SPINAL

BIOMECHANICS
POSTURE ANALYSIS
Lecture by: M.K. Sastry
Program Director,
Post Graduate Studies and PhD Program
 POSTURE
 Keep in mind the spine is found at the
posterior aspect of the body, behind
the center of gravity
 Center of gravity lies:

 Through the atlanto-occipital joint

 Tragus of the ear
 POSTURE
 Center of gravity lies:
 Anterior humeral head

 Anterior-inferior edge of T11

 Greater trochanter
 Just behind the patella
 Through the lateral malleoli
 DURING POSTURAL ANALYSIS…
 Usually stance is asymmetrical if not
intentional.
 The weight of the body is borne by the
skeleton aided by the action of intrinsic
back muscles
 Sway occurs during stance.
 DURING POSTURAL ANALYSIS…
 Postural sway of the vertebral column on
the pelvis is controlled by the erector
spinae, and the rectus abdominis.
 80% of the contraction occurs in the E.S.,
whereas only 20% of contraction occurs in
the abdominals, as confirmed by EMG
studies.
 DURING POSTURAL ANALYSIS…
 In scoliosis, E.S. contraction is higher on the
convex side.
 AFFECTS OF AXIAL
COMPRESSIVE FORCES
 Increases from the C / S to the L / S

 Lumbar problems are common--#1 reason to

see a Chiropractor
 HOW DO MUSCLES
BECOME IMBALANCED?

 Skeletal misalignment- triggers other muscles

to be recruited to restore normal posture
 Joint pain or malformation- imbalance in
stance and gait
 Ligamentous injury / instability- recruits
muscles to support the joint
 HOW DO MUSCLES
BECOME IMBALANCED?

 Muscle fatigue- recruits other muscles to

contract to accomplish the same movement,
often resulting in myofascial trigger points
 BEGINNING POSTURE ANALYSIS
 Work from the “ground-up”:
 Check for any lower extremity deformity that may be
creating imbalance above
 EXAMINE THE FEET

 LONGITUDINAL ARCH

 PRONATION
 SUPINATION
 MEDIAL MALLEOLI LEVELS
 ACHILLES TENDON POSITION

 SIGNS OF LIGAMENTOUS LAXITY

Pes Planus

Pes Cavus
 REASONS BEHIND
TOE-IN & TOE-OUT

 TOE-IN

 INTERNAL TIBIAL ROTATION Blount's disease

 TIBIA VARUS
 INCREASED INTERNAL ROTATION of
FEMUR —often due to muscular
contraction / imbalance
 REASONS BEHIND
TOE-IN & TOE-OUT

 TOE-OUT

 BILATERAL- SACRAL ANTERIORITY Blount's disease

 UNILATERAL- PELVIC ANTERIORITY
 INCREASED EXTERNAL ROTATION
of FEMUR—often due to muscular
contraction / imbalance
 EXAMINE THE KNEES

 FLEXED

 Hamstring spasm
 Quad weakness
 Acute low back pain
 EXAMINE THE KNEES

 HYPEREXTENDED

 Ligamentous
 Anterior compression
fracture
 KNEES
GENU VARUS GENU VALGUS
 Q – ANGLE
(Quadriceps)

 Wide Hips (female

runners)
 Knock Knees (·Genu
valgum)
 Pronation of the feet
 Subluxating Patella
 Q – ANGLE
(Quadriceps)

 High riding patella

(patella alta)
 Weak Vastus Medialis
 Imbalance of Hip Rotators

 Leg length discrepancies and foot pronation may

lead to:
 Iliotibial band syndrome
 Piriformis syndrome

 Recurrent muscle strains (hamstring and groin

pulls) can be an indicator of asymmetry in
structural alignment.
 HIP MUSCLES…
 Transfer ground-reaction forces from legs to trunk
during gait
 Supply coordinated propulsion
 Provide balanced stability for the pelvis and spine

 Through repetitive use patterns and after injuries, hip

muscles may become shortened and/or weak
 THIGH AND PELVIS

 BULK OF HAMSTRINGS
 GREATER TROCHANTERS
 PELVIC TILT, SWAY (antalgia), TORTION- AS or
PI
 ILIAC CREST LEVELS
 PSIS LEVELS
 SACRAL ROTATION (S2—PSIS distance)
 GLUTEAL MUSCLES- Deeper Dimpling
 POSTURAL ANALYSIS
P-A View
 Sacral Base-

 Level
 Held in place by innominate bones

 Dependant upon equal leg lengths

 What can go wrong?
 POSTURAL ANALYSIS
P-A View
 What can go wrong?

