POSTURE

Dr. CHAITANYA. B
 Posture

• Definition:

 Position or attitude of the body.

 Relative arrangement of body parts for a
specific activity.
 Characteristic manner of bearing one’s body.
 Factors Maintaining Posture
1. Inert structures supporting the body
posture
a. Ligaments
b. Fascia
c. Bones
d. Joints
2. Dynamic structures maintaining body
posture
a. Muscles
b. Tendinous attachments
3. Gravity

• Places stress on structures responsible for

maintaining the body’s upright posture.

• Normally gravitational line goes through the

physiologic curves of spinal column & they are
balanced.

• If the wt. in one region shifts away from the line

of gravity → the remainder of the column will
compensate to regain equilibrium.
What
: is posture?
▫ “The position of the body at a given point in
time.” (Starkey)
▫ “A set of muscle contractions that place the
body in the necessary location from which a
movement is performed.” (Enoka)
▫ “The situation or disposition of the several
parts of the body with respect to each other for
a particular purpose.” (Webster)
 What is good posture?
• Ideal posture serves as a
reference point.
• Ideal posture…
▫ Distributes gravitational stress for
balanced muscle function.
▫ Allows joints to move in their mid
range to minimize stress on
ligaments and articular surfaces.
▫ Effective for the individual’s
activities of daily living.
▫ Allows the individual to avoid injury.
Definition of a “ Good Posture”:
A good posture is the state of muscular and skeletal balance
which protects the supporting structures of the body against
injury and progressive deformities, irrespective of the
attitude in which these structures are working or resting.
• Under these conditions, the muscles will function most
efficiently and the optimum positions are afforded for the
thoracic and abdominal organs.
• There is no single best posture for all individuals. Each
person must take the body he / she has and make the best of
it. The “ good Posture” is the one that suits one’s own
condition and the condition of the environment.
• e.g. during attention. The normal posture will be erect, while
in extreme fatigue, the normal posture will be that conserves
energy.
The “good posture” is the posture in which the body segments
are balanced in the position of least strain and maximum
support.
 Postural Development

• Birth
▫ Entire spine concave
forward (flexed)
▫ “Primary curves”
 Thoracic spine
 Sacrum
• Developmental
(usually around 3 mos.)
▫ Secondary curves
▫ Cervical spine
▫ Lumbar spine
 Postural Development
• Factors affecting posture
▫ Bony contours
▫ Laxity of ligamentous structures
▫ Fascial & musculotendinous tightness
▫ Muscle tonus
▫ Pelvic angle
▫ Joint position & mobility
 Causes of poor posture

▫ Positional factors
 Appearance of increased height
(social stigma)
 Muscle
imbalances/contractures
 Pain
 Respiratory conditions
▫ Typically can be managed
conservatively through
therapeutic ex & education
▫ Structural factors
 Congenital anomalies
 Developmental problems
 Trauma
 Disease
▫ Not typically easily managed
Example: Total Spinal Posture
• Ideal 6. Iliac crests, ASIS’s &
1. Head sits straight on PSIS’s .
shoulders
 nose in-line c/ 7. ASIS sit lower than PSIS
manubrium, 8. Gluteal folds and knee
xiphoid, umbilicus joints even
 Earlobes in-line with 9. Patellae point forward
acromion process 10. No Genu conditions
2. Shoulders and clavicles noted
level are equal
11. Heads of fibula and all
3. normal appearance of
Shoulders malleoli level
4. Arms equidistant from 12. Achilles tendons & heels
trunk appear to be straight
5. Normal spinal curves 13. Evident arches
Good Spinal Posture
What is bad posture?

• Any position that

deviates from “good
posture”
▫ Static
 Standing
 Sitting
 Sleeping
▫ Dynamic
 Running
 Throwing, etc.
• Correct posture
▫ “Position in which
minimum stress is placed
on each joint.”

