Static Posture Assessment



Static Posture 




Postural assessment is used from ages, were a critical element of any evolution. In current time, when knowledge is developed and evidence-based medicine progressed It is time to establish if the postural assessment is effective, however, there are limited clinical studies and evidence-based whether the postural assessment is effective. Posture assessment can be static and dynamic Static posture assessment is the view of physical looks in the mirror, when a person is in stance. Is need of a strong visual observation skill from the person who does it. Starts from feet and goes upwards towards the head. The static postural assessment has been the basis to recognize muscle imbalance. (Clark et al., 2014).




Posterior View




is very similar to the anterior view. This what showed a posterior view, an anterior view will confirm. The head (ear level), shoulder position, knee interspace, and ankle position are all assessed in addition to the overall symmetry of the body (Clark et al., 2014).



The posterior view has given extra information towards a heel position and scoliosis screening of the spine. Scoliosis is a lateral and from time to time rotatory curvature of the spine resulting in a "C" or "S" shaped curve the ankle allows assessment of the heel (Gies et al., 2018). 



                                                                             Plumb line



left side                                                          right side













Client A, is a 35-year-old female. Mother of two boys aged an 11 and an 8. She works in a bank from 12 years, five days in week, average of thirty hours. Her work is sedentary and she drives a car every day, everywhere. She does exercise from many years, it is depended on how often, but she is active. She does yoga one times a week, zumba twice and she walks with her dog every day at least thirty minutes. Almost every Sunday she goes with her family for a trip. She does not complain about low back pain at the moment, but every time when she stops exercise, low back pain comes back, she is aware that she must exercise to help herself and she is not getting younger, age is a factor which can make her lower back pain worse.  

Head and neck



Person spins three times and then stands still. An imaginary line goes from midway between the heels, extending upward between the lower extremities, through the midline of the pelvis, through the spine and skull.  Head has very small flexion. Ears level is almost the same on both sides. The right side is slightly lower than the left side. This can point at lateral flexion; the cause can be shortened muscles on the side the neck is flexed to. The head and neck tilt looks correct, asymmetrically. There is no cervical rotation and cervical vertebrae is correct. 



Shoulder height



A person is a right hand, it is a dominate side where hypotrophy is noticed. Can be that there is tightness in the upper trapezius and levator scapulae muscles on the side, or because is right hand. 



Scapula


Adducted scapula on the left side, is too close to the midline of the thoracic vertebrae (only two fingers).  The right side: scapula is far from the midline on three fingers so it is correct distance.  



The position of the inferior angle of the scapula is slightly different. The left scapula is lower campers to the right which is elevated. Muscles which are responsibility for elevater the scapula are shorter on the side that elevates the scapula - upper fibres of the trapezius and lavator scapulae.

Rotation of the scapula in this situation is a downward rotation. In downwardly rotated scapulae it will be abducted at the superior angle and adducted at the inferior angle. The left scapula is bigger and wider. There is no winging of the scapulae. 



Trunk   


 Lateral deviation (Scoliosis). The spinous processes of the vertebrae are lateral to the midline of the trunk. Intrinsic trunk muscles are shortened on one side and contralateral intrinsic trunk muscles lengthened and compression of the vertebrae on the concave side. Leg-length discrepancy. 





Thoracic Cage is not rotate in relation to the client's head and hips.



Upper Limb Position


Space is not the same between the client's arms and their body. On the right side there is no space. The hip hitched and their pelvis is laterally tilted upwards. 



Elbow position are almost correct as well as hands. Palms are facing their thighs, they are not rotated forward. 



Pelvis and Hip


Lateral pelvic tilt, right side of the pelvis is higher posterior superior iliac. What can point to scoliosis with ipsilateral lumbar convexity, leg-length discrepancies. Can be tight ipsilateral hip abductor muscles on the same side as well as tight contralateral hip adductor muscles and can be a weakness of the contralateral abductor muscles. Lumbar spine - pelvis raised on the right. Flex to the right and concave on the right. In the lumbar muscles can be shortened, right quadratus and lumbar erector spine, this can have an effect on the hip joint which means that the right one is adducted and the left one is abducted. Right hip can be shorter adductors and the left hip opposite abductors, this can point that there is an imbalance between the right and left hamstring. Posterior Iliac Spine (PSIS) is not on the same level which suggests that the client has lateral tilt of the pelvis.





 Calf
  we can see that the feet are slightly flat going interior - calcaneovalgus (everted-pronated). Weak muscles can be supinators of the foot.















Anterior View will confirm posterior view 





  Plumb line










The head is deviating slightly, laterally from the midline, is shorter stronger upper Trapezius, shoulders are not on the same level, one is elevated. Shoulders are not rounded. The anterior iliac spines (ASIS) is slightly lower than the other (lateral pelvis). Legs have got different lengths. I took a measurement and one is longer by 1cm, than the other one and the patella is rotated inwards, it should point straight with the respect to the tibiofemoral joint (Edgerton et al., 1996). The rotation of the patella can be link with rotation of the femur or torsion of the tibia (Vesci et al., 2007). The shorter leg will therefore have to over compensate to work as effectively as the other. Ankles slightly inwards towards the midline of the body - forefoot valgus feet flat (plantarflexed position.)





     

Abducted hip -hip shift 









Client has hip shift - she has weak hip abductor with compensation reason can be a weakness of contralateral adductors and ipsilateral abductors (Clark et al., 2014).




Lateral View




Plumb line











Client's head is pushed forward with the chin out from the midline and increased - lumbar spine, lordotic curve. An anteriorly tilted, it is very often that during pregnancy time, baby weight which is growing cause the abdominal muscles to lengthen and weaken, hip extensors, thereby pelvis can change position which can cause be a hyperlordotic posture (Connes et al., 2010).  

  Client was twice pregnant, she gave natural birth. 

It is a big difference between the height of PSIS and ASIS- which is much lower, pelvic tilt, but sometimes can be an anatomic structure (Clark et al., 2014).  

Knee is hyperextended - genu Recurvatum, the gravitational stresses lie forward of the joint axis which can be caused from the tightness of the quadriceps, gastrocnemius, soleus muscle, stretched popliteus and hamstring muscles, at the knee can sometimes compression forces anteriorly or shape of tibial plateau.

Feet have arch to low -(pes planus).
After a prolonged amount of weight bearing exercise the client could experience symptoms of plantar fasciitis, 1stMPTJ pain, Metatarsalgia, arch pain and generalised inflammation around soft tissue structures(Vesci et al., 2007).




Reference 



Connes, P., Hue, O. and Perrey, S. (2010). Exercise physiology. Amsterdam: IOS Press.

 Gies, T. (2018). The ScienceDirect accessibility journey: A case study. Learned Publishing, 31(1), pp.69-76.

 Sloot, L., van der Krogt, M. and Harlaar, J. (2014). Self-paced versus fixed speed treadmill walking. Gait & Posture, 39(1), pp.478-484.

 Micheal A. Clark, Scott C. Lucett, Brian G. Sutton (2014). Corrective Exercise Training. Knee. 28(5), pp100.107.


Vesci BJ, Padua DA, Bell DR, Strickland LJ, Guskiewicz KM, Hirth CJ. Influence of hip muscles strength, flexibility of hip and ankle musculature, and hip muscle activation on dynamic knee valgus motion during a double - egged squat. J Athl Train. 2007;42:S-83


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