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
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
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
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