• Faulty posture
▫ Any position that increases
stress on joints
 Common Spinal Deformities
• Lordosis
▫ Excessive anterior
curvature of the spine
▫ Exaggeration of normal
curves in the cervical &
lumbar spines
 Common Spinal Deformities
 Lordosis causes:
› Postural deformity
› Lax muscles (esp. abs)
› Heavy abdomen
› Compensatory
mechanisms
› Hip flexion contracture
› Spondylolisthesis
› Congential problems
› Fashion (high heels)
 Common Spinal Deformities
• Swayback deformity
 Increased pelvic
inclination (40)
 Typically includes
kyphosis
 Common Spinal Deformities
• Kyphosis
▫ Excessive posterior
curvature of the spine
 Round back
 Humpback/gibbus
 Flat back
 Dowager’s Hump
 Common Spinal Deformities
 Scoliosis
› Nonstructural
 “Functional”
 May be related to leg
length discrepancy
› Structural
 Lacks normal
flexibility
 Asymmetric
movements
Relevant History
• Identify factors that ▫ Hypermobile Jts
influence posture ▫ Hypomobile Jts
▫ ST Flexibility
▫ Overuse ▫ Bony Abnormality
▫ Neurological ▫ Leg Length Disc.
Problems
▫ Pain
▫ Lack of awareness
▫ Ms weakness/
Imbalance
Inspection
• Use of a plumb line
▫ Anatomical reference
▫ 3 views
 Lateral (sagittal plane
movements)
 Anterior (frontal/
transverse plane
movements)
 Posterior (frontal/
transverse plane
movements)
 Observation
• Body type
▫ Ectomorph
▫ Mesomorph
▫ Endomorph
Lateral View

• Look for:
▫ @ ankle?
▫ @ knee?
▫ @ hip?
▫ @ shoulder?
▫ @ neck?
▫ @ head?
From lateral View:

The line of Gravity passes through:

a. Vertex.
b. Mastoid process( behind).
c. Anterior to the axis of flexion and extension
of the neck.
d. Acromion Process ( bisecting)
e. Body of C1,C6,T11, L5, S1 ( it passes posterior to the axes of rotation
of the
cervical and lumbar vertebrae and anterior to thoracic vertebrae.
f. Via or behind the axis of the hip joint.
g. Anterior to the axis of the knee joint.
h. 5 cm anterior to lateral malleolus.
Side view (Lateral view)
 Anterior view

• Anterior view
▫ Head straight on shoulders
▫ Shoulders level ▫ Malleoli level
▫ Clavicles/AC joints ▫ Arches
▫ Sternum & ribs ▫ Foot rotation
▫ Waist angles & arm ▫ Bowing of bones
positions ▫ Diastematomyelia (hairy
▫ Carrying angles patches)
▫ Iliac crests ▫ Pigmented lesions
 Café au lait spots
▫ ASIS
▫ Patellae
▫ Knees
▫ Fibular heads
From Front or Back View:
The line of gravity passes from
the vertex through S2 to a
point between the two feet in
the base of support.
Posterior View

• Look for:
▫ @ heel?
▫ @ pelvis?
▫ @ lumbar spine?
▫ @ scapulae?
▫ @ neck?
▫ @ head?
Palpation

• In assessment position
(i.e., standing), palpate: Posteriorly
▫ Laterally PSIS positions
 ASIS vs. PSIS Spinal alignment
▫ Anteriorly Scapular positions
 Patellae
 Iliac Crests
 ASIS heights
 Lateral Malleolar
heights
 Fibular Head heights
 Shoulder heights
Postural Control:

Postural control refers to the ability to maintain

the stability of the body as a whole and body
segments “against gravity” or “movement of
different body segments” or “changes in the
supporting surface”.

Control depends on the integrity of nervous

system, muculoskeletal system and special
senses.
Types of Postures

• Easy posture
• Fatigue posture.
• Rigid posture.
Easy Posture:

• It is a good, symmetrical and balanced

position though this position cannot be maintained
for a long time.
• The subject will therefore shift his weight in a swaying
movement in order to prevent fatigue and to maintain
a good circulation in the postural muscles of the legs
when standing.
• By alternating the main support from one leg to
another, the muscles become periodically unloaded
and relaxed.
• The pelvic inclination is about 60°.
Fatigue Posture:

• It is asymmetrical or sagging posture.

This position s relaxed and can be maintained
for a long time as most of the body’s joints are in
semi- flexion.
• The load on the muscles will decrease and the
energy expenditure is 10 % less than easy
posture.
• The pelvic inclination decreases due to posterior
tilting of the pelvis.
Rigid Posture:

• It is called normal
stellung posture or
posture of attention. It
doesn’t mean normal posture.
This position cannot be
assumed for a long time as
most of body’s joints are in
extension. Therefore, the load
will increase on the joints and
muscles and the energy
expenditure is 20% more
than in the easy posture.
• The pelvic inclination
increases due to the anterior
tilting of the pelvis.
Faulty Posture

• A faulty posture results

from:
• Faulty relationship of the
various body parts which
produces increased strain on
the supporting structures.
• Inadequate balance over the
base of support.
• Postural deviations will occur
with an increase or decrease of
body curvatures and pelvic
inclination.