This action might not be possible to undo. Are you sure you want to continue?
Definition: It is attitude or position of the body , the relative arrangement of body parts for a specific activity, or a characteristic manner of bearing one s body. It is attitude assumed by body either with support during muscular inactivity or by means of co- ordinate action of many muscles working to maintain stability or to from an essential basis which is being adapted constantly to the movement which is superimposed upon it.
Types of posture: 1.Inactive posture: Attitude adopted for resting or sleeping 2.Active posture: Integrated action of many muscles is required to maintain active posture. -static posture -dynamic posture
jumping. throwing.g. and kneeling.g. Dynamic Posture: Dynamic posture refers to postures in which the body or its segments are moving E. running. sitting. E. Static Posture: Static posture refers to the body and its segments are aligned and maintained in certain positions. standing. . walking. and lifting. lying.
as well as changes in other segments. Primary goals of posture: Minimizing energy expenditure Minimizing stress on supporting structures Any change in position or mal alignment of one body segment will cause changes to occur in adjacent segments. as the body seeks to adjust or compensate for the mal alignment .
irrespective of attitude in which these structure are resting or working. Pattern of posture: Good posture : it is defined as state of musculoskeletal balance which protect the supporting structure of the body against injury or progressive deformity . by posture committee of american acedemy of orthopedic surgeon . Poor posture : it is defined as faulty relationship of the various parts of the body which produces increased strain on supporting structure & less balance of the body over base of support.
. Postural dysfunction: It is posture that deviate from normal alignment with adaptive shortening of soft tissues & muscle weakness. Postural fault: It is posture that deviate from normal alignment but has no structural limitation.
Various factor affecting posture: Age: Postural pattern change during life cycle. Gender: Higher % of fat & wide pelvis in women Nutritional factor: Required for good structural & functional development .development of spinal curves. As position of lower extremity joints. thus affect posture . affect the growth before maturation &lead to fatigue after maturation .
Emotional status: Habits: poor postural habits Disease & disability: Occupation& recreation: .
and musculoskeletal system .Postural Control Definition: It is a person s ability to maintain stability of the body and body segments in response to forces that threaten to disturb the body s equilibrium. vestibular system. Maintenance and control of posture depend on the integrity of the CNS. visual system.
Reactive(compensatory) responses occur as reactions to external forces that displace the body s CoM . Proactive (anticipatory) responses occur as reactions to internally generated destabilizing forces that displace the body s CoM . .
2. To control the body s orientation in space. To stabilize the head with regard to the vertical so that the eye gaze is appropriately oriented. .Goals of postural control 1. To maintain the body s CoM over the BoS. 3.
12 in the sagittal plane . With 4 inches base. little or no acceleration of the body occurs. 16 in the frontal plane sway . except that the body undergoes a constant swaying motion called postural sway or sway envelope.Postural sway In the erect standing posture.
tendons.Kinetics & kinematics of Posture In response to perturbations . The internal forces are produced by muscle activity and passive tension in ligaments. and ground reaction forces(GRFs). gravity.active internal forces employed to counteract the external forces that affect the equilibrium and stability of the body The external forces are inertia. and other soft tissue structures . joint capsules.
Having three components: A vertical component force (along the y-axis). the ground pushes back on the body. This force is known as the GRF. The vector representing it is known as the ground reaction force vector (GRFV). Ground Reaction Forces: Whenever the body contacts the ground. two force components directed horizontally in a medial-lateral direction (along the x-axis) & other horizontal force in an anterior-posterior direction (along the z-axis) .
it is opposed by a counterbalancing internal moment . an external gravitational moment is created. Coincident Action Lines : When the LoG passes directly through a joint axis. no external gravitational torque is created around that joint. if the LoG passes at a distance from the axis.
the gravitational moment will tend to cause anterior motion of the proximal segment of the body. If the LoG is located anterior to a particular joint axis. . If the LoG is posterior to the joint axis. the moment will tend to cause posterior motion of the proximal segment of the body.
Equipment: Postural board with foot prints Plumb line Folding ruler with spirit level Set of blocks for limb length measurement Marking pencil Tape measure Test for muscle length & strength .
or line with a weight on one end. used to represent the LoG.Analysis of Posture Standing posture: A plumb line. dropped from the ceiling and passing through the external auditory meatus of the ear. .
Atlantooccipital Cervical Thoracic Lumbar Sacroiliacjoi nt Hip joint Knee joint Ankle joint Anterior Flexion Posterior Anterior Posterior Anterior Extension Flexion Extension Flexion Posterior Anterior Anterior Extension extension dorsi Flexion .
the ankle joint is in the neutral position. The LoG passes slightly anterior to the lateral malleolus creates an external dorsiflexion moment & opposed by an internal plantarflexion moment EMG studies have demonstrated that soleus and gastrocnemius . or midway between dorsiflexion and plantarflexion. Ankle: In the optimal erect posture.
Knee: In optimal posture. the LoG passes anterior to the midline of the knee and posterior to the patella. creates an external extension moment & counterbalancing internal flexion moment created by passive tension in the posterior joint capsule and hamstring. the knee joint is in full extension. .
