Postural Deviations

Lecture X

Dr. Amaal Hassan Mohammed Ebrahim

Definition of Poor posture

• Poor posture： is a faulty relationship of the various parts of the body which produce increased strain on the supporting structures and in which there is less efficient balance of the body over its base of support

What is postural deviation?

• It means you are not using proper body mechanics. it means that your posture is poor.

• Can happen with either an increase or decrease of the normal body curves, leading to:

1. Uneven pressure within joint surface

2. Ligament strain3. Increase muscle work4. May cause pain

• Poor body mechanics may cause:

• • Serious injury to back/neck

• • Postural deviations

• • Chronic neck/low back pain

• • Increased wear on joint tissues

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Factors Influencing Posture

• Neurologic issues

• Muscle weakness

• Hypermobile joints

• Hypomobile joints

• Bony abnormalities

• Leg length

• Spinal column

Poor Posture

• Poor posture may result in:

Headaches

neck/back pain

Forward head

Poor Posture

• Poor posture may result in:

sunken chest

Protruding abdomen

• Strain on muscles in the neck, back, abdomen, and legs

Poor Posture

• Poor posture may result in:

Protruding abdomen

Strain on muscles in the neck, back, abdomen, and legs

Clinical Evaluation of Posture

• Where to Start?

– Draw a plumb line down vertical axis

– History

– Inspection/observation

– Anatomical assessment

– Functional tests

Views to Evaluate

• Lateral

– Deviations in the A/P aspect

• Anterior/posterior

– Deviations in the saggital plane

Foot Deviations

• Pes planus

(flat feet) causes increased abduction of the forefoot and valgus deviation of the hind-foot, thereby increasing tension on the tibial nerve

Pes planus(Flat feet)

Hallux Valgus

• Hallux Valgus is a common deformity that can affect anyone. It is the deviation of the big toe towards the 2nd

toe.

Bunion deformity

what are bunions?

Outwardly, is the painful bony "bump" that "grows" out of the foot at the base of the big toe. In addition, the deformities associated with bunions is deviation of the big toe towards the 2nd

Hammer toe

• A hammer toe is a deformity of the proximal interphalangealjoint of the second, third, or fourth toecausing it to be permanently bent, resembling a hammer.

The Knee

• Genu Recurvatum – hyperextension

• Genu Valgum – knock-kneed

– Excessive Q-angle

• Genu Varum – bow legged

Genu Recurvatum

Poor Posture, 10 Year Old Child

Genu Valgum – knock-kneed

• Genu valgum, commonly called "knock-knees", is a condition where the knees angle in and touch one another when the legs are straightened.

Genu Varum – bow legged

• Genu varum (also called bow-leggedness or bandiness), is a deformity marked by medial angulation of the leg in relation to the thigh, an outward bowing of the legs, giving the appearance of a bow.

The Spine

• Lordosis – extension

• Kyphosis – flexion

• Scoliosis – lateral curvature

KyphosisKyphosis is usually associated with an increase curve of the thoracic spine. Along with this, a slightly posterior pelvic tilt is seen along with a reduced lumber curve and a forward head position. The client will show a hunched over posture with a depressed chest.

LordosisWe speak of Lordosiswhen there is an increased curve in the lumbar spine of lower back. Often there is also an increased pelvic tilt. The client will show a posture in which the stomach and head are pushed forward.

Military typeAlthough this posture is not one of the four main types of postural alignment, the Military type posture can occasionally be observed.It is characterised by an increased curve in the lumbar spine of lower back and an anterior pelvic tilt.The client shows a posture in which the chest is pushed forward.

The Spine

• Hyperlordotic

– Lumbar lordosis with normal thoracic and cervical spines

– Excessive anterior tilt

• Kypholordotic

– Lumbar lordosis with increased thoracic kyphosis

– Excessive anterior tilt

Scoliosis

• Scoliosis a condition in which the spine is curved from side to side, shaped like an "s" and may also be rotated.

• The spine curves away from the middle or sideways.

Diagnosis?

The Spine

• Swayback

– Hypermobility of joints

– Genu recurvatum

– Posterior pelvic tilt

– Thoracic kyphosis

• Flat Back

– Posterior pelvic tilt

– Decreased lumbar lordosis

– Decreased thoracic kyphosis

– Extended upper cervical spine

The Spine

• Scoliosis - Lateral curves

– Functional Scoliosis

• Muscular imbalance

• Leg length discrepency

– Structural Scoliosis

• Defect or congenital bony anomaly in vertebral column

Upper Extremity

• Forward Shoulder

– Rounded shoulders (excessive protraction)

– Tight anterior shoulder musculature

– Excessive curvature in cervical/thoracic

Upper Extremity

• Forward Head

– Flexion of lower/mid cervical spine

– Extension of upper cervical spine

The Role of Physical Therapy

Early detection of postural errors.

Education of good posture and bad posture.

Reduce of abnormal tension and pain

Increase strength and mobility

Enhance of neuromuscular control

Increase self motivation and confidence.

Reduce fatigue.