 Sacral deformity-
 Transitional segment

 Plateau base
 Anatomical short leg
 Congenital

 Acquired
 POSTURAL ANALYSIS
P-A View
 Functional

 Due to muscle
imbalance
 Due to pelvic
distortion
BODY RESPONDS IN A PREDICTABLE
MANNER
 Attempts to restore balance:
 Eyes on horizontal plane “Righting Reflex”
 Equally distributing weight to center of
gravity
VERTICAL PLANE of LUMBAR SPINE
 SPINOUS ALIGNMENT
 SECTIONAL TOWERING
 CURVATURE
 LORDOSIS
 PARASPINAL MUSCLE TONICITY
 SKIN DISCOLORATION
 THORACIC OBSERVATIONS
 SPINOUS ALIGNMENT

 SECTIONAL TOWERING

 CONVEXITY or SCOLIOSIS
 + ADAM’S SIGN

 KYPHOSIS
 RIB HUMP
 THORACIC OBSERVATIONS
 SCAPULAR WINGING (myopathies,
shoulder instability, Serratus
anterior weakness)
 POSTERIOR SCAPULA (scoliosis)
 HIGH SHOULDER/TRAP

 INTERNAL ROTATION HUMEROUS

 NECK and HEAD OBSERVATIONS
 C2 spinous aligns with S2
tubercle?
 Mastoid process levels
 Head tilt or rotation
 Anterior head carriage
 Lordosis
 Muscle tone
 LATERAL VIEW
 SACRUM: Inclines from 26-56º from
horizontal
 LUMBAR: Levels off at L4 superior body
surface (Apex), continues posteriorly in
upper L/S
 LATERAL VIEW
 SACRUM: Inclines from 26-56º from
horizontal
 THORACIC: Gradual reversal of curve: body
wedging to create kyphosis at apex (T4-T6)
 CERVICAL: Curve reverses again: apex (C4)

 What constitutes postural abnormality?

 LATERAL VIEW
 What constitutes postural abnormality?

 Any Variation in the AP or Lat

 Pelvic unleveling
 Spinal segment unleveling
 Produces imbalance & altered weight
imposition
 FROM THE SIDE
KYPHOSIS LORDOSIS
 NORMAL RANGES of MOTION
 Varies
 Age

 Activity
 EVALUATE: As a total unit; comparing symmetry
more than degrees
 Break it down by section—if blocked in one
section may lead to hypermobility in another
NORMAL RANGES of MOTION
 Look for:
 Abnormal coupling of motion (rotation with
flexion)
 Bilateral symmetry; smoothness & ease of
motion
 MOTION T/L C
FLEXION 90 60
EXTENSION 40 50
UNILAT 30 80
ROTATION
UNILAT LAT 35 45
FLEXION
SACROILIAC KINETICS
 THE SACROILIAC JOINT

A Controversial Topic

Complicated Anatomy
and Biomechanics:

1. Small ROM

2. Passive movement

3. Stress-relieving joint
 MOTION IN THE S/I JOINT
 No gross excursion (except due to severe
trauma)
 Movement: Normal physiological effect of
shock absorption
 Obvious movement during ambulation-
Sacral nutation
 MOTION IN THE S/I JOINT
 Clear osseous limitation-

 Interlocking ridges & grooves

 Strong reinforcing ligaments
 Key-stone in arch stability
 Age Factors in degree of motion:

 Flexible—to—Ankylosis
 Gillett’s test …
Demonstrates pelvic motion by comparing
PSIS motion B/L:
 Fixation
 Pseudo-ankylosis
 Fusion
 Lumbar or hip muscle hypertonicity
 Pelvis Tips and Rotates in
Accommodation…
A response to dysfunction above or below
 Leads to:
 Abnormal: unequal weight into each S/I
joint leading to…
 Pelvic distortion
 Pelvis Tips and Rotates in
Accommodation…
A response to dysfunction above or below
 Leads to:
 Eccentric weight imposition into each S/I
joint
 Abnormal posture

