Mazyad Alotaibi

Posture means position Posture is the body’s alignment and

positioning with respect to COG. Attitude of the body, the relative alignment

of body/limb segmentsTypes Static posture: In which body segments

aligned and maintained in certain positions (Standing, lying, sitting). No mechanical work.

Dynamic posture: In which body segments are moving (Walking – running, lifting)

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The adult spine is divided into four curves:

Two primary or posterior curves because they are present in the infant and the convexity is posterior

Thoracic spine Sacrum

Two compensatory or anterior curves because they are Develop as the infant learns to lift the head and eventually stand, and the convexity is anterior› Cervical spine› Lumbar spine

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Causes of poor posture Positional factors

Muscle imbalances/contractures Pain Respiratory conditions Typically can be managed through therapeutic

ex & educationStructural factors Congenital deformity Developmental problems Trauma Disease Not typically easily managed

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Through ear lobes

Through bodies CV

Through shouder jt.

Through trunk

Through GT

Anterior to midline knee

Anterior to lat malleolus

Line of Gravity

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Any deviation from the normal/proper posture

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Foot: Only muscular activity is in the push-off phase or rising on the toes

Leg: Posterior calf muscles are more active than anterior

Thigh & Hip: Very little activity› Swaying produces bursts of ab/adductors› Iliopsoas constantly active, preventing

hyperextension of the hip joint

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Spine: Very slight activity is sacrospinalis or abdominals

Upper Extremity: low-grade activity in a number of muscles› Serratus anterior & trapezius support the

shoulder girdle› Supraspinatus resist downward traction of

the humerus› No activity in elbow or wrist joints, when

passively hanging

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Factors affecting posture Neurologic issues Muscle weakness Hypermobile joints Hypomobile joints Bony abnormalities Leg length Spinal column

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•Postural pain syndromes▫Posture deviates from normal

alignment but no structurallimitation

▫Mechanical stress but relievedby 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

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Head and neck Shoulder and scapula Head, neck, shoulder and scapula Trunk Feet and knees

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Forward head› Inc flexion of the

lower cervical and upper thoracic regions

› Inc extension of the occipital on the upper cervical vertebrae

› Protrusion of mandible

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•Flat neck▫Dec cervical

lordosis▫Inc flexion of the

occiput on the atlas

▫Retraction of the mandible

▫Exaggeratedmilitary posture

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Head Posterior Tilt

Head Anterior Tilt

MarkedAnterior Tilt

Forward Head with Attempted Correction

Head and Neck

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Shoulders and scapula Good position

Scapula AbductedSlightly Elevated

Scapula Adducted Slightly Elevated

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Shoulders and scapula Good position

Shoulders Elevated Scapula Adducted

Shoulder DepressedScapula Abducted

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Scapula depressed Winging of the Scapula

Shoulders and scapula Good position

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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

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Upper crossed syndrome

› Tight muscles: Pectoralis major and minor, upper trapezius, Levator scapulae, SCM

› Weak muscles: Lower and middle trapezius, Serratus Anterior, Rhomboids

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A medio-lateral curve of the vertebral column Exceeding 100

› Types Structural Neuromuscular Idiopathic Non-structural

› Treatment Exercises Bracing

An exaggerated curvature in the sagittal plane

Long rounded curve (round back)

Sharp posterior angulation (hump back)

Possible causes› Wedge compression fracture› Ankylosing spondylitis› osteoporosis› Destructive tumors of spine

Trunk • Kyphosis-LordosisForward 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

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Trunk • Sway-back Forward head

Increased cervical lordosisIncreased

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

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Trunk • Military type

Normal-slightly posterior

Normal

Normal kyphosis

Increased lumbar lordosis

Anterior pelvic tilt

Knees slightly hyperextended

Ankles slightly plantarflexed

Short and Tight:• Lumbar extensors• Hip flexors

Lengthened and Weak:• Abdominals• Hamstrings

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Trunk • Flat back Forward head

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

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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

Trunk

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Forward bending test

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Ideal alignment › Patella faces

forward› Feet are in good

alignment › Hips and feet

neutral

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Genu Varum› Knee separation › Hyperextension of the

knee› Axis of knee is oblique › Hindfoot Supination › Forefoot pronation

SquintingPatella

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Genu valgum› Hip adducted; IR of the femur› Patella tilted medial› Hindfoot pronation› Forefoot supination › Hyperextension › Knee is oblique

Frog eyes

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• Patella alta • Patella baja

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