Hip: In optimal posture, the hip is in a neutral position. When the LoG passes slightly posterior to the axis of the hip joint, through the greater trochanter creates an external extension moment at the hip & opposed by internal flexion moment. EMG studies have shown activity of the iliopsoas muscle
Pelvis: in the optimal position, the pelvis is level with no anterior or posterior tilt In a level pelvis position, lines connecting the symphysis pubis and the anterior-superior iliac spines(ASISs) are vertical, and the lines connecting the ASISs and posterior-superior iliac spines (PSISs) are horizontal.
Sacroiliac Joints: in the optimal position, the LoG passes slightly anterior to the sacroiliac joints. The external gravitational moment cause the anterior superior portion of the sacrum to rotate anteriorly and inferiorly, whereas the posterior inferior portion tends to move posteriorly and superiorly opposed by passive tension in ligaments.
. the LoG passes through the body of the fifth lumbar vertebra & creates a slight extension moment at L5 to S1 opposed primarily by the anterior longitudinal ligament and the iliolumbar ligaments. Lumbosacral Joints: The average lumbosacral angle measured between the bottom of the L5 vertebra and the top of the sacrum (S1) is about 30 In the optimal posture.
thoracic. The Vertebral Column: the LoG passes through the bodies of the lumbar and cervical vertebrae and anterior to the thoracic vertebrae in the optimal posture. the gravitational moments tend to increase the natural curves in the lumbar. . and cervical regions.
Head: The LoG in relation to the head passes slightly anterior to axis of rotation for flexion and extension of the head creates an external flexion moment & counteracted by internal moments generated by activity of the neck extensors .
Deviations from Optimal Alignment In the Sagittal Plane: Foot and Toes: Claw Toes The toes characterized by hyperextension of the metatarsophalangeal (MTP) joint & flexion of the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints Hammer Toes hyperextension of the MTP joint. . flexion of the PIP joint. and hyperextension of the DIP joint.
Because knee flexion in the upright stance is accompanied by hip flexion and ankle dorsiflexion. . Knee: Flexed Knee Posture The LoG passes posterior to the knee joint axes. Other consequences of a flexed-knee erect standing posture are related to the ankle and hip.
result in a more unstable joint. . Increase in the external extensor moment at the knee and puts the posterior joint capsule under considerable tension stress & consequently. Hyperextended Knee Genu Recurvatum The LoG is located anterior to the knee joint axis.
the anterior convexity of the cervical curve increases to bring the head back over the sacrum. . Pelvis: Excessive Anterior Pelvic Tilt: pelvis is excessively tilted anteriorly. the lower lumbar vertebrae are forced anteriorly. The upper lumbar vertebrae move posteriorly to keep the head over the sacrum. Similarly. thereby increasing the lumbar anterior convexity. The posterior convexity of the thoracic curve increases and becomes kyphotic to balance the lordotic lumbar curve and maintain the head over the sacrum.
. Vertebral Column: Lordosis and Kyphosis The term lordosis refers to the normal sagittal plane anteriorly convex curves in the cervical and lumbar regions of the vertebral column. The term kyphosis refers to the normal sagittal plane posteriorly convex curves in the thoracic and sacral regions of the vertebral column.
Head: Forward Head Posture the head is positioned anteriorly and the normal anterior cervical convexity is increased .
Passes through the middle of the xyphoid process. Passes between knees equidistant from medial femoral condyles. nose and chin. . Passes on a line equidistant from the right and left anterior superior iliac spines. Passes between ankles equidistant from the medial maleoli. Passes through the symphysis pubis. Passes through the umbilicus (navel).Frontal Plane Optimal Alignment Anterior Aspect Passes through middle of the forehead.
Passes through gluteal cleft of buttocks and should be equidistant from posterior superior iliac spines. Passes between the knees equidistant from medial joint aspects. . Passes along vertebral column in a straight line. Posterior Aspect Passes through middle of head. Passes between ankles equidistant from the medial malleoli.
.Deviations from Optimal Alignment in the frontal plane: Foot and Toes Pes Planus (Flat Foot) characterized by a reduced or absent medial arch Pes Cavus The medial longitudinal arch of the foot is unusually high.
The patella may be laterally displaced and therefore predisposed to subluxation. . the patellae may be displaced medially. Genu valgum (knock knee) the mechanical axes of the lower extremities are displaced laterally. Genu varum (bowleg ) knees are widely separated when the feet are together and the malleoli are touching.
patella tracking may be affected . In both.Squinting or cross-eyed patella: patella that faces medially Grasshopper-eyes patella refers to a high. laterally displaced position of the patella in which the patella faces upward and outward.
Vertebral Column Scoliosis the vertebral column is vertically aligned and bisected by the LoG. lateral deviations of a series of vertebrae from the LoG in one or more regions of the spine indicate the presence of a lateral spinal curvature in the frontal plane called a scoliosis .
Common impairment/problems associated with postural dysfunction: Pain : from stress to sensitive structure & from muscle tension Decrease range of motion : From flexibility imbalance Muscle weakness & poor muscle endurance : From sustained faulty posture or disuse Altered kinesthetic awareness of normal alignment & control: from prolonged faulty postural habits .
