Transcript Chapter 3 - Assessment of Posture

Chapter 3
Assessment of Posture
Introduction
 Posture is the position of the body at a given
point in time
 Correct posture can:
– improve performance
– decrease abnormal stresses
– reduce the development of pathological
conditions
Introduction
 Faulty posture:
– Deviates from ideal posture
– Requires an increased amount of muscular
activity
– Places an increased amount of stress on the
joints and surrounding tissues
 Restrictions in normal movement patterns
may cause compensatory postures
– Overtime can result in muscle imbalances and
soft tissue dysfunction
Introduction
 Pain related to postural deviations is a
common clinical occurrence
– Many do not seek help until pain is experienced
 Postural assessment is used to determine if
postural deviations are contributing factors
in patient’s pain or dysfunction
 Posture must be evaluated in functional and
nonfunctional positions
Clinical Anatomy
 Musculoskeletal system is designed to
function in a mechanically and
physiologically efficient manner to use the
least possible amount of energy
 Postural deviations or skeletal malalignment
cause other joints in kinetic chain to undergo
compensatory motions or postures to allow
body to move as efficiently as possible
The Kinetic Chain
 Closed kinetic chain
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Weight-bearing
Lower extremity
Distal segment meets resistance or is fixated
Interdependency of each joint = predictable changes in
position
– Figure 3-1A, page 53
 Open kinetic chain
– Non-weight-bearing
– Upper extremity
– Distal segment moves freely in space
The Kinetic Chain
 A dysfunction occurring in one area may
affect the proximal or distal associated joints
and soft tissue structures
– Causing a specific postural deviation
 The body compensates for these deviations
to maintain as much efficiency as possible in
movement and function
 Table 3-1, page 54
Muscular Function
 Muscles produce joint motion and provide
dynamic joint stability
 Muscles must be of adequate length and
function in a proper manner
– If too short or too long
 Adverse stress on joints
 Work inefficiently
 Create need for compensatory motions
 Table 3-2, page 55
Muscular Length-Tension
Relationships
 Describes how a muscle is capable of
producing different amounts of tension
(force), depending on its length
 Active insufficiency
– Muscle is shortened and maximum tension
cannot be produced
 Passive insufficiency
– Muscle is lengthened and cannot generate
sufficient tension to be effective
 Figure 3-4, page 56
Agonist and Antagonist
Relationships
 Agonist
– Muscle that contracts to perform the primary movement
of a joint
 Antagonist
– Performs opposite movement of agonist and must relax
to allow agonist’s motion to occur
– Reciprocal inhibition
 Bicep/triceps example
 Co-contraction
– Used for dynamic stability of joint
Muscular Imbalances
 Impaired relationship between a muscle that
is overactivated, subsequently shortened
and tightened and another that is inhibited
and weakened
– Table 3-3, page 57
 Postural vs. phasic muscles
– Table 3-4, page 57
– Table 3-5, page 57
Soft Tissue Imbalances
 Joint’s capsule and surrounding ligaments
undergo adaptive changes from prolonged
overstressing or understressing of structure
 Faulty posture can alter the position of
joints, causing an increase in stress on
different portions of the joint capsule and
surrounding ligaments
Clinical Evaluation of Posture
 Not an exact science
– Radiographs, photographs, computer analysis
– Clinical tools – plumb lines, goniometers,
flexible rulers, inclinometers (fig. 3-5, page 58)
 Subjective vs. objective methods
– Normal, mild, moderate, severe posture
– Quantifiable measurements can assess
treatment plan
Clinical Evaluation of Posture
 Commonly assessed in various positions
– Standing and sitting
– Sport-specific and ADLs
 Orthoposition
– Normal or properly aligned posture
– 4 movements to perform before assessment
 Page 58
History
