Posture deviations

Plumb line ideal alignment

anterior to lateral malleolus, slightly anterior to midline of knee, greater trochanter, midway through trunk, acromion, middle of ear lobe

claw/hammer toe - definition

MTP joints hyperextended, PIP/DIP joints flexed; Claw = DIP flexed, Hammer = DIP straight

claw/hammer toe - cause

weak intrinsic foot muscles

claw/hammer toe - increased risk of

pressure sores on toes, changes in gait due to avoidance of weight on toes

Plumb line posterior to whole body - definition

leaning forward with increased WB on forefoot; increased activity in hip and spine extensors and PF's

plumb line posterior to whole body - cause

habitual posture, stenosis

plumb line posterior to whole body - increased risk of

pain/injury in forefoot, hip, spine; loss of balance/risk of falls

plumb line falls posterior to midline of knee joint

knee is flexed

plumb line falls posterior to midline of knee joint - cause

knee flexion contracture (hamstrings) or dorsiflexors

plumb line falls posterior to midline of knee - increased risk of

spine pain if it causes lateral pelvic tilt (unlateral)

plumb line falls anterior to knee joint

knee hyperextension (genu recurvatum)

plumb line falls anterior to knee joint - causes

generalized ligamentous laxity, tight plantarflexors, weak quads/stretched posterior capsule

plumb line falls anterior to knee joint - increased risk of

pain/injury to posterior capsule or ligaments of knee (instability)

posterior pelvic tilt - definition

ASIS is higher than PSIS and posterior to pubic symphysis; decreased lumbar lordosis (flexion)

posterior pelvic tilt - causes

habitual posture, arthritis of lumbar spine

posterior pelvic tilt - associated muscle imbalances

tight hip extensors and abs, lengthened/weak hip flexors and lumbar extensors

posterior pelvic tilt - increased risk of

back pain due to flexed lumbar spine posture

flat back

flattening of lumbar lordosis involving posterior pelvic tilt

sway back

posterior pelvic tilt posture that causes the pelvis to be displaced anteriorly and increases thoracic kyphosis

anterior pelvic tilt - definition

ASIS is lower than PSIS and anterior to pubic symphysis (lumbar extension)

anterior pelvic tilt - cause

habitual posture, obesity

anterior pelvic tilt - associated muscle imbalance

tight hip flexors and lumbar extensors, lengthened/weak abs and hip extensors

anterior pelvic tilt - increased risk of

facet joint pain, lordosis - kyphosis posture

barrel chest

increased anteroposterior diameter of ribcage; due to chronic respiratory problems/overuse of accessory breathing muscles

increased thoracic kyphosis - causes

arthritis of spnie, habitual posture, compression fx, Scheuermann's disease

increased thoracic kyphosis - associated muscle imbalance

tight rectus abdominis, lengthened/weak thoracic extensors

increased thoracic kyphosis - increased risk of

back and neck pain

forward shoulders - cause

habitual posture

forward shoulders - associated muscle imbalance

tight pecs, lengthened rhomboids and middle/lower traps

forward shoulders - increased risk of

neck and shoulder pain

forward head - cause

habitual posture

forward head - associated muscle imbalance

tight suboccipitals, lengthened deep neck flexors

forward head - increased risk of

TMJ and neck pain

supinated feet - definition

pes cavus; calcaneus is inverted - high arch

pes cavus - cause

structural abnormality of arches of foot - high arch

pes cavus - increased risk of

pain in any WB joint, stress fx on outside of foot

pronated feet - definition

pes planus; calcaneus is everted (normal in children under 7)

pes planus - cause

structural abnormality of arch - flat foot; generalized ligamentous laxity; weak intrinsic foot muscles

pes planus - increased risk of

pain in any WB joint, stress fx on inside of foot, overuse injuries of arch support muscles (posterior tibialis)

femoral rotation - definition

hamstring lines on back of knee don't point posteriorly

medial femoral rotation - cause

weak hip external rotators, pronated feet

genu valgum

knock knees; valgus angle < 165*; normal for kids under 7

structural genu valgum - cause

knock knees related to coxa varum

coxa varum

abnormally decreased angle of neck of femur

postural genu valgum

hyperextended knees, femoral anteversion

static genu valgum

structural or postural genu valgum - seen when standing

dynamic genu valgum

knees pushing medially during activity such as squatting or jumping; need to strengthen external rotators

genu varum

bow legs; valgus angle > 180*

structural genu varum - cause

bow legs related to coxa valgum or due to degeneration of medial compartment of knee

coxa valgum

abnormally straight angle of neck of femur

postural genu varum

hyperextended knees/ medially rotated femurs

lateral tilt of pelvis - causes

leg length discrepancy, knee flexion contracture, hip add or abd contracture, scoliosis

lateral tilt of pelvis - increased risk of

spine pain

scoliosis - definition

lateral curvature of the spine

structural scoliosis sign

rib hump

scoliosis - increased risk of

spine pain, breathing difficulty if severe

winging of scapulae

medial borders of scapulae lift off rib cage

winging of scapulae - cause

weak serratus anterior

winging of scapulae - increased risk of

shoulder pain (shoulder muscles overcompensating)

abducted scapulae - definition

vertebral border of scapulae is at least 3 inches away from spine

abducted scapulae - associated muscle imbalance

tight pecs, lengthened rhomboids/mid/lower trap

abducted scapulae - increased risk of

shoulder pain (overcompesation)

shoulder medial rotation - sign

olecranon processes point laterally instead of posteriorly

shoulder medial rotation - associated muscle imbalance

tight internal rotations, lenghtened external rotators

shoulder medial rotation - increased risk of

shoulder pain

elevated or depressed shoulder girdle - cause

hand dominance - lowers shoulder girdle; protective posturing elevates shoulder girdle

elevated shoulder girdle - associated muscle tightness and pain

scapular elevators --> neck, shoulder pain

head tilt/rotation - cause

habit, cervical pathology, tight muscles

head tilt/rotation - increased risk of

neck pain

bunions

hallux valgus; abduction of big toe

hallux valgus - cause

hereditary bone structure, tight/pointy shoes

hallux valgus - increased risk of

MTP joint pain, gait deviations

tibial torsion

patella facing straight ahead but toes are not

medial tibial torsion

patellae facing straight ahead, toes are pigeon-toed (in)

lateral tibial torsion

patellae facing straight ahead, toes are facing outward

tibial torsion - cause

abnormal bony structure

medial-facing patella - definition

patella face medially

medial-facing patella - cause

abnormal bony structure

medial-facing patella - associated deviations

femoral anteversion (inward twist), medial femoral rotation, pigeon-toed feet (unless lateral tibial torsion is also present)

lateral-facing patella - definition

patella faces up and out

lateral-facing patella - cause

abnormal bony structure

lateral-facing patella - associated deviations

femoral retroversion (twist out), lateral femoral rotation, excessive toe out (unless medial tibial torsion is also present)

asymmetry of clavicles - causes

Fx, depressed shoulder girdle due to hand dominance, elevated shoulder girdle due to protective posturing