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Posterior Postural Assessment Step 1: Ear Level

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360 Questions

What is the first thing to look at in the postural assessment described in the text?

Client's ear height

Why is it advised to avoid having clients hold their hair up during the assessment?

It changes the natural posture observation

What can uneven ear height indicate in the client's postural assessment?

A laterally flexed cervical spine

Which muscle could be tight causing lateral flexion if the client's head is tilted to the right?

Right levator scapulae

Why might some clients find it difficult to get glasses or sunglasses to fit properly?

Uneven ear level

Are the earlobes ______?

level

If you cannot see the client’s neck, simply leave this section of your assessment ______

blank

Uneven ear height could suggest that your client has her head tilted to one side, with a laterally flexed ______

cervical spine

Lateral flexion of the neck can result from shortened muscles on the side to which the neck is ______

flexed

Sometimes such clients are aware of this and report finding it difficult to get glasses or sunglasses to ______ properly

fit

Avoid having them do this because it alters the position of the head, neck and shoulders, which you need to observe in a neutral ______

position

Uneven ear height always indicates a laterally flexed cervical spine.

False

Clients with long hair should always tie their hair up during the postural assessment to ensure accurate observation of the ears.

False

Having clients hold their hair up during the assessment can help observe the natural position of the head, neck, and shoulders.

False

If a client offers to hold their hair up, it is recommended to let them do so to avoid any obstruction on their neck.

False

Uneven ear height can sometimes make it hard for clients to wear glasses or sunglasses correctly.

True

If the upper fibers of the trapezius are tight on the right side, it means the client's head is tilted to the left.

False

What is the purpose of Step 2 in the postural assessment described in the text?

To observe whether the head is tilted to one side

What might tightness in the left sternocleidomastoid muscle indicate during a postural assessment?

Left lateral flexion in the neck

In a postural assessment, what could marked lateral flexion suggest in a client?

Torticollis

Why do clients with shoulder pain often flex their necks to the side of the pain according to the text?

To minimize movement and reduce discomfort

What muscle group might be affected if a client's head is tilted to one side during a postural assessment?

Trapezius muscles

What is a common outcome of whiplash injury mentioned in the text?

"Wry neck" or torticollis

In a postural assessment, if the client's head is tilted to one side, it indicates tightness in the muscles that laterally flex the head and neck on the ______ side.

side

Clients with shoulder pain often flex their necks to the side of the pain to minimize movement and reduce ______.

discomfort

Torticollis, also known as 'wry neck', is a spasming of the neck muscles resulting in lateral flexion, rotation of the neck, or ______.

both

Lateral flexion of the neck can result from shortened muscles on the side to which the neck is ______.

tilted

If your client is suffering from torticollis, there will be marked ______ flexion.

lateral

If the upper fibers of the trapezius are tight on the left side, it means the client's head is tilted to the ______.

right

Torticollis is commonly a result of muscle spasms in the back muscles of the neck.

False

Clients with shoulder pain often laterally flex their necks to the side that hurts.

True

If a client has marked lateral flexion in their neck, they might be experiencing whiplash.

False

The upper fibers of the trapezius muscle on the side opposite to where the head tilts will be tight if there is lateral flexion.

False

Uneven ear height always indicates lateral flexion in a client's cervical spine.

False

Shoulder pain can cause clients to laterally flex their necks away from the side of pain.

False

What muscles contribute to rotation of the head as mentioned in the text?

Sternocleidomastoid and scalenes

How can you assess for rotation of the head as described in the text?

Look for differences in cheek visibility

What might a client with a tight right sternocleidomastoid muscle and tight left scalenes experience as per the text?

Neck stiffness

Why is it significant to identify rotation of the head during an assessment according to the text?

To evaluate muscular imbalance

What issue might a client with a rotated head face according to the text?

Potential neck pain

Which muscles could be affected if a client shows more of one side of their face than the other?

Sternocleidomastoid and levator scapulae

The man is rotated to the ______ (you can see more of the right side of his jaw)

right

The woman is rotated to the ______ (you can see more of the left side of her jaw)

left

The woman could have a tight right sternocleidomastoid muscle, tight left scalenes, plus a tight left levator scapulae muscle relative to these same muscles on the ______ side of the neck

opposite

Many muscles contribute to rotation of the head, including ______ and scalenes

sternocleidomastoid

The woman could have a tight right sternocleidomastoid muscle, tight left scalenes, plus a tight left levator scapulae muscle relative to these same muscles on the ______ side of the neck

opposite

Uneven ear height could suggest that your client has her head tilted to one side, with a laterally flexed ______

cervical spine

Uneven ear height always indicates rotation of the head in a client's cervical spine.

False

Torticollis is caused by muscle spasms in the front muscles of the neck.

False

Clients with shoulder pain often laterally flex their necks towards the side of pain.

False

If a client has marked lateral flexion in their neck, they might be experiencing whiplash.

True

The man mentioned in the text is rotated to the left based on the description provided.

False

If a client offers to hold their hair up during postural assessment, it should be allowed to avoid obstruction on their neck.

False

What is the main caution advised in placing marks for spinous processes during palpation, as per the text?

Place marks where you feel the spinous processes, not where you think they ought to be.

Why is it crucial for massage therapists to be aware of potential misaligned vertebrae, according to the text?

Misaligned vertebrae could be contributing to the client's problem.

Why should massage therapists exercise caution in revealing potential cervical spine misalignments to clients?

Clients might become worried unnecessarily.

How can observing the marks placed on a client help massage therapists during postural assessments?

Identify any vertebrae that are out of alignment.

Why is it important for massage therapists to recognize deviations in postural assessments?

Deviations may inform the treatment plan.

What could be the implication of a noticeably crooked cervical spine observed during a postural assessment?

A crooked cervical spine may indicate misalignments contributing to a client's problem.

What is a recommended way to assess the alignment of the cervical spine with a client standing?

Palpate the spinous processes and mark them

Why is palpation of the cervical spine considered tricky according to the text?

The ligamentum nuchae lies deep to all vertebrae

Which action can help stabilize the head and neck during palpation of the cervical spine?

Placing a hand gently on the client's forehead

What should be done after marking the spinous processes of the cervical spine during assessment?

Stand back and observe the marks

Why is it useful to include some elements of palpation in a postural assessment according to the text?

To assess muscle tone in neck muscles

What is a key reason for having clients stand while assessing cervical spine alignment?

