Posture (2024) PDF

Posture http://pranayoga.co.in/asana/wp-content/uploads/posture-chart-final-Copy.png Alan Wong, PhD [email protected] References Kendall, F. P., McCreary, E. K., Provance, P. G., Rodgers, M. M., & Romani, W. A. (2005). Muscles, test...

Posture http://pranayoga.co.in/asana/wp-content/uploads/posture-chart-final-Copy.png Alan Wong, PhD [email protected] References Kendall, F. P., McCreary, E. K., Provance, P. G., Rodgers, M. M., & Romani, W. A. (2005). Muscles, testing and function: with posture and pain. (5th ed.). Baltimore, MD: Lippincott Williams & Wilkins. Johnson. (2012). Postural assessment. Human Kinetics. https://singaporetech.primo.exlibrisgroup.com/permalink/65SIT_INST/1i4buil/alma9910008004 95204056 Slater, D., Korakakis, V., O'Sullivan, P., Nolan, D., & O'Sullivan, K. (2019). “Sit up straight”: time to Re-evaluate. Journal of orthopaedic & sports physical therapy, 49(8), 562-564. O'Sullivan, K., O'Sullivan, P., O'Sullivan, L., & Dankaerts, W. (2012). What do physiotherapists consider to be the best sitting spinal posture?. Manual therapy, 17(5), 432-437. Korakakis, V., O'Sullivan, K., O'Sullivan, P. B., Evagelinou, V., Sotiralis, Y., Sideris, A.,... & Giakas, G. (2019). Physiotherapist perceptions of optimal sitting and standing posture. Musculoskeletal Science and Practice, 39, 24-31. References Raine, S., & Twomey, L. (1994). Posture of the head, shoulders and thoracic spine in comfortable erect standing. Australian Journal of Physiotherapy, 40(1), 25-32. Refshauge, K., Goodsell, M., & Lee, M. (1994). Consistency of cervical and cervicothoracic posture in standing. Australian Journal of Physiotherapy, 40(4), 235-240. Booshanam, D. S., Cherian, B., Joseph, C. P. A., Mathew, J., & Thomas, R. (2011). Evaluation of posture and pain in persons with benign joint hypermobility syndrome. Rheumatology international, 31(12), 1561-1565. Glista, J., Pop, T., Weres, A., Czenczek-Lewandowska, E., Podgórska-Bednarz, J., Rykała, J.,... & Rusek, W. (2014). Change in anthropometric parameters of the posture of students of physiotherapy after three years of professional training. BioMed research international, 2014. Britnell, S. J., Cole, J. V., Isherwood, L., Stan, M. M., Britnell, N., Burgi, S.,... & Watson, L. (2005). Postural health in women: the role of physiotherapy. Journal of obstetrics and gynaecology Canada, 27(5), 493-500. References Wilkes, C., Kydd, R., Sagar, M., & Broadbent, E. (2017). Upright posture improves affect and fatigue in people with depressive symptoms. Journal of behavior therapy and experimental psychiatry, 54, 143-149. Chansirinukor, W., Wilson, D., Grimmer, K., & Dansie, B. (2001). Effects of backpacks on students: measurement of cervical and shoulder posture. Australian Journal of physiotherapy, 47(2), 110-116. Lomas-Vega, R., Garrido-Jaut, M. V., Rus, A., & del-Pino-Casado, R. (2017). Effectiveness of global postural re-education for treatment of spinal disorders: a meta-analysis. American journal of physical medicine & rehabilitation, 96(2), 124-130. Assessing Posture Here are three people. - One has had chest surgery 2 - One has hypermobile joints 3 - One has very tight external hip rotators. Can you tell which is which by looking at these photographs? Johnson, J. (2012). Introduction to Postural Assessment. In Postural Assessment: Hands-On Guides for Therapists (pp. 3–14). Champaign, IL: Human Kinetics. Retrieved August 20, 2023, from http://dx.doi.org/10.5040/9781718209619.ch-001  hypermobile chest sungey light hip morefore Johnson, J. (2012). Introduction to Postural Assessment. In Postural Assessment: Hands-On Guides for Therapists (pp. 3–14). Champaign, IL: Human Kinetics. Retrieved August 20, 2023, from http://dx.doi.org/10.5040/9781718209619.ch-001  "Good posture is that state of