Posture Lecture PowerPoint PDF

CONSIDERATIONS FOR THE EXAMINATION OF POSTURE (POSTURE AS A TEST/MEASURE) PT 8311 Foundations of Examination Jolene Walsh, PT, MPT  What is Posture?  Subjective, based on ideal models  Normal posture definition: ????  Abnormal posture definition: ???? De...

CONSIDERATIONS FOR THE EXAMINATION OF POSTURE (POSTURE AS A TEST/MEASURE) PT 8311 Foundations of Examination Jolene Walsh, PT, MPT  What is Posture?  Subjective, based on ideal models  Normal posture definition: ????  Abnormal posture definition: ???? Development of Posture  Spinal curvatures  Entire spine kyphotic at birth  Secondary curvatures develop with erect positions, growth from infant to toddler  Skeletal muscle roles  “Movement” muscles  Development of Posture- Spinal curvatures https://bodyalivefitness.com/the-basics-of-the-spine/ https://www.slideshare.net/HarshilMehta2/arches-58864968  Development of posture  Muscle imbalances  Agonist and antagonists  Compensations  Reactions of inert tissues https://www.completechiropracticsolutions.com/single-post/2015/10/13/ Lower-Crossed-Syndrome-Explained  “Ideal” Posture  “Optimal alignment of the patient’s body that allows the neuromuscular system to perform actions requiring the least amount of energy to achieve the desired effect.”  To be classified as abnormal, the alignment must produce functional limitations Dutton, M. Orthopedic Examination, Evaluation, and Intervention. 2nd ed. New York: McGraw-Hill. 2008 http://www.thepilatesloft.co.nz/ideal-posture-2/  Factors related to postural maintenance  Energy cost  Strength and flexibility  Age  Psychological aspects  Evolution and hereditary influences  Structural deformities  Disease  Pregnancy  Habit  Pain Dutton, M. Orthopedic Examination, Evaluation, and Intervention. 2nd ed. New York: McGraw-Hill. 2008  Factors…  Energy cost https://meded.ucsd.edu/clinicalimg/thorax_tripod.htm https://www.researchgate.net/figure/Posture-defined-indicators-A- Neutral-B-Sway-back-C-Lordosis_fig1_318436356  Factors…  Strength and flexibility https://www.healthandexercise.com.au/exercise-physiology/exercise- https://montana-fitness.com/2016/12/25/genu-valgum- physiologyposture-correction-exercises-upper-crossed-syndrome/ / the-problem-of-knock-knees  Factors…  Age  Stooped posture  Osteoporosis  “Dowager’s hump” https://www.youtube.com/watch?v=DBiJ_An07nY http://www.sarameekspt.com/postural_change.asp  Factors…  Psychological aspects What postures/positions do we assume when we are Stressed? Afraid? Bold? Confident? Embarrassed? Ashamed? https://www.istockphoto.com  Factors…  Evolution and hereditary influences https://futurelifenow.com/npr-holistic-back-pain/ https://massagetablesnow.com/blog/how-to-improve- posture  Factors…  Structural deformities  Leg length discrepancy  Congenital anomalies  Trauma  Scoliosis http:// pranayoga. co.in/ asana/ exercises- to-correct- your- posture/  Factors- scoliosis  Lateral curvature of 10+ degrees, accompanied by a rotational abnormality  Occurs in 2-3% of general population  Types of scoliosis  Structural- adolescent idiopathic  Functional- acquired due to other factors (leg length, imbalances, disease processes) https://medlineplus.gov/ency/article/ 001241.htm  Factors…  Disease  Ex: osteoarthritis, Parkinson’s, cerebral palsy https://www.kintec.net/blog/knee-osteoarthritis-degenerative- arthritis/ http://www.childortho.com/cerebral_palsy_main.html  Factors…  Pregnancy  Increased lumbar lordosis  Increased thoracic kyphosis  Shift of center of gravity (COG)  Pes planus -Center of mass (COM): point that is the center of total body mass -Center of gravity (COG): vertical projection of the COM -Base of support (BOS): area of the body in