To observe how extensor muscles are active

In a postural assessment, when the client's head is tilted to one side, it indicates tightness in the muscles that laterally flex the head and neck on the ______ side.

opposite

Avoid having clients hold their hair up during the assessment to observe in a neutral ______.

position

Uneven ear height always indicates a laterally flexed ______ spine.

cervical

Clients with shoulder pain often laterally flex their necks towards the ______ of pain.

side

The woman is rotated to the ______ (you can see more of the left side of her jaw).

right

The man mentioned in the text is rotated to the ______ based on the description provided.

left

Sometimes with palpation, a vertebra feels slightly too far to the left or too far to the right of the midline, and it is tempting to mark where you think it ought to be, in the midline of the neck. However, what you have discovered could well be a misaligned vertebra and should be recorded. What Your Findings Mean Few of us have perfectly straight spines. Standing back to observe the marks you have placed on your ______, you may see that all but one of the vertebrae appear to be in alignment. Knowing that a vertebra may be out of alignment is useful for massage therapists in particular, because this factor could be contributing to the ______’s problem and is a good example of when referral to an experienced physical therapist, osteopath or chiropractor may be appropriate. TIP If the cervical spine does not appear to be straight, be careful how you reveal this information (if at all) to the ______. Many ______s could become worried if told they have mal-aligned cervical vertebrae. Remember, many of us go about our daily lives with less than straight spines and have no pain and no problems in this structure whatsoever. The purpose of putting marks on the neck area is simply to help you identify deviations when learning the technique of postural assessment. Such deviations may provide additional information that could inform your treatment.

client

TIP If you are using body pens, place your marks where you feel the spinous processes to be when you palpate, not where you think they ought to be. The purpose of putting marks on the ______ area is simply to help you identify deviations when learning the technique of postural assessment. Such deviations may provide additional information that could inform your treatment.

neck

Avoid having them do this because it alters the position of the head, neck and shoulders, which you need to observe in a neutral ______

position

What muscles contribute to rotation of the head as mentioned in the text?

sternocleidomastoid, scalenes, levator scapulae

What is the first thing to look at in the postural assessment described in the text?

marks

What is the purpose of Step 2 in the postural assessment described in the text?

palpation

Is Step 4 of the postural assessment focused on the position of the head and neck?

False

During postural assessment, palpation of the cervical spine involves touching through thick tissue and inactive muscles.

False

It is recommended to place one hand on the client's forehead during palpation of the cervical spine to stabilize the head and neck.

True

Lateral flexion of the neck can result from shortened muscles on the opposite side to which the neck bends.

False

The spinous processes of some cervical vertebrae are bifurcated and easy to palpate individually in a neutral neck position.

False

Observing marks placed on the client after palpating the cervical spine can provide additional information for treatment.

True

It is recommended to mark the spinous processes during palpation where you feel them to be, not where you think they ought to be.

True

Perfectly straight spines are common among people.

False

Uneven ear height in a postural assessment always indicates lateral flexion in the client's cervical spine.

False

Clients with shoulder pain may laterally flex their necks towards the side of pain, according to the text.

True

Torticollis is caused by muscle spasms in the front muscles of the neck, as mentioned in the text.

False

After marking the spinous processes of the cervical spine during assessment, the next step is to observe if all vertebrae appear to be in alignment.

True

Why might one shoulder appear higher than the other in a postural assessment?

Tightening in levator scapulae and upper fibers of the trapezius on one side

How can you differentiate between a truly higher shoulder and a lower one during a postural assessment?

By checking which side is easier to shrug the shoulders

In a postural assessment, what could a dropped shoulder indicate?

Low tone on one side of the body

Why might a right-handed person's right shoulder appear slightly lower and more protracted than the left?

Natural depression and slight protraction of the dominant shoulder

What might a person with neck pain tend to do with their shoulders as a protective mechanism?

Elevate them to reduce discomfort

How can muscle asymmetry between shoulders manifest in a postural assessment?

By laterally flexing the neck towards the lower shoulder

The levator scapulae and upper fibers of the trapezius may contribute to one shoulder appearing higher than the other due to shortening. If a scapula is elevated, you would expect the inferior angle of that scapula to be superior to the inferior angle of the scapula on the opposite side. How do you know whether one shoulder is truly higher or the other is lower? Try this simple exercise: ______ your shoulders, elevating your scapulae; then relax. Now depress your shoulders; then find that ______ging the shoulders is easier than depressing them. It seems reasonable to assume that if your client’s right shoulder appears higher, muscles on the right are shorter and tighter than the corresponding muscles on the left. An exception to this might be if you were assessing someone with a neurological condition (e.g., having suffered a stroke) and she had a dropped shoulder as a result of low tone on one side of her body. Therapists have observed that, for many people, the dominant shoulder is naturally depressed and slightly protracted. If you are right-handed, your right shoulder may be slightly lower and more protracted than your left. Clients with neck pain may subconsciously elevate their shoulder protectively in an attempt to reduce their discomfort. This woman is standing ‘relaxed’.

shrug

If your client's right shoulder appears slightly lower and more protracted than the ______, it might indicate that muscles on the right are shorter and tighter than the corresponding muscles on the ______. An exception to this might be if you were assessing someone with a neurological condition (e.g., having suffered a stroke) and she had a dropped shoulder as a result of low tone on one side of her body. Therapists have observed that, for many people, the dominant shoulder is naturally depressed and slightly protracted. Clients with neck pain may subconsciously elevate their shoulder protectively in an attempt to reduce their discomfort. This woman is standing ‘relaxed’.

left

If a client's ______ shoulder appears higher, it could be due to shorter and tighter muscles on the ______ compared to the left. An exception to this might be if you were assessing someone with a neurological condition (e.g., having suffered a stroke) and she had a dropped shoulder as a result of low tone on one side of her body. Therapists have observed that, for many people, the dominant shoulder is naturally depressed and slightly protracted. If you are ______-handed, your ______ shoulder may be slightly lower and more protracted than your left. Clients with neck pain may subconsciously elevate their shoulder protectively in an attempt to reduce their discomfort. This woman is standing ‘relaxed’.

right

If a client's right shoulder appears higher, it could be due to shorter and tighter muscles on the right compared to the ______. An exception to this might be if you were assessing someone with a neurological condition (e.g., having suffered a stroke) and she had a dropped shoulder as a result of low tone on one side of her body. Therapists have observed that, for many people, the dominant shoulder is naturally depressed and slightly protracted. If you are right-handed, your right shoulder may be slightly lower and more protracted than your ______. Clients with neck pain may subconsciously elevate their shoulder protectively in an attempt to reduce their discomfort. This woman is standing ‘relaxed’.

