Posture and Inclinometry

posture

relative arrangement of parts of the body, position in which you hold your body

posture is often thought of as

static positioning - but involves coordinated action of many muscles to maintain stability

inactive posture

postures adopted during resting or sleeping, require little muscular activity

active posture

integrated action of many muscles required for active posture

static posture

how the body is positioned, aligned and maintained during certain positions like standing, sitting, kneeling

dynamic posture

the body or its segments are moving (walking, running, throwing, jumping, lifting) (AKA body mechanics)

traditional view of posture

ideal posture with "correct" and "incorrect"

studies about posture vary in stating

theres no link in posture and MSK pain, correcting posture does not alleviate chronic pain, etc.

emerging view of posture

beneficial to strive for postural variability, comofortable change posture and ability to adapt posture to a situation (next posture is best posture)

assessments necessary to determine the role of posture in body mechanics

body alignment, muscle strength, muscle length/flexibility and ROM

common PT goal for posture

adequate ROM and strength, but not excessive - attempt to restore their balance (patient specific)

posture is often the first assessment done following

subjective assessment

typical sequence of PT exam tests

subjective, posture, GAIT, ROM-strength, special tests

reasons why some have bad posture and no pain

variance in constancy of postural deviance, mobility deficits or advantages, motor control issues, etc.

postural dysfunction

chronic positioning of the spine/body in position that is unnatural or out of neutral position

postural dysfunction results in

joints, muscles, and vertebra in stressful positions

prolonged positioning increases load/stress on tissues, can lead to

imbalance, elongated/shortened tissues, stretch weakness, stiffness/weakness, microtrauma, difficulty digesting or breathing, urinary incontinence

potential causes of postural dysfunction

repetitive activities, sports, work stresses, physiological/age, medical/pathology, anything that can lead to asymmetry or muscular imbalance

if it is deemed a postural deficit is structural

it can be attributed to a bony cause - determine if PT can change this, or if there are accommodations that can be made to improve function

taking a "normal" postural assessment can be helpful for

describing asymmetries

ideal anterior/posterior plumb line

midway between heels, betweens LEs, midline of pelvic, spine, sternum and skull

ideal lateral plumb line

external auditory meatus, midway shoulder/acromion, lumbar vertebral bodies, through greater troch. of hip, slightly anterior to knee and lateral malleolus, calcaneocuboid joint

neutral position =

zero position

normal spinal curves for weightbearing

cervical lordosis (ant convex), thoracic kyphosis (ant concave), lumbar lordosis (ant convex)

neutral pelvis position

ASIS same horizontal plane, ASIS and pubic symphysis same vertical plane

describe any deviation from standard as

mild, moderate or significant

common methods for postural assessment

visual, photographs, posture grids, smartphone apps

forward head posture

head froward of shoulders, upper back increase kyphosis, cranial extension (to keep eyes up), neck and cranial extensors shorten (increased tone), neck and cranial flexors lengthen and weaken

upper crossed syndrome states what is weak

deep neck flexor and scapular stabilizers, retractors and depressors

upper crossed syndrome states what is unihibited/overactive

upper trap, levator scap, and pectoral group

pelvic crossed syndrome

low ASIS, high PSIS

what is lengthened and weak with pelvic crossed syndrome

abdominals, gluteals

what is tight with pelvic crossed syndrome

erector spinae, iliopsoas, and hamstrings

flat back posture

head forward, slightly extended, upper thoracic increased flexion, lower thoracic flattened, lumbar spine flattened, posterior pelvic tilt, hips slightly extended

sway back posture

head forward, C-spine slight extension, thoracic increased flexion, posterior displacement of upper trunk, flattened lumbar

kyphotic/lordotic posture

head forward, C-spine hyperextended, scapulae abducted (rounded shoulders), thoracic kyphosis increased, lumbar lordosis increased, anteriorly tilted pelvis, hips slightly flexed, knees potentially hyperextended, ankles slight relative PF

likely muscle imbalances with kyphotic/lordotic posture

weak deep neck flexors, abdominals, glute max, and long thoracic extensors, tightened upper trap, levator scap, iliopsoas, erector spinae, lumbar extensors

methods to measure resting scapular position

use scapular landmarks - inferior/superior angles, spine of scap

postural assessment views

anterior, posterior and lateral (start at the feet and work upwards)

to standardize a posture assessment

have patient make a sandwich with one of your feet in the middle

inclinometers can

be used on small surfaces, good to measure cervical ROM (can meausre back ROM with 2 inclinometers)

smart phone apps as inclinometers have

good intra-rater reliability, low inter-rater reliability, good validity for frontal and sagittal plane