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Postural Assessment

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Upper Crossed Syndrome Postural Signs of Upper Crossed Syndrome Postural finding Rounded ... abdominals Shortened piriformis Hypermobile lumbosacral ... – PowerPoint PPT presentation

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Title: Postural Assessment


1
Postural Assessment
  • Dr. Michael P. Gillespie

2
Posture
  • Posture is how the body balances.
  • Muscles, bones, and ligaments all work together
    to exert postural control.
  • The nervous system innervates these structures to
    regulate growth and function.
  • Muscles and their nerves
  • A) provide stability to the trunk.
  • B) produce movement during physiologic activity.

3
Postural Analysis
  • The motor system consists of bones, muscles, and
    ligaments.
  • The nervous system controls the motor system.
  • Postural analysis is an assessment of the
    function of the motor system as well as the
    nervous system.

4
Pain Cycle
5
Neutral Posture
  • The brain and nervous system utilize information
    from three sources to balance the body in space.
  • Sources of balance
  • Eyes level.
  • Ears vestibular apparatus.
  • Muscles and joints proprioceptive pathways.

6
Righting Reflex
  • A postural reaction that turns a falling animal's
    body in space so that its paws or feet are
    pointed at the ground.
  • Returns the animal to sternal recumbency after
    being placed on its back or side.
  • A normal reaction is dependent on normal
    vestibular, visual and proprioceptive functions.

7
Causality
  • Postural changes can be the cause of a clinical
    problem.
  • Postural changes can be the effect of a clinical
    problem.
  • Orthopedic problems can cause a postural change,
    which can worsen the orthopedic problem.
  • Asymptomatic postural problems can produce
    mechanical stress, which can predispose an
    individual to injury.

8
Ideal Posture
  • There is no normal posture.
  • Ideal posture serves as a reference point.
  • Ideal posture
  • Distributes gravitational stress for balanced
    muscle function.
  • Allows joints to move in their mid range to
    minimize stress on ligaments and articular
    surfaces.
  • Effective for the individuals activities of
    daily living.
  • Allows the individual to avoid injury.

9
Balanced Posture
10
Effect of Habits on Posture
  • Good habits contribute to a strong and stable
    posture.
  • Bad habits contribute to poor posture and
    instability.

11
Examples of Poor Postural Habits
  • Excessive sitting.
  • Carrying a heavy backpack.
  • Slumping.
  • Poor sleeping positions.
  • One-sided activities
  • Carrying a heavy purse.
  • Sitting on a wallet.
  • Sitting in a twisted position.

12
Postural Changes
13
Effects of Poor Posture on Muscles
  • Overstressed muscles tighten.
  • Favored muscles weaken.
  • This imbalance perpetuates the poor posture.

14
Spinal Distortions
  • Anterior to posterior.
  • Lateral.
  • Helical.
  • Foundational distortions create changes above.

15
Spinal Column Views
16
Helical Spinal Distortion
17
Muscle Palpation
  • Palpate for hypertonic (overused) muscles.
  • Palpate for weak / inhibited muscles.
  • A muscle is weak because it is unstressed and
    should be strengthened with exercise.
  • An inhibited muscle is not being used because
    its antagonistic muscle is being overused.

18
Reciprocal Inhibition
  • Reciprocal inhibition describes muscles on one
    side of a joint relaxing to accommodate
    contraction of muscles on the other side of a
    joint.

19
Reciprocal Inhibition
20
Postural and Phasic Muscles
  • Postural (tend to hyperactivity)
  • Triceps surae
  • Hamstrings
  • Adductors
  • Rectus femoris
  • Tensor fascia latae (TFL)
  • Psoas
  • Erector spinae
  • Phasic (tend to hypoactivity)
  • Tibialis anterior
  • Gluteus maximus
  • Gluteus medius
  • Rectus abdominus
  • Lower / middle trapezius
  • Longus capitus and colli
  • Deltoids
  • Digastrics

21
Postural and Phasic Muscles
  • Postural (tend to hyperactivity)
  • Quadratus lumborum (QL)
  • Pectoralis
  • Upper Trapezius
  • Sternocleidomastoid
  • Suboccipital
  • Masticatories

22
Posture Blocks
23
Prior To Postural Evaluation
  • Obtain pertinent history.
  • Description of symptoms.
  • Fractures.
  • Injuries.
  • Congenital anomalies.
  • Dominant hand.
  • Note gross structural asymmetries such as
    scoliosis.

24
Postural Views
25
Posture Types
26
Posterior View Evaluation
  • Occipital protruberance.
  • Cervical, thoracic, and lumbar spinous processes.
  • Coccyx.
  • Gluteal folds.
  • Arms should hand equally with palms slightly
    visible.