left

During a postural assessment, if one shoulder appears higher than the other, it may be due to shortening in the levator scapulae and upper fibers of the trapezius. Shrugging your shoulders and then relaxing can help differentiate whether one shoulder is truly higher or the other is lower. It is reasonable to assume that if a client’s right shoulder appears higher, muscles on the right are shorter and tighter than the corresponding muscles on the left. Therapists have observed that, for many people, the dominant shoulder is naturally depressed and slightly protracted. Clients with neck pain may subconsciously elevate their shoulder protectively in an attempt to reduce their discomfort. This woman is standing ‘relaxed’.

opposite

During a postural assessment, if one shoulder appears higher than the other, it may be due to shortening in the levator scapulae and upper fibers of the trapezius. Shrugging your shoulders and then relaxing can help differentiate whether one shoulder is truly higher or the other is lower. It is reasonable to assume that if a client’s ______ shoulder appears higher, muscles on the ______ are shorter and tighter than the corresponding muscles on the left. Therapists have observed that, for many people, the dominant shoulder is naturally depressed and slightly protracted. Clients with neck pain may subconsciously elevate their shoulder protectively in an attempt to reduce their discomfort. This woman is standing ‘relaxed’.

right

Muscles in the levator scapulae and upper fibers of the trapezius can contribute to one shoulder appearing higher than the other.

True

If a scapula is elevated, you would expect the inferior angle of that scapula to be inferior to the inferior angle of the scapula on the opposite side.

False

It is reasonable to assume that if a client's right shoulder appears higher, it means the corresponding muscles on the right are longer and looser than those on the left.

False

Clients with neck pain may subconsciously elevate their shoulder protectively to increase discomfort.

False

If a person is right-handed, their right shoulder may be slightly lower and more protracted than their left shoulder.

True

Shrugging the shoulders and then relaxing can help determine which shoulder is truly higher or lower in a postural assessment.

True

What can an increase in muscle bulk on the dominant side indicate in sportspeople?

Atrophy in muscles on the dominant side

Why might a client with adhesive capsulitis or upper limb immobilization show atrophy of the shoulder muscles on the affected side?

Due to disuse of the shoulder

What is a potential indicator of a client not using one shoulder, especially following an injury?

Atrophied supraspinatus and infraspinatus muscles

What is a common outcome of disuse of the shoulder, particularly noticeable in older clients?

Decreased muscle tone in all associated muscles

Why do right-handed archers often have hypertrophied rhomboids on the right side?

To retract the scapula maximally

What can observing noticeably atrophied supraspinatus and infraspinatus muscles indicate in a postural assessment?

Potential adhesive capsulitis

Observation of people with adhesive capsulitis or who have had their upper limb immobilised may reveal atrophy of the shoulder muscles on the affected ______.

side

Disuse of the shoulder results in atrophy in all of the associated ______.

muscles

Clients with neck pain may subconsciously elevate their shoulder protectively in an attempt to reduce their ______.

discomfort

Clients with shoulder pain may laterally flex their necks towards the side of ______, according to the text.

pain

If a client's right shoulder appears higher, it could be due to shorter and tighter muscles on the right compared to the ______.

left

Many clients could become worried if told they have mal-aligned cervical vertebrae. Remember, many of us go about our daily lives with less than straight spines and have no pain and no problems in this structure whatsoever. The purpose of putting marks on the neck area is simply to help you identify deviations when learning the technique of postural ______.

assessment

A right-handed archer often has hypertrophied rhomboids on the left side.

False

Disuse of the shoulder results in hypertrophy in all associated muscles.

False

Observation of people with adhesive capsulitis may reveal atrophy of the shoulder muscles on the affected side.

True

Lateral flexion of the neck can result from shortened muscles on the same side to which the neck bends.

False

Uneven ear height always indicates rotation of the head in a client's cervical spine.

False

If a person's right shoulder appears higher, it could be due to shorter and tighter muscles on the right compared to the left.

True

What is a common reason many clients have slightly protracted scapulae?

Adoption of a kyphotic posture

Which muscle group is often lengthened and weak bilaterally in individuals with protracted scapulae?

Rhomboids

What posture is associated with retraction of the scapulae?

Military-style posture

How can one locate the medial border of the scapula when observing scapular adduction/abduction?

Palpate for it while the client places their hand behind their back

What muscles are often shortened on both sides of the body in individuals with retracted scapulae?

Trapezius

Why might rhomboids be lengthened and weak in individuals with protracted scapulae?

Accompanying poor posture

Clients with poor posture often have slightly ______ scapulae

protracted

Retraction of the scapulae is less common and occurs with a military-style posture: chests pushed up and out, shoulders drawn back and ______

down

Protraction of the scapulae often accompanies poor posture where the rhomboids and lower fibers of the trapezius are lengthened and weak ______

bilaterally

Many people adopt a kyphotic posture when sitting, leading to protracted scapulae and potential weakness in the rhomboids and lower fibers of the ______

trapezius

Observing the relationship between the medial borders of the scapulae and the spine helps determine if the scapulae are adducted (retracted) or ______

abducted

Gently palpating for the medial border of the scapula is recommended if you cannot see it, and asking the client to place their hand behind their back can help locate this ______

border

Clients with poor posture often have slightly adducted scapulae.

False

Protraction of the scapulae often accompanies strong rhomboids and trapezius muscles.

False

Retraction of the scapulae is common in individuals with a military-style posture.

False

Palpating for the medial border of the scapula is recommended if it cannot be observed visually.

True

Clients with torticollis may experience lateral flexion and rotation of the neck.

True

Observing uneven ear height is a reliable indicator of lateral flexion in a client's cervical spine.

False

Clients with poor posture often have slightly ______ scapulae

protracted

Protraction of the scapulae is associated with lengthened and weak ______

rhomboids

Retraction of the scapulae occurs when people adopt a military-style ______

posture

Clients with neck pain may subconsciously elevate their shoulder protectively to reduce ______

discomfort

Many of us have less than straight spines and have no pain or problems in this structure ______

whatsoever

The purpose of putting marks on the neck area is to help identify deviations in the technique of postural assessment, which may inform your ______

treatment

What is the impact on the rhomboid major and minor muscles during downward rotation of the scapula?

Rhomboid major lengthens, rhomboid minor and levator scapulae shorten

Why is it cautioned not to jump to conclusions about the source of shoulder pain solely based on anatomical positions?

The source of shoulder pain can often be neurological in origin

In a postural assessment, what is the role of the serratus anterior muscle according to the text?

Contributes to upward rotation of the scapula

How does Cloward's research in 1959 contribute to understanding sources of scapular and upper limb pain?