muscular and skeletal balance which protects the supporting structures of the body against injury or progressive deformity irrespective of the attitude What is Good (erect, lying, squatting, stooping) in which these Posture? structures are working or resting. Under such conditions the muscles will function most efficiently and the optimum positions are afforded for the thoracic and abdominal organs." American Academy of Orthopaedic Surgeons (AAOS), 1949, quoted by Kendall, F. P., McCreary, E. K., Provance, P. G., Rodgers, M. M., & Romani, W. A. (2005). Muscles, testing and function: with posture and pain. (5th ed.). Baltimore, MD: Lippincott Williams & Wilkins.  parts of body other hande worke to need T to compensate Poor posture is "... a faulty relationship of the various parts of the body What is Poor which produces increased strain on the Posture? supporting structures and in which there is less efficient balance of the body over its base of support." Posture Committee of the American Academy of Orthopaedic Surgeons (AAOS), 1947, quoted by Kendall, F. P., McCreary, E. K., Provance, P. G., Rodgers, M. M., & Romani, W. A. (2005). Muscles, testing and function: with posture and pain. (5th ed.). Baltimore, MD: Lippincott Williams & Wilkins. Posture Ideal posture ensures physiological and biomechanical efficiency, reduces undue stress and strain on bones, joints, ligaments and muscles. symptoms Faulty or non-ideal (and habitual) posture may be related to pain, discomfort, muscle weakness or tightness. Faulty alignment results in undue stress and strain. Joint positions in faulty posture indicate muscles that are weak or tight. Kendall, F. P., McCreary, E. K., Provance, P. G., Rodgers, M. M., & Romani, W. A. (2005). Muscles, testing and function: with posture and pain. (5th ed.). Baltimore, MD: Lippincott Williams & Wilkins, pp.49-95  What Does Research Say About Posture? Physiotherapists differ in their professional opinion of the optimal sitting/standing posture although majority (>40%) prefer upright sitting/standing with normal lumbar spine lordosis (O’Sullivan et al., 2012; Korakakis et al., 2019). There is limited evidence supporting a correlation between spinal symptoms and poor sitting/standing postures (O’Sullivan et al., 2012) whereas some researchers have found some evidence that supports posture correction improves spinal symptoms (Lomas-Vega et al., 2017) Forces acting on the body can affect posture, e.g. carrying a backpack weighing 15% of body weight appeared to be too heavy to maintain head and shoulder posture in standing for adolescents (Chansirinukor et al., 2001). Forward head posture appears to be related to thoracic kyphosis, rather than rounded shoulders or upper cervical extension (Raine & Twomey, 1994). Posture re-education by physiotherapists is important for people with benign joint hypermobility (Booshanam et al., 2011), for women during or after pregnancy (Britnell et al., 2005) and improves arousal/reduce fatigue in depressive conditions (Wilkes et al., 2017). PT students appear to have poorer posture at the end of their studies (Glista et al., 2014)! * Plumb Line Test When viewed from the side, the body is observed in relation to a real or imaginary plumb line that hangs just in front of the centre of the ankle joint. In ideal alignment, the plumb line – bisects the ear bisects the shoulder joint runs down the bodies of the lumbar vertebrae bisects the greater trochanter of the femur runs just behind the centre of the knee runs just in front of the centre of the ankle The point of reference is at the base, hence aligned to a point just anterior to the lateral malleolus.  