Postural Evaluation Spinal Column

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					Postural Evaluation:
  Spinal Column
Orthopedic Assessment III – Head,
    Spine, and Trunk with Lab
            PET 5609C
                 Postural Evaluation
   Hyperlordotic Posture:
       Joints involved:
            Lumbar spine, pelvis, hip
       Possible cause:
          Tightened or shortened hip flexor muscles
          Weakened or elongated hip extensors or abdominals
          Poor postural sense

       Adverse effects:
          ↑ lumbar lordosis
          Anterior pelvic tilt
          Hips assuming a flexed position
                 Postural Evaluation
   Hyperlordotic Posture:
       Pathological conditions:
            ↑ shear forces on lumbar vertebral
             bodies secondary to psoas
            ↑ compressive forces on facet
            Adaptive shortening of posterior
             lumbar spine ligaments and
             anterior hip ligaments
            Elongation of anterior lumbar
             spine ligaments and posterior hip
            Narrowing of lumber intervertebral
                  Postural Evaluation
   Kypholordotic Posture:
       Similar to hyperlordotic posture:
            ↑ total lumbar lordosis
       Differences:
            Compensatory ↑ in thoracic kyphosis:
                 Attempt to maintain spine in position of equilibrium
            Cervical spine: ↑ in lordosis (Forward head posture)
       Joints involved:
            Pelvis, hip joint, lumbar spine, thoracic spine,
             cervical spine
                   Postural Evaluation
   Kypholordotic Posture:
       Possible causes:
            Poor postural sense
            Muscle imbalance:
                  Tightened/shortened hip flexors
                  Weakened or elongated hip
                   extensors or trunk flexors
       Adverse effects:
            Anterior pelvic tilt
            Hip joint flexion
            ↑ lumbar lordosis
            ↑ thoracic kyphosis
                  Postural Evaluation
   Kypholordotic Posture:
       Pathological conditions:
            Adaptive shortening of anterior
             chest muscles
            Elongation of thoracic paraspinal
            ↑ compressive forces on anterior
             thoracic vertebrae and posterior
             lumbar vertebrae
            ↑ tensile forces on ligamentous
             structures in posterior thoracic
             spine and anterior lumbar spine
            ↑ facet joint compression
            Forward head posture
            Forward shoulder posture
                 Postural Evaluation
   Swayback Posture:
       Key: ↑ reliance on ligaments for postural stability
            Joints at end ROM (excessive stress on ligaments)
       Joints involved:
            Knees, hips, lumbar spine, lower thoracic spine, cervical
       Possible causes:
            Ectomorph body: hypomobility of joints
            Poor postural sense
            Tightened/shortened hip extensors
            Weakened or elongated hip flexors or lower abdominals
            ↓ general muscular strength
              Postural Evaluation
   Swayback Posture:
       Adverse Effects:
          Genu recurvatum
          Hip joint extension