Cloward's research linked cervical discs to scapular and upper limb pain

Why does the text mention that clients with neck pain may elevate their shoulders protectively?

To reduce discomfort

What is the significance of observing uneven ear height in a client's postural assessment according to the text?

Indicates lateral flexion in the neck

During postural assessment, if one shoulder appears higher than the other, it may be due to shortening in the __________ and upper fibers of the trapezius.

levator scapulae

Observation of people with adhesive capsulitis may reveal atrophy of the shoulder muscles on the affected __________.

side

Torticollis, also known as 'wry neck', is a spasming of the neck muscles resulting in lateral flexion, rotation of the neck, or __________.

tilting

Many people adopt a kyphotic posture when sitting, leading to protracted scapulae and potential weakness in the rhomboids and lower fibers of the __________.

trapezius

Protraction of the scapulae often accompanies strong rhomboids and trapezius muscles.

serratus anterior

During a postural assessment, what is the role of the _________ muscle according to the text?

serratus anterior

During downward rotation of the scapula, the medial border and inferior angle are adducted towards the spine, shortening the rhomboid ______ and lengthening the rhomboid minor and levator scapulae.

major

The serratus anterior attaches to the medial border of the scapulae on the anterior surface of the bone, making it an important muscle in scapular ______.

position

Clients with protracted scapulae and internally rotated humerus may not necessarily experience scapular pain due to the anatomical positions of these bony structures; there could be other possible sources of ______.

pain

Cloward reported in 1959 on the likelihood of scapular and upper limb pain originating from cervical ______.

discs

Retraction of the scapulae occurs when people adopt a military-style ______.

posture

Many people adopt a kyphotic posture when sitting, leading to protracted scapulae and potential weakness in the rhomboids and lower fibers of the ______.

trapezius

During downward rotation of the scapula, the medial border and inferior angle are adducted towards the spine.

True

The rhomboid major is lengthened during upward rotation of the scapula.

False

The serratus anterior muscle is not included in the table summarizing changes in muscle length depending on scapular position.

False

The rhomboid minor is lengthened during downward rotation of the scapula.

False

Scapular pain resulting from anatomical positions of bony structures always originates from the positions themselves.

False

The levator scapulae muscle is shortened during downward rotation of the scapula.

True

During downward rotation of the scapula, the medial border and inferior angle are ______ towards the spine

adducted

The serratus anterior muscle attaches to the medial border of the scapulae on the ______ surface of the bone

anterior

Cloward reported on the likelihood of scapular and upper limb pain originating from ______ discs

cervical

When assessing the shoulder region, it is important not to jump to conclusions regarding the source of shoulder pain just based on the anatomical positions of bony structures like protracted scapulae and internally rotated ______

humerus

In individuals with protracted scapulae, there may be potential weakness in the rhomboids and lower fibers of the ______

trapezius

Clients with neck pain may subconsciously elevate their shoulder protectively to reduce ______

discomfort

The inferior angle is elevated when the whole scapula is elevated. Muscles of scapular elevation may be shorter on the side of the elevation. So if you observe that the inferior angle on the client’s left scapula is higher compared to the inferior angle of the client’s right scapula, this could mean that the upper fibers of the trapezius on the left, plus the left levator scapulae are ______.

shortened

Clients with neck pain may subconsciously elevate their shoulder protectively in an attempt to reduce their ______.

discomfort

Shrugging your shoulders and then relaxing can help differentiate whether one shoulder is truly higher or the other is ______.

lower

During a postural assessment, if one shoulder appears higher than the other, it may be due to shortening in the levator scapulae and upper fibers of the trapezius. Shrugging your shoulders and then relaxing can help determine which shoulder is truly higher or ______.

lower

Many people adopt a kyphotic posture when sitting, leading to protracted scapulae and potential weakness in the rhomboids and lower fibers of the ______.

trapezius

Clients with shoulder pain may laterally flex their necks towards the side of ______, according to the text.

pain

What could an elevated inferior angle of the scapula indicate?

Tight levator scapulae muscles

Why might the right clavicle raise when the right scapula is elevated?

Due to acromioclavicular joint attachment

What does an elevated inferior angle of the left scapula compared to the right suggest?

Tight rhomboid major on the left

What may cause one shoulder to appear higher than the other during a postural assessment?

Longer levator scapulae and trapezius on one side

How can you differentiate if one shoulder is truly higher than the other during a postural assessment?

Ask client to shrug shoulders and then relax

What might be observed in a client with an inferior angle that cannot be palpated easily?

Elevated clavicle

During the assessment, if the inferior angle of the left scapula is higher than the inferior angle of the right scapula, it indicates an elevated left scapula.

True

If the upper fibers of the trapezius on the right side are shortened, the right scapula will be depressed.

False

Elevated scapulae can result in shorter muscles responsible for scapular depression.

False

If one shoulder is elevated, you would expect the clavicle on that same side to be raised as well.

True

Clients with neck pain may subconsciously elevate their shoulder protectively to reduce discomfort.

True

An elevated right scapula can lead to a raised right clavicle due to their anatomical attachment at the acromioclavicular joint.

True

The inferior angle is elevated when the whole ______ is elevated. Muscles of ______r elevation may be shorter on the side of the elevation. So if you observe that the inferior angle on the client’s left ______ is higher compared to the inferior angle of the client’s right ______, this could mean that the upper fibers of the trapezius on the left, plus the left levator ______e are shortened. Before moving on to the next step, consider for a moment what you might observe on the anterior of the body in a client with an elevated ______. When the right shoulder is elevated, you might expect to see the right clavicle raised too, because the two bones are attached at the acromioclavicular joint, as you know.

scapula

Many people adopt a kyphotic posture when sitting, leading to protracted scapulae and potential weakness in the rhomboids and lower fibers of the ______

trapezius

During downward rotation of the scapula, the medial border and inferior angle are adducted towards the spine, shortening the rhomboid ______ and lengthening the rhomboid minor and levator scapulae.

major

During a postural assessment, what is the role of the ______ muscle according to the text?

levator scapulae

The levator scapulae and upper fibers of the trapezius may contribute to one shoulder appearing higher than the other due to shortening. If a scapula is elevated, you would expect the inferior angle of that scapula to be superior to the inferior angle of the scapula on the opposite side. How do you know whether one shoulder is truly higher or the other is lower? Try this simple exercise: ______ your shoulders, elevating your scapulae; then relax. Now depress your shoulders; then find that ______ging the shoulders is easier than depressing them. It seems reasonable to assume that if your client’s right shoulder appears higher, muscles on the right are shorter and tighter than the corresponding muscles on the left. An exception to this might be if you were assessing someone with a neurological condition (e.g., having suffered a stroke) and she had a dropped shoulder as a result of low tone on one side of her body. Therapists have observed that, for many people, the dominant shoulder is naturally depressed and slightly protracted. If you are right-handed, your right shoulder may be slightly lower and more protracted than your left. Clients with neck pain may subconsciously elevate their shoulder protectively in an attempt to reduce their discomfort. This woman is standing ‘relaxed'.

