Postural deviation in different planes.pptx

Postural deviation refers to any abnormal alignment or positioning of the body's joints and structures while standing, sitting, or moving. These deviations can occur due to a variety of factors, including muscle imbalances, skeletal abnormalities, poor posture habits, injuries, or neurological conditions. Postural deviations can affect people of all ages and can lead to discomfort, pain, reduced mobility, and functional limitations if left unaddressed.

There are several common types of postural deviations:

*Kyphosis: This is an excessive curvature of the upper back, leading to a rounded or hunched posture. It can result from factors such as poor sitting habits, weak back muscles, or structural abnormalities in the spine.

*Lordosis: Lordosis is an exaggerated inward curvature of the lower back, often causing the pelvis to tilt forward and the abdomen to protrude. Factors contributing to lordosis include tight hip flexors, weak abdominal muscles, obesity, or pregnancy.

*Scoliosis: Scoliosis is characterized by an abnormal sideways curvature of the spine, which can cause the shoulders, hips, or waist to appear uneven. It can be congenital or develop during growth spurts in adolescence.

*Forward head posture: This occurs when the head juts forward from its ideal alignment with the spine. It can be caused by prolonged sitting, excessive screen time, weak neck muscles, or carrying heavy backpacks.

*Flat feet: Flat feet, or pes planus, is a condition where the arches of the feet collapse, causing the entire foot to make contact with the ground. This can lead to altered gait patterns and contribute to knee, hip, and back pain.

*Knock knees and bow legs: Knock knees (genu valgum) is when the knees angle inward, while bow legs (genu varum) is when the knees angle outward. These deviations can be due to genetic factors, abnormal bone growth, or muscle imbalances around the knees.

*Uneven shoulders or hips: A noticeable difference in the height or alignment of the shoulders or hips can indicate postural deviations such as scoliosis, muscle imbalances, or leg length discrepancies

1. BY AVANI AKBARI POSTUR AL DEVIATION

2. Contents Changes In body due to deviation Deviations From Optimal Alignment Viewed From the Side: Sagittal Plane Foot ad toes Knees Pelvis Vertebral Column Head Deviations From Optimal Alignment : Anterior and Posterior Views: frontal plane Foot and Toes Knees Vertebral Column

3. Changes In body due to deviation Goal : Minimizing energy expenditure and stress on supporting structures change in one body segment will cause changes in adjacent segments, as the body seeks to compensate for the malalignment (closed-chain response to keep the head over the sacrum). Large changes - increase per unit area on body structures. stresses - long periods of time, body structure altered.

4. Changes In body due to deviation Muscles – sarcomeres ↓es - shortened positions for extended periods. adaptive shortening - abnormal posture, - ↓es full rom. Muscles – sarcomeres ↑es - lengthened position - the muscle’s length-tension relationship will be altered- prolonged stretching of ligamentous - ↓es ligament’s ability to provide sufficient tension to stabilize and protect the joints. Prolonged weight-bearing stresses on the joint - ↑es cartilage deformation and interfere with the nutrition of it. joint surfaces - early degenerative changes.

5. Changes In body due to deviation Postural problems - originate in any part of the body and cause ↑es stresses and strains - musculoskeletal system. Postures that represent an attempt to either improve function or normalize appearance are called compensatory postures . Ex, antalgic posture, forward head posture, scoliosis, etc …

6. Deviations From Optimal Alignment Viewed From the Side: Sagittal Plane Foot ad toes Claw Toes Hammer Toes Knees Flexed Knee Posture Hyperextended Knee Posture (Genu Recurvatum) Pelvis Excessive Anterior Pelvic Tilt Excessive Posterior Pelvic Tilt Vertebral Column Kyphosis and Lordosis Head Forward Head Posture

7. Claw Toes MTP- hyperextension, DIP & PIP- flexion Present in – 2 nd to 5 th toes Cause: restrictive footwear, NMD, weak intrinsic foot muscles, cavus type of foot, age related changes Callus formation under- MTP head & dorsal region of DIP BOS- ↓es, postural sway ↑es, stability- ↓es Proximal phalanx can subluxate dorsally

8. Hammer Toes MTP- hyperextension, PIP- flexion, DIP - hyperextension Cause: long/ short toe extensor/ lumbrical paralysis Flexor muscle - stretched at MCP joint and short at PIP, vice versa for extensors Callus formation under- PIP superiorly & tips of DIP BOS- ↓es, postural sway ↑es, stability- ↓es

9. Flexed Knee Posture Cause: knee flexion contracture LOG is posterior to knee – external flexion, maintained by internal extension ,quadriceps activity – to maintain position, Normally – knee flexion 15°= quadriceps MVC 22%, if knee flexion 30°= quadriceps MVC 51% ↑es Compressive stress on knee (TF & PF joints) Hip - LOG anterior- flexion - ↑es extensor activity ankle – dorsiflexion - ↑es soleus activity

10. Hyperextended Knee Posture (Genu Recurvatum) LOG – anterior -All the load on posterior joint capsule & ligament Adaptive lengthening ↑es Compressive stress on knee (anterior surface of femoral condyles and tibial plateaus) –wear and tear of cartilage - early degeneration Length tension relation – changes in anterior and posterior muscle, stability- ↓es Occur due to ↓es dorsiflexion (planter flexors contracture) Cerebral palsy or childhood habit (stand with hip & knee hyperextension – sway back posture)

