Medical surgical nursing

ure assessment Post

Group 12
2020/2021

Under
supervision of
-1
-2
-3
‫‪GROUP12‬‬

‫‪Presented by‬‬

‫‪.‬عبدالرؤوف اسامة فايز احمد‪1-‬‬

‫‪.‬عبدالعزيز سليمان عبدالعزيز‪2-‬‬

‫‪.‬عبدهللا اسعد سعيد ابو المجد‪3-‬‬

‫‪.‬عبدهللا رجب احمد عبدهللا‪4-‬‬

‫عبدهللا فوزى عبدالحميد عمر‪5-‬‬

‫عبدالوهاب سيد احمد امام‪6-‬‬

‫عزت عبدالناصر ابراهيم‪7-‬‬

‫على رضا عبدالفتاح ابراهيم‪8-‬‬

‫على عبدالظاهر احمد عبدالظاهر‪9-‬‬

‫احمد عبدالمنعم محمد منير‪10-‬‬

‫عبدالحميد جمال عبدالحميد ‪11-‬‬

‫عالءالدين مجدى حماقى‪12-‬‬

Outlines

-Introduction

-Definition of Postural Assessment.

-Purpose of Postural Assessment.

-Methods of Postural Assessment.

-Factors Affecting Posture.

-Comparison between normal and abnormal posture.

-Causes of Poor Posture.

-Technique of Postural Assessment.

-Reference

Introduction;-

Assessment of posture forms the very basis of physiotherapy

Assessment. It helps in identifying the defects in body, which lead

To various musculoskeletal problems. Postural assessment is an

Important tool which can be used to assess the reasons behind

Various injuries in sports persons, since repetitive loading of body

Caused by sports activities leads to certain postural alterations,

 Which can ultimately cause pain and injury. A variety of postural

Assessment methods have been in use. Some are conventional,

While some are latest and few are those which got modified into

Latest form from conventional forms i.e. these evolved into better

And convenient methods. Only conventional methods were used in

The past when advanced methods were not available. These have

Now been superseded by newer methods. However, the older ones

Are still used when the option of availability of advanced methods

Is not there. Following are some of the conventional methods.

DEFINITION OF POSTURE ASSESSMENT

Body posture refers to the way that the body is positioned, including
whether one is standing or sitting, the relative positions of body
parts, and how much space the body occupies. Body posture is a
.form of nonverbal communication

The outcome of the overall position of the joints adopted to balance

the skeletal segments
Against gravity in a given position, serving as a basis for movement
and non-verbal communication, maintained by the connective

.Tissue and muscles under the control of the nervous system

..PURPOSE OF POSTURE ASSESSMENT

The purpose of this document is

to help practitioners assess working posture for the prevention – 1

.and control of occupational musculoskeletal disorders (MSDs)

Quantitative or semiquantitative descriptions of posture are -2

inputs to many job analysis tools applied in MSD prevention and
.control

Studies of the-3
Relationship between risk factors (such as posture, repetition, and
force) and resulting MSD
Prevalence have used various approaches to
,Characterizing working posture
Including
Observation-based methods. Posture classification by systematic
observation of a worker
Is commonly used in research and by practitioners, such as

ergonomists-1

industrial hygienists -2

,safety professionals -3

To help inform job design decisions and establish safe

Work limits to reduce MSD injury risk in the workplace
,.
.Methods of posture assessment
1-Visual observation method
It is the commonest method which is used to assess posture in clinical
practice. The one and only advantage of this method is that it does not
require any equipment. With this method, quantitative data cannot be
obtained. Thus, minor postural alterations cannot be detected. Also, it has
.been reported to have a poor interrater agreement
2-Plumb line method
Use of plumb line for the evaluation of posture, along with a postural grid, too
is very common, owing to its low cost and simplicity. Posture is evaluated in
accordance with the guidelines which are given by Kendall, in form of ideal
.plumb line alignment for side and back views
3-Goniometry
Goniometers are used in physiotherapy practice, not only to measure joint
ROM, but, also for the assessment of posture [6]. Measurement of postural
angles, such as neck inclination angle (Craniovertebral angle) and cranial
rotation angle (sagittal head tilt) by using manual goniometry has been
.reported in the literature [7]. Manual
-4Photographic and digitization method
Photographic and digitization procedure has been in use since a long time. It
has been compared with the radiographic method for postural evaluation. Its
reliability too has been tested. Following are some of the research studies
.which were conducted in the past by using this method

Factors Affecting Posture.