shrug

During a postural assessment, if one shoulder appears higher than the other, it may be due to shortening in the levator scapulae and upper fibers of the trapezius. Shrugging your shoulders and then relaxing can help differentiate whether one shoulder is truly higher or the other is lower. It is reasonable to assume that if a client’s ______ shoulder appears higher, muscles on the ______ are shorter and tighter than the corresponding muscles on the left. Therapists have observed that, for many people, the dominant shoulder is naturally depressed and slightly protracted. Clients with neck pain may subconsciously elevate their shoulder protectively in an attempt to reduce their discomfort. This woman is standing ‘relaxed'.

right, right

What does upward rotation of the scapula suggest?

Tension in the levator scapulae

Which muscle weakness is associated with downward rotation of the scapula?

Rhomboid major

What might differences in the position of the inferior angle of the scapula indicate?

Rotation of the scapula

What happens to a downwardly rotated scapula at the superior and inferior angles?

Abducted superior, adducted inferior

In clients with poor posture, what is a common observation related to scapula position?

Protracted scapulae

What is a potential implication of tension in the levator scapulae based on scapular rotation?

Downward rotation of scapula

Upward rotation of the scapula suggests tension in the levator scapulae, rhomboid minor, and upper fibers of the trapezius, and weakness in the __________ major and the lower fibers of the trapezius.

rhomboid

During upward rotation, an upwardly rotated scapula will be adducted at the superior angle and abducted at the inferior angle; a downwardly rotated scapula will be abducted at the superior angle and adducted at the inferior angle. In both cases, the scapulae could be elevated or __________.

depressed

Scapular rotation occurs as a result of tension in some tissues and weakness or slackening in others. Upward rotation suggests tension in the levator scapulae, rhomboid minor, and the upper fibers of the trapezius, and weakness in the rhomboid major and the lower fibers of the __________.

trapezius

An upwardly rotated scapula will be adducted at the superior angle and abducted at the inferior angle; a downwardly rotated scapula will be abducted at the superior angle and adducted at the inferior angle. In both cases, the scapulae could be __________ or depressed.

elevated

Scapular rotation occurs as a result of tension in some tissues and weakness or slackening in others. Upward rotation suggests tension in the levator scapulae, rhomboid minor, and the upper fibers of the trapezius, and weakness in the rhomboid major and the lower fibers of the __________.

trapezius

During upward rotation, an upwardly rotated scapula will be adducted at the superior angle and abducted at the inferior angle; a downwardly rotated scapula will be abducted at the superior angle and adducted at the inferior angle. In both cases, the scapulae could be __________ or depressed.

elevated

Tension in the levator scapulae and upper fibers of the trapezius can result in downward rotation of the scapula.

False

Differences in the position of the inferior angle can only be due to elevation or depression of the scapula, not rotation.

False

An upwardly rotated scapula will be adducted at the superior angle and abducted at the inferior angle.

True

Scapular rotation occurs solely due to weakness in the rhomboid major muscle.

False

The levator scapulae is a muscle that contributes to upward rotation of the scapula.

True

Retraction of the scapulae is common in individuals with a slouched posture.

False

Scapular rotation occurs as a result of tension in some tissues and weakness in others. Upward rotation suggests tension in the levator scapulae, rhomboid minor and the upper fibers of the trapezius, and weakness in the ______ major and the lower fibers of the trapezius.

rhomboid

During a postural assessment, if one shoulder appears higher than the other, it may be due to shortening in the levator scapulae and upper fibers of the trapezius. Shrugging your shoulders and then relaxing can help determine which shoulder is truly higher or ______.

lower

In a postural assessment, when the client's head is tilted to one side, it indicates tightness in the muscles that laterally flex the head and neck on the ______ side.

opposite

The inferior angle is elevated when the whole ______ is elevated. Muscles of ______r elevation may be shorter on the side of the elevation. So if you observe that the inferior angle on the client’s left ______ is higher compared to the inferior angle of the client’s right ______, this could mean that the upper fibers of the trapezius on the left, plus the left levator ______e are shortened.

scapula

In individuals with protracted scapulae, there may be potential weakness in the rhomboids and lower fibers of the ______

trapezius

Upward rotation of the scapula suggests tension in the levator scapulae, rhomboid minor, and upper fibers of the trapezius, and weakness in the ______ major and the lower fibers of the trapezius.

rhomboid

What term is more accurately used to describe a scapula sticking out like a wing due to the serratus anterior muscle's inability to keep it fixed against the rib cage?

Winging

What postural issue can occur if muscles attaching to the anterior of the scapula shorten, causing the scapula to tilt forwards with the inferior angle becoming prominent?

Winging

What can be a cause of true winging of the scapula, as mentioned in the text?

Damage to the long thoracic nerve or muscle itself

In a postural assessment, what might an elevated inferior angle of the left scapula compared to the right suggest?

Elevation of the left scapula

What is a potential indicator that a client may not be using one shoulder, especially following an injury?

Lateral flexion of the neck towards the unaffected side

What is a common outcome of disuse of the shoulder, particularly noticeable in older clients, as mentioned in the text?

Muscle asymmetry between shoulders

The term often used to describe what happens to the scapula when the serratus anterior muscle is unable to keep it fixed against the rib cage is ______.

winging

True winging of the scapula can occur due to damage to the ______ nerve or the muscle itself.

long thoracic

During a postural assessment, if one shoulder appears higher than the other, it may be due to shortening in the levator scapulae and upper fibers of the ______ muscle.

trapezius

Many people adopt a kyphotic posture when sitting, leading to protracted scapulae and potential weakness in the rhomboids and lower fibers of the ______ muscle.

trapezius

Observation of people with adhesive capsulitis or who have had their upper limb immobilized may reveal atrophy of the shoulder muscles on the affected ______.

side

Uneven ear height could suggest that your client has her head tilted to one side, with a laterally flexed ______.

neck

The term 'winging' is accurately used to describe the tilting of the scapula when the trapezius muscle is unable to keep it fixed against the rib cage.

False

True winging can occur due to damage to the long thoracic nerve.

True

The inferior angle of a scapula becomes more prominent when muscles attaching to the posterior of the scapula shorten.

