Posture of geriatric population and management of posture

1. POSTURE
HIRA SHAHID
LEC-4

3. POSTURE
• Posture is the alignment of body parts in relationship to one an other
at any given moment.
• Posture involves complex interactions between bones, joints,
connective tissue, skeletal muscles and the nervous system, both
central and peripheral.
• The complexity of these interactions is compounded when one
considers the near infinitesimal variety of human balance, motor
control, and movement in relation to gravity.

4. • Further more, with the passage of time, each organism undergoes
change resulting from micro-trauma and frank injuries to, and the
effects of disease on, the connective tissues, muscles and neural
control mechanisms, which results in the unique variations of aging
posture.
• Posture is commonly assessed using a grid or a plumb-line, with the
patient in a static standing position; however, within the aging
population, this becomes more difficult because of the age associated
increase in postural sway.
• The postural control mechanisms produce minor shifts in weight in
order to avoid fatigue, excessive tissue compression and venous stasis

6. • Multiple factors are involved in common age-related postural
changes. These factors may be pathological, degenerative or
traumatic, or may result from primary musculoskeletal changes,
primary neurological changes or a combination of diminutions in the
neuro-musculoskeletal system.

7. AXIAL AND APPENDICULAR SKELETAL
CHANGES
• Age-associated postural axial skeletal changes and their clinical
implications
Axial skeletal changes Clinical implications
Head forward Shifts center of mass forward; may increase dizziness because of a compromised basilar artery
Dorsal kyphosis Reduces trunk motions for breathing and motor responses; encourages scapular protraction; may
provoke shoulder pathologies
Flat lumbar spine Reduces trunk/hip extension for gait strides
Occasional kyphosis
Of lumbar spine
Results from compression of vertebral bodies; not reversible
Increased lordosis
(least common)
Results in tightness of trunk/hip extensors; weakened abdominals
Posterior pelvic tilt Results from prolonged sitting; reduces trunk/hip extension for gait strides
Scoliosis May alter balance, breathing and extremity motions

8. Diseases responsible for theses changes
• Osteoporosis
• Responsible for decalcification of bones, silent fractures, frequent falls and
deterioration of structures.
• Spinal spondylosis
• Responsible for deterioration of facet joint, loss vertebral height, narrowing of
neural foramina, loss IV disc space, ant. Lipping, formation of bonny bridges,
calcification of particularly connective tissues. These changes cause pain,
reduction in ROM, especially the subtle rotation motions involved in
segmental rolling and the normal reciprocal pattern of the extremities in
normal gait.

9. Age-associated postural extremity changes and
their clinical implications
Extremity skeletal changes Clinical implications
Scapular protraction or abduction Alters normal scapulohumeral rhythm, leading to painful
shoulder conditions
Tightness/contractures in Elbow flexion, wrist ulnar
deviation, finger flexion
Reduces reach and hand function
Hip flexion contractures (loss of hip extension to
Neutral or 0·)
Reduces stride length; may increase Energy cost of mobility and
may increase postural control requirements, especially if
change is unilateral
Knee flexion contractures (loss of knee extension to Neutral or
0·)
Reduces stride length and gait push off; may increase energy
cost of mobility and may increase postural control
requirements, especially if Change is unilateral
Varus/ valgus changes at hip, knee, ankle Reduces stride length and gait push off; may increase energy
cost of Mobility and may increase postural
Control requirements especially if Change is unilateral. Usually
is a Cause of pain because of mechanical
Deformation and strain on Musculoskeletal tissues

10. SOFT TISSUE
• Postural changes caused by soft-tissue alterations may be a result of
Previous injuries that have lengthened or tightened tendons,
ligaments and joint capsules.
• Collagen is a major component of skin, tendons, cartilage and
connective tissue and it may become increasingly stiff because of
cross-linkage between collagen fibers.
• Elastin is another major fibrous component of connective tissue that
is found in the skin, ligaments, blood vessels and lungs. With
increasing age, elastin is supplanted by pseudo-elastin, which is a
partially degraded collagen or faulty elastin protein.

11. • Additional soft-tissue changes that may lead to postural alterations
can be found in the muscle. The muscle length may be increased or
decreased. There is a loss of muscle fibers, which is likely to result in
reduced strength. The type I and type II muscle fiber relationship may
be altered, which can influence postural control responses and
mechanisms. In addition, there is an increase in non-contractile tissue
because of the deposition of fat and collagen, which causes the
muscle to become increasingly stiff. Muscle tone may increase,
decrease or vary because of changes in nervous system control.

12. CLINICAL CONSIDERATIONS
• In the geriatric population, posture should be assessed not only in the
standing and sitting positions but also in bed, especially in a patient who is
confined to bed because of an injury or illness.
• It is particularly imp. To secure pressure areas.
• Prolong positioning should be avoided
• Take care of those muscles which are specially effected
• It is common for the patient to assume a supine but side-bent posture that
may lead to muscle imbalance.
• Special attention should be pain when the patient is with some surgical
procedure. Muscle imbalance is very common in the situation.
• An example is trendelenberg’s sign.

13. • Kyphosis is also common in elderly individuals
• Associated with various problems like reaching difficulties, heavy
lifting, speed of gait problems and stair climbing.
• females with osteoporotic-related kyphosis had reduced antero-
posterior displacement and velocity and increased medio-lateral
displacement and velocity on a balance force platform when
compared with slightly younger healthy control subjects. The kyphotic
subjects also had greater balance abnormalities when measured on
posturography.
• Grip strength was also significantly associated with this postural
change; the greater the kyphosis, the less the strength.

14. • The strength of postural muscles in the lower extremities and
functional tasks including walking, stair climbing and getting up from
a chair. Weakness of calf muscles coupled with insufficient strength of
the scapulothoracic stabilizers can contribute to increased kyphotic
posture and loss of balance, especially when reaching forward with
the upper extremities.
• Feet care is also important here.(disease, disabilities or abnormalities
whether by injury or congenital type). Associated balance problems
should be considered.

15. Clinical Interventions for postural changes
Causing pain or dysfunction
• Brace, support, immobilize, protect
• Heat, cold, electrical stimulation
• Therapeutic exercise to enhance functional muscle strength, tone,
length , coordination, and balance between agonist and antagonist
• Medications
• Surgery