11. Excessive Anterior Pelvic Tilt Upper lumbar vertebrae – posteriorly & lower lumbar vertebrae – anteriorly LOG – posteriorly – extensor activity ↑es Balanced by kyphosis at thorax, to maintain head over the sacrum Cervical – anterior convexity ↑es, Lumbar disc: tension – anteriorly, compression – posteriorly, nutrition, anteriorly > posteriorly zygapophyseal joints - compression ↑es

12. Excessive posterior Pelvic Tilt Lordosis ↓es, straightening of lumbar spine Flexibility ↓es ↓es ability to take load

13. Thoracic and sacral Abnormal ↑es in posterior thoracic convexity Cause : as compensation of ↑es lumbar curve, poor postural habits, osteoporosis, etc.. Dowgers hump – osteoporosis (postmenopausal women), Gibbus – tuberculosis, lead to vertebral # Anterior aspect of vertebra collapse due to ↑es compression and osteoporosis, compress anterior- annulus & vice versa. LOG – anterior, length tension disturbed, ↓es force generating capacity of extensor Sustained posture - ↓es chest expansion kyphosis

14. C ervical a nd lumbar Abnormal ↑es in anterior convexity Compression at posterior structure (annulus and vertebrae) Tensile force - anterior longitudinal ligament and vertebrae LOG - posterior Lordosis

15. Forward head posture Head anterior - ↑es cervical lordosis, Compression of posterior zygapophysial jt, disc compression, ↓es space In intervertebral foramen LOG - posterior ↑es extensor activity – ischemic muscle due to constant isometric contraction against external flexion torque Shoulder medially rotated, ↑es kyphosis, ↓es vital capacity, ↓es height, affect TMJ.

16. Deviations From Optimal Alignment Viewed From the Side: Frontal Plane asymmetry of body segments - by movement or by a unilateral postural deviation will disturb optimal muscular and ligamentous balance. Symmetrical postural deviations (bilateral knock knee), that disturb the optimal vertical alignment of body segments cause an abnormal compressive forces on one side of a joint and ↑es tensile forces on the other side. The ↑es gravitational torques that may occur require ↑es muscular activity and cause ligamentous stress.

17. Deviations From Optimal Alignment Viewed From the Side: Frontal Plane Foot ad toes Pes Planus (Flat Foot) Pes Cavus Knees Genu valgum (knock knee) Genu varum (bowleg) Vertebral Column Scoliosis

18. PES PLANUS (FLAT FOOT) Calcaneal eversion ↓es or absent medial arch Two type: Rigid flat foot – structural, present in weight bearing and non weight bearing, can be hereditary Talus displaced – anteriorly, medially & inferiorly, depression of navicular, tension – calcaneonavicular ligament, lengthening - TP Flexible flat foot – only present in weight bearing Feiss line – b/w navicular & 1 st metatarsal head Also called – over mobile foot Callus – 2 nd metatarsal Knee jt function affect – rotate tibia medially

19. PES CAVUS High arch foot Stable compared to flat foot Weight bearing on lateral aspect of feet Calcaneal inversion, lateral ligaments and peroneus- stretched Very rigid foot - unable to adapt to uneven surfaces Foot stuck in supination hence bad at shock absorption

20. GENU VALGUM (KNOCK KNEE) Seen In children (2-6 yr ) Mechanical axis displaced laterally External torque on knee with tensile stress on medial structure and compressive forces on lateral structures Patella laterally displaced and subjected to dislocation Due to this – person prone to have – flat foot (stress on medial longitudinal arch), poster0- medial pressure on calcaneum, lateral tibial torsion, and lumbar spine contralateral rotation

21. GENU VARUM ( BOWLEG) Knees separated, feet are together & malleoli are touching Seen In children (3-4 yr ) – normal Cortical thickening and compression in medial compartment of the knees Patella displaced medially Cause : vitamin D deficiency, real rickets, osteochondritis & epiphyseal injury

22. muscular/ ligamentous/ fascial support system defect Lateral flexion and rotation of vertebrae Deformity will take place in all 3 planes Unequal shoulder level, Unequal waist angle, unequal scapula level, Rib hump, obvious lateral spinal curvature Asymmetrical loading of intervertebral disc, Deformation of disc, Wedging of disc, affects disc nutrition Growth inhibition of vertebra on compression side, wedging of vertebra, end plate calcification, deviation of vertebra with rotation Head out of sacrum, compensatory curve SCOLIOSIS

23. SCOLIOSIS Adolescent idiopathic scoliosis Pay attention to body contours as early as 8 year old child Home screening every 6 months till age of 14 years To identify unrecognised AIS and understand more about the disease Age of onset Infantile (0-3 yrs ) Juvenile (4-10 yrs ) Adolescent (>10 yrs ) Cause : developmental instability, vestibular dysfunction, disturbed muscle control spindle, hereditary connective tissue disorder, subcortical brainstem abnormality, melatonin production abnormality, growth hormone secretion, and platelet abnormalities.

24. Functional scoliosis – it can be reversed if the cause is fixed. Ex, leg length discrepancy or muscle spasm Structural scoliosis – changes in bone, soft tissue Named after direction of convexity and the location of the curve Ex, right thoracic left lumbar scoliosis A double major curve – two structural curves of same size A triple major curve – involves 3 regions of a vertebral column

25. Pulmonary dysfunction - ↓es vital capacity, ↓es exercise capacity, impaired function of internal organs & cosmetically unacceptable. High risk – girl with right thoracic curve before menses, boys with right lumbar curve Brace effective – 70-80% cases In rapid progression – wear brace 23 hours Curve treatment < 25° Follow up to check progression 25° - 40° Brace if curve is flexible > 40° surgery

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