 To determine if a postural dysfunction is
contributing to the patient’s pathology
 Identify any routine repetitive motions
 IF injury is chronic
– Explore day to day tasks and posture
 If injury is acute
– Determine factors that may have predisposed
athlete to the injury
History
 Mechanism of injury
– Common responses
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Insidious onset
Pain worsening as day progresses
Posture-specific pain
Intermittent, vague , or generalized pain
Starting as an ache and progressing
 Type, location, and severity of symptoms
 Side of dominance
 Activities of daily living
– Table 3-7, pages 60-61
History
 Driving, sitting, and sleeping postures
– Table 3-8, page 62
 Specific postures causing discomfort
 Level and intensity of exercise
 Medical History
Inspection
 Considerations
– Area being used is private, comfortable
– Patient preparedness
– Do not inform patient you are assessing posture
– Use systematic approach
 Start at feet and work superiorly or vice versa
– Compare bilaterally for symmetry
– Your eyes should be at level of region you are
observing
Overall Impression
 Determine patient’s general body type
– Ectomorph, mesomorph, endomorph
– Inherited
– Can indicate a person’s natural abilities and
disabilities
– Does not necessarily dictate how they may
function
– Box 3-1, page 64
Views of Postural Inspection
 Inspect from lateral, anterior, posterior views
 Plumb line
– Feet as permanent landmark
– Lateral view
 Slightly anterior to lateral malleolus
– Anterior and posterior view
 Equidistant from both feet
– Box 3-2, page 65
Views
 Lateral view
– Table 3-9, page 63
 Anterior view
– Table 3-10, page 66
 Posterior view
– Table 3-11, page 67
Inspection of Leg Length
Discrepancy
 Three categories
– Structural (true)
– Functional (apparent)
– Compensatory
– Table 3-12, page 68
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Block method (Box 3-3, page 69)
Figure 3-6, page 68
Figure 3-7, page 70
Figure 3-8, page 70
Palpation
 To determine specific positions (key
landmarks) not necessarily for point
tenderness
 Lateral aspect
– Pelvic position
 ASIS and PSIS, 9-100
 Box 3-4, page 71
Palpation
 Anterior aspect
– Patellar position
– Iliac crest heights
 Figure 3-9, page 70
– ASIS heights
 Figure 3-10, page 70
– Lateral malleolus and fibula head heights
– Shoulder heights
 Figure 3-11, page 72
Palpation
 Posterior aspect
– Many of same landmarks used for anterior view
– PSIS position
 Figure 3-12, page 72
– Spinal alignment
– Scapular position
 Box 3-5, page 73
 Not important at this time
Common Postural Deviations
 Not all postural deviations cause pathology
 Clinicians must identify
– Normal posture
– Asymptomatic deviations
– Deviations causing dysfunction and/or pain
 Potential muscle imbalances can cause
poor posture OR be a result of poor posture
 Deviations also caused by skeletal
malalignment, anomalies, or combination
Foot and Ankle
 Hyperpronation
– Review chapter 4
– Figure 3-13, page 74
 Supination
– Review chapter 4
The Knee
 Genu Recurvatum
– Knee axis of motion is posterior to plumb line
– Box 3-6, page 75
 Genu Valgum
– Occurs due to
 structural anomalies or muscular weaknesses at the hip
 Secondary to hyperpronation of the feet
– Can lead to
 Increased pronation
 Internal tibial and femoral rotation
 Medial patellar positioning
The Knee
 Genu Varum
– Occurs due to
 Structural anomalies at the hip
 Excessive supination
– Can lead to
 Supination
 External tibial and femoral rotation
 Lateral patellar positioning
Interrelationships Between Regions
 Table 3-14, page 83
 May be impossible to determine if posture is
the cause or the effect
– Understand relationships and importance of
correcting the factors involved
 Most soft tissue dysfunctions that have a
gradual, insidious onset have, at least, a
minimal postural component
Documentation of Postural
Assessment
 Table 3-15, page 85
– As part of a SOAP note
 Figure 3-14, page 84
– Standard postural assessment form
 Guidelines for documenting posture
– Pages 83, 85