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Posture

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Posture is a “position or attitude of the body a relative arrangement of body part
for a specific activity or a characteristic manner of bearing the body”.

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Posture

  1. 1. Posture is a “position or attitude of the body a relative arrangement of body part for a specific activity or a characteristic manner of bearing the body”.  POSTURE acronym for easy reference: P:-Pelvis in neutral, with weight distributed O:-on the whole foot. S:-Stable joints; T:-Tight abdominals; U:-upright ribs; R:-retracted shoulders and E:-ear over shoulder.
  2. 2. Classification of posture A. Inactive Posture B. Active A) Static Posture B) Dynamic posture
  3. 3. Postural Reflex – 1. Muscle 2. Eyes 3. Ears 4. Joint Structure  Skin sensation also plays a part, eg.soles of the feet, when the body in standing position.  Impulses from all these receptors are conveyed and coordinated in the central nervous system.
  4. 4. Good / Correct Posture- Good posture is the state of muscular and skeletal balance that protect the supporting structures of the body against injury or progressive deformity irrespective of the attitude.  A stable psychological background Joy, Happiness- Posture in which position of extension. Sad, Unhappy- In which position of flexion.  Good hygienic condition.  Opportunity for plenty of natural free movement.
  5. 5. Poor Posture / Faulty Posture . Faulty posture Postural/Positional Structural
  6. 6. Postural Development Correct posture “Position in which minimum stress is placed on each joint.” (Magee) Faulty posture Any position that increases stress on joints
  7. 7. Postural Development  Birth ›Entire spine concave forward (flexed) ›“Primary curves” Thoracic spine Sacrum  Developmental (usually around 3 mos.) ›Secondary curves ›Cervical spine ›Lumbar spine
  8. 8. Postural Development Factors affecting posture  Bony contours  Laxity of ligamentous structures  Fascial & musculotendinous tightness  Muscle tonus  Pelvic angle Joint position & mobility  Neurogenic outflow & inflow
  9. 9. Postural Development  Causes of poor posture ›Positional factors  Appearance of increased height (social stigma)  Muscle imbalances/ contractures  Pain  Respiratory conditions
  10. 10. Postural Development Structural factors •Congenital anomalies •Developmental problems •Trauma •Disease
  11. 11. Postural Control  Maintenance of Body and its Segment  Stabilization of the Spinal Column by the Muscle of Trunk  Standard Posture-
  12. 12. POSTURAL EXAMINATION The assessment of posture is in standing position. The whole posture is asessed from head to toes in different views, (a) Lateral views (b) Posterior views (c) Anterior views The examiner should first determine the patient body type. There are three body types: (i) Ecotomorph is a person who has a thin body builds characterized by a relative prominence of structure developed from the embryonic ectoderm. (ii) Mesomorph has muscular or sturdy body build characterized by a relative prominence of structure developed by the embryonic mesoderm. (iii) Endomorph has a heavy or fat body builds characterized by a relative prominence of structure developed from the embryonic endoderm.
  13. 13. Body type Ectomorph Mesomorph Endomorph
  14. 14. Anterior View Lateral View Correct Posture
  15. 15. Anterior view  Head straight on shoulders  Posture of jaw  Tip of nose  Upper trapezius neck line  Shoulders level  Clavicles/AC joints  Sternum & ribs  Waist angles & arm positions  Carrying angles
  16. 16. Iliac crests ASIS Pubic bone level Patellae Knees Fibular heads Malleoli Arches Foot rotation Bowing of bones Diastematomyelia (hairy patches) Pigmented lesions Café au lait spots  Neurofibromatosi Anterior view
  17. 17. Lateral View-  The ear lobe  Spinal segment  Shoulder  The chest, abdominal & the back muscles  No chest deformity  The pelvic angle  The knees.
  18. 18. NORMAL POSTURE
  19. 19. FAULTY POSTURE ANALYSIS AND TREATMENT * Lordotic posture * Kyphotic posture / Round back * Scoliotic posture * Sway back posture / slouched posture * Flat back posture * Flat neck posture * Forward head posture
  20. 20. Types of Faulty Posture
  21. 21. (1) Lordotic Posture – Lordosis is the normal curve (anterior convexity) of cervical and lumbar spine which is found all normal individual pathologically. it is an exaggeration of the normal curve found in cervical and lumbar spine. Potential Sources of Pain • Stress to the anterior longitudinal ligament • Narrowing of the posterior disk space and narrowing of intervertebral foramen. • Approximation of the articular facets. The facets may become weight bearing which may cause syonovial irritation and joint inflammation.