Factors split into 9 main types.
1) Structural and Anatomical parameters: for e.g. Scoliosis in all
parts of spine, discrepancy in the length of the long bones in
upper or lower limb, extra ribs, extra vertebrae etc.
2) Age: Posture changes considerably as we grow into our adult
forms.
3) Physiological factors: Posture changes temporarily in a minor
way when we feel alert and energized as compared to when we
feel subdued and tired. Pain or discomfort may affect the
posture, physiological changes caused due to pregnancy are
 usually temporary but could result into permanent,
compensatory postural change.
4-Pathological factors: Illness and disease affect our postures
especially when bones and joints are involved. Pain can lead to
altered postures as we attempt to minimize the discomfort.
Mal-alignment in the healing of fractures may sometimes be
observed as change in bone contour. Certain conditions may
sometimes result into increase or decrease in muscle tone.
5-Occupational factors: There will be postural differences
between a manual worker and an office worker, and between
someone active and someone sedentary.
6-Recreational factors: Depending on regular habits, practices
and hobbies, there could be difference in posture.
7-Environmental factors: In various environmental conditions,
in order to adopt to the change in conditions, posture may get
affected. For e.g. in cold posture is different as compared to in
heat.
8-Social and Cultural factors: People who grow up sitting cross
legged or squatting develop postures that are different from
those who grow up sitting on chairs.
9-Emotional factors: Usually posture sub-consciously adopted
to match certain moods is temporary. But in certain cases, it
persists if the emotional state is habitual
.Factors contributing to postural abnormalities
Congenital or acquired structural changes (egg. Idiopathic scoliosis, •
deformed vertebra, foot and ankle abnormalities)
Abnormal gait (e.g. Pes planus, leg length discrepancy •
• The commonest cause according to Jada.
Comparison between normal and abnormal posture.
Normal
The key to good posture is the position of the spine. The spine has three
natural curves - at the neck, mid/upper back, and lower back. Correct
posture should maintain these curves, but not increase them. The head
should be above the shoulders, and the
Top of the shoulder should be over the hips .
In an ideal posture, the line of gravity should pass through specific
points of the body. This can simply be observed or evaluated using a
.plumb line to assess the midline of the body
• This line should pass through the lobe of the ear, the shoulder joint,
the hip joint, though the greater trochanter of the femur, then slightly
anterior to the midline of the knee joint and lastly anterior to the lateral
malleolus.
When viewed from either the front or the back, the vertical line
passing through the body's center of gravity should theoretically bisect
the body into two equal halves, with the bodyweight distributed evenly
.between the two feet
While assessing posture, symmetry and rotations/tilts should be
:observed in the anterior, lateral and posterior views. Assess
Head alignment
Cervical, thoracic and lumbar curvature
Shoulder level symmetry
Pelvic symmetry
Hip, knee and ankle joints
:In sitting
The ears should be aligned with the shoulders and the shoulders
aligned with the hips
The shoulders should be relaxed and elbows are close to the sides of
the body
The angle of the elbows, hips and knees is approximately 90 degrees
The feet flat on the floor
The forearms are parallel to the floor with wrists straight
• Feet should rest comfortably on a surface.
Correct posture
Abnormal.
Factors contributing to postural abnormalities

• Congenital or acquired structural changes (eg. Idiopathic

scoliosis, deformed vertebra, foot and ankle abnormalities)

• Abnormal gait (eg. Pes planus, leg length discrepancy)

• The commonest cause according to Janda (neurologist,

rehabilitation physician and researcher of muscle function
analysis) is muscle imbalance arising from modern lifestyle with
constrained postures from repetitive tasks and limited range in
movement and inactivity.
Common signs of leg length discrepancies seen in gait:

Body part Gait manifestation

Shoulder Dropped on the longer side

Arm Abducted arm swing on the longer side

Pelvis Higher on the longer side (especially noticeable in

swing phase)

Leg Circumduction on the longer side in swing

Knee Excessive flexion on the longer side in swing to allow

ground clearance

Foot Out toe on the shorter side

Shoulder (proximal) cross syndrome:

Muscle imbalances:

