Postural
Analysis
Aila Nica J. Bandong, PTRP
Instructor
Department of Physical Therapy
UP- College of Allied Medical Professions
PT 142: Assessment in Physical Therapy
LEARNING OBJECTIVES
At the end of the session the learners should
be able to:
•
•
•
•
•
Review basic biomechanics of normal posture.
Review abnormal postures in terms of clinical
picture and anatomic changes
Discuss the examination procedure and related
concepts
Describe the documentation format of results
of postural assessment
Discuss other postural assessment procedures
with technology and work applications
POSTURE
• Relative disposition of the body at any one
moment
• Composite of the positions of the different
parts of the body at the time
• Result of underlying processes or
tensional relationship throughout the
body
• Affected by the integrity of the inert and
dynamic structures surrounding the body
POSTURE
Static
posture
a vertical line,
directly through
the center of
gravity of the body
must fall within the
base of support
the net torque
about each
articulation of the
body must be zero
Dynamic
posture
that which is
adopted while the
body is in action,
or in the
anticipatory phase
just prior to an
action
BIOMECHANICS
Abductors
Abductors
Adductors
Adductors
Tibialis anterior
Peroneals
SIRT
G. Maximus
Hamstrings
Quadriceps
Hamstrings
Gastrocs
Popliteus
Dorsiflexors
Plantarflexors
BIOMECHANICS
Rectus abdominis
Ext. oblique
Lat. trunk ms.
Lat. trunk ms.
Lat. trunk ms
Lateral tilt
Abdominals
External Rotators
External Rotators
Gmax & Gmed
Anterior Pelvic Tilt
Internal Rotators
Internal Rotators
SIRT
ES, QL
Post. back ms
Low back ms
Post. Pelvic Tilt
Rotation
Gluteus max
Hams
Hip adductors
STANDARD POSTURE
Line of
Gravity
Posterior to apex
of coronal suture
Through
EAM
& dens
Plumb
line
alignment
Through ear lobes
Through bodies CV
Through shouder jt.
Through
VB of LV
Posterior to the
center of the
hip jt
Through trunk
Through
sacral
promontory
Ant. To
knee
joint axis
Through
calcaneocuboid jt
Through GT
Anterior to midline
knee
Anterior to lat
malleolus
FAULTY POSTURE
• Any deviation from the normal/proper
posture
FAULTY POSTURE
• Postural pain syndromes
▫ Posture deviates from normal
alignment but no structural
limitation
▫ Mechanical stress but relieved
by activity or change of position
▫ No abnormalities in musculoskeletal
structures
• Postural dysfunctions
▫ Adaptive shortening of soft tissues
and muscle weakness
▫ Imbalance in strength and flexibility
FAULTY POSTURE:
Standing
• Head and neck
• Shoulder and scapula
• Head, neck, shoulder and scapula
• Trunk
• Feet and knees
Head and Neck
• Forward head
▫ Inc flexion of the
lower cervical and
upper thoracic
regions
▫ Inc extension of the
occiput on the upper
cervical vertebrae
▫ Pr0trusion of
mandible
Head and Neck
• Flat neck
▫ Dec cervical lordosis
▫ Inc flexion of the
occiput on the atlas
▫ Retraction of the
mandible
▫ Exaggerated
military posture
Head and Neck
Head
Posterior
Tilt
Head
Anterior
Tilt
Marked
Anterior
Tilt
Forward
Head with
Attempted
Correction
Shoulders and Scapula
Shoulders and scapula
Good position
Scapula Abducted
Slightly Elevated
Scapula Adducted
Slightly Elevated
Shoulders and scapula
Shoulders and scapula
Good position
Shoulders Elevated
Scapula Adducted
Shoulder Depressed
Scapula Abducted
Shoulders and Scapula
Shoulders and scapula
Good position
Scapula depressed
Winging of
the Scapula
Head, Neck, Shoulders and Scapula
• Upper crossed syndrome
▫ The occiput and C1/C2
will hyperextend with
the head being pushed
forward
▫ The lower cervical to 4th
Thoracic vertebrae will
be posturally stressed
▫ Rotation and abduction
of the scapulae occurs
