Transcript Posture - Hompages | University of Michigan

Posture
PTP 565 Fundamentals of Tests and
Measures
Make vs Break Test
• Make test
– Try to do this motion
– Make a msucle contract
• Break test
– Hold a muscle
contraction
– Don’t let me move you
Exam 2
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•
•
•
Posture
Gait
Balance
Assistive devices
• 4-point (2 assistive aids)
Modified 4point, two
touching at a time,
opposite hand and foot
together. 1 assistive
devise is used.
• Patient Care
– Pg. 232-233
– Use for Exam
• 2 point (using a cane or
hemi-walker) assistive
aid and opposite leg
touch together
•
What is Posture?
• Posture: A position of the body
– Good: “lifting up entire body”
– Bad: relaxation-use of ligaments, and natural bony
shape, anterior trunk shortening/ tightening,
posterior trunk lengthening==leads to muscle
imbalances, which creates more pain for
individual.
– Emotional Aspect of Posture: get a read off of how
someone holds themselves.
Factors Affecting Posture
• Age
• Physiological: state of being at any one time can
have a postural effect
• Structural Factors: scoliosis, extra ribs, leg length
discrepancies
• Occupational Factors
• Social and Cultural
• Recreational
• Environmental
• Muscle Strength
• Emotional
– Protective posture (UE bent at 90 held against body),
rotator cuff tear (elevated shoulder)
• Pathological:
–
–
–
–
–
Illness
Pain
Mal-alignment after a fracture
Muscle tone: floopy vs hypertonic
Osteoporosis: fractures of vertebral spine
Soda Pop Model of Respiration and
Postural Control
• Every muscle of the trunk is a respiratory muscle
AND a postural muscle.
• Diaphragm is very important
• Breathing is compromised – exercise etc, posture
response is reduced so as to focus on the needs of
the respiratory system
• When faced with conflict, diaphragm will always
choose respiration over posture
Massery, M. Musculoskeletal and Neuromuscular Interventions: a physical approach
to Cystic Fribrosis. J Royal Soc of Med. 2005 98(Sup):55-66.
• Aluminum Shell
• Unopened
• Opened
• Trunk
– Muscular
contractions protect
the skeleton from
being crushed by
outside forces
Diaphragm
• Separates the two
chambers of the
body: thoracic and
abdominal
• Primary pressure
regulator
• Sealed at top by
vocal folds
• Sealed at bottom by
pelvic floor
• Regulated by the
muscles of the trunk
and pelvic floor
which gives pressure
regulation
• Allows multi-tasking
• Function of internal
organs is supported
by this pressure
• Take the muscle
function away and
the pressure collapse
has an effect on the
function of the
internal organs
Posture
• Static
– Kneeling, standing, lying, sitting
• Dynamic
– Walking, running, jumping, etc.
• Analysis
– X-Ray (Scoliosis), Photography, EMG
– Force Plates
– Plumb Line?-divide body in half
Good Posture
• In a standing position:
– Straight vertical alignment
– Through top of head
– Through body center
– To bottom of feet
Key Points
Ext. Auditory Meatus
Acromion, bisect
Ant. Thoracic spine
Bisect Lumbar
Spine
Posterior to hip joint
Anterior to knee joint
Ant. To lateral
malleolus=very
anterior tip of bone
Muscle Testing and Function, 3rd ed.
Sagittal View: Questions
• Are the normal spinal curves exaggerated or
reversed?
• Is the body displaced relative to the center of
gravity?
• Is the head position balanced over the body?
Forward Head Posture
Sagittal View
• Upper cervical
• Lower cervical
• Thoracic spine
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–
–
–
–
Facet joints
Intervertebral foramen
Extensor mm.
TMJ
Scapula, GH joint.
