Posture Evaluation

Posture is dynamic it changes in response to our emotions, attitudes, height, weight, and physical conditioning. One major contributor to poor postural alignment is faulty body mechanics. It is important to keep opposing muscle groups of the body in equal tone and length in order to avoid, or to reduce, poor postural alignment. In order to correct postural problems, they must first be identified. Many types of posture evaluation are available the New York Posture Evaluation is one such method, and has been modified for the purposes of this lab. Some of the common postural deviations are presented in the following paragraphs: Lateral Head Deviation: A head tilt or twist to the side (also referred to as torticollis or wryneck). When held in the position of tilt or twist over time, there is an adaptive shortening of the neck muscles on the side of the tilt or twist. Exercises to correct the problem must be designed to stretch the tight/shortened muscles and strengthen the weak/lengthened muscles. Low Shoulder: When shoulder heights are unequal, the condition is referenced according to the high side (i.e., left high, right high). Unequal shoulder height may be due to scoliosis, muscular imbalance, or anatomical deformity (e.g., leg length discrepancy). Scoliosis: A lateral curvature of the spine. The deviation can be a single curve (C) or a double curve (S). If scoliosis is caused by a muscular imbalanced, it is referred to as functional, and exercise can be used to reduce or correct the curvature. If scoliosis is caused by a bony structure problem, it is referred to as structural, and exercise will be of little value; it may even be harmful. Most cases of scoliosis, however, are idiopathic, meaning that the cause is unknown. Exercises designed for functional scoliosis should stretch the muscles on the concave side of the curve and strengthen the muscles on the convex side. CAUTION: exercises for scoliosis should be symmetrical. Use asymmetrical exercises only on the advice of a physician. Low Hip: When hips are of uneven height, the cause may be scoliosis, uneven leg length, or the habit of standing on one leg for prolonged periods. Exercises should be geared toward resolving pelvic balance. Pronation: A straight line running through the patella, center of the ankle joint, and second toe is indication of properly aligned feet. Pronated feet roll medially away from that straight line. Exercises to correct pronation should focus on strengthening the medial muscles of the ankle and foot while stretching the lateral muscles. Flat Feet: Good alignment can be maintained with a high, medium, or low arch. If the muscles of the legs and feet are strong, and there is no pain or discomfort, a flatfoot is not a postural problem. Tibial Valgus: In this condition, the distal end of the tibia deviates laterally. This places stress on the medial structures of the knee and the lateral structures of the ankle; the condition is often referred to as knock knees. Tibial Varus: In this condition, the distal end of the tibia deviates medially. This places stress on the lateral structures of the knee and the medial structures of the ankle; the condition is often referred to as bowlegs. Forward Head: To be properly aligned, the ear lobe should be in line with the tip of the shoulder. In its mildest form, the head droops forward because the person is unaware of the forward posture being assumed. Exercises for this form should focus on strengthening the neck extensors. In its severe form, forward head is associated with round back, or hyperkyphosis. This form of forward head requires exercises designed to stretch the neck extensors.

Winged Scapulae: The inferior angle (medial border) of the scapulae lift away from the thoracic wall (ribs). The functional cause of winging scapula is usually attributable to a weakness in the Serratus Anterior, or a nerve deficit in the Long Thoracic nerve, or in the Brachial Plexus prior to the Long Thoracic nerve. Developmentally winged scapulae are normal for preschool and early elementary children. Round Shoulders: This is a forward deviation of the shoulder girdle. Round shoulders result in the acromion processes being brought forward and the scapulae protracted with some lateral tilt. Corrective exercises should stretch the protractors and strengthen the retractors. Sagging Abdomen or Lordosis: Lordosis is an exaggerated curve in the low back and is often referred to as swayback (this condition is more appropriately termed hyperlordosis, due to the natural lordotic curve of the lumbar spine). Weak abdominal and hip extensor muscles and shortened (tight) lumbar hyperextensors and hip flexors contribute to lordosis. To correct lordosis, exercises which strengthen the abdominals/hip extensors and stretch the lumbar hyperextensors/hip flexors.

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Posture Evaluation
For the following described postural deviations, describe an exercise/exercise regimen that would be appropriate. Additionally, discuss why the suggested exercise(s) is/are appropriate. TYPE your answers. 1. 2. 3. 4. 5. You are treating a patient with a left lateral head deviation. Describe appropriate corrective exercise(s). You are treating a patient with pronated feet. Describe appropriate corrective exercise(s). A patient with a mild right C curve scoliosis comes to your for treatment. Assuming that the scoliosis is functional, describe appropriate corrective exercise(s). A patient presents with a lordosis score of 1; describe appropriate corrective exercise(s). A person in your exercise class has a rounded shoulders condition. Describe two exercises that would be contraindicated (not recommended).

Posture Scoring Sheet Good 10 Head

Head erect, gravity line passes through center Shoulders level (horizontally)

Fair 5
Head twisted or turned slightly to one side One shoulder slightly higher

Poor 0
Head twisted or turned markedly to one side One shoulder markedly higher

Shoulders

Spine

Spine Straight

Spine slightly curved laterally

Spine markedly curved laterally

Hips

Hips level (horizontally)

One hip slightly higher

One hip markedly higher Feet pointed out markedly, ankles sag in pronation Neck markedly forward, chin markedly out Upper back markedly rounded Trunk inclined markedly to rear

Ankles

Feet pointed straight ahead

Feet pointed out

Neck

Neck erect, chin in, head directly above shoulders Upper back normally rounded Trunk erect

Neck slightly forward, chin slightly out Upper back slightly more rounded Trunk inclined slightly to rear

Upper Back

Trunk

Abdomen

Abdomen flat

Abdomen protruding

Abdomen protruding and sagging Lower back markedly hollow

Lower Back

Lower back normally curved

Lower back slightly hollow

Final Score

NEW YORK STATE POSTURE TEST Purpose: To evaluate lateral and anteroposterior body posture. Equipment: Plumb line, screen (or suitable background), masking tape, measuring tape. Procedure: 1. 2. 3. Hang a plumb line from a stationary support about 4 feet in front of a screen. Perpendicular to the screen, place a line of masking tape on the floor directly beneath the plumb line; extend it 10 feet toward the examiner. The person being examined stands between the screen and the plumb line, facing the screen, for the first part of the evaluation. The plumb line should pass directly up the middle of the back. The examiner rates the posture from the rear by comparing it with the profiles shown on the accompanying page. The examiner then rates posture from the side in a similar manner.

4. 5.

Scoring: The examiner assigns a point value of 10, 5, or 0 for each body area, according to the profile that best matches the persons posture. Final score is determined by totaling the individual scores.

3 - 4 ft

10 ft

Observer stands here