Head, Neck, Shoulders and Scapula
• Upper crossed syndrome
▫ Tight muscles:
Pectoralis major and
minor, upper trapezius,
Levator scapulae, SCM
▫ Weak muscles: Lower
and middle trapezius,
Serratus Anterior,
Rhomboids (Chaitow, 2001)
Trunk
• Kyphosis-Lordosis
Forward head
Increased
cervical lordosis
Scapula Abducted
Increased
thoracic kyphosis
Increased lumbar
lordosis
Anterior pelvic tilt
Knees slightly
hyperextended
Ankles slightly
plantarflexed
Short and Tight:
• Neck extensors
• Hip flexors
• Low back
Lengthened and
Weak:
• Neck flexors
• Hamstrings
• Erector spinae
• Possibly
abdominals
Trunk
• Sway-back
Forward head
Increased
cervical lordosis
Increased
thoracic kyphosis
Decreased
lumbar lordosis
Posterior pelvic tilt
Knees slightly
hyperextended
Ankles neutral
Short and Tight:
• Upper abdominals
• Intercostals
• Hamstrings
Lengthened and
Weak:
• Neck flexors
• Hip flexors
• Thoracic
extensors
• Lower abdominals
Trunk
Normal-slightly
posterior
• Military type
Normal
Normal kyphosis
Increased lumbar
lordosis
Short and Tight:
• Lumbar extensors
• Hip flexors
Anterior pelvic tilt
Knees slightly
hyperextended
Ankles slightly
plantarflexed
Lengthened and
Weak:
• Abdominals
• Hamstrings
Trunk
Forward head
• Flat back
Increased
cervical lordosis
Decreased
kyphosis
Decreased
lumbar lordosis
Posterior pelvic tilt
Knees slightly
hyperextended
Ankles slightly
plantarflexed
Short and Tight:
• Neck extensors
• Abdominals
• Hamstrings
Lengthened and
Weak:
• Neck flexors
• Back extensors
• Hip flexors
Trunk
• Lower crossed syndrome
▫ Tight muscles:
Erector Spinae, Iliopsoas
▫ Weak muscles:
Gluteus maximus,
Abdominals
Trunk
• Scoliosis
▫ Lateral deviation of the spine
▫ Deformity
 Structural
 Fixed deformity
 Apical vertebrae
 Vertebral body on convex
 Spinous process on concave
 Non-structural
 Flexible deformity
 Positional, functional, postural
How is scoliosis detected?
Forward bending test
Skyline view
Description of the curve
1. Named according to convexity
2. Major curve - most significant
curve
3. Minor curve - compensatory
curve
4. Double major curve-2 major
curves that are both
structural
5. Transitional vertebrae neutral vertebra between 2
curves
6. Apex of the curve - greatest
rotation, farthest from the
midline
How is severity of scoliosis measured?
• Angle of curvature
Risser-Ferguson method
Cobb method
How is progression of scoliosis measured?
• Nash-Moe Scale
Feet and Knees
• Ideal alignment
▫ Patella faces forward
▫ Feet are in good
alignment
▫ Hips and feet neutral
Feet and Knees
• Genu Varum
▫
▫
▫
▫
▫
Knee separation
Hyperextension of the knee
Axis of knee is oblique
Hindfoot Supination
Forefoot pronation
Squinting
Patella
Feet and Knees
• Genu valgum
▫ Hip adducted; IR of the femur
▫ Patella tilted medial
 Tracks lateral
▫
▫
▫
▫
Hindfoot pronation
Forefoot supination
Hyperextension
Knee is oblique
Frog eyes
Feet and Knees
• Patella alta
• Patella baja
FAULTY POSTURE:
Sitting
Ideal
Lordosis
Weak support
from low back
POSTURE IN LYING DOWN
• Supine accentuates kyphosis
• Prone position accentuates lordosis
• Sidelying position straightens spine
POSTURAL ANALYSIS
• System of detecting deviations from the
normal posture
• Principles
▫ Faulty alignment results in
undue stress and strain on
inert and dynamic structures
▫ Detection of muscles that are
in an elongated and shortened
position
▫ Correlation exist between alignment and muscle
test findings
POSTURAL ANALYSIS
Good
posture
Muscles
function most
efficiently
Optimum
conditions for
internal organs
Poor
posture Increased
strain on
supporting
structures
Less efficient
balance of the
body over its
base of support
EVALUATION PROCEDURE
