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Posture Evaluation Martha Macht Sliwinski PT PhD
Posture Evaluation
Martha Macht Sliwinski PT PhD
Correct Posture Maximal physiological and biomechanical efficiency Minimize stress and strains Segments aligned
Correct Posture
Maximal physiological and biomechanical
efficiency
Minimize stress and strains
Segments aligned vertically with gravity
line through axis of all joints
Balanced strength and length of muscles
Balance is based on a force couple
Postural Analysis View from different positions Use dominant eye Identify bony landmarks Assess with and
Postural Analysis
View from different positions
Use dominant eye
Identify bony landmarks
Assess with and without orthotic devices
and shoewear
Assess in ideal and real-life postures
Note relevant medical history
Posture The alignment and positioning of the body in relation to gravity, center of mass
Posture
The alignment and positioning of the body
in relation to gravity, center of mass and
base of support
The physical therapist uses posture tests and
measures to assess structural abnormalities
in addition to the ability to right the body
against gravity
“Good Posture” A state of musculoskeletal balance that protects the supporting structures of the body
“Good Posture”
A state of
musculoskeletal
balance that protects
the supporting
structures of the body
against injury or
progressive deformity
Endomorphs The naturally large person characterized with a round face, wide hips, big bones, slow
Endomorphs
The naturally large
person characterized
with a round face,
wide hips, big bones,
slow metabolism and
high number of fat
cells.
Mesomorphs The naturally muscular person with wide shoulders, small waist, athletic build, low body fat
Mesomorphs
The naturally
muscular person with
wide shoulders, small
waist, athletic build,
low body fat
percentage with an
increased metabolism
Postural Tests & Measures Analysis of resting (static) posture or preferred in any position Analysis
Postural Tests & Measures
Analysis of resting (static) posture or
preferred in any position
Analysis of dynamic posturing/functional
movements
Analysis of static and dynamic postures,
using computer-assisted imaging, posture
grids, plumb lines, still photography,
videotape, visual analysis
Ideal Posture – lateral view Ear lobe Dens Cervical vertebral bodies Tip of the acromion
Ideal Posture – lateral view
Ear lobe
Dens
Cervical vertebral bodies
Tip of the acromion
Mid trunk
Lumbar bodies/sacral
promontory
Greater trochanter
Slightly anterior to knee
Slightly anterior to lateral
malleolus
Ectomorphs The skinny person with a linear appearance, small muscles, ultra fast metabolism, low body
Ectomorphs
The skinny person
with a linear
appearance, small
muscles, ultra fast
metabolism, low body
fat, narrow shoulders,
hips and waist.
Clinical Indications for Postural Tests & Measures Abnormal bony alignment Impaired aerobic capacity Impaired
Clinical Indications for Postural
Tests & Measures
Abnormal bony alignment
Impaired aerobic capacity
Impaired joint integrity/mobility
Impaired motor function
Impaired muscle performance
Impaired sensory integrity
Pain
joint integrity/mobility Impaired motor function Impaired muscle performance Impaired sensory integrity Pain 2
Ideal Posture Head Cervical Spine Scapulae Thoracic Spine Lumbar Spine Pelvis Hips Knees Ankle
Ideal Posture
Head
Cervical Spine
Scapulae
Thoracic Spine
Lumbar Spine
Pelvis
Hips
Knees
Ankle
Poor Posture (AAOS 1947) Increases strain on supporting structures (ie, ligaments, cartilage, bone-tendon interface,
Poor Posture (AAOS 1947)
Increases strain on supporting
structures (ie, ligaments, cartilage,
bone-tendon interface, etc)
Less efficient balance of body
over its base of support
Alteration of the normal
arthokinematics/kinetics of
affected joints irrespective of
position (eg, standing erect,
lying, squatting, etc)
Development of Posture
Development of Posture
Muscle Balance Abdominals Hip Flexors Erector Spinae Hip Extensors
Muscle Balance
Abdominals
Hip Flexors
Erector Spinae
Hip Extensors
Poor Posture Anatomic impairments Physiologic impairments Psychosocial impairments Bony structure abnormalities
Poor Posture
Anatomic impairments
Physiologic impairments
Psychosocial impairments
Bony structure abnormalities
Habitual Posturing
Lordosis A marked anterior pelvic tilt A marked lordosis Marked anterior pelvic tilt and lordosis
Lordosis
A marked anterior
pelvic tilt
A marked lordosis
Marked anterior pelvic
tilt and lordosis
Hyperlordotic and Kypholordotic
Hyperlordotic and Kypholordotic
Military Type Head: neutral C-spine: normal, slightly anterior T spine:normal, slightly posterior L spine:
Military Type
Head: neutral
C-spine: normal, slightly
anterior
T spine:normal, slightly
posterior
L spine: hyperextended lordosis
Pelvis: anterior tilt
Knees: slightly hyperextended
Ankles: slightly plantar flexed
Sway Back and Flat Back
Sway Back and Flat Back
Kypholordotic Posture Head: forward C-spine: hyperextended Scapulae: abducted T spine:↑ flexion L spine:
Kypholordotic Posture
Head: forward
C-spine: hyperextended
Scapulae: abducted
T spine:↑ flexion
L spine: hyperextended
Pelvis: anterior tilt
Hips: flexed
Knees: slightly hyperextended
Ankles: slight plantar flexion
Sway Back Head: forward C-spine: slightly extended T spine:↑ flexion L spine: flexion, flattening Pelvis:
Sway Back
Head: forward
C-spine: slightly extended
T spine:↑ flexion
L spine: flexion, flattening
Pelvis: posterior tilt
Hips: hyperextended
Knees: hyperextended
Ankles: neutral
Flat Back Head: forward C-spine: slightly extended T spine:↑ flexion upper part, lower part, straight
Flat Back
Head: forward
C-spine: slightly extended
T spine:↑ flexion upper
part, lower part, straight
L spine: flexed, straight
Pelvis: posterior tilt
Hips: extended
Knees: extended
Ankles: slight plantar
flexion
Ideal Alignment: Posterior View Head Cervical Spine Shoulders Thoracic Spine Lumbar Spine Pelvis Hips
Ideal Alignment: Posterior View
Head
Cervical Spine
Shoulders
Thoracic Spine
Lumbar Spine
Pelvis
Hips
Lower Extremities
Feet
Faulty Alignment: Posterior View Head C spine Shoulders Scapulae T and L spine Pelvis Hips
Faulty Alignment: Posterior View
Head
C spine
Shoulders
Scapulae
T and L spine
Pelvis
Hips joints
Lower Extremities
Feet
Anterior View Lower Extremity Torso Shoulder Head and Neck
Anterior View
Lower Extremity
Torso
Shoulder
Head and Neck
Faulty Alignment: Posterior View Head C spine Shoulders Scapulae T and L spine Pelvis Hips
Faulty Alignment: Posterior View
Head
C spine
Shoulders
Scapulae
T and L spine
Pelvis
Hips joints
Lower Extremities
Feet
Faulty Postures: Side & Back Views Figure A; posture appears good from the posterior view
Faulty Postures: Side & Back Views
Figure A; posture
appears good from the
posterior view but is
faulty from the side
Figure B faulty
posture both front and
side views
Measuring Leg Length Structural Leg Length Test (or “true”): measure from ASIS to medial malleolus
Measuring Leg Length
Structural Leg Length
Test (or “true”):
measure from ASIS to
medial malleolus
Functional Leg Length
Test (or apparent):
measure from medial
malleolus to umbilicus