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ASSESSMENT OF POSTURE

Prepared by: Floriza P. de Leon, PTRP

Erect position

Advantage: enables the hands to be free and the eyes to be farther from the ground so that the individual can see farther ahead Disadvantage: increased strain on the spine and lower limbs and comparative difficulties in respiration and transport of the blood to the brain

Ideal Postural Alignment

Straight line (line of gravity) that passes through the ear lobe, the bodies of the cervical vertebrae, the tip of the shoulder, midway through the thorax, through the bodies of the lumbar vertebrae, slightly posterior to the hip joint, slightly anterior to the axis of the knee joint, and just anterior to the lateral malleolus

Correct Posture Position in which minimum stress is applied to each joint Faulty Posture Any position that increases the stress to the joints

Evolution of Posture

At birth, the entire spine is concave forward, or flexed Curves of the spine found at birth are called primary curves. (thoracic spine and sacrum) Secondary curves appear at 3 months, the cervical spine becomes convex forward, producing the cervical lordosis. In the lumbar spine, the secondary curve develops slightly later (6-8 mos) In the child, the center of gravity is at the level of the 12th thoracic vertebra. Adults COG is at the 2nd sacral vertebra Child stands with a wide base to maintain balance, and the knee are flexed. The knees are slightly bowed (genu varum) until about 18 mos of age. The child then becomes slightly knock kneed (genu valgum) until the age of 3 yrs. By the age of 6 years, the legs should naturally straighten. The lumbar spine in the child has an exaggerated lumbar spine, or excessive lordosis. The accentuated curve is caused by the presence of the large abdominal contents, weakness of the abdominal

Evolution of Posture

Initially, a child is flatfooted or appears to be as the result of the minimal development of the medial longitudinal arch and the fat pat that is found in the arch. As the child grows, the fat pad slowly decreases in size, making the medial arch more evident. In addition, as the foot develops and the muscles strengthen, the arches of the feet develop normally and become more evident

Factors Affecting Correct Posture

Bony contours (hemivertebra) Laxity of ligamentous structures Fascial and musculotendinous tightness (tensor fascia latae, pectoralis, hip flexors) Muscle tonus (gluteus maximus) abdominals, erector spinae) Pelvic angle (normal is 30o) Joint position and mobility Neurogenic outflow and inflow

Cause of Poor Posture


Postural (positional) factors Most common postural problem is poor postural habit. This type of posture is often seen in the person who stands or sits for long periods and begins to slouch not wanting to appear taller than ones peers. Muscle imbalance or muscle contractures Pain may also cause poor posture Respiratory conditions (emphysema), general weakness, excess weight, loss of proprioception, or muscle spasm may also lead to poor posture Treatment involves strengthening weak muscles, stretching tight structures, and patient education Structural factors Results of congenital anomalies

Common Spinal Deformities


Lordosis Excessive anterior curvature of the spine Exaggeration of the normal curves found in the cervical and lumbar spines. Causes: postural deformity; lax muscles especially the abdominal muscles; heavy abdomen (excess weight or pregnancy); compensatory mechanisms that result from another deformity, such as kyphosis; hip flexion contracture; spondylolisthesis; congenital problems, such as bilateral congenital dislocation of the hip; failure of segmentation of the neural arch of a facet joint segment; fashion In pathological lordosis, one may observe sagging shoulders, medial rotation of the legs, and poking forward of the head so that it is in front of the center of gravity (most common postural deviation seen)

Common Spinal Deformities


Lordosis 0 Pelvic angle (normal is 30 ) is increased with lordosis accompanied by a mobile spine and an anterior pelvic tilt. Accompanied by tight hip flexors, tensor fascia latae, and hip flexors combined with weak abdominals Swayback deformities, there is an increased pelvic inclination to approximately 400, and the thoracolumbar spine exhibits a kyphosis. Results in the spines bending back rather sharply at the lumbosacral angle. With this postural deformity, the entire pelvis shifts anteriorly, causing the hips to move into extension. There is an increase in the lumbar and thoracic curves. Such deformity may be associated with tight hip extensors, lower lumbar extensors, and upper abdominals, along with weak hip flexors, lower abdominals, and lower thoracic extensors

