Posture: Introduction to Posture Analysis PDF

POSTURE DR SARA ABDULLA Introduction The postural alignment starts its development from early period of life with development of the spine and its curvature. You will learn what is meant by posture, the development and characteristics of normal posture, advantages of correct posture, types of pos...

POSTURE DR SARA ABDULLA Introduction The postural alignment starts its development from early period of life with development of the spine and its curvature. You will learn what is meant by posture, the development and characteristics of normal posture, advantages of correct posture, types of postures, what is meant by poor or faulty posture, the disadvantages of poor posture. And practically diagnose posture deviations of normal.  DEVELOPMENT OF POSTURE The postural alignment starts its development from early period of life with development of the spine and its curvature. At first, at birth the spine has one "C"- shaped curve with one convexity and one concavity. Then, as the child is trying to raise his head 'from prone lying position cervical curve starts to develop and in the early phase of education of walking, another curve will be developed which is the lumbar curve. These two curves are considered as"secondarycurves" to the first one which is called "primary curve".  CURVATURES OF THE SPINE 1- FROM FRONTAL VIEW: If the spine is viewed from the front or the back view it seems to be straight and symmetrical. Posterior (Back) Spinal Column  CURVATURES OF THE SPINE 2- FROM SAGITTAL VIEW: If the spine is viewed from the lateral side, four normal curves will appear which are: a- Two primary curves: dorsal and sacral which are convex posteriorly. b- Two secondary curves: cervical and lumbar which are convex anteriorly. CHARACTERISTICS OF GOOD POSTURE (Prerequisites of good posture): For good posture to be maintained the following must be obtained: The ability to maintain 'the body upright in good and erect position with less energy. The ability to maintain balance in upright position via keeping the line of gravity near the center of the base of support.  Effects of good posture Maintaining good posture has its values in different body functions and systems. The effects of good posture include: 1- Helps the muscles in the body to be unloaded and relaxed. 2- Improves respiratory and circulatory efficiency. 3- Prevents unnecessary strain and fatigue. 4- Decreases the incidence of diseases resulting from bad posture. 5- Improves the subject’s state; mentally or psychologically.  TYPES OF POSTURE 1) Fatigue posture 2) Easy posture 3) Rigid posture dr.mohammed elsayed PT,PhaD Easy Posture It is good, symmetrical and balanced position This position can not be maintained for a long time. So, the subject will shift his weight in a swaying movement in order to prevent fatigue and to maintain a good circulation in the postural muscles of the legs when standing. By alternating the main support from one leg to the other; the muscles become periodically unloaded and relaxed. Fatigue Posture It is asymmetrical or sagging posture This position is relaxed and can be maintained for. a long time as most of body's joints are in semi-flexion. The load on the muscles will decrease and the energy expenditure is 10% less than easy posture. Rigid Posture It is called posture of attention. It doesn't mean normal posture This position can not be assumed for a long time as most of body's joints are. In extension; so, the load will increase on joints and muscles and energy expenditure is 20% more than easy posture. So, with referring to 3 types of posture the energy in : Rigid > Easy > Fatigue Poor posture Definition: Poor posture is a position resulting from any deviation from ideally aligned erect posture (good posture).  CAUSES OF POOR POSTURE Poor posture may occur due to: 1- Defects in: Joints: such as stiffness or immobilization.  Bones: such as shortening or deformity.  Muscles: such as weakness, paralysis or contracture. Vision or hearing. 2- Bad habits: either from early childhood or from occupational positions. Example for that is the workers that perform jobs which require continuous flexed position of the trunk. 3- Pain, fatigue or bad psychological state.  EFFECTS OF POOR POSTURE Poor posture causes deviations from the normally aligned posture. As a result the body functions are altered and this may lead to dysfunction and diseases. Poor posture may cause one or more of the following dysfunction: 1. Secondary deformities and compensatory postural defects. 2. Easy fatigability and high energy expenditure.  3. Decrease both respiratory and circulatory efficiency. 