Head Position and Forward Posture

Head Position

• A forward head posture affects the neck, chest, and arms, with the head positioned too far in advance of the body.
• Cervical extensor muscles, such as the levator scapulae, are lengthened and weak, rather than shortened and tight.
• This posture increases the strain on posterior cervical soft tissues, potentially leading to neck, shoulder, and upper back pain.

Cervical Spine

• An exaggerated lordotic curve in the cervical spine often accompanies a kyphotic posture.
• This increases compression on the posterior part of some cervical intervertebral discs and may compress the zygapophyseal joints.

Thoracic Spine

• A kyphotic posture is associated with an exaggerated kyphosis in the thoracic spine, reducing the thoracic cavity.
• This leads to shortened intercostals, pectoralis minor, adductors, and internal rotators of the shoulders.
• Muscles often weak in a kyphotic posture include the thoracic spine extensors and the middle and lower fibers of the trapezius.

Shoulder Position

• Protraction of the shoulders (slumped position) is associated with lengthened and weak rhomboids, tight pectorals, and shortened intercostals.
• Retracted shoulders are associated with shortness in the rhomboid muscles and in the middle fibers of the trapezius, and some parts of the pectoralis major may be lengthened.
• An internally rotated humerus suggests shortness in the muscles of medial rotation, while an externally rotated humerus suggests shortness in muscles such as the infraspinatus and teres minor.

Thorax

• A severely kyphotic posture is associated with shortened pectorals, tight intercostals, and perhaps even shallow breathing due to a depressed chest cavity.
• Thoracic spine extensors, the middle and lower fibers of the trapezius, and the rhomboids may be lengthened and weak.

Abdomen

• Protrusion of the abdomen could be a natural consequence of pregnancy or the result of increased lumbar lordosis, or it could simply be excess adipose tissue due to being overweight.
• Clients with restrictions in the muscles and fascia of the chest may appear to have a protruding abdomen, with a distinct change in shape from the chest area.

Lumbar Spine

• An increased lordotic curve indicates an anteriorly tilted pelvis, potentially leading to pain resulting from compression of soft tissues in this region.
• The correct functioning of the zygapophyseal joints in the lumbar spine may also be compromised if they are compressed.
• The rectus abdominis may be longer and therefore weaker than usual, as may the hip extensors, whereas the muscles responsible for lumbar extension may be shortened.

Pelvis

• An anteriorly tilted pelvis is associated with lengthened but weak hamstrings, plus a lengthened rectus abdominis.
• The psoas may be shortened, and there may be shortened rectus femoris, too.
• A posteriorly tilted pelvis is associated with tightness in the hip extensors and longer, and perhaps weakened, hip flexor muscles.

Knees

• Flexed knees are associated with tight hamstrings and popliteus muscles and weak quadriceps and soleus muscles.
• A flexed knee may accompany an increase in flexion at the hip and an increase in dorsiflexion at the ankle joint.
• Certain pathologies affecting the knee inhibit extension of the joint, while hypermobile clients may hyperextend their knees in standing.

Feet

• Foot arches can appear normal, dropped, or elevated.
• Foot position can be affected by external rotation at the hip joint, lateral tibial torsion, or both.

Anterior Postural Assessment

• Clavicles should have smooth contours and be gently angled upwards away from the sternoclavicular joint.
• Sharply angled clavicles indicate elevated shoulders.
• Uneven contours could indicate a fracture that has healed in mal-alignment or a more recent injury.

Chest

• The thorax may shift laterally or rotate relative to the neck and pelvis.
• Shifts of the chest occur for many reasons, including lateral curvatures in the spine and muscle imbalances.
• When the thorax rotates, compensatory changes occur in the neck and lumbar spine.

Carrying Angle

• The carrying angle is the angle formed between the long axis of the humerus and the long axis of the forearm.
• A normal carrying angle is 5 degrees in males and 10-15 degrees in females.
• An abnormal carrying angle can affect a person's ability to bear weight through the upper limb.

Lateral Pelvis

• The anterior superior iliac spines (ASIS) of the pelvis should be level.
• A lateral tilt in the pelvis corresponds with a lateral curve in the lumbar spine.

Rotated Pelvis

• A rotated pelvis can lead to increased pressure on the lateral or medial side of the foot.

Genu Valgum and Genu Varum

• In genu valgum, there is increased pressure on the lateral side of the knee joint, leading to degenerative changes on that side of the knee.
• In genu varum, there is increased pressure on the medial side of the knee joint.
• Structurally, genu valgum is associated with shorter muscles of the lateral thigh, while genu varum is associated with shorter muscles of the medial thigh.

Foot Position

• Feet turned out in a ballet-type stance could result from external rotation at the hip joint, lateral tibial torsion, or both.
• External hip rotation could indicate shortening of the gluteus maximus and the posterior fibers of the gluteus medius, along with the iliotibial band.
• A client who stands with their feet turned inwards (pigeon-toed) may have shortened internal rotators of the hip, a medially rotated tibia, or both.

Pes Planus and Pes Cavus

• In pes planus, the medial side of the foot might even be touching the floor completely, leaving no gap at all.
• In pes cavus, there will be a greater-than-normal space between the floor and the medial side of the foot.