Posture Posture Evaluation

Martha Macht Sliwinski PT PhD The alignment and positioning of the body in relation to gravity, center of mass and base of support The physical therapist uses posture tests and measures to assess structural abnormalities in addition to the ability to right the body against gravity

Correct Posture
Maximal physiological and biomechanical efficiency Minimize stress and strains Segments aligned vertically with gravity line through axis of all joints Balanced strength and length of muscles Balance is based on a force couple

Good Posture

A state of musculoskeletal balance that protects the supporting structures of the body against injury or progressive deformity

Postural Analysis
View from different positions Use dominant eye Identify bony landmarks Assess with and without orthotic devices and shoewear Assess in ideal and real-life postures Note relevant medical history

Endomorphs

The naturally large person characterized with a round face, wide hips, big bones, slow metabolism and high number of fat cells.

Mesomorphs

Ectomorphs

The naturally muscular person with wide shoulders, small waist, athletic build, low body fat percentage with an increased metabolism

The skinny person with a linear appearance, small muscles, ultra fast metabolism, low body fat, narrow shoulders, hips and waist.

Postural Tests & Measures

Analysis of resting (static) posture or preferred in any position Analysis of dynamic posturing/functional movements Analysis of static and dynamic postures, using computer-assisted imaging, posture grids, plumb lines, still photography, videotape, visual analysis

Clinical Indications for Postural Tests & Measures

Abnormal bony alignment Impaired aerobic capacity Impaired joint integrity/mobility Impaired motor function Impaired muscle performance Impaired sensory integrity Pain

Ideal Posture lateral view

Ear lobe Dens Cervical vertebral bodies Tip of the acromion Mid trunk Lumbar bodies/sacral promontory Greater trochanter Slightly anterior to knee Slightly anterior to lateral malleolus

Ideal Posture

Muscle Balance

Head Cervical Spine Scapulae Thoracic Spine Lumbar Spine Pelvis Hips Knees Ankle

Abdominals Hip Flexors Erector Spinae Hip Extensors

Poor Posture (AAOS 1947)

Poor Posture
Anatomic impairments Physiologic impairments Psychosocial impairments Bony structure abnormalities Habitual Posturing

Increases strain on supporting structures (ie, ligaments, cartilage,

bone-tendon interface, etc)

Less efficient balance of body over its base of support Alteration of the normal arthokinematics/kinetics of affected joints irrespective of position (eg, standing erect, lying, squatting, etc)

Development of Posture

Lordosis

A marked anterior pelvic tilt A marked lordosis Marked anterior pelvic tilt and lordosis

Hyperlordotic and Kypholordotic

Kypholordotic Posture

Head: forward C-spine: hyperextended Scapulae: abducted T spine: flexion L spine: hyperextended Pelvis: anterior tilt Hips: flexed Knees: slightly hyperextended Ankles: slight plantar flexion

Military Type

Sway Back
Head: neutral C-spine: normal, slightly anterior T spine:normal, slightly posterior L spine: hyperextended lordosis Pelvis: anterior tilt Knees: slightly hyperextended Ankles: slightly plantar flexed

Head: forward C-spine: slightly extended T spine: flexion L spine: flexion, flattening Pelvis: posterior tilt Hips: hyperextended Knees: hyperextended Ankles: neutral

Sway Back and Flat Back

Flat Back

Head: forward C-spine: slightly extended T spine: flexion upper part, lower part, straight L spine: flexed, straight Pelvis: posterior tilt Hips: extended Knees: extended Ankles: slight plantar flexion

Ideal Alignment: Posterior View

Faulty Alignment: Posterior View

Head Cervical Spine Shoulders Thoracic Spine Lumbar Spine Pelvis Hips Lower Extremities Feet

Head C spine Shoulders Scapulae T and L spine Pelvis Hips joints Lower Extremities Feet

Faulty Alignment: Posterior View

Faulty Postures: Side & Back Views

Head C spine Shoulders Scapulae T and L spine Pelvis Hips joints Lower Extremities Feet

Figure A; posture appears good from the posterior view but is faulty from the side Figure B faulty posture both front and side views

Anterior View

Measuring Leg Length

Lower Extremity Torso Shoulder Head and Neck

Structural Leg Length Test (or true): measure from ASIS to medial malleolus Functional Leg Length Test (or apparent): measure from medial malleolus to umbilicus