Observation A core competency of Physiotherapist Passier, L. N., Nasciemento, M. P., Gesch, J. M., & Haines, T. P. (2010). Physiotherapist observation of head and neck alignment. Physiotherapy theory and practice, 26(6), 416-423. Kendall, F. P., McCreary, E. K., Provance, P. G., Rodgers, M. M., & Romani, W. A. (2005). Muscles, testing and function: with posture and pain. (5th ed.). Baltimore, MD: Lippincott Williams & Wilkins. # Ideal Plumb Alignment Head and Neck Upper Back Shoulder Side: through the lobe of Side: slight curve Side: midway through the the ear shoulder Back: equidistant of Back: spinous processes of scapulae from the vertebral Back: scapulae flat against cervical spine column upper back, approx. T2 to T7 level Pelvis and Low Back Hips and Knees Ankles and Feet Side: pelvis in neutral Side: slight posterior to hip Side: slight anterior to position, normal low back joint (through greater lateral malleolus and apex curvature; midway of trunk trochanter) and slight anterior of arch (calcaneocuboid to knee joint joint) Back: bilat. PSIS are level Back: level gluteal folds Back: heels equidistant apart Factors Affecting Posture (1) Structural or anatomical Scoliosis in all or part of the spine Discrepancy in the length of the long bones in the upper or lower limbs Extra ribs Extra vertebrae Increased elastin in tissues (decreasing the rigidity of ligaments) > Marten's syndrome Age Posture changes considerably as we grow into our adult forms, with postures in children being markedly different at different ages. Physiological Posture changes temporarily in a minor way when we feel alert and energised compared to when we feel subdued and tired. Pain or discomfort may affect posture as we adopt positions to minimise discomfort. This may be temporary or could result in long-term postural change if the position is maintained. Physiological changes that accompany pregnancy are temporary (e.g., low backache before or after childbirth), but sometimes result in more permanent, compensatory postural change. Factors Affecting Posture (2) Pathological Illness and disease affect our postures especially when bones and joints are involved. Osteomalacia may show up as genu varum; arthritic changes are often revealed when joints in the limbs are observed. Pain can lead to altered postures as we attempt to minimise discomfort (e.g., following a whiplash injury a client may hunch the shoulders protectively; abdominal pain may lead to spinal flexion). Mal-alignment in the healing of fractures may sometimes be observed as a change in bone contour. Certain conditions may lead to an increase or a decrease in muscle tone. For example, someone who has suffered a stroke may have increased tone in some limbs but decreased tone in others. As elderly adults, we tend to lose height as a result of osteoporotic changes and so develop stooped postures; postmenopausal women may develop a dowager’s hump. Factors Affecting Posture (3) Occupational Consider the postural differences between a manual worker and an office worker, and between someone active and someone sedentary. Recreational Consider the postural differences between someone who plays regular racket sports and someone who is a committed cyclist. Environmental When people feel cold they adopt a different posture to that when they feel warm. Social and cultural People who grow up sitting cross-legged or squatting develop postures that are different from those of people who grow up sitting on chairs. Johnson, J. (2012). Introduction to Postural Assessment. In Postural Assessment: Hands-On Guides for Therapists (pp. 3–14). Champaign, IL: Human Kinetics. Retrieved August 20, 2023, from http://dx.doi.org/10.5040/9781718209619.ch-001 Factors Affecting Posture (4) Emotional Usually, the posture we subconsciously adopt to match certain moods is temporary, but in some cases it persists if the emotional state is habitual. Consider the posture