  22. 22. Lordotic posture
  23. 23. Common Cause of Excessive Lumbar Lordosis  Weakness of abdominals muscle  Tightness or contracture of hip flexor (iliopsoas)  Congenital problems such as bilateral congenital dislocation of hip  Pregnancy  High heel shoes / foot wears  Spondylolisthesis  Anterior tilt of pelvis as a result of weak extensor of hip and Abdominals  Tightness or shortening of cervical extensor.
  24. 24. Treatment for Excessive Lumbar Lordosis  Mobilization of the lumbar spine.  Anterior stretching of the lumbar spine Strengthening of the abdominals, glutei and hamstring. Training in grade correction of pelvic tilt has to be emphasized active backward or posterior pelvic tilting by contracting abdominals and glutei in supine is initiated.  Toe touching in long sitting or forward bending sitting exercise  Spinal extension or hyper extension should be strictly avoided.  Treat the cause of increase lumbar lordosis.
  25. 25. Exaggerated lordosis Kyphotic Lordotic Posture Faulty Posture
  26. 26. (2) Kyphotic Posture / Round Back – It is a faulty posture in which lumbar spine and cervical spine get hyper extended while thoracic spine get flexed and head become slightly forward. Potential Sources of Pain * Stressed to the posterior longitudinal ligament. * Fatigue of the thoracic erector spinae and rhomboid muscle. * Thoracic outlet syndromes. * Cervical posture syndromes.
  27. 27. Common Cause of kyphosis Shortening or tightness of extensors of cervical spine and lumbar spine and flexor of hip joint. Weakness of neck flexors,upper back extensors (erector spinae) and Hamstring muscle. Bony anomaly generally in anterior tilt of pelvis, abdominals get elongated but in this posture excessive flexion of thoracic spine offsets the effect of anterior pelvic tilt. Ankylosing spondylitis. Other congenital anomalies.
  28. 28. Treatment of kyphosis  Relaxation  Repeated stretching session  Posture of head, neck and shoulder  Mobilization of the whole spine  Resistive exercise for longitudinal and transverse back muscle  Controlled pelvic tilt
  29. 29. (3) Scoliotic Posture- A lateral curvature of spine which exceeds 10 bending of the vertebral from the normal is tended as scoliosis column to one side combined with rotation of the vertebral bodies towards the convexity and the spinous process towards the concavity.
  30. 30. Potential Source of Pain – *Muscle fatigue and ligamentous strain on the side of convexity. *Nerve root irritation on the side of concavity. Common Cause – Structural scoliosis – Neuromuscular disease,osteopathic disorder, and idiopathic disorder Non structural – Leg length discrepancy,either structural or functional, muscle guarding or spasm a painful stimuli in the back or neck, and habitual or asymmetric posture.
  31. 31. Treatment of scoliosis Active Correction with postural adaptation Passive Correction by Hanging Educate the patient by active effort Relaxation technique Repeated sessions of maintenance General free mobility exercises Deep breathing Balance Exercises Traction
  32. 32. CCP – Curve correcting pad Milwaukee brace
  33. 33. (4) Sway Back Posture/Slouched – * It is faulty posture in which head becomes slightly forward there is extension of cervical spine, flexion of thoracic and loss of lordosis of lumbar spine extension of hip and knee joint during standing are also the feature of sway back posture pelvis rotates posteriorly. * In this there is increased pelvic inclination up to 40.When standing for prolonged period the person usually assumes an asymmetric stance. * In which most of the weight is borne on one lower extremity with periodic shifting of weight to the opposite extremity.
  34. 34. Potential Source of Pain –  Stress to iliofemoral ligament, the anterior longitudinal ligament of lower lumbar spine and posterior longitudinal ligament of upper lumbar and thoracic spine.  Narrowing of intervertebral foramen in lower lumbar spine that may compress the blood vessel dura & nerve root. Approximation of articular facets in to lower lumbar spine
  35. 35. Common Cause of Sway Back 1)Tightness of hamstring and abdominal muscle. 2)Weakness of one joint iliopsoas 3)Bony anomaly
  36. 36. Treatment of Sway Back • Stretching of hamstring and abdominal muscle • Relaxation of the body • Strengthening of iliopsoas • Maintain position of head is backward, extension of thoracic Spine • Maintain normal lordosis of lumbar spine • Always standing in erect position
  37. 37. Flat Back Posture Sway Back Posture
  38. 38. 5) Flat Back Posture – Flat back is faulty posture in which whole lumbar and thoracic spine gets flattened. Although the cause and symptom of both flat back and sway back are common but can be differentiated by excessive flexion and back ward deviation of the upper thoracic spine in sway back posture while in flat back posture spine become almost straight. It is reverse a lumbar lordosis. There is flattening of normal lumbar lordosis.