Muscle relaxation Restore range of motion Restore muscle strength .Treatment goals & plan of care: Treatment goal Relieve pain & muscle tension Plan of care External postural support if necessary. endurance & function Specific stretching & flexibility exercise Specific resistive exercises Endurance exercises Retrain kinesthetic awareness & control of normal alignment Reinforcement techniques .
Kypho-lordotic posture .
Postural fault Forward head Anatomical position of joint Cervical spine hyperextension Muscle in shortened position Muscle in lengthened position treatment Cx spine Cx spine flexor extensors. upper trepezius &levator Serratus Middle & lower anterior. pectoral minor.hip joint flexion . upper tapezius. hip extensor Forward shoulder Scapulae abducted & elevated Steretching of tight muscles & strengthening of weak muscles kyphosis Thoracic spine flexion lordosis Lumber spine hyperextension. trapezius pectoralis minor. thoracic spine extensor Abdominals. hip flexor Middle & lower Trapezius. inter costal Lower back erector spinae. upper trapezius Shoulder adductor. pelvis anterior tilt.
Flat back posture .
hip extensor Lower back erector spinae.Postural fault Anatomical position of joint Muscle in shortened position Muscle in lengthened position treatment Flat back posture Lumber spine flexion Pelvis posterior tilting Hip joint extension abdominals. hip flexor Lower back & hip flexor strengthening .
Sway back posture .
hip flexor treatment Sway back posture lumber spine upper flexion abdominals.Postural fault Anatomical position of joint Muscle in shortened position Muscle in lengthened position Lower abdominals. Pelvis posterior hip extensor. tilting. Inter costal Hip joint extension Lower abdominals & hip flexor strengthening .
R: retracted shoulders and E: ear over shoulder. . POSTURE acronym for easy reference: P: Pelvis in neutral. U: upright ribs. with weight distributed O: on the whole foot. S: Stable joints. T: Tight abdominals.
Millitary/lordotic posture .
soleus Check length of hip flexor.stretching of knee flexor if tight .Postural fault Anatomical position of joint Muscle in shortened position Muscle in lengthened position treatment Hyperextended Of knee Knee hyperextension Ankle planter flexion Knee flexion. soleus hamstring Strengthening of hamstring Flexed knee hamstring Qudriceps.ankle dorsiflexion Qudriceps.
Postural fault of feet Anatomical position of joint Muscle in shortened position Muscle in lengthened position treatment Pronation Foot eversion Peroneal & toe extensor Tibials posterior & long toe flexor peroneal Inner wedges on heels & strengthen inverters Outer wedges on heels &strengthen everters Supination Foot inversion tibialis .
Clavicles also should be symmetrical. In anterior view of the human body. Malleoli should be symmetrical. . Anterior superior iliac spines should be level. Right and left angles between shoulders and neck should be symmetrical. divides the body into two symmetrical parts. in optimal posture. Eyes and ears should be level and symmetrical. and feet should be parallel. Toes should not be curled. Right and left waist angles should be symmetrical. Ribs on each side should be symmetrical. Patella should be symmetrical and facing straight ahead. or deviated to one side. the LoG. overlapping.
Head should be straight with no lateral tilting. The posterior superior iliac spines should be level. The gluteal folds should be level and symmetrical. and be separated by about 4 inches in the adult. Scapulae should lie flat against the rib cage. . Arms should hang naturally so that the palms of the hands are facing the sides of the body. Look to see that the knees are level. Angles between shoulders and neck should be equal. be equidistant from the LoG. The heel cords should be vertical and the malleoli should be level and symmetrical.
perturbation It is sudden change in conditions that displaces the body posture away from equilibrium. The perturbation can be sensory or mechanical. .Basic elements of postural control: Muscle Synergies / postural responses : Synergies are centrally organized patterns of muscle activity that occur in response to perturbations of standing postures they are involuntary reaction.
Stability is regained through movements of parts of the body. but the feet remain fixed on the BoS .Muscle Synergies: 1) Fixed-Support Synergies: Patterns of muscle activity in which the BoS remains fixed during the perturbation and recovery of equilibrium. .
The hip synergy The hip synergy consists of discrete bursts of muscle activity on the side of the body opposite to the ankle pattern in a proximal-to-distal pattern of activation in response to forward and backward perturbation. The ankle synergy The ankle synergy consists of discrete bursts of muscle activity on either the anterior or posterior aspects of the body that occur in a distal-to-proximal pattern in response to forward and backward perturbation. .
backward. or sidewise) and grasping (using one s hands to grab a bar or other fixed support) Only synergies that are maintaining stability in case of a large perturbation .2) Change-in-Support Strategies The change-in-support strategies include stepping (forward.
The HST strategy is one in which the head and trunk move as a single unit. . The HSS strategy is one in which the head position are independent of trunk motion.3) Head-Stabilizing Strategies used to maintain the head during dynamic tasks modification of head position in responce to displacements of the body s CoG.
This action might not be possible to undo. Are you sure you want to continue?
We've moved you to where you read on your other device.
Get the full title to continue listening from where you left off, or restart the preview.