History-taking
Past musculoskeletal condition / congenital
problems
Respiratory problems
Dominant hand
Growth history
Neurologic signs and symptoms
OI/ Postural Evaluation
Ocular Inspection
• Done before assessment of posture
• Assessment of physique
▫ Ectomorph/ Asthenic
▫ Mesomorph/ Athletic
▫ Endomorph/ Pyknic
Well
* Ectomesomorphic
* Endomesomorphic
Pediatric
* Well nourished
* Over nourished
* Undernourished
DOCUMENTATION
Ambulatory using BAC
Alert, coherent,cooperative
Ectomorphic
(+)Dysarthria
(+) postural deviation(see postural
assessment
(+) gait deviation (see gait analysis)
Postural Analysis
Position
Patient is standing with arms
relaxed at the side of the
body;
looking straight ahead;
feet are angled ~100
Views
Anterior
Posterior
Lateral
Skyline (special conditions)
EVALUATION PROCEDURE
Anterior view
Head
Nose
Shoulders
Clavicles
Sternum
Carrying angle
Waist angle
Iliac crests
ASIS
Greater trochanter
Patella
Knees
Fibular head
Malleoli
Medial arch
Forefoot
Posterior view
Trapezius
Shoulders
Scapulae
Spinal alignment
PSIS
Gluteal folds
Popliteal line
Malleoli
Achille’s tendon
Calcaneus
Lateral view
Earlobes and
shoulder
Chin
Shoulder
Breast
Thoracic curve
Lumbar curve
Knees
DOCUMENTATION
All landmarks in the anterior, posterior, and lateral
views are level and WNL except on lateral view:
▫ Acromion process anterior to the earlobes
▫ Chin protruded anteriorly
▫ Increased cervical lordosis
Significance: Rounded shoulders posture probably
20 ms imbalance
EVALUATION TOOL
•
•
•
•
•
•
•
Posture boards
Plumb line
Dermatograph
Tape measure
Posture grid
Appropriate clothing
Chart for recording
EVALUATION TOOLS
• video and
photographs in
orthogonal planes
• images, computer
softwares to identify
the alignment of the
body
APPLICATION TO WORK
• used as a basis of controls and limits that
are aimed at preventing work-related
musculoskeletal conditions
▫ Time study based methods
 Continuous description of posture and force level
which is applicable to routine work
▫ Work sampling methods
 Random and fixed time intervals which is applicable
to non-routine work
APPLICATION TO WORK
• five dimensions relevant to the definition
of a posture in relation to workloads:
1.angular relationship between body parts
2.distribution of the masses of the body parts
3.forces exerted on the environment during the
posture
4.length of time that the posture is held
5.effects on the person of maintaining the
posture
APPLICATION TO WORK
• OWAS
• RULA
• PATH
OWAS
• Ovako Work posture Analysing System
• General principles
▫ Balance
▫ Symmetry
▫ No twisting
• Individual scores for positions of body segments
▫ Trunk (4 codes)
▫ Arms (3 codes)
▫ Legs (7 codes)
• Potential for musculoskeletal discomfort is
related to the amount of time in awkward
postures
RULA
• Rapid Upper Limb Assessment
• Assessment of upper body parts applicable to
sedentary work
• Severity of postural loading in the following
body parts
▫
▫
▫
▫
▫
Head
Trunk
Upper arm
Lower arm
Wrist
• Looks into static or repetitive muscle work and
the force exertion
PATH
• Postures, Activities, Tools, and Handling
• Measure the frequency of exposure to manual
materials handling
• For non-routine work
• Real time observations concerning
▫
▫
▫
▫
Task
Body postures
Tools used
Loads handled
▫
▫
▫
▫
▫
Lift
Lower
Carry
Push/pull
Move/place
• Manual materials handling activities are those
involving at least 4.5 kg
REFERENCES
• Kendall,McCreary, Provance (1993), Muscles
Testing and Function: Williams and Wilkins:
Maryland USA
• Magee, DJ.(1997), Orthopedic Physical
Assessment : WB Saunders Co: PA
• Lecture notes by Professor CMCapio and
Professor MGBEncabo