Practical Part

Analysis of posture :
A systematic approach to postural analysis involves viewing the body’s
anatomical alignment relative to a certain established reference line. This
reference (gravity) line serves to divide the body into equal front and back
halves and to bisect it laterally. In preparing to carry out postural assessment,
the examiner should be aware of factors that will enhance the success and
validity of the examination process. These factors are:
1. Postural assessment must be performed with the subject minimally clothed, in
order to ensure a clear view of the contours and anatomical landmarks used for
reference.
2. The examiner should instruct the subject to assume a comfortable and relaxed
posture.
3. Subjects who use orthotic or assistive devices should be assessed with and
without them to determine their effectiveness in correcting posture.
4. The examiner should note relevant medical history and other information that
may account for certain postural abnormalities. Important information includes:
- Any history that accounts for present postural abnormalities.
- A complete description of present symptoms.
- All previous treatments for the presenting postural complaints, including
orthopedic and neurological therapy.
- The upper limb dominance of the subject, which is often responsible for
symptomatic postural deviations.
Postural examination is most commonly performed by assessing the
body’s alignment in lateral, posterior and anterior views.

1) Standing Posture
a) Lateral View
Lateral postural assessments should be performed from both sides to
detect and rotational abnormalities that might go undetected if observed from
only one lateral perspective. Ideally, the plumb line should pass through the ear
lobe and shoulder joint.
1. Head and neck:
Plumb line: The line falls through the ear lobe to the acromion process.
Common faults include:
* Forward head: The head lies anterior to the plumb line (fig 7. B). It may be
due to: - Excessive cervical lordosis. - Right cervical extensor, upper trapezius,
and levator scapulae muscles. - Elongated cervical flexor muscles.

Figure 7. (A) Ideal head posture (B) Forward head posture

* Flattened lordotic cervical curve: The plumb line lies anterior to the vertebral
bodies (Fig 8 ). It may be due to:
- Stretched posterior cervical ligaments and extensor muscles.
- Tight cervical flexor muscles.

Figure 8. Flattened
lordotic cervical curve.
Figure 9. Excessive
lordotic curve
* Excessive Lordotic
curve: The gravity
line lies posterior
to the vertebral
bodies (Fig 9 ). It
may be due to:
- Vertebral bodies and joints compressed posteriorly. - Anterior longitudinal
ligament stretched. - Tightness of posterior ligaments and neck extensor
muscles. - Elongated levator scapulae muscles.
2. Shoulder:
Plumb line: It falls through the acromion process. Common faults include:
* Forward shoulders: The acromion process lies anterior to the plumb line; the
scapulae are abducted as shown in figure 10 . It may be due to:
- Tight pectoralis major and minor, serratus anterior and intercostal muscles.
- Excessive thoracic kyphosis and forward head.
- Weakness of thoracic extensor, middle trapezius and rhomboid muscles.
- Lengthened middle and lower trapezius muscles.

Figure 10. Forward shoulder Figure 11. Thoracic Kyphosis

3. Thoracic vertebrae:
Plumb line: The line bisects the chest symmetrically. Common faults include:
* Kyphosis: Increased posterior convexity of the vertebrae (fig 11). It may be
due to:
- Compression of inter-vertebral disks anteriorly. - Stretched thoracic extensors,
middle and lower trapezius muscles and posterior ligaments. - Tightness of
anterior longitudinal ligament, upper abdominal and anterior chest muscles.
* Pectus excavatum (Funnel chest): Depression of the anterior thorax and
sternum (fig 12). It may be due to:
- Tightness of upper abdominal, shoulder adductor, pectoralis minor and
intercostal muscles. - Bony deformities of sternum and
ribs.
- Stretched thoracic extensors, middle and lower trapezius muscles.
* Barrel chest: Increased overall antero-posterior diameter of rib cage (fig 13).
It may be due to: - Tightness of scapular adductor muscles.
- Respiratory difficulties. - Stretched intercostals and anterior chest muscles.
* Pectus cavinatum (Pigeon chest). The sternum projects anteriorly and
downward(fig14). It may be due to:
- Bony deformity of the ribs and sternum. - Stretched upper abdominal
muscles.
- Tightness of upper intercostal muscles.

Figure 12. Funnel chest Figure 13. Barrel chest Figure 14. Pigeon chest