Fig. 9-50
Forward Head Posture
• Muscles:
• Upper Cervical Spine
extensors are tight if
the chin looks tilted
in the air or is
leading the body
• Levator Scapula
muscles are weak,
lengthened
3) Upper Cross Shoulder Syndrome
Affects the functional
capacity of the cervical
spine and upper
extremity
Muscles which are weak
and inhibited;
lower trapezius and
serratus anterior, deep
neck flexors
Muscles which are shortened
and hypertonic:
upper trapezius, levator
scapulae, scalene muscles
Muscles which are short and
tight: pectoralis major and
minor, interscapular muscles,
sternocleidomastoid,
suboccipital muscles
UCS cont.
• Results:
– Forward head posture
– Loss of lower cervical lordosis
– Extension of upper cervical spine
– Increase kyphosis of cervical thoracic junction
– Internal rotation of shoulder girdles
C-T junction: Dowager's hump
• 1-3 thoracic vertebrae
fracture
• Increase in soft tissue
around the CT junction
• Osteoporosis is the
main cause
• Anterior wedging of the
vertebrae, height
anterior is less then
posterior
Shoulder Position
• Anterior Shoulders
– Humerus is in front of
acromion rather than
centered
– Creates a rounded
anterior position of
shoulder girdle
– Leads to impingement
syndromes of the
shoulder
Faulty Thoracic Spine and Chest
Postures
• Kyphotic Posture:
– Shortened pectorals
– Tight intercostals
• Flat T Spine
– Hypermobility
– Spinous processes are more approximated
– Less shock absorption
T-Spine: Round Back (kyphosis)
• Most begin with a
decrease in pelvic
inclination (angle of
inclination=less of an
angle then less shock
absorption.
• Body compensates by
rounding out the
thoracic or
thoracolumbar spine
T-Spine: Hunch Back (gibbus)
• Structural
• Anterior wedging of 1-2
thoracic vertebrae
• Increased lumbar,
change in width
T Spine: Pigeon Chest
• Sternum projects
forward and downward
• Increase in AP diameter
• Congenital Deformity
• Restricts ventilation
volume
Magee D. Orthopedic Physical
Assessment, 4ed
T Spine: Funnel Chest
• Congenital deformity
• Sternum is pushed posterior
by overgrowth of ribs
• A/P diameter is decreased
• Heart may be displaced
• Inspiration: hollow
depression
Magee D. Orthopedic Physical
Assessment, 4ed
T Spine: Barrel Chest
• Sternum projects
upward
• Increase in A/P
diameter
• Pathological conditions:
emphysema
Magee D. Orthopedic Physical
Assessment, 4ed
• Exam question on
last 3 pervious slides,
over increase in A/P
for two, but not for
one.
Normal and Faulty L and T Spine
Alignments
Muscle Testing & Function, 3rd ed.
Human Movement, 5th ed
Muscles
activation:
isometric?
Endurance
Muscle Testing and Function, 3rd ed.
KyphosisLordosis
Posture
Muscle Testing and Function, 3rd ed.
Postural Fault/Increased Lumbar
Lordosis
• Lumbar spine
– Hyperextension
• Pelvis
– Anterior tilt
• Hip joint
– Flexion
• Muscles Shortened
– Erector spinae
– Hip flexors
• Muscles Lengthened
– Abdominals
– Hip extensors
Mechanical Low Back Pain, 2nd ed.
Muscle Testing and Function, 3rd ed.
Sway-back Posture
• Lumbar spine
– Lordosis?
• Pelvis
– Posterior tilt
• Hip joint
– Extension
• Muscles Shortened
– Abdominals
– Hip extensors
• Muscles Lengthened
– Hip flexors
Flat back
• T spine is mobile, with Inc.
flexion
• L spine: flexed (straight)
• Decrease in pelvic
inclination, posterior pelvic
tilt
• Hip and Knees: extended
• Ankles: slight plantar flexion
• Not structural but
functional
Kendall F. Muscle Testing and
Function, 5ed
Flat-Back Posture
• Lumbar spine
– Flexion
• Pelvis
– Posterior tilt
• Hip joint
– Extension
• Muscles Shortened
– Abdominals
– Hip extensors
• Muscles Lengthened
– Erector Spinae
– Hip flexors
“Slouched” sitting posture
• C-spine
• T-Spine
Fig. 9-70
Muscle Testing and Function, 3rd ed.