  39. 39. FLAT BACK POSTUERE
  40. 40. Potential Source of Pain • Lack of the normal physiologic lumbar curve which reduces the shock absorbing effect of lumbar region and predisposes the person to injury. • Stress to the posterior longitudinal ligament. • Increase of the posterior disk space which allow the nucleus pulposus to imbibe extra fluid and under certain circumstance may protrude posteriorly when the person attempts extension.
  41. 41. Common Cause of Flat Back 1) Tight trunk flexor (rectus abdominis and intercostal) and hip extensor muscle. 2) Stretched and weak lumbar extensor and possibly hip flexor muscle.
  42. 42. Treatment of Flat Back • Increase lumbar lordosis which results in forward tilting of pelvis. • Maintance of arch by active holding and also passive support in sitting are effective in maintaining lordosis. • Mobility and strengthening exercise of lumbar extensor are important. • Stretching of trunk flexor and hip extensor muscle.
  43. 43. 6) Flat Neck Posture – It is an abnormal posture which is characterized by any increased upper flexion of the occiput on atlas and decreased lordosis of the cervical spine. It may be seen with an exaggerated military posture. There may be tempomandibular joint dysfunction with protection of the mandible.
  44. 44. FLAT NECK POSTURE
  45. 45. Potential Source of Pain • Temporomanibular joint pain and occlusive changes • Decrease in the shock absorbing function of the lordotic curve which may predispose the neck to injury. • Stress to ligamentum nuchae.
  46. 46. Common Cause of Flat Neck Posture • Short anterior neck muscle • Activity which require straightening of cervical spine predisposes to this type of posture such as – * soldier keep their upper back straight(attention position) for prolonged period of time, * using high pillow under the head and spasm of cervical spine.
  47. 47. Treatment of Flat Neck Posture • Relaxed passive movement this includes manipulation and mobilization of cervical spine. • Strong isometric are indicated when mobility is contraindicated but strength,endurance,and tone of the cervical muscle are maintained or improved. • Stretching the anterior neck muscle. • Strengthening exercises of levator scapulae, strenocledomastoid and scalene muscle. • Improvement of the posture and function of neck.
  48. 48. 7) Forward Head Posture – It is faulty posture which is characterized by excessive extension of uppegr cervical spine and flexion of the lower cervical and upper thoracic. There also may be temporomandibular Joint (TMJ) dysfunction with retrusion of the mandible.
  49. 49. Potential Source of Pain • Stress to anterior longitudinal ligament in the upper cervical spine and posterior longitudinal ligament in the lower cervical and upper thoracic spine. • Muscle tension or fatigue. • Irritation of facet joint in upper cervical spine • Narrowing of the intervertebral foramina in the upper cervical region which may impinge on the blood vessel and nerve roots, especially if there are degenerative change
  50. 50. • Impingement on the neurovascular bundle from anterior scalene muscle tightness. • Impingement on the cervical plexus from levator scapulae muscle tightness. • Impingement on the greater occipital nerve from a tight or tense upper trapezius muscle leading to tension headaches. • TMJ pain from faulty head, neck and manibular alignment and associated facial muscle tension. • Lower cervical disc lesion from the faulty flexed posture.
  51. 51. Cause of Forward Head Posture • Working on computer which is slightly higher than the position of head. • Enthusiastically watching match on television for prolonged time also predisposes to this type of faulty posture. • Using of high pillow under the neck • Tight levator scapulae,Sternocledomastoid,Scalene and Sub-occipital muscle. • Stretched and weakened anterior throat muscle and lower cervical and upper thoracic erector spinae muscle.
  52. 52. Treatment of Forward Head Posture • Stretching of levator scapulae, Sterocledomastoid, Scalene and Sub-occipital muscle. • Avoid pillow or small pillow under the neck. • PNF (Proprioceptive Neuromuscular Fasciculation) technique ideally combines all the four above mentioned effect selectively. • Strong isometric and indicated when mobility is contraindicated but strength, endurance and tone of the cervical muscle are to be maintained or improved.