False

A client's posterior postural assessment can provide insights into the state of soft tissues on the anterior of the body.

False

Upward rotation of the scapula suggests tension in the levator scapulae, rhomboid minor, and lower fibers of the trapezius.

False

Clients with neck pain may elevate their shoulders protectively in an attempt to reduce their neck pain.

True

The figure on the right shows evidence of ______.

scoliosis

A trick you can do if you do not wish to use body pens is to gently run a fingernail down either side of the ______.

spine

You will gain more information about the spine when you carry out your lateral postural assessment, in which you assess for ______ and kyphosis.

lordosis

It is important to remember that there are many causes of ______.

scoliosis

It may be congenital, the result of injury or altered biomechanics or the result of a leg length discrepancy, in which case the pelvis tilts laterally and the spine is forced to ______.

compensate

Neverthless, it is useful when making your first impressions of this region to note whether the client is kyphotic or has a flat ______.

back

What is a potential cause of scoliosis mentioned in the text?

Leg length discrepancy

How can a massage therapist assess for scoliosis without using body pens according to the text?

Run a fingernail down either side of the spine

What should a massage therapist observe in a client's spine to check for deviations according to the text?

Slight red marks from gentle nail running

Why is it cautioned against assuming treatments for scoliosis aimed at lengthening tissues on one side will resolve the problem?

Different causes require unique treatments

What is the importance of noting if a client is kyphotic during the initial assessment?

Understanding potential spine deviations

What additional information can a massage therapist gain during a lateral postural assessment?

Evaluation of lordosis and kyphosis

It is important to remember that there are many causes of ______.

scoliosis

A trick you can do if you do not wish to use body pens is to gently run a fingernail down either side of the spine to leave a slight red mark, then observe if they are straight or deviate to assess for ______.

scoliosis

Many people adopt a ______ posture when sitting, leading to protracted scapulae and potential weakness in the rhomboids and lower fibers of the ______ muscle.

kyphotic

During downward rotation of the scapula, the medial border and inferior angle are adducted towards the spine, shortening the rhomboid ______ and lengthening the rhomboid minor and levator scapulae.

major

Uneven ear height always indicates a laterally flexed ______ spine.

cervical

It may be congenital, the result of injury or altered biomechanics or the result of a leg length discrepancy, in which case the pelvis tilts laterally and the spine is forced to ______.

compensate

Lateral deviation of the spine, known as scoliosis, can be caused by a leg length discrepancy.

True

In a lateral postural assessment, kyphosis and lordosis are primarily evaluated in the thoracic spine.

True

A client who is kyphotic will have an exaggerated inward curvature in the lumbar spine.

False

Scoliosis is only congenital and never caused by injury or altered biomechanics.

False

An individual with protracted scapulae may experience weakness in the lower fibers of the trapezius muscle.

True

True winging of the scapula can result from damage to the long thoracic nerve.

True

The thoracic cage could be imagined as a cylinder positioned between the head (also a cylinder) and the pelvis (a rectangular block). Not only can these structures rotate, but they can also shift to one side, sliding across one another like a child’s wooden play blocks. In this photo, the medial border of the right scapula appears not only more prominent than the left scapula but also closer to the observer. This suggests that the trunk is rotated _______.

clockwise

Many muscles affect the rotation of the thorax, not just the muscles attaching to this part of the body. Table 3.2 summarises how muscle length may correspond to the positions of the trunk when it is rotated. If you are wondering why muscles of the neck are included in this table, look in a mirror and rotate your trunk one way; notice what the muscles of your neck must do in order to keep your head facing forward. Table 3.2 Muscle Length Corresponding to rotation of the trunk *The psoas is not a definitive rotator, yet recent research suggests it may be more involved in stability of the spine, including rotation, than originally thought.

Many people adopt a ______ posture when sitting, leading to protracted scapulae and potential weakness in the rhomboids and lower fibers of the ______ muscle.

kyphotic, trapezius

During postural assessment, if one shoulder appears higher than the other, it may be due to shortening in the ______ and upper fibers of the trapezius.

levator scapulae

An upwardly rotated scapula will be adducted at the superior angle and abducted at the inferior angle; a downwardly rotated scapula will be abducted at the superior angle and adducted at the inferior angle. In both cases, the scapulae could be _______ or depressed.

elevated

Retraction of the scapulae occurs when people adopt a military-style ______.

posture

The thoracic cage is positioned between the head and the pelvis, and can only rotate but not shift to one side.

False

The medial border of the right scapula appearing more prominent than the left suggests a counterclockwise trunk rotation.

False

Muscles of the neck play no role in the rotation of the trunk as per the information provided in Table 3.2.

False

The psoas muscle is considered a definitive rotator according to recent research findings.

False

During upward rotation of the scapula, the levator scapulae, rhomboid minor, and upper fibers of the trapezius are under tension.

True

A right-handed archer typically has hypertrophied rhomboids on the right side.

False

What can be a helpful way to visualize the relationship among the head, thorax, and pelvis?

As cylinders moving in three dimensions

Why is the medial border of the right scapula appearing more prominent in the text?

Because of right trunk rotation

How is the psoas muscle mainly described in relation to the rotation of the spine in the text?

Involved in spine stability and rotation

What muscles may affect the rotation of the thorax according to Table 3.2 in the text?

Abdominal muscles

In what way do structures like cylinders and rectangular blocks interact in the context of body movement in the text?

By sliding across one another

Why is it important for massage therapists to identify misaligned vertebrae during postural assessment?

To understand potential contributors to a client's issue

What recent research suggests about the role of the psoas muscle?

It plays a more substantial role in spine stability, including rotation.

During a postural assessment, what might an elevated inferior angle of the left scapula suggest?

Lengthened rhomboids on the left side

What happens during downward rotation of the scapula?

Lengthening of the rhomboid major and minor muscles

What can an exaggerated inward curvature in the lumbar spine indicate?

Tightness in the psoas muscle

What would observing noticeably atrophied supraspinatus and infraspinatus muscles indicate during a postural assessment?

Potential issues with shoulder stability

The psoas is more involved in stability of the spine, including rotation, than originally thought. Trunk rotated to the right would shorten the left psoas and left lumbar erector spinae. Muscles that rotate the neck to the left include the left internal oblique and right external oblique.

trunk

The right psoas and right lumbar erector spinae are muscles that rotate the neck to the right. Trunk rotated to the left would shorten the _____ muscles.

left internal oblique

Observing marks placed on the client after palpating the cervical spine can provide additional information for treatment. A trick you can do if you do not wish to use body pens is to gently run a fingernail down either side of the spine to leave a slight red mark, then observe if they are straight or deviate to assess for ____.

deviations

During downward rotation of the scapula, the medial border and inferior angle are ____ towards the spine.

adducted

An upwardly rotated scapula will be adducted at the superior angle and abducted at the inferior angle. Weakness in the rhomboids and lower fibers of the ____ may be present in individuals with protracted scapulae.

trapezius

What does observing more or deeper skin creases on one side of the trunk compared to the other indicate?