Tight/shortened (postural) muscles - Weak/inhibited (phasic)

muscles

Upper shoulder girdle fixators: Lower

shoulder girdle fixators:

• upper trapezius • middle

trapezius • serratus anterior

• levator scapulae • lower

trapezius

• scalenes •
rhomboids

Shoulder girdle protractors: Shoulder girdle

retractors:
• pectoralis major •
rhomboids • lower trapezius

• pectoralis minor • middle

trapezius

Neck extensors: Deep neck

flexors:

• short neck extensors • longus

cervicis

• sternocleidomastoid • longus coli

• upper trapezius • longus

capitis

• levator scapulae
Janda’s postural syndromes

Muscle imbalance’ refers to the tendency of certain muscles to

become tight, hypertonic, and activating earlier and more readily
in movement patterns whereas other muscles are more likely to
exhibit hypotonia, inhibition, weakness, atrophy and activate less
readily and later in movement patterns. This tendency is not
random but occurs in a predictable and recognisable pattern. The
tight, hypertonic muscles have predominately antigravity function
during gait whereas their antagonists tend toward weakness and
inhibition. Muscle imbalances result in faulty postures, joint
malalignment and development of altered inefficient movement
patterns resulting in strain and degeneration of joints, myofascial
and ligamentous structures. There are two commonly seen
postural syndromes whose characteristics have been described by
Janda from observations from clinical studies:

• shoulder (proximal) cross syndrome – involving head and

shoulder girdles

• pelvic (distal) cross syndrome – involving lower back and hip

girdles.
Shoulder cross syndrome

Possible symptoms Cervical dysfunction :

Painful reduction in range of movements with local or referred

axial neck pain, occipital, frontal, temporal and posterior shoulder
pain from articular strain, myofascial and ligamentous strain.
Shoulder dysfunction – protraction of the shoulder and poor
scapular stabilisation results in malalignment of the head of the
humerus with the glenoid fossa causing tautness in superior
anterior shoulder capsule, supraspinatus and posterior fibres of
deltoid muscles. These imbalances over time result in
impingement syndromes and rotator cuff dysfunctions. Muscles of
the shoulder and cervical region have a stabilising function and
arm elevation requires a fixed point (shoulder). Muscle imbalance
moves the fixed point to the head and neck causing additional
stress on cervical spine.
Pelvic cross syndrome

Possible symptoms:

Back and leg pain from the following proposed mechanisms:

• increased lumbar lordosis causing increased pressure on the

posterior portion of the disc, jamming of lumbar facet joints
especially L5/S1 and ligamentous strain and myofascial
dysfunction

• sacroiliac joint dysfunction from alteration of lumbopelvic

mechanics (lateral shift and anterior pelvic tilt). Pain referral to
lower back and leg

• altered gait.
Muscle imbalances:

Tight/shortened (postural) muscles - Weak/inhibited (phasic)

muscles

Hip flexors: Hip

extensors:

• iliopsoas •
gluteus maximus

• rectus femoris

Lumbar extensors: Lumbar flexors:

• lumbar erector spinae • rectus
abdominis

Substitute hip abductor: Hip abductor:

• tensor fascia lata • gluteus

medius

• gluteus
minimus

Pelvic elevator:

• quadratus lumborum
-Causes of Poor Posture.
The causes of poor posture can broadly be classified into two
-:categories
.acquired- due to some accident or disease )I(
Congenital- present at birth or hereditary )Ii(
:The deformities caused due to poor posture can be of two types
Functional divergence, and )I(
.Structural divergence )ii(
:The main causes of poor posture are listed below
Injury: when a bone, ligament, or muscle is injured it is likely to .1
weaken the support at
That point and throw the framework out of balance. When such
condition exists, it I not
Possible to have a perfect posture. Even after the injury has fully
healed, the habit
Developed during the injury may still persist, and faulty posture
may continue for a long
.Time
Disease: posture is greatly affected by the disease that weakens .2
the bones or the muscles
Or causes the joints to lose their strength or mobility. The
examples of this kind of disease
Are, rickets caused due to faulty nutrition of bone, and tubercular
disease of joints or
Vertebrae. Poliomyelitis may cause weakening or distorting of
motor nerve cells in the
Spinal cord, and thereby causing partial or complete loss of
function in certain muscle
Groups. This type of loss of power in muscle groups upsets the
body control and balance
.And also causes other kind of defects
Habit: habits of posture, whether good or bad, are acquired in .3
the same way as the habits
Of walking, speaking or sitting, i.e. by practicing a certain type of
coordination so many
Times that the act becomes unconscious and habitual. In case of
school and college
Students, though the bones, joints, ligaments and muscles are in
normal condition, but due
To faulty and wrong habits, their coordination is disturbed,
causing poor posture wrong.
Weakness: it is not possible to assume and maintain erect .4
,Posture without expenditure of some energy. Such efforts
,Therefore, require some strength and endurance
Experiments have shown that slumped or slouched
Position of body can be maintained with quite less
Metabolic energy as compared to the erect position. The
Muscular weakness and lack of viability is thus
.Responsible for such faulty postures
Mental Attitude: the posture is the manner in which we .5
Carry or hold our body and it is bound to reflect our
Mental attitude. Feelings of happiness, confidence and
Satisfaction help in maintaining a balanced and erect
Posture, whereas depression and feeling of sadness pose
.Hurdles in maintaining proper posture
Heredity: heredity is another factor which is responsible .6
For poor or defective posture. Hereditary defects like
Kyphosis and other genetic defects may cause poor
.Posture
Improper Clothing: the type of dress one wears also has .7
Impact on individual’s posture. For example wearing tight
Fitted dress, tight shoes, high heel shoes etc. will result in
Adopting poor posture. Such improper clothing makes one
.Uncomfortable and may lead to faulty posture
Improper Diet or Malnourishment: improper diet or .8
Malnourishment may result in various diseases due to
.Deficiencies of vitamins and minerals e.g. rickets etch
.Which result in adopting faulty and poor posture
Chronic Fatigue: due to continuous work, lack of rest .9
And sound sleep, body tends to develop fatigue, and such
Condition becomes chronic with persistence of such
Conditions. Without proper relaxation, rest and sleep, the
.Body and the mind becomes over worked and inefficient
Such conditions put undue stress upon muscles there by
.Causing postural deviations
over Load: one may develop round shoulders and .10
Deformities of spine like kyphosis and scoliosis by
Continuously lifting and carrying heavy weight on
Shoulders and the upper back. Everyday example of
Overloading can be observed as we find school children
.Carrying heavy school bags on their back
Imitation: due to over exposure of the children to popular .11
Media like TV, network etc., there is general tendency
,Among children to imitate their favorite heroes, models
Stars, teacher, friends etc., such imitation may distort their
.Natural posture and may cause postural deviations
.Unhygienic Conditions: it is very common to find 12
,Crowded class rooms with improper sitting arrangement
Improper furniture, improper and insufficient lighting
Arrangements etc. in our country. Such unhygienic
.Conditions result in postural deviations
.Improper Time Table: improperly planned school 13
Curriculum puts extra stress upon the children. E.g. during
Long practical hours they have to maintain a static and
Most of the time bent posture which may be a factor
.Causing postural defects
Lack of Exercise: exercises tone up the spinal nerves and .14
,Abdominal organs, improve appetite and digestion
Promotes flexibility and co-ordination, reduces mental
Strain, and provides energy, improves the physical ability
And efficiency. Lack of exercises has several adverse
Effects which may lead to postural deformities.
Lack of Awareness: many people are unaware regarding .15
The concept of proper posture and continue on to follow
Wrong or faulty postures. This becomes their permanent
Habit and a life style which leads to postural defects
.Deformities
Obesity: obesity or undue body overweight puts extra .16
Stress and strain on the muscular as well as skeletal
Structure of the body which may result in postural
.Deviations
Poverty: lack of essential and basic facilities due to. 17
Poverty is another important factor which may lead an
.Individual to adopt bad or faulty posture
Occupation: certain occupations require sitting, standing .18
Or working in an imbalanced or improper posture
Constantly for long hours, which may result in postural
Defects and deviations.
-Technique of Postural Assessment.
Evaluate the position of the spine and back so that )1
we ask the patient to walk a few steps forward and
.back
Then we notice it from the side, and if there is any )2
forward or backward bending or difficulty walking, the
. aforementioned abnormal diseases are evaluated
The patient is seen standing in the longitudinal )3
position, so that He stands upright, and sees him
forward, his hands are next to his body, and the palm
.is facing forward
4) And his position is evaluated is there anything
abnormal, pain, or something unusual.