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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
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 patients 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 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
Passive insufficiency
Muscle is lengthened and cannot generate sufficient tension to be effective
Antagonist
Performs opposite movement of agonist and must relax to allow agonists motion to occur Reciprocal inhibition
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
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 patients 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
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 patients general body type
Ectomorph, mesomorph, endomorph Inherited Can indicate a persons natural abilities and disabilities Does not necessarily dictate how they may function Box 3-1, page 64
Views
Lateral view
Table 3-9, page 63
Anterior view
Table 3-10, page 66
Posterior view
Table 3-11, page 67
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
Palpation
Posterior aspect
Many of same landmarks used for anterior view PSIS position
Figure 3-12, page 72
Potential muscle imbalances can cause poor posture OR be a result of poor posture Deviations also caused by skeletal malalignment, anomalies, or combination
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
Most soft tissue dysfunctions that have a gradual, insidious onset have, at least, a minimal postural component