ONE1_02_Postural_Assessment
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Transcript ONE1_02_Postural_Assessment
Chapter 2
Posture is how the body balances.
Muscles, bones, and ligaments all work together to
exert postural control.
The nervous system innervates these structures to
regulate growth and function.
Muscles and their nerves…
A) provide stability to the trunk.
B) produce movement during physiologic activity.
The motor system consists of bones, muscles, and
ligaments.
The nervous system controls the motor system.
Postural analysis is an assessment of the function of
the motor system as well as the nervous system.
The brain and nervous system utilize information from
three sources to balance the body in space.
Sources of balance…
Eyes – level.
Ears – vestibular apparatus.
Muscles and joints – proprioceptive pathways.
A postural reaction that turns a falling animal's body
in space so that its paws or feet are pointed at the
ground.
Returns the animal to sternal recumbency after being
placed on its back or side.
A normal reaction is dependent on normal vestibular,
visual and proprioceptive functions.
Postural changes can be the cause of a clinical
problem.
Postural changes can be the effect of a clinical
problem.
Orthopedic problems can cause a postural change,
which can worsen the orthopedic problem.
Asymptomatic postural problems can produce
mechanical stress, which can predispose an
individual to injury.
There is no “normal” posture.
Ideal posture serves as a reference point.
Ideal posture…
Distributes gravitational stress for balanced muscle
function.
Allows joints to move in their mid range to minimize
stress on ligaments and articular surfaces.
Effective for the individual’s activities of daily living.
Allows the individual to avoid injury.
Good habits contribute to a strong and stable posture.
Bad habits contribute to poor posture and instability.
Excessive sitting.
Carrying a heavy backpack.
Slumping.
Poor sleeping positions.
One-sided activities…
Carrying a heavy purse.
Sitting on a wallet.
Sitting in a twisted position.
Overstressed muscles tighten.
Favored muscles weaken.
This imbalance perpetuates the poor posture.
Anterior to posterior.
Lateral.
Helical.
Foundational distortions create changes above.
Palpate for hypertonic (overused) muscles.
Palpate for weak / inhibited muscles.
A muscle is weak because it is unstressed and should
be strengthened with exercise.
An inhibited muscle is not being used because it’s
antagonistic muscle is being overused.
Reciprocal inhibition describes muscles on one side of
a joint relaxing to accommodate contraction of
muscles on the other side of a joint.
Postural (tend to
hyperactivity)
Triceps surae
Hamstrings
Adductors
Rectus femoris
Tensor fascia latae (TFL)
Psoas
Erector spinae
Phasic (tend to
hypoactivity)
Tibialis anterior
Gluteus maximus
Gluteus medius
Rectus abdominus
Lower / middle trapezius
Longus capitus and colli
Deltoids
Digastrics
Postural (tend to
hyperactivity)
Quadratus lumborum (QL)
Pectoralis
Upper Trapezius
Sternocleidomastoid
Suboccipital
Masticatories
Obtain pertinent history.
Description of symptoms.
Fractures.
Injuries.
Congenital anomalies.
Dominant hand.
Note gross structural asymmetries such as scoliosis.
Occipital protruberance.
Cervical, thoracic, and lumbar spinous processes.
Coccyx.
Gluteal folds.
Arms should hang equally with palms slightly visible.
The space between the arms and sides of the body
should be equal.
Legs should be equally abducted.
The backs of the knees should be the same.
Ankles and feet aligned b/l (no pronation or
supination).
Structures that should be level and equal.
Tips of mastoid processes.
Acromia.
Scapula.
Lower margins of 12th ribs.
Iliac crests.
Posterior superior iliac spines (PSIS).
Ischial tuberosities.
Evaluate from both sides.
Landmarks.
External auditory canal.
Acromion process of shoulder.
Axillary line.
Mid-point of iliac crest.
Greater trochanter of hip.
Lateral condyles of femur.
Tibia slightly anterior to lateral malleolus.
Balanced posture should appear equal from left to
right.
Landmarks.
Bridge of nose.
Center of chin.
Episternal notch.
Xiphoid process.
Umbilicus.
Pubes.
Arms should hang similarly with palms at the side of
the thighs
Shoulder girdle symmetry
Hands should show similar rotation and placement on
the body
Legs should appear equally abducted from the center
line
Feet aligned b/l
No pronation / supination
No inversion of eversion
Knees forward and symmetric b/l
Structures that should be equal b/l and level
Eyes
Clavicles
Lower margins of the ribcage
Anterior superior iliac spines (ASIS)
Femoral trochanters
Knees
Ankles
Affects the head, neck and shoulders.
Result of long-term seated postures.
Rolled-in and forward shoulders.
Increased thoracic kyphosis.
Forward head posture.
Loss of cervical lordosis.
Postural finding
Dysfunction
Rounded shoulders
Shortened pectorals
Forward-drawn head
Kyphotic t-spine
C0-C1 hyperextension
Winging of scapulae
Elevation of shoulders
Short suboccipitals
Weak serratus anterior,
weak rhomboids
Shortened upper trap,
shortened levator
scapulae, weak lower and
middle trap
Tight-short muscles
Weak-long muscles
Suboccipitals
Mid to lower trapezius
Pectorals
Serratus anterior
Anterior shoulder
Rhomboids
Upper trapezius
Affects the lumbar spine and pelvis.
Anterior pelvis and increased lumbar lordosis.
Tightness in the psoas and lumbar erector spinae.
Long-term sitting contributes to this syndrome as well.
Weak gluteus maximus and short hip flexors.
Weak abdominals and short lumbar erector spinae.
Weak gluteus medius and short TFL and QL.
Postural finding
Dysfunction
Lumbar hyperlordosis
Shortened erector spinae
Anterior pelvic tilt
Weak gluteus maximus
Protruding abdomen
Weak abdominals
Foot turned out
Shortened piriformis
Hypertrophy of
Hypermobile lumbosacral
thoracolumbar junction
Groove in iliotibial band
junction
Shortened tensor fascia
latae
Layered syndrome is a combination of the muscle
imbalances seen in both upper and lower crossed
syndrome.
It develops with chronic cases.