27
Posterior View Evaluation
  • The space between the arms and sides of the body
    should be equal.
  • Legs should be equally abducted.
  • The backs of the knees should be the same.
  • Ankles and feet aligned b/l (no pronation or
    supination).

28
Posterior View Evaluation
  • Structures that should be level and equal.
  • Tips of mastoid processes.
  • Acromia.
  • Scapula.
  • Lower margins of 12th ribs.
  • Iliac crests.
  • Posterior superior iliac spines (PSIS).
  • Ischial tuberosities.

29
Ideal Posterior Alignment
30
Scoliosis
31
Pelvic Unleveling
32
Gothic Shoulder
33
Scapular Winging
34
Scapular Winging and Abduction
35
Tight Levator Scapula
36
High Left Shoulder
37
Right Head Tilt and Rotation
38
Lateral View
  • Evaluate from both sides.
  • Landmarks.
  • External auditory canal.
  • Acromion process of shoulder.
  • Axillary line.
  • Mid-point of iliac crest.
  • Greater trochanter of hip.
  • Lateral condyles of femur.
  • Tibia slightly anterior to lateral malleolus.

39
Ideal Lateral Alignment
40
Head Alignment Lateral View
41
Forward Head Posture
42
Head and Neck Weight Distribution
43
Forward Head Tilt
44
Abdominal Protrusion
45
Pelvic Tilt (Anterior and Posterior)
46
Anteroposterior / Front View
  • Balanced posture should appear equal from left to
    right.
  • Landmarks.
  • Bridge of nose.
  • Center of chin.
  • Episternal notch.
  • Xiphoid process.
  • Umbilicus.
  • Pubes.

47
Anteroposterior / Front View
  • Arms should hang similarly with palms at the side
    of the thighs
  • Shoulder girdle symmetry
  • Hands should show similar rotation and placement
    on the body
  • Legs should appear equally abducted from the
    center line

48
Anteroposterior / Front View
  • Feet aligned b/l
  • No pronation / supination
  • No inversion of eversion
  • Knees forward and symmetric b/l

49
Anteroposterior / Front View
  • Structures that should be equal b/l and level
  • Eyes
  • Clavicles
  • Lower margins of the ribcage
  • Anterior superior iliac spines (ASIS)
  • Femoral trochanters
  • Knees
  • Ankles

50
Internal Rotation of Shoulders / Rounded Shoulders
51
Genu Valga (Knock-knees)
52
Genu Vara (Bowlegs)
53
Upper Crossed Syndrome
  • Affects the head, neck and shoulders.
  • Result of long-term seated postures.
  • Rolled-in and forward shoulders.
  • Increased thoracic kyphosis.
  • Forward head posture.
  • Loss of cervical lordosis.

54
Upper Crossed Syndrome
55
Postural Signs of Upper Crossed Syndrome
  • Postural finding
  • Rounded shoulders
  • Forward-drawn head
  • C0-C1 hyperextension
  • Winging of scapulae
  • Elevation of shoulders
  • Dysfunction
  • Shortened pectorals
  • Kyphotic t-spine
  • Short suboccipitals
  • Weak serratus anterior
  • Shortened upper trap, shortened levator scapulae,
    weak lower and middle trap

56
Muscle Imbalances in Upper Crossed Syndrome
  • Tight-short muscles
  • Suboccipitals
  • Pectorals
  • Anterior shoulder
  • Upper trapezius
  • Weak-long muscles
  • Mid to lower trapezius
  • Serratus anterior

57
Lower Crossed Syndrome
  • Affects the lumbar spine and pelvis.
  • Anterior pelvis and increased lumbar lordosis.
  • Tightness in the psoas and lumbar erector spinae.
  • Long-term sitting contributes to this syndrome as
    well.

58
Lower Crossed Syndrome
59
Imbalances in the Following Pairs of Muscles
  • Weak gluteus maximus and short hip flexors.
  • Weak abdominals and short lumbar erector spinae.
  • Weak gluteus medius and short TFL and QL.

60
Postural Signs of Lower Crossed Syndrome
  • Postural finding
  • Lumbar hyperlordosis
  • Anterior pelvic tilt
  • Protruding abdomen
  • Foot turned out
  • Hypertrophy of thoracolumbar junction
  • Groove in iliotibial band
  • Dysfunction
  • Shortened erector spinae
  • Weak gluteus maximus
  • Weak abdominals
  • Shortened piriformis
  • Hypermobile lumbosacral junction
  • Shortened tensor fascia latae

61
Upper and Lower Crossed Syndrome
62
Layered Syndrome
  • Layered syndrome is a combination of the muscle
    imbalances seen in both upper and lower crossed
    syndrome.
  • It develops with chronic cases.

63
Layered Syndrome
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