Questions to Ask
• Are the shoulders and the scapulae
symmetrical?
• Is there a lateral curvature of the midspinal
line?
• Is the head held to one side? Which side?
• Is the pelvic position asymmetrical? (are the
iliac crests level?)
• Is there a special flatness or fullness of the
paravertebral muscle mass?
• Are the feet placed symmetrically or not?
• Is the body rotated as a whole?
• Are the Achilles tendons deviated or
symmetrical?
• Are the positions of the malleoli symmetrical
in relation to the heels?
• Are the arm positions symmetrical?
• Are the waist folds symmetrical?
Muscle Testing and Function, 3rd ed.
Muscle Testing and Function, 3rd ed.
Muscle Testing and Function, 3rd ed.
L. Thoracolumbar scoliosis
• T-spine
– R. lateral flexion
– Convex toward left
• Pelvis
– May or may not be
affected
• Muscles Shortened
– Right lateral trunk
muscles
– Left Psoas
• Muscles Lengthened
– Left lateral trunk
muscles
– Right Psoas
Scoliosis
• Functional vs.
Structural
• Named superior 1st
• Wedging of vertebral
bodies
• Other changes:
– Sh. Height
– Scapular position
– Rib hump
Joint Structure & Function, 3rd ed.
Curve Patterns
Magee D. Orthopedic Physical
Assessment
Rib Hump
• Seen when a patient flexes
forward
• Spine rotates to one side
• Ribs push out posterior,
appear higher
• Narrowing of thoracic rib
cage occurs
CIBA 30(1) 1978
Therapeutic Exercise Moving Toward
Function, 2nd Ed.
Scoliosis
Fig. 9-59
Anterior View: Questions
• Are the shoulders level symmetrical at the midsternal line?
• Is the head tilted to one side? Which side?
• Does the normal horizontal clavicular line deviate?
Which direction?
• Is the pelvic position asymmetrical?
• Are the patella deviated laterally or medially?
• Is the femur rotated medially or laterally?
Cock Robin Head Position
• Upper cervical joint dysfunction:
Rotation of the Occiput between
C0 and C1
• Frontal plane motion about a Z
axis (through the nose)
• Gives appearance of a tilted
head to one side
• May be an indication of upper
cervical trauma or biomechanical
dysfunction
Handedness Pattern
• Right handed:
– Right shoulder lower than the left
– Pelvis deviated slightly to the right side
– Right hip appears higher than the left
– May see deviation of spine to the left side slightly
– Left foot is more pronated than right
Lower Extremity
• Hip and Knee flexion contracture
– Quad activation: @ 15 dg., up to 22% increase in MVC
• Genu Recurvatum
– Plantar flexed ankle
Joint Structure & Function, 3rd ed.
LE – may observe patella
positioning in relation
to the LE alignment,
Varus or valgus
position of knees,
Patella: Frontal Plane
• Torsion (Hip, tibia)
• Patella tracking?
Joint Structure & Function, 3rd ed.
Foot Alignment: Sagittal View
• Feiss Line: - blue line 1st metatarsal, through
middle of navicular and goes to medial malleolus.
• Navicular drop
• Sagittal view
Joint Structure & Function, 3rd ed.
Pes Planus-flat foot
• Talar Head
• Spring ligament
• Tibialis posterior
Joint Structure & Function, 3rd ed.
Pronated Foot
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•
•
•
Affect at:
Knee joint
Patella
Hip joint
Fig. 14-30
Pes Cavus
• Mobility vs. Pes Planus
Joint Structure & Function, 3rd ed.
Supinated Foot
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•
•
•
Affect at:
Knee joint
Patella
Hip joint
Fig. 14-31
Genu Recumvatum
Ankle PF
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Affect @
Knee joint
Hip joint
Hip
Lumbar spine
Tight gastroc
Fig. 13-42