  53. 53. Postural Examination Chart Name ……………………Date………………………… Height…………… cm. Mass……………kg. Handedness …………… Age…………… Sex………… Leg Length: Left…………… Right…………….. Plumb Alignment Lateral view: Left…………… Right…………… Back view: Deviated Left…………… Deviated Right……………
  54. 54. 1)Relationships Between Lumbar Lordosis, Pelvic Tilt, and Abdominal Muscle Performance MARTHA L. WALKER, et al Purpose- The purpose of this study was to examine the relationships between measurements of lumbar lordosis, pelvic tilt, and abdominal muscle performance during normal standing. METHODS Subjects-The subjects were 31 healthy physical therapy students, 23 women and 8 men, between the ages of 20 and 33 years, with a mean age of 23.9 years (s = 3.8 years). Inclusion criteria- ages between 20 and 33years Exclusion criteria- acute or chronic back pain scoliosis of greater than 15 degrees
  55. 55. Instrumentation- inclinometer Procedure Measurements of pelvic tilt and lumbar lordosis were taken before testing the abdominal muscle function Location of bony landmarks  Examiner palpated the right ASIS and PSIS  Palpated spinous processes of S2 and L3 and marked them with adhesive markers. Measurement of pelvic tilt  Examiner placed the arms of the inclinometer on the marked ASIS and PSIS, and the second examiner (S.D.F.) read and recorded the angle of inclination. Measurement of lumbar lordosis  The points that intersected L3 and S2 were marked, and a line was drawn between them.
  56. 56. Reliability Testing of abdominal muscles RESULTS  The ICC values for repeated measures (ie, reliability) of pelvic tilt and lordosis were .84 and .90, respectively.  The Spearman's rho correlation coefficient for repeated abdominal muscle tests was .71.  The Spearman's rho correlation of abdominal muscle test values with pelvic tilt measurements was. 18 and with lumbar lordosis measurements was .0  Pearson product-moment correlation of lumbar lordosis measurements with pelvic tilt was .32.
  57. 57. DISCUSSION  Lumbar Lordosis  Pelvic Tilt  Abdominal Muscle Function  Relationship of Abdominal Muscle Function,  Lordosis, and Pelvic Tilt CONCLUSION  Lumbar lordosis, pelvic tilt, and abdominal muscle function during normal standing are not related.  This study demonstrates the need for a reexamination of clinical practices based on assumed relationships of abdominal muscle performance,pelvic tilt, and lordosis.
  58. 58. 2)Effects of Approximation on Postural Sway in Healthy Subjects KATHERINE T. RATLIFFE PURPOSE- investigate the effect of approximation provided by a weighted belt on postural sway in healthy subjects. METHOD Subjects- studied 20 subjects, 6men and 14 women, between the ages of 23 and 30 years. Inclusion criteria- healthy subjects
  59. 59. Exclusion criteria-  History of ear surgery  Central or peripheral nervous system disorder  Injury of the spine, hip, knee, or ankle that required immobilization or surgery during the past 10 years  Respiratory illness within five days before data collection.  Pregnant or had undergone childbirth within the previous three months  Currently had ataxia,vertigo, or nausea  Permanent musculoskeletal abnormalities  Taking any drugs
  60. 60. Equipment standing platform weighted belt
  61. 61. Procedure Twenty subjects between the ages of 23 and 30 years stood on a polyurethane foam platform that amplified their postural sway and were filmed from a lateral view. All subjects wore markers over their mandibles, hips, and knees and were filmed three times with the weighted belt worn on a randomly selected trial. Frames from a 10-second interval of film from each trial were studied, and the summed displacement at each bony landmark between each frame of film was calculated.
  62. 62. Subject with mandible, hip, and knee markers positioned on standing platform.
  63. 63. RESULTS Data Analysis- A one-sample t test was used to determine the significance(p < .02) of the mean weight effect (d) at each bony landmark.
  64. 64. DISCUSSION Further study is indicated to determine the factors influencing exaggerated sway in patient populations and to assess the clinical benefits of using both manual pelvic approximation and pelvic weighted belts on healthy subjects and patients.
  65. 65. CONCLUSION  A significant decrease in postural sway was measured at the mandible when subjects wore a pelvic weighted belt.  A significant decrease was not seen in postural sway at the hip or knee.  Additional research is needed to assess the effectiveness of both manual pelvic approximation and approximation through the use of a pelvic weighted belt in patient populations
  66. 66. 3)Effect of Pelvic Tilt on Standing Posture JAMES W. DAY PURPOSE- To use an objective noninvasive method to determine the effect of the pelvic tilt on the spinal curves in the sagittal plane. METHOD Subjects Thirty-two healthy subjects and 15 patients with chronic low back dysfunction (CLBD) were studied.
  67. 67. Inclusion criteria- Healthy Group –No complaints of back dysfunction within six months preceding data collection -Not undergone back surgery Chronic low back dysfunction (CLBD) -At least a threeyear history of low back pain -Who had experienced low back pain within three months of the laboratory assessment Exclusion criteria- Spinal fusions, herniated intervertebral disks Lateral curvatures of spine Muscle atrophic diseases.
