inspection
Inspect from lateral, anterior, posterior views
Plumb line
–Feet as permanent landmark
–Lateral view
Slightly anterior to lateral malleolus
–Anterior and posterior view
Equidistant from both feet
–Box 3-2, page 65

21. Views
Lateral view
–Table 3-9, page 63
Anterior view
–Table 3-10, page 66
Posterior view
–Table 3-11, page 67

22. Inspection of Leg Length
Discrepancy
Three categories
–Structural (true)
–Functional (apparent)
–Compensatory
–Table 3-12, page 68
Block method (Box 3-3, page 69)
Figure 3-6, page 68
Figure 3-7, page 70
Figure 3-8, page 70

23. Palpation
To determine specific positions (key
landmarks) not necessarily for point
tenderness
Lateral aspect
–Pelvic position
ASIS and PSIS, 9-10
0
Box 3-4, page 71

24. Palpation
Anterior aspect
–Patellar position
–Iliac crest heights
Figure 3-9, page 70
–ASIS heights
Figure 3-10, page 70
–Lateral malleolus and fibula head heights
–Shoulder heights
Figure 3-11, page 72

25. Palpation
Posterior aspect
–Many of same landmarks used for anterior view
–PSIS position
Figure 3-12, page 72
–Spinal alignment
–Scapular position
Box 3-5, page 73
Not important at this time

26. Common Postural Deviations
Not all postural deviations cause pathology
Clinicians must identify
–Normal posture
–Asymptomatic deviations
–Deviations causing dysfunction and/or pain
Potential muscle imbalances can cause
poor posture ORbe a result of poor posture
Deviations also caused by skeletal
malalignment, anomalies, or combination

27. Foot and Ankle
Hyperpronation
–Review chapter 4
–Figure 3-13, page 74
Supination
–Review chapter 4

28. The Knee
Genu Recurvatum
–Knee axis of motion is posterior to plumb line
–Box 3-6, page 75
Genu Valgum
–Occurs due to
structural anomalies or muscular weaknesses at the hip
Secondary to hyperpronation of the feet
–Can lead to
Increased pronation
Internal tibial and femoral rotation
Medial patellar positioning

29. The Knee
Genu Varum
–Occurs due to
Structural anomalies at the hip
Excessive supination
–Can lead to
Supination
External tibial and femoral rotation
Lateral patellar positioning

30. Interrelationships Between Regions
Table 3-14, page 83
May be impossible to determine if posture is
the cause or the effect
–Understand relationships and importance of
correcting the factors involved
Most soft tissue dysfunctions that have a
gradual, insidious onset have, at least, a
minimal postural component

31. Documentation of Postural
Assessment
Table 3-15, page 85
–As part of a SOAP note
Figure 3-14, page 84
–Standard postural assessment form
Guidelines for documenting posture
–Pages 83, 85