 Abnormal gait
PELVIC DISTORTION IS PREDICTABLE…
 Predictable patterns of
accommodation have
been demonstrated as a
response to imbalance
both above and below.
PELVIC DISTORTION IS PREDICTABLE…
 Therefore, pelvic
distortion is often not a
primary subluxation, but
a compensatory,
secondary distortion
 PRIMARY SUBLUXATION IN THE
LUMBAR SPINE
(Secondary S/I Dysfunction)
 IVD HERNIATION

 CURVATURE OR SCOLIOSIS

 TRANSITIONAL SEGMENT

 ALTERED SAGITTAL CURVE

 FUNCTIONAL: GROSS MUSCULAR

 PRIMARY DISTORTION DUE TO
LOWER LIMB DEFICIENCY
(Secondary S/I Dysfunction)
 ANATOMICALLY SHORT FEMUR OR TIBIA
 GENU VARUM OR VALGUS
 PRONATION
 FLAT FOOT
 HIP, KNEE, ANKLE OR FOOT PAIN
 PRIMARY
Sacroiliac Fixation

 Chronic stress to the S/I joints leads to:

 Repetitive microtraumas
 Gross muscular compensation—holding
joint in the fixed malposition
 PRIMARY
Sacroiliac Fixation

 May eventually lead to :

 Sclerotic changes
 PRIMARY
Sacroiliac Instability

 Sprain
 Pregnancy & Child Birth

 Pubic Symphysis Dysfunction

 CHARACTERISTICS OF S/I PAIN
 Painful to walk
 Ascending or descending stairs

 Standing from a sitting position

 Hopping or standing on involved leg

 Sharp pain that awakens the patient
from sleep upon turning in bed
What Research Has Shown
 L/S may refer pain to S/I
 S/I ROM:
 Decreases with age
 Minimal compared to spine
What Research Has Shown
 Pain can=
 1° Fixation, Instability or
 2° Accommodation
 CONTINUED S/I JOINT STRESS…
 May lead to true fixation in its misalignment—
becoming a primary subluxation
 Prolonged accommodation to chronic spinal
subluxation and postural abnormality or leg
deficiency may lead to
 Fixation
 CONTINUED S/I JOINT STRESS…
 Prolonged accommodation to chronic spinal
subluxation and postural abnormality or leg
deficiency may lead to
 Gross muscular change
 Sclerosis
 OTHER ENTITIES CAUSING S/I JOINT
PAIN
 Pelvic disorders- Prostatitis, Interstitial Cystitis, or
breast, lung or prostate metastasis
 Enteric disorders- Iliopsoas abscess

 Inflammatory arthrotides or
“Spondyloarthropathies”- A.S, Lupus, Reactive
Arthritis (“Reiter’s”), Crohn’s disease
 EXAMINATION
1. Observation

2. Primary Stress Tests

3. Leg Length Tests

4. Weight Bearing Kinetic Tests
5. Secondary Stress Tests

6. Orthopedic Tests
 OB SER VA TION

I. OB SERV ATI ON

1. Postural Analysis:
1. Pelvic tilt (Anterior or Posterior)
2. Lateral pelvic tilt

3. Any structural asymmetry

 OB SER VA TION

I. OB SERV ATI ON

2. Check for landmark:

1. Alignment
2. Tenderness

3. Belt Test: Test to R/O lumbar involvement

 REINERT SPECIFIC LISTINGS FOR
PELVIC DISTORTIONS AS RELATED TO THE
SACROILIAC JOINT
 POSTERIOR
 POSTERO-INFERIOR

 INFERIOR
 ANTERIOR
 ANTERO-SUPERIOR
 SUPERIOR
II. PRIMARY STRESS TESTS
LEG LENGTH
WEIGHT-BEARING KINETIC TESTS
Sacral Compression Test

Forced
Counternutation
GAENSLEN’S
TEST
YEOMAN’S TEST
FABER PATRICK’S TEST
HIBB’S TEST
PRONE PALPATION
 MOTION PALPATION-
Comparing Symmetry

1. PRONE PASSIVE: Spring S/I joints

2. SEATED PASSIVE: Spring S/I joints
3. PRONE ACTIVE: Stabilize S/I joints and ask patient
to extend lower limb while knee remains
extended
 CONCLUSION
 Determine if S/I pain is 1° or 2 °
 Once this is achieved, the doctor can determine the
appropriate treatment
Thank You