  68. 68. Anatomical Position System A noninvasive computerized method, Iowa Anatomical Position System(IAPS)  Pelvic Tilt Instructions  Data Acquisition Process  Variables Measured  Data Analysis - We analyzed the ratios and angles using an analysis of variance (ANOVA) test with split level, three-factor,  Randomized block design  Accuracy of Measurement System
  69. 69. Fig. 1. Body reference points and sagittal plane for standing posture. Orientation is anterior to the right. 5M = base of 5th metatarsal, LM = lateral malleolus, K = lateral femoral epicondyle, GT = tip of greater trochanter, ASIS = anterior superior iliac spine, S2 = 2nd sacral vertebra, S = distal point on sacrum, T = tragus of ear, E = superolateral corner of the eye orbit, A = ankle angle, K = knee angle, PF = pelvifemoral angle, GT = pelvic orientation with respect to vertical line, SAS = pelvic orientation with respect to horizontal line, S = sacral angle, and H = head angle.
  70. 70. RESULTS-  No significant differences between the DL for the Healthy Group and Patient Group flexed knee position tended to flatten the lordotic curve.  Both the Healthy Group and Patient Group were able to rotate their pelvis a sufficient amount to change the thoracolumbar curve Pelvic rotation or pelvic tilt did not alter the configuration of the thoracic spinal curve.  For the extended knee position,the postures of anterior and neutral pelvic tilt were not significantly different.
  71. 71. DISCUSSION-  Tilting the pelvis posteriorly decreased the absolute depth of the lumbar curve.  Tilting the pelvis anteriorly increased the absolute depth of the lumbar curve.  A person properly trained in a pelvic tilt maneuver can voluntarily rotate his pelvis a sufficient amount to alter the lumbar lordotic curve.
  72. 72. 4) Thoracic Kyphosis Affects Spinal Loads and Trunk Muscle Force Andrew M Briggs Background and Purpose Patients with increased thoracic curvature often come to physical therapists for management of spinal pain and disorders. Although treatment approaches are aimed at normalizing or minimizing progression of kyphosis, the biomechanical rationales remain unsubstantiated. Subjects Forty-four subjects (mean age [±SD]=62.3±7.1 years) were dichotomized into high kyphosis and low kyphosis groups.
  73. 73. Methods Lateral standing radiographs and photographs were captured and then digitized.These data were input into biomechanical models to estimate net segmental loading from T2–L5 as well as trunk muscle forces Participants with (A) high kyphosis and (B) low kyphosis in a standing posture with their respective lateral thoracic radiograph.
  74. 74. Sequential steps in estimating net segmental loads and muscle forces for each participant.
  75. 75. Results  The high kyphosis group demonstrated significantly greater normalized flexion moments and net compression and shear forces.  Trunk muscle forces also were significantly greater in the high kyphosis group.  A strong relationship existed between thoracic curvature and net segmental loads (r.85–.93) and between thoracic curvature and muscle forces (r.70 –.82). Discussion and Conclusion This study provides biomechanical evidence that increases in thoracic kyphosis are associated with significantly higher multisegmental spinal loads and trunk muscle forces in upright stance. These factors are likely to accelerate degenerative processes in spinal motion segments and contribute to the development of dysfunction and pain.
  76. 76. 5) Relationship Between Standing Posture and Stability David E Krebs Background and Purpose This study determined whether persons with stability impairments have postural aberrations. We investigated wholebody posture and its relationship to center-of- gravity (COG) stability Subjects- Data from 27 subjects with vestibular hypofunction and 26 subjects without vestibular impairment were analyzed.
  77. 77. Method  An optoelectronic full-body system measured kinematics.  Force plates measured ground reaction forces while subjects stood with their feet 30 cm apart and eyes open and with their feet together and eyes closed. Results  The subjects with vestibular hypofunction demonstrated less stability than the subjects without impairment, but there were no postural differences.  Subjects with vestibular hypofunction had more weight on the left lower extremity during standing with feet apart. In all subjects during standing with feet apart, the COG was anterior to the ankle, knee, back, and shoulder and posterior to the hip and neck.  Subjects had an anterior pelvic tilt, extended trunk and head, right laterally flexed trunk and pelvis, and flexed.
  78. 78. Conclusion and Discussion  Posture and stability had a low correlation.  Subjects with bilateral vestibular hypofunction did not demonstrate a forward head or backward trunk lean, as has been reported anecdotally.  Changing from standing with feet apart to feet together increased whole-body movement patterns to control standing stability.

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