4. Pain, bad cosmetic appearance and psychological disturbances. Analysis of Posture Posture assessment To assess posture ideally, the subject stands upright, and attention should be given to the following: No movement in the atlantoaxial or Atlanta-occipital joint which results in protrusion of the jaw. Stands as straight as possible. Knees should be straight as much as possible. Head faces forward and arms beside the body. Almost all joints of the body must be in the neutral position.  Assessment should be From 3 Views: 1- Anterior view. 2- Posterior view. 3- Lateral view. The Parts Which are Important to be Observe: 1- Head alignment. 2- Curvature of the spine; cervical, thoracic and lumbar. 3- Shoulders and arms. 4- Pelvic inclination. 5- Hip, knee and ankle joints.  Correct Posture (Lateral) Line is… Through external auditory meatus (Ear) Midway through shoulder Through lumbar bodies Slightly anterior to midline of knee Slightly anterior to lateral malleolus  Correct Posture (Posterior) Line is…  In the center of head, neck, back and pelvis  Falls exactly in the mid point between the two Knees and ankles Types of Poor Posture (from the lateral view) Kyphotic-lordotic Posture Flat-back Posture Sway-back Posture  Kyphotic-Lordotic Posture Head- Forward Cervical Spine- Hyper-lordosis (hyper- extended) Thoracic Vertebrate- increased flexion Lumbar Vertebrate- Hyperlordosis; (hyperextended). Pelvis- Anterior tilt (forward and down) Knees- hyperextended (Genorecarvetum) Ankle joints- plantar flexed, legs are behind midline  Flat-Back Posture Head- Forward Cervical Spine- extended Thoracic Vertebrate- reduced curvature (extension) Lumbar Vertebrate – straight (flexion) Pelvis- posterior tilt Hips- extended Knees- extended Ankle joints- slightly plantar flexed IDEAL  Sway-Back Posture Head: Forward Cervical Spine -Hyper extended Thoracic Vertebrate- slight flexion Lumbar Vertebrate –slight extension Pelvis-posterior tilt and anterior to midline Hips- Hyper extended Knees- Hyper extended Ankle- slightly planter-flexed Evaluation Lateral Evaluation  Plumb Alignment: aligned anterior to lateral malleolus Things to Examine  Position of knees – Check for hyperextension or flexion  Pelvic position and spine curvature  Head, chest and abdominal position Lateral: Knee Position It is important to observe the patient from both the right and  left lateral views and compare the findings The feet should show a normal longitudinal arch. The navicular tuberosity should be located on Feis’ line (from the medial malleolus to the first metatarsophalangeal joint). The knees should be from 0 to 5 degrees of flexion. The hips should be in 0.degrees of flexion dr.mohammed elsayed PT,PhaD.Lateral : pelvis The pelvis should not be rotated. The anterior superior iliac spine and pubic symphysis should be in the same plane vertically. The normal posterior–anterior pelvic angle is 30 degrees from the posterior superior iliac spine to the pubic ramus. The spine should demonstrate the normal anterior– posterior curves of lumbar lordosis, thoracic kyphosis, and cervical lordosis dr.mohammed elsayed PT,PhaD Evaluation Anterior Evaluation Position of feet – Check for pronation or supination – Check arch of the foot Position of legs – Check for bowlegs Position of knees – Check for knock-knees Appearance of ribs Position of head Anterior: Good Alignment Anterior: Foot Supination & Pronation Contracted anterior tibalis Feet are supinated Slight knee knocking Weight is on outside of Feet are pronated feet  Posterior Evaluation Plumb Alignment- align midway between heels Things to Examine Note alignment of Achilles Tendon Hip adduction/abduction Check for level posterior iliac spine Check for lateral pelvic tilt Check for spine and shoulder problems.  Posterior Evaluation Scoliosis  Lateral curve in the spine Types of Scoliosis  Congenital  Neuromuscular  Paralytic  Idiopathic 85% of cases unknown Cause Adolescent Idiopathic Scoliosis (AIS)  Posterior Evaluation Scoliosis: Perform Posture Analysis Check if shoulders are level Check distance between arms and side of body Check if hips are level Check if head is centered over the pelvis.  Posterior Evaluation. Scoliosis Shoulders not level, prominent or uneven scapulas Uneven gap between arm and body Elevated or uneven hip Head not centered over pelvis Bending test reveals uneven portions of back  Summary of Posture The spinal column has 2 primary curves (Thoracic & Sacral) and 2 secondary curves (Cervical & Lumber). Good posture is the attitude which, is assumed by body parts to maintain stability and balance with minimum effort and least strain during supportive and non supportive positions. Poor posture is a position resulting from any deviation from ideally aligned erect posture (good posture). of normal posture, Easy, fatigue and rigid postures. Evaluation of posture is conducted from 3 views. Lateral, Anterior and posterior views.