          Posterior pelvic tilt

          Lumbar spine in neutral or
           minimal flexed position
          ↑ in lower thoracic,
           thoracolumbar curvature
               Postural Evaluation
   Swayback Posture:
       Pathological Conditions:
          Elongated or ↑ tensile forces on
           anterior hip ligaments and
           posterior aspect of lower
           thoracic spine
          Adapted/shortened or ↑
           compressive forces on posterior
           hip ligaments and anterior
           lower thoracic spine
          ↑ tensile force on posterior knee
           and compressive force on
           anterior knee
          ↑ shearing forces on L5/S1
          Forward head and shoulder
                  Postural Evaluation
   Flat Back Posture:
       Key: Lost normal “S” shape spine curvature in the
        sagital plane
       Joints:
            Hip joint, lumbar spine, thoracic spine, cervical spine
       Possible causes:
            Shortened/tightened hip extensors, abdominal musculature
            Weakened, elongated hip flexors
            Poor posture
       Adverse effects:
            Extended hip joint / posterior pelvic tilt
            Extended thoracic spine
            Flexed middle and lower cervical spine, extended upper cervical
                 Postural Evaluation
   Flat Back Posture:
       Pathological
            Compressive forces in
             posterior hip joint,
             anterior lumber and
             mid-low cervical
             spines, posterior
             thoracic and upper
             cervical spines
            Elongation of soft
            Forward head posture
             (compensation for
             posterior spine
                   Postural Evaluation
   Scoliosis:
       Lateral curvature of spinal
            Functional: spine attempts
             to compensate to maintain
             the head in a neutral
             position and keep eyes level
                  Muscular imbalance,
                   pelvic obliquity, limb-
                   length discrepancy
            Structural: defect or
             congenital bony abnormality
             of vertebrae
                   Postural Evaluation
   General Inspection: Scoliosis
      Signs and symptoms:
            Uneven shoulders
            One shoulder blade appears more
            Uneven waist / 1 hip higher vs.
            Leaning to one side
            Back pain and difficulty breathing
             (severe scoliosis)
       Causes:
            Idiopathic (85% of cases)
            Underlying neuromuscular disease,
             leg-length discrepancy, birth
             defect, fetal development
            Not caused by poor posture, diet,
             exercise, or the use of backpacks
                   Postural Evaluation
   Diagnosis:
       Angle: X-ray
            Normal Spine (0
            Scoliosis: (> 10
       Complications:
        (severe scoliosis)
            Lung and heart
             compression of rib
             cage against heart,
                  > 70 degrees
            Back problems
                   Postural Evaluation
   General Inspection:
       Scoliosis Test: Adam’s Forward Bend Test
            Patient Position: Standing with hands held in front (arms
            Evaluation Procedure: Patient bends forward, sliding hands
             down the front of each leg
            Positive Test:
                  Asymmetrical hump along lateral aspect of thoracolumbar spine
                  One shoulder blade appears more prominent
                  Uneven hips
            Implications:
                  Functional scoliosis: scoliosis present when patient stands
                   straight, disappears during flexion
                  Structural scoliosis: present during both standing and with
Postural Evaluation
                  Postural Evaluation
   Forward Shoulder Posture:
       Key: characterized by
        protraction and elevation of
        scapulae and a forward,
        rounded position of shoulders
            May include scapula winging and
            Forward head posture
       Joints:
            Scapulothoracic articulation
            Glenohumeral joint
            Thoracic spine
            Cervical spine
                  Postural Evaluation
   Forward Shoulder Posture:
       Possible causes:
            Tightened, shortened pectoral
            Weakened or elongated scapular
             retractors (mid and low trapezius,
            Poor postural awareness and/or
             muscle fatigue
            Large breast development
       Adverse effects:
            Humeral head stress (displaced
            Forward head posture
                  Postural Evaluation
   Forward Shoulder Posture:
       Pathological conditions:
            Thoracic outlet syndrome:
                 Adaptive shortening of pectoralis minor, anterior/middle
                  scalenes → compression of subclavian artery, vein, and
                  medial cord of brachial plexus
          Abnormal scapulohumeral rhythm and scapular
          Acromioclavicular degeneration
          Bicipital tendonitis
          Impingement syndrome
          Abnormal GH biomechanics
                 Postural Evaluation
   Scapula Winging:
       Weakness of serratus
        anterior, middle and
        lower trapezius
            Long thoracic nerve
       Biomechanics of
        normal arm
        movement thrown
                  Postural Evaluation
   Forward Head Posture:
       Key: anterior displacement of
        head relative to thorax
       Joints:
            Cervical spine, GH, thoracic spine
       Possible causes:
            Poor eyesight (need glasses)
            Muscle fatigue/weakness
            Poor postural sense
       Adverse effects:
            Flexion of lower cervical spine
            Flattening of mid cervical spine
            GH motion affected
              Postural Evaluation
   Forward Head Posture:
       Pathological conditions:
          Shortened suboccipital muscles, scalenes, upper
           trapezius, levator scapula
          Hypomobile upper cervical region

          Abnormal GH biomechanics

          TMJ dysfunction

          Thoracic outlet syndrome (scalene involvement)

          Forward shoulder posture

          Myofascial pain (posterior cervical muscles)
               Ectomorph        Mesomorph Endomorph
Description    Slender, thin   Medium,           Short, stocky
               build; low body athletic build,   build, high
               weight          average body      body weight
Joint shape    Small, flat joint Medium joint    Large, concave-
               surfaces          surfaces        convex joint
Muscle mass Minimal             Medium           Thick muscle
               muscle bulk,     muscle build     mass
               thin muscles
Joint mobility Increased        Within normal    Decreased
Joint stability Decreased       Within normal    Increased

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