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KIN 191A
Assessment of Posture
2
INTRODUCTION
• WHAT IS POSTURE
• CLINICAL ANATOMY
• CLINICAL EVALUATION OF POSTURE
• COMMON POSTURAL DEVIATIONS
3
WHAT IS POSTURE
• The position of the body at a given point in time
• Ideal posture– Characterized by specific landmarks
being aligned with the force of gravity, keeping the body as close to physiological equilibrium as possible
4
CLINICAL ANATOMY
• Kinetic chain
• Muscular function
• Muscular length-tension relationships
• Agonist and antagonist relationships
• Muscular imbalances
• Soft tissue imbalances
5
Kinetic Chain
• Open kinetic chain (OKC)– Non-weight-bearing
– Movement occurs at predominantly at one joint (movement at one joint does not affect at other joints)
• Closed kinetic chain (CKC)– Weight-bearing
– Movement at one joint affects movement at other joints in a consistent and predictable fashion
7
Muscular Function
• Produce joint motion
• Provide dynamic joint stability
8
Muscular Length-Tension Relationships
• Describes how a muscle is capable of producing different amounts of tension (force) depending on its length
• Active insufficiency– Occurs when muscle is shortens and the actin
and myosin myofilaments are overlapped to the point where maximum tension cannot be produced
• Passive insufficiency– Occurs when the muscle is lengthened and the
actin and myosin myofilaments lack sufficient overlap to stretch enough to complete full ROM
10
Agonist and Antagonist Relationships
• Agonist– A muscle that contracts to perform the primary
movements of the joint
• Antagonist– Performs the opposite movement of the agonist
muscle– Must reflexively relax to allow the agonist’s
motion to occur
• Co-contraction– Concurrent contraction of the agonist and
antagonist muscles
11
Muscular Imbalances
• An impaired relationship between a muscle that is overactivated, subsequently shortened and tightened and another that is inhibited and weakened
• Nerve injury/Pain/Joint effusion/ Poor posture/Repetitive activity of one muscle group
12
Soft Tissue Imbalances
• A joint capsule and surrounding ligaments adaptation due to abnormal compressive or shear forces being produced within the joint(s) crossed by those muscles
13
CLINICAL EVALUATION OF POSTURE
• Views of Postural Inspection– Lateral view– Anterior view– Posterior view
• Inspection of Leg length Discrepancy• Palpation
– Lateral aspect– Anterior aspect– Posterior aspect
14
Views of Postural Inspection
15
Assessment of Ideal Posture
16
Lateral View• Determinations of the anterior and
posterior alignment of the body relative to the frontal plane
• Alignment relative to plumb line (bisects)– Auditory meatus– Acromion process– Mid thoracic region– Greater trochanter– Lateral femoral condyle (slightly anterior)– Lateral malleolus (slight posterior)
17
Anterior View• Bisects the midline of the body in
sagittal plane
• Alignment relative to plumb line (bisects)– Head– Chest– Umbilicus
18
Posterior View
• Plumb line should be equal distance from both feet, bisecting spinal column or trunk and head
• Alignment relative to plumb line (bisects)– Occipital protuberance– Cervical spinous processes– Scapular borders– Thoracic spinous processes– Lumbar spinous processes– Median sacral crests
Classification of Body Types
20
Palpation
21
Lateral Aspect
• Pelvic position– Palpate ASIS and PSIS on the same side– Relationship between ASIS and PSIS,
normally 8-10°
23
Anterior Aspect
• Patellar position
• Iliac crest heights
• ASIS heights
• Lateral malleolus and fibular head heights
• Shoulder heights
24
Posterior Aspect
• PSIS positions
• Spinal alignments
• Scapular positions
25
COMMON POSTURAL DEVIATIONS
• FOOT AND ANKLE– Hyperpronation– Hypersupination
• KNEE– Genu recurvatum– Genu varum– Genu valgum
26
• SPINAL COLUMN– Hyperlordotic posture– Kypholordotic posture– Swayback posture– Flat back posture– Scoliosis
27
• SHOULDER AND SCAPULAR– Forward shoulder posture– Scapular winging
• HEAD AND CERVICAL SPINE– Forward head posture
Lordosis / Good / Sway Back
29
Hyperlordotic Posture
• Increase in the anterior curve of the lumbar spine
• Tighten or shortened hip flexor muscles
• Anterior pelvic tilt• General concavity viewed from behind
30
Lordosis
31
During Extension
32
Kypholordotic Posture
• Increase in total lumbar lordosis
• Compensatory increase in thoracic kyphosis
• Tighten or shortened hip flexor muscles or back extensors
• Anterior pelvic tilt
33
Swayback Posture
• Tightens or shortens hip extensors
• Posterior pelvic tilt
• Genu recurvatum
34
Flat Back Posture
• Tightens or shortens hip extensors
• Posterior pelvic tilt
• Flexed lumbar spine (↓ lumbar lordosis)
• Extended thoracic spine (↓ thoracic kyphosis)
35
Scoliosis
• Lateral curve of the vertebral column– Curve is named according to the convexity– If the curve is convex to the left: left
scoliotic curve– “C” curves or compound “S” curves
36
Scoliosis Curve Patterns
37
Adams’ Position
38
Cobb’s Angle
39
Forward Shoulder Posture
• Tightened, shortened, overdeveloped anterior shoulder girdle muscles
• Large breast development
• Humeral head displaced anteriorly
40
Scapular Winging
• Weakness of serratus anterior muscle
• Weakness of middle and lower trapezius muscles
• Trauma to the long thoracic nerve
41
Forward Head Posture
• Extension of upper cervical spine
• Flexion of lower cervical spine
• Forward shoulder