Chapter 3

Assessment of Posture

Introduction
Posture is the position of the body at a given point in time Correct posture can:
improve performance decrease abnormal stresses reduce the development of pathological conditions

Introduction
Faulty posture:
Deviates from ideal posture Requires an increased amount of muscular activity Places an increased amount of stress on the joints and surrounding tissues

Restrictions in normal movement patterns may cause compensatory postures

Overtime can result in muscle imbalances and soft tissue dysfunction

Introduction
Pain related to postural deviations is a common clinical occurrence
Many do not seek help until pain is experienced

Postural assessment is used to determine if postural deviations are contributing factors in patients pain or dysfunction Posture must be evaluated in functional and nonfunctional positions

Clinical Anatomy
Musculoskeletal system is designed to function in a mechanically and physiologically efficient manner to use the least possible amount of energy Postural deviations or skeletal malalignment cause other joints in kinetic chain to undergo compensatory motions or postures to allow body to move as efficiently as possible

The Kinetic Chain

Closed kinetic chain
Weight-bearing Lower extremity Distal segment meets resistance or is fixated Interdependency of each joint = predictable changes in position Figure 3-1A, page 53

Open kinetic chain

Non-weight-bearing Upper extremity Distal segment moves freely in space

The Kinetic Chain

A dysfunction occurring in one area may affect the proximal or distal associated joints and soft tissue structures
Causing a specific postural deviation

The body compensates for these deviations to maintain as much efficiency as possible in movement and function Table 3-1, page 54

Muscular Function
Muscles produce joint motion and provide dynamic joint stability Muscles must be of adequate length and function in a proper manner
If too short or too long
Adverse stress on joints Work inefficiently Create need for compensatory motions

Table 3-2, page 55

Muscular Length-Tension Relationships

Describes how a muscle is capable of producing different amounts of tension (force), depending on its length Active insufficiency
Muscle is shortened and maximum tension cannot be produced

Passive insufficiency
Muscle is lengthened and cannot generate sufficient tension to be effective

Figure 3-4, page 56

Agonist and Antagonist Relationships

Agonist
Muscle that contracts to perform the primary movement of a joint

Antagonist
Performs opposite movement of agonist and must relax to allow agonists motion to occur Reciprocal inhibition

Bicep/triceps example Co-contraction

Used for dynamic stability of joint

Muscular Imbalances
Impaired relationship between a muscle that is overactivated, subsequently shortened and tightened and another that is inhibited and weakened
Table 3-3, page 57

Postural vs. phasic muscles

Table 3-4, page 57 Table 3-5, page 57

Soft Tissue Imbalances

Joints capsule and surrounding ligaments undergo adaptive changes from prolonged overstressing or understressing of structure Faulty posture can alter the position of joints, causing an increase in stress on different portions of the joint capsule and surrounding ligaments

Clinical Evaluation of Posture

Not an exact science
Radiographs, photographs, computer analysis Clinical tools plumb lines, goniometers, flexible rulers, inclinometers (fig. 3-5, page 58)

Subjective vs. objective methods

Normal, mild, moderate, severe posture Quantifiable measurements can assess treatment plan

Clinical Evaluation of Posture

Commonly assessed in various positions
Standing and sitting Sport-specific and ADLs

Orthoposition
Normal or properly aligned posture 4 movements to perform before assessment
Page 58

History
To determine if a postural dysfunction is contributing to the patients pathology Identify any routine repetitive motions IF injury is chronic
Explore day to day tasks and posture

If injury is acute
Determine factors that may have predisposed athlete to the injury

History
Mechanism of injury
Common responses
Insidious onset Pain worsening as day progresses Posture-specific pain Intermittent, vague , or generalized pain Starting as an ache and progressing

Type, location, and severity of symptoms Side of dominance Activities of daily living
Table 3-7, pages 60-61

History
Driving, sitting, and sleeping postures
Table 3-8, page 62

Specific postures causing discomfort Level and intensity of exercise Medical History

Inspection
Considerations
Area being used is private, comfortable Patient preparedness Do not inform patient you are assessing posture Use systematic approach
Start at feet and work superiorly or vice versa

Compare bilaterally for symmetry Your eyes should be at level of region you are observing

Overall Impression
Determine patients general body type
Ectomorph, mesomorph, endomorph Inherited Can indicate a persons natural abilities and disabilities Does not necessarily dictate how they may function Box 3-1, page 64

Views of Postural Inspection

Inspect from lateral, anterior, posterior views Plumb line
Feet as permanent landmark Lateral view
Slightly anterior to lateral malleolus

Anterior and posterior view

Equidistant from both feet

Box 3-2, page 65

Views
Lateral view
Table 3-9, page 63

Anterior view
Table 3-10, page 66

Posterior view
Table 3-11, page 67

Inspection of Leg Length Discrepancy

Three categories
Structural (true) Functional (apparent) Compensatory Table 3-12, page 68

Block method (Box 3-3, page 69) Figure 3-6, page 68 Figure 3-7, page 70 Figure 3-8, page 70

Palpation
To determine specific positions (key landmarks) not necessarily for point tenderness Lateral aspect
Pelvic position
ASIS and PSIS, 9-100 Box 3-4, page 71

Palpation
Anterior aspect
Patellar position Iliac crest heights
Figure 3-9, page 70

ASIS heights
Figure 3-10, page 70

Lateral malleolus and fibula head heights Shoulder heights

Figure 3-11, page 72

Palpation
Posterior aspect
Many of same landmarks used for anterior view PSIS position
Figure 3-12, page 72

Spinal alignment Scapular position

Box 3-5, page 73 Not important at this time

Common Postural Deviations

Not all postural deviations cause pathology Clinicians must identify
Normal posture Asymptomatic deviations Deviations causing dysfunction and/or pain

Potential muscle imbalances can cause poor posture OR be a result of poor posture Deviations also caused by skeletal malalignment, anomalies, or combination

Foot and Ankle

Hyperpronation
Review chapter 4 Figure 3-13, page 74

Supination
Review chapter 4

The Knee
Genu Recurvatum
Knee axis of motion is posterior to plumb line Box 3-6, page 75

Genu Valgum
Occurs due to
structural anomalies or muscular weaknesses at the hip Secondary to hyperpronation of the feet

Can lead to
Increased pronation Internal tibial and femoral rotation Medial patellar positioning

The Knee
Genu Varum
Occurs due to
Structural anomalies at the hip Excessive supination

Can lead to
Supination External tibial and femoral rotation Lateral patellar positioning

Interrelationships Between Regions

Table 3-14, page 83 May be impossible to determine if posture is the cause or the effect
Understand relationships and importance of correcting the factors involved

Most soft tissue dysfunctions that have a gradual, insidious onset have, at least, a minimal postural component

Documentation of Postural Assessment

Table 3-15, page 85
As part of a SOAP note

Figure 3-14, page 84

Standard postural assessment form

Guidelines for documenting posture

Pages 83, 85