Common Spinal Deformities


Kyphosis Excessive posterior curvature of the spine Pathologically, it is an exaggeration of the normal curve found in the thoracic spine Causes includes tuberculosis, vertebral compression fractures, scheuermanns disease, ankylosing spondylitis, senile osteoporosis, tumors, compensation in conjunction with lordosis, and congenital anomalies. Scheuermanns vertebral osteochondritis Results in a structural kyphosis Inflammation of the bone and cartilage occurs around the ring epiphysis of the vertebral body Leads to an anterior wedging of the vertebra It is a growth disorder that affects approximately 10% of the population Common area for the disease to occur is between T10 and L2

Common Spinal Deformities


Types of kyphosis Round back Px with a round back has a long, rounded curve with decreased pelvic inclination (<300) and thoracolumbar kyphosis Presents with the trunk flexed and a decreased lumbar curve. There is tight hip extensors and trunk flexors with weak hip flexors and lumbar extensors Humpback or gibbus Localized, sharp posterior angulation in the thoracic spine Flat back 0 Has decreased inclination to 20 and a mobile lumbar spine Dowagers hump Seen in older patients especially women Caused by osteoporosis in which the thoracic vertebral bodies begin to degenerate and wedge in an anterior direction, resulting in a kyphosis

Common Spinal Deformities


Scoliosis Lateral curvature of the spine Most famous example of scoliosis is the hunchback of notre dame Torticollis: scoliosis of the cervical spine Can be structural or non structural Non-Structural scoliosis caused by postural problems, hysteria, nerve root irritation, inflammation, or compensation caused by leg length discrepancy or contracture (in the lumbar spine). Structural Scoliosis primarily involves body deformity, which may be congenital or acquired. This may be caused by wedge vertebra, hemivertebra, or failure of segmentation. It may be idiopathic (genetic), neuromuscular, resulting from an upper or lower motor neuron lesion; or myopathic, resulting from muscular dystrophy. Or, it may caused by arthrogryposis, resulting from persistent joint flexure or

Common Spinal Deformities

Idiopathic Scoliosis accounts for 75-85% of all cases of structural scoliosis. The vertebral bodies rotate into the convexity of the curve, with the spinous processes going toward the concavity of the curve. There is a fixed rotational prominence on the convex side, which is best seen on forward flexion from the skyline view (razorback spine). Disc spaces are narrowed on the concave side and widened on the convex side. There is distortion of the vertebral body, and vital capacity is considerably lowered if the lateral curvature exceeds 600; compression and malposition of the organs within the rib cage also occur

Patient History

History of injury Exacerbation or relief of symptoms in certain positons Family history History of previous illness, surgery or severe injuries Footwear makes a difference Age of the patient Presence of growth spurt Presence of deformity, progressive vs stationary Neurological symptoms Nature, extent, type and duration of pain Positions or activities increase the pain or discomfort Difficulty in breathing Dominant hand Previous treatment

Observation

Body types (ectomorph, mesomorph, endomorph) Standing position (anterior view, lateral view, posterior view

Anterior view

Head is straight on the shoulders (in midline) Posture of the jaw is normal Tip of the nose is in line with the manubrium sternum, xiphisternum, and umbilicus (anterior line of reference) Trapezius neck line is equal on both sides Shoulders are level (dominant side is slightly lower) Clavicles and acromioclavicular joints are level and equal No protrusion, depression, or lateralization of the sternum, ribs or costocartilage. Waist angles are equal, and the arms are equidistant from the waist Carrying angle at each elbow is equal High points of the iliac crest are the same height on each side ASIS are level Pubic bones are level at the symphysis pubis Patellae of the knees point straight ahead. (frog eyes patellae or squinting patellae) Knees are straight (genu varum or genu valgum) Heads of the fibulae are level Medial and lateral malleoli of the ankle are level