contact with support surface http://www.yourpregnantcore.com/2016/05/31/8-consequences-of- slouching-during-pregnancy/  Factors… Habit  Computer/Work ergonomics  Driving  Watching TV  Reading  Casual stance  Backpacks  Child care https://www.gettyimages.com/videos/bad- posture https://www.uhs.umich.edu/ computerergonomics  Factors…  Pain  Nociception has top priority for the motor system  Body will adopt a posture that will decrease pain https://thetaorthotics.com/conditions/  Examination of Posture  Visual observation  Plumb line method/posture grid  Goniometry  Photographic and digitization method  Radiographic method  Misc: posturometer, flexiruler, Morie topography Singla D. Vegar Z. Methods of Postural Assessment Used for Sports Persons. J Clin Diagn Res. 2014 Apr; 8(4) https://www.kenthealth.com/tag/posture-grid  Examination of posture  Adequate undressing  Use of assistive devices (Yes? No?)  Barefoot  “March in place a few times….” is a good cue to get the patient into relaxed stance Anterior View  Landmarks  Even eyes  Acromion processes  Iliac crests  ASIS  Greater trochanter  Patellae  Malleoli http://sortyourpostureout.com/body-alignment-what-does-perfect-posture- / look-like  Note the:  Indentation of the right temporal bone  Protrusion of right mandible  Retrusion of left mandible  Symphysis menti shifted left  Difference in skin creases   Skin creases  Waist angle  Elbow window  Patellar “laser beam” http://www.kevinneeld.com/pri-crossfit-and-stability/ Posterior View  Landmarks  Even ear lobes  Shoulders  Inferior angles of scapulae  Iliac crest  PSIS  Greater trochanter  Buttock/knee creases  Malleoli http://sortyourpostureout.com/body-alignment-what-does-perfect-posture- look-like/   Popliteal “eyes”  Lateral toe sign https://www.hockeystrengthandconditioning.com/members/login.cfm? hpage=Core_Integration_Utilizing_PRI_and_DNS_Approaches_Theoretical_Co https://www.youtube.com/watch?v=ca7IbuS3NCQ nstructs.cfm Lateral View  LOG should bisect:  External auditory meatus  Acromion  Greater trochanter  Just posterior to patella  About 2 cm anterior to lateral malleolus http://sortyourpostureout.com/body-alignment-what-does-perfect-posture- look-like/  http://www.femininebeauty.info/mandible-profile-and-marquardt-mask https://www.researchgate.net/figure/Sway-back-posture-in-a-11-year-old- boy-a-Habitual-standing-lateral-view-b_fig7_323558106  Postural asymmetries Normal anatomic asymmetries: -diaphragm- different sizes R vs L (which is larger?) -big liver, small heart (position of aorta and vena cava) Hand dominance- slightly lower shoulder on dominant side is normal (why?)  Common postural abnormalities https://www.len.com.ng/csblogdetail/200/Posture-and- Postural-Defects https:// https:// www.mendelsonortho.com mskneurology.com/really- /patient-resources/patient- assess-lumbar-lordosis- education/spine/back- dispelling-fallacy-anterior- pain-in-children/ pelvic-tilt/ cons1_275_329/ https://link.springer.com/chapter/10.1007/978-3-319- Now what?  View postural syndromes as dysfunction disorders, rather than a disorder of pain.  Postural syndromes can limit optimal function  Example: can’t fully flex your shoulders with upper crossed syndrome  Pain likely related to the TIME spent in a posture/position rather than the posture itself  What’s next? Postural CONTROL  Controlling the body’s position in space for the dual purposes of stability and orientation  Postural orientation- the ability to maintain an appropriate relationship between the body segments, and between the body and the environment for a task Shumway-Cook A., Woollacott M. Motor Control. Translating Research into Clinical Practice. 4th ed. Baltimore: Lippincott Williams & Wilkins. 2012