Shortened quadratus lumborum on that side

What is the purpose of asking a client to lean (laterally flex) to one side during the observation of skin creases?

To deepen the creases on the flexed side

In the context of lateral flexion, what does lengthening tissues on one side and compressing on the other result in?

Deepening creases on the compressed side

What could a lack of skin creases indicate in a client?

Low body fat

How does lateral flexion affect the skin creases on the trunk?

It deepens creases on the flexed side

Why is it important to observe skin creases when assessing lateral flexion?

To explain deeper structural changes

When we laterally flex, we lengthen tissues of the opposite side while compressing the side to which we are flexing. The result is to deepen the creases on the side to which we are flexed. A key lateral flexor of the spine is the quadratus lumborum. More or deeper creases on the right side of the trunk may indicate a shortened quadratus lumborum on that side. This step is about determining whether there is a difference between the left and right sides of the body and enables you to use your observations of the skin to explain what may be happening to deeper structures. ________________

Step 13 Skin Creases

Retraction of the scapulae occurs when people adopt a military-style ______.

posture

The term often used to describe what happens to the scapula when the serratus anterior muscle is unable to keep it fixed against the rib cage is ______.

winging

The result of a leg length discrepancy, in which case the pelvis tilts laterally and the spine is forced to ______.

tilt

Protraction of the scapulae often accompanies poor posture where the rhomboids and lower fibers of the trapezius are lengthened and weak ______.

weak

Many people adopt a ______ posture when sitting, leading to protracted scapulae and potential weakness in the rhomboids and lower fibers of the ______ muscle.

slouched

In a postural assessment, if a client's right shoulder appears higher, what might be a possible reason?

Shorter and tighter muscles on the right side compared to the left

What could be a reason for a client having a shorter quadratus lumborum on one side?

Being hip hitched and pelvis laterally tilted upwards on that side

What could cause a client's arm to be abducted more, leading to greater space between the arm and trunk?

Shorter deltoid and supra-spinatus muscles

What could be a reason for the space between the left arm and trunk being larger than that between the right arm and trunk?

Lateral flexion to the right side

Why might a client experience a larger space between their left arm and trunk than their right arm?

Lateral flexion to the left side

What could result in greater space between a client's arm and trunk on one side?

Shortening of quadratus lumborum on the opposite side

The client may have a shorter quadratus lumborum on the side to which he is ______

flexed

The space between your right arm and that side of your trunk increases when you laterally ______ to the right

flex

If a person's right shoulder appears higher, it could be due to shorter and tighter muscles on the right compared to the ______

left

Clients with neck pain may subconsciously elevate their shoulder protectively in an attempt to reduce their ______

discomfort

Many people adopt a kyphotic posture when sitting, leading to protracted scapulae and potential weakness in the rhomboids and lower fibers of the ______

trapezius

If you are ______-handed, your ______ shoulder may be slightly lower and more protracted than your left

right

In a relaxed posture, the space between the right arm and the trunk is usually larger compared to the space between the left arm and the trunk.

False

If a client is laterally flexed to one side, they may have a shorter quadratus lumborum on the opposite side.

True

Tension in the levator scapulae and upper fibers of the trapezius can result in upward rotation of the scapula.

False

An upwardly rotated scapula will be abducted at the superior angle and adducted at the inferior angle.

False

Protraction of the scapulae leads to lengthening and weakness in the rhomboids and lower fibers of the trapezius.

True

Clients with shoulder pain often flex their necks to the opposite side of the pain to minimize movement.

False

What is the significance of observing the position of the elbow in a client's postural assessment?

To assess the internal rotation of the humerus at the glenohumeral joint

Why might internally rotated humerus contribute to shoulder pain?

It results in impingement of soft tissues

How can observing the client's elbows help in identifying shoulder issues?

By determining the level of the client's shoulders

What could be a result of a client having dropped or elevated shoulders?

Issues with shoulder impingement and soft tissue pain

In postural assessment, what might internally rotated elbows indicate about a client?

Shortening of the pectoralis major and subscapularis

Why is it important to assess whether a client is internally rotated at the glenohumeral joint?

To understand potential contributors to shoulder pain

Observation of the position of the ______ can help you assess whether the client is internally rotated at the glenohumeral joint.

elbow

The internal rotators of the humerus might be shortened, such as the subscapularis, pectoralis major, and teres major, if the client's humerus is internally rotated at the ______.

glenohumeral

During postural assessment, internally rotated elbows might indicate issues with the client's shoulder pain caused by the impingement of soft tissues due to an internally rotated ______.

humerus

If a client's right shoulder appears higher, it could be due to shorter and tighter muscles on the right compared to the ______.

left

Observation of the position of the ______ is significant in understanding the client's postural alignment and potential shoulder issues.

elbow

The woman could have a tight right sternocleidomastoid muscle, tight left scalenes, plus a tight left levator scapulae muscle relative to these same muscles on the ______ side of the neck.

right

The inferior angle is elevated when the whole scapula is elevated.

True

Uneven ear height could suggest that your client has her head tilted to one side, with a laterally flexed knee.

False

The psoas muscle is considered a definitive rotator according to recent research findings.

False

During downward rotation of the scapula, the rhomboid minor is lengthened.

True

Shoulder pain can cause clients to laterally flex their necks towards the side of pain.

False

The figure on the right shows evidence of protracted scapulae.

True

What does the visibility of the palm indicate during a postural assessment?

The humerus is internally rotated

How might shortening of the supinators or pronators affect the hand position in a standing client?

Alter the position of the hand

In a postural assessment, what might an internally rotated humerus indicate for the client?

Shoulder pain

What can be inferred about a client with a visibly internally rotated humerus?

They may experience neck pain

How can alterations in the position of the hand during a postural assessment affect the humerus?

Lead to external rotation of the humerus

Clients with neck pain may subconsciously elevate their shoulder protectively in an attempt to reduce their ______.

pain

Protraction of the scapulae leads to lengthening and weakness in the rhomboids and lower fibers of the trapezius.

muscles

Many of us have less than straight spines and have no pain or problems in this structure ______

alignment

Retraction of the scapulae occurs when people adopt a military-style ______.

posture

If a client is laterally flexed to one side, they may have a shorter quadratus lumborum on the opposite ______.

side

The purpose of putting marks on the neck area during postural assessment is to help identify deviations.