of a person who is grieving, or the muscle tone of a person who is angry. Clients who fear pain may adopt protective postures. arsident pain behavious Johnson, J. (2012). Introduction to Postural Assessment. In Postural Assessment: Hands-On Guides for Therapists (pp. 3–14). Champaign, IL: Human Kinetics. Retrieved August 20, 2023, from http://dx.doi.org/10.5040/9781718209619.ch-001  Four types of postural alignments Kendall, F. P., McCreary, E. K., Provance, P. G., Rodgers, M. M., & Romani, W. A. (2005). Muscles, testing and function: with posture and pain. (5th ed.). Baltimore, MD: Lippincott Williams & Wilkins. 1. ‘Ideal’ Segmental Alignment Head: Neutral position, not tilted forward or back Cervical spine: Normal curve, slightly convex anteriorly Scapulae: Flat against upper back Thoracic spine: Normal curve, slightly convex posteriorly normal kyphosis Lumbar spine: Normal curve, slightly convex anteriorly normal verdosis Pelvis: Neutral position, ASISes in the same vertical plane as symphysis pubis Hip joints: Neutral position, neither flexed nor extended Knee joints: Neutral position, neither flexed nor hyperextended Ankle joints: Neutral position, leg vertical and at a right angle to the sole of the foot Kendall, F. P., McCreary, E. K., Provance, P. G., Rodgers, M. M., & Romani, W. A. (2005). Muscles, testing and function: with posture and pain. (5th ed.). Baltimore, MD: Lippincott Williams & Wilkins. 2a. Kyphotic-Lordotic Posture Head: Forward a ↑ Cervical spine: Hyperextended evie dis Scapulae: Abducted Thoracic spine: Kyphotic (increased flexion) Lumbar spine: Lordosis (hyperextended) Pelvis: Anteriorly tilted lumbo pelvic rhythm Hip joints: Flexed Knee joints: Slight hyperextended Ankle joints: Slight plantarflexed because of backward inclination of the leg Which muscles tend to be weak? Which muscles tend to be tight? Kendall, F. P., McCreary, E. K., Provance, P. G., Rodgers, M. M., & Romani, W. A. (2005). Muscles, testing and function: with posture and pain. (5th ed.). Baltimore, MD: Lippincott Williams & Wilkins. 2b. Lordotic Posture Head: Neutral position Cervical spine: Normal curve (slight anterior) Thoracic spine: Normal curve (slight posterior) Lumbar spine: Lordosis (hyperextended) Pelvis: Anteriorly tilted Hip joints: Flexed Knee joints: Slight hyperextended Ankle joints: Slight plantarflexed Which muscles tend to be weak? Which muscles tend to be tight? Kendall, F. P., McCreary, E. K., Provance, P. G., Rodgers, M. M., & Romani, W. A. (2005). Muscles, testing and function: with posture and pain. (5th ed.). Baltimore, MD: Lippincott Williams & Wilkins. 3. Flat-Back Posture Head: Forward Cervical spine: Slightly extended mana , Thoracic spine: Upper part - increased loss of kyphosis flexion; lower part - straight Lots of Lumbar spine: Flexion (straight) hordosis Pelvis: Posteriorly tilted Hip joints: Extended Knee joints: Extended Ankle joints: Slight plantarflexion Which muscles tend to be weak? Which muscles tend to be tight? Kendall, F. P., McCreary, E. K., Provance, P. G., Rodgers, M. M., & Romani, W. A. (2005). Muscles, testing and function: with posture and pain. (5th ed.). Baltimore, MD: Lippincott Williams & Wilkins. 4. Sway-Back Posture Head: Forward Cervical spine: Slightly extended Thoracic spine: Increased flexion (long kyphosis) with posterior displacement of the upper trunk [ Lumbar spine: Flexion (flattening) of the lower lumbar area ofkyphosa a lose Pelvis: Posteriorly tilted Hip joints: Hyperextended with anterior displacement of the pelvis Knee joints: Hyperextended Ankle joints: Neutral Which muscles tend to be weak? Which muscles tend to be tight? Kendall, F. P., McCreary, E. K., Provance, P. G., Rodgers, M. M., & Romani, W. A. (2005). Muscles, testing and function: with posture and pain. (5th ed.). Baltimore, MD: Lippincott Williams & Wilkins.  > - PSIS-Asis Pelvic Tilt < Ass > - psis Asymptomatic normal individuals: Ave. 8.35° SD 4.17 (range 1.99°-15.72°) (Gajdosik et al., 1985). Cadavers: Ave. 13° SD 5 (range 0-23°) (Preece et al 2011). What is ‘normal’? (Herrington 2011) Among 65 male: 85% - anterior tilt 6% - posterior tilt 9% - neutral Among 55 female: 75% - anterior tilt Gajdosik, R., Simpson, R., Smith, R., & DonTigny, R. L. (1985). Pelvic tilt: Intratester reliability of measuring the standing position 7% - posterior tilt and range of motion. Physical Therapy, 65(2), 169-174. 18% - neutral Herrington, L. (2011). Assessment of the degree of pelvic tilt within a normal asymptomatic population. Manual Therapy, 16(6), 646-648. Preece, S. J., Willan, P., Nester, C. J., Graham-Smith, P., Herrington, L., & Bowker, P. (2008). Variation in pelvic morphology may prevent the identification of anterior pelvic tilt. Journal of Manual & Manipulative Therapy, 16(2), 113-117. Le Huec, J. C., Aunoble, S., Philippe, L., & Nicolas, P. (2011). Pelvic parameters: origin and significance. European Spine Journal, 20(5), 564. Kendall, F. P., McCreary, E. K., Provance, P. G., Rodgers, M. M., & Romani, W. A. (2005). Muscles, testing and function: with posture and pain. (5th ed.). Baltimore, MD: Lippincott Williams & Wilkins. Posterior View – Ideal Alignment Head: Neutral, not tilted nor rotated Cervical spine: Slight lateral flexion Shoulders: Level, not elevated nor depressed Scapulae: Neutral, medial borders parallel Thoracic and lumbar spines: Straight Pelvis: Level, both PSISes in same horizontal plane Hip joints: Neutral, not abducted nor adducted Lower extremities: Straight, not bowed nor knocked Feet: Parallel, neither pronated nor supinated Kendall, F. P., McCreary, E. K., Provance, P. G., Rodgers, M. M., & Romani, W. A. (2005). Muscles, testing and function: with posture and pain. (5th ed.). Baltimore, MD: Lippincott Williams & Wilkins. Posterior View – Faulty Alignment 1 Head: Erect, not tilted nor rotated Cervical spine: Straight Shoulders: Right -> low f Scapulae: Adducted, right -> slightly depressed Thoracic and lumbar spines: Curve · convex to the left · Pelvis: Lateral tilt, right -> higher Hip joints: Right -> adducted, slightly medial rotated; left -> abducted Lower extremities: Straight, not bowed nor knocked Feet: Slight pronated What muscles are likely to be ‘elongated and weak’ or ‘short and tight’? Kendall, F. P., McCreary, E. K., Provance, P. G., Rodgers, M. M., & Romani, W. A. (2005). Muscles, testing and function: with posture and pain. (5th ed.). Baltimore, MD: Lippincott Williams & Wilkins. Posterior View – Faulty Alignment 2 Head: Erect, not tilted nor rotated Cervical spine: Straight Shoulders: Elevated and adducted. Joints are medially rotated as indicated by hand g position facing posteriorly Scapulae: Adducted and elevated Thoracic and lumbar spines: Slight convex Reha in to the right Pelvis: Lateral tilt, left -> higher Hip joints: Left -> adducted, slightly medial rotated; right -> abducted Lower extremities: Straight, not bowed nor knocked Feet: Slightly pronated What muscles are likely to be ‘elongated and weak’ or ‘short and tight’? Kendall, F. P., McCreary, E. K., Provance, P. G., Rodgers, M. M., & Romani, W. A. (2005). Muscles, testing and function: with posture and pain. (5th ed.). Baltimore, MD: Lippincott Williams & Wilkins. Summary Posture analysis as an introduction to understanding human movements. Faulty postures may or may not be related to muscle weakness (tendency to be elongated) and tightness (tendency to be short). Identifying faulty postures help physiotherapists decide whether to test muscle weakness/tightness. There is a need to correlate with symptoms. Developing observational skills.