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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
             tightness
            ↑ compressive forces on facet
             joints
            Adaptive shortening of posterior
             lumbar spine ligaments and
             anterior hip ligaments
            Elongation of anterior lumbar
             spine ligaments and posterior hip
             ligaments
            Narrowing of lumber intervertebral
             foramen
                  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
             muscles
            ↑ 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
             spine
       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
           posture
                  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
             spine
                 Postural Evaluation
   Flat Back Posture:
       Pathological
        conditions:
            Compressive forces in
             posterior hip joint,
             anterior lumber and
             mid-low cervical
             spines, posterior
             thoracic and upper
             cervical spines
            Elongation of soft
             tissue
            Forward head posture
             (compensation for
             posterior spine
             displacement)
                   Postural Evaluation
   Scoliosis:
       Lateral curvature of spinal
        column
            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
             prominent
            Uneven waist / 1 hip higher vs.
             other
            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
             (congenital)
            Not caused by poor posture, diet,
             exercise, or the use of backpacks
                   Postural Evaluation
   Diagnosis:
       Angle: X-ray
            Normal Spine (0
             degrees)
            Scoliosis: (> 10
             degrees)
       Complications:
        (severe scoliosis)
            Lung and heart
             damage:
             compression of rib
             cage against heart,
             lungs
                  > 70 degrees
            Back problems
                   Postural Evaluation
   General Inspection:
       Scoliosis Test: Adam’s Forward Bend Test
            Patient Position: Standing with hands held in front (arms
             straight)
            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
                   flexion
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
             IR
            Forward head posture
       Joints:
            Scapulothoracic articulation
            Glenohumeral joint
            Thoracic spine
            Cervical spine
                  Postural Evaluation
   Forward Shoulder Posture:
       Possible causes:
            Tightened, shortened pectoral
             muscles
            Weakened or elongated scapular
             retractors (mid and low trapezius,
             rhomboids)
            Poor postural awareness and/or
             muscle fatigue
            Large breast development
       Adverse effects:
            Humeral head stress (displaced
             anteriorly)
            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
           stability
          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
        off
                  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
                               weight
Joint shape    Small, flat joint Medium joint    Large, concave-
               surfaces          surfaces        convex joint
                                                 surfaces
Muscle mass Minimal             Medium           Thick muscle
               muscle bulk,     muscle build     mass
               thin muscles
Joint mobility Increased        Within normal    Decreased
                                limits
Joint stability Decreased       Within normal    Increased
                                limits

				
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posted:5/15/2010
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