True

Observation of uneven ear height is a reliable indicator of lateral flexion in a client's cervical spine.

False

During downward rotation of the scapula, the rhomboid minor is shortened.

False

Lateral deviation of the spine, known as scoliosis, can be caused by a leg length discrepancy.

True

Clients with poor posture often have slightly adducted scapulae.

False

Study Notes

Postural Assessment

  • Postural assessment involves observing the client's posture and identifying any deviations or abnormalities.
  • It is a useful tool for massage therapists, physical therapists, osteopaths, and chiropractors to identify potential causes of pain and discomfort.

Step 1: Ear Level

  • Observe the level of the client's ears to determine if they are even or uneven.
  • Uneven ear height may indicate a laterally flexed cervical spine.
  • Lateral flexion may result from shortening in the muscles that flex the head and neck, such as the trapezius, levator scapulae, sternocleidomastoid, and scalene muscles.

Step 2: Head and Neck Tilt

  • Observe the client's head and neck to determine if there is any lateral flexion or tilt.
  • Lateral flexion may indicate tightness in the muscles that flex the head and neck, such as the trapezius, levator scapulae, sternocleidomastoid, and scalene muscles.
  • Clients with shoulder pain may subconsciously flex their neck to the side of the pain to minimize movement and reduce discomfort.

Step 3: Cervical Rotation

  • Observe the client's head and neck to determine if there is any rotation.
  • Rotation may indicate tightness in the muscles that rotate the head and neck, such as the sternocleidomastoid and scalene muscles.
  • A tight right sternocleidomastoid muscle, tight left scalenes, and tight left levator scapulae muscle may contribute to rotation.

Step 4: Cervical Spine Alignment

  • Palpate the cervical spine to determine if it is straight or misaligned.
  • Misalignment may indicate a rotated or laterally flexed cervical spine.
  • A misaligned vertebra may contribute to the client's pain and discomfort.

Tips for Palpation

  • Palpate the cervical spine gently, using a body pen or crayon to mark the location of the spinous processes.
  • Place one hand gently on the forehead to stabilize the head and neck.
  • Be aware of the difficulties of palpating the cervical spine, including the bifurcated spinous processes, ligamentum nuchae, and active extensor muscles.

Referral to Other Professionals

  • If the client's postural assessment reveals misalignment or abnormalities, consider referring them to a physical therapist, osteopath, or chiropractor.
  • These professionals can help to identify and treat underlying causes of pain and discomfort.

Key Muscles

  • Trapezius: involved in lateral flexion and rotation of the head and neck.
  • Levator scapulae: involved in lateral flexion and rotation of the head and neck.
  • Sternocleidomastoid: involved in lateral flexion and rotation of the head and neck.
  • Scalene muscles: involved in lateral flexion and rotation of the head and neck.

Torticollis

  • Also known as "wry neck".

  • A spasming of the neck muscles resulting in lateral flexion, rotation, or both.

  • Common following whiplash.

  • May be identified during postural assessment.### Postural Assessment of the Upper Body

  • Step 4: Cervical Spine Alignment

    • Assess the alignment of the cervical spine by gently palpating the spinous processes and marking them with a body pen or crayon
    • Observe the marks to determine if the spine is straight
    • Note: Palpation of the cervical spine can be tricky due to bifurcated spinous processes, ligamentum nuchae, and thick extensor muscles
  • Step 5: Shoulder Height

    • Assess if the client's shoulders are level or if one appears higher than the other
    • Shortening in levator scapulae and upper fibers of the trapezius may contribute to one shoulder appearing higher than the other
    • If a scapula is elevated, the inferior angle of that scapula will be superior to the inferior angle of the scapula on the opposite side
  • Step 6: Muscle Bulk and Tone

    • Assess if there is an increase or decrease in muscle bulk on any part of the shoulders
    • Document any increase or decrease in tone by hatching or shading the relevant illustration on the postural assessment chart
    • Note: Manual workers and sportspeople may have hypertrophy in muscles on the dominant side, while clients with adhesive capsulitis or immobilized upper limbs may have atrophy on the affected side
  • Step 7: Scapular Adduction and Abduction

    • Observe the relationship between the medial borders of the scapulae and the spine
    • Determine if the scapulae are adducted (retracted) or abducted (protracted)
    • Note: Protraction of the scapulae often accompanies poor posture, while retraction of the scapulae is less common and occurs when people adopt a military-style posture
  • Scapular Rotation and Muscle Length

    • Downward rotation: medial border and inferior angle are adducted towards the spine, shortening the rhomboid major and lengthening the rhomboid minor and levator scapulae
    • Upward rotation: medial border and inferior angle are abducted from the spine, lengthening the rhomboid major and shortening the rhomboid minor and levator scapulae
    • Table 3.1 summarizes the changes in muscle length depending on scapular position### Scapular Movement
  • Upward rotation: movement of the glenoid fossa upward, resulting in adduction of the superior angle and abduction of the inferior angle

  • Downward rotation: movement of the glenoid fossa downward, resulting in abduction of the superior angle and adduction of the inferior angle

  • Scapular rotation occurs due to tension in some tissues and weakness or slackening in others

  • Upward rotation suggests tension in the levator scapulae, rhomboid minor, and upper fibers of the trapezius, and weakness in the rhomboid major and lower fibers of the trapezius

Scapular Position

  • The inferior angle of the scapula is elevated when the whole scapula is elevated
  • Muscles of scapular elevation may be shorter on the side of the elevation
  • If the inferior angle on one side is higher than the other, it could mean that the upper fibers of the trapezius and levator scapulae on that side are shortened

Winging of the Scapula

  • Winging occurs when the serratus anterior muscle is unable to keep the scapula fixed against the rib cage, causing it to stick out like a wing
  • True winging can occur due to damage to the long thoracic nerve or the muscle itself
  • If muscles attaching to the anterior of the scapula shorten, they can tilt the scapula forwards, making the inferior angle more prominent

Thoracic Spine

  • Scoliosis can be congenital, the result of injury or altered biomechanics, or due to a leg length discrepancy
  • Treatment for scoliosis depends on the cause and should not be assumed to be resolved by lengthening shortened tissues on the concave side of the curve
  • Kyphosis or a flat back can be noted during the initial assessment of the thoracic spine

Learn about the first step in a posterior postural assessment which involves checking if the client's earlobes are level. Find out how to handle clients with long hair during the assessment process and tips to ensure accuracy.

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