Posture Assessment Methods

Study Notes

Posture Assessment Methods

Manual measurement of posture involves subjective assessment using plumb line analysis and posture grid.

Plumb Line Analysis

Lateral view: The line of gravity passes through the ear lobe, shoulder joint, vertebral bodies (posterior to hip), and anterior to knee, and in front of the lateral malleolus.
Anterior view: The line of gravity divides the body into two equal halves, with all anatomical landmarks at the same position (anterior superior iliac spine, scapulae, shoulder level, and ribs).
Posterior view: The line of gravity divides the body into two equal halves, with all anatomical positions at the same level.

Posture Grid

The posture grid is a valuable tool for assessing posture, making it more effective and efficient.
It can be used for all types of postural assessment, including static and dynamic observations.
It helps identify differences to the norm or previous assessments by comparing the two.

Postural Assessment Parameters

Shoulder symmetry: Are the shoulders level when viewed from the front or back?
Roundedness of shoulders: Are the shoulders held in internal rotation with anterior translation of the humeral head?
Thoracic spine alignment: Is the thoracic kyphosis increased or decreased?
Spinal curvature: Is the subject having spinal scoliosis?
Lumbar lordosis: Is the lumbar lordosis increased or flattened?
Hip symmetry: Are the hips level when viewed from the front or back?
Knee hyperextension: Are the knees held in hyperextension?

Common Faulty Postures

Head and neck:
- Anterior tilt: Head is tilted forward, causing stretched posterior cervical ligaments and extensor muscles, and tight cervical flexor muscles.
- Posterior tilt: Head is tilted backward, causing vertebral bodies and joints compressed posteriorly, tightness of posterior ligaments and neck extensor muscles, and elongated levator scapulae muscles and anterior longitudinal ligament.
Shoulder position:
- Protraction of shoulders: One of the most common postures, often accompanied by forward head and increased thoracic kyphosis.
- Retracted shoulders: Less common than protracted shoulders.
Thorax:
- Increased kyphosis: An exaggeration of the thoracic curve, which may be compensatory, accompanying an increase in cervical or lumbar lordosis, or both.
Cervical and thoracic region:
- Round back (increased kyphosis) with forward head: Characterized by forward head, protrusion of the mandible, and increased extension of the upper cervical spine.
Pelvic and lumbar region:
- Lordotic posture: Characterized by an increase in the lumbosacral angle, lumbar lordosis, and anterior pelvic tilt, often accompanied by increased thoracic kyphosis and forward head.
- Flat low-back posture: Characterized by a decreased lumbosacral angle, decreased lumbar lordosis, hip extension, and posterior tilting of the pelvis.
Lower body:
- Pelvis:
  - Anterior pelvic tilt: Exaggerates the curve of the lumbar spine.
  - Posterior pelvic tilt: Decreases the lumbar lordosis.
- Knee:
  - Genu recurvatum (back kneeing): The knee is hyperextended, with gravitational stresses lying far forward of the joint axis, causing tightness of quadriceps and soleus muscles, and stretched popliteus, gastrocnemius, and hamstring muscles at the knee.