Posture Examination

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There is a lot of controversy about examination for posture regarding its validity and reliability. Many clinicians state that there is no such thing as poor or ideal posture. Some may however still choose to make comments about posture, or at least want to be aware of the terminology, or think that there is some limited value in the concept.

Posture Assessment

The patient should be instructed to adopt their usual posture. Examine the anterior, lateral, posterior views of the patient.

In Standing

In the sagittal plane the line of gravity should pass through the earlobe, shoulder joint, hip joint, greater trochanter of the femur, slightly anterior to the midline knee joint, and finally to the lateral malleolus. Also assess for head alignment and spinal curvatures. (See also sagittal balance of the spine)

In the coronal plane the line should bisect the body into equal halves with even weight between the two feet. Also assess for shoulder and pelvic symmetry; and alignment of the hips, knees, and ankles. Look at the "hole" between the elbows and the trunk and assess if the area and shape is symmetrical. (see also coronal balance of the spine).

In Sitting

Assess if the ears are aligned with the shoulders, and that the shoulders are aligned with the hips. Look at the shoulders whether they are relaxed and if the elbows are close to the sides of the body. The angles of the elbows, hips, and knees should be around 90 degrees. The feet should be flat on the floor. The forearms should be parallel to the floor with straight wrists.

"Syndromes"

The following syndromes all have limited reliability and validity. They all come with assumptions about which muscles are "weak" or "tight." Vladimir Janda was an important doctor who promulgated the idea of certain postural problems and their relationship to the activity of phasic and tonic muscles.

The upper (or shoulder) crossed syndrome

there is elevation and protraction of the shoulders, rotation and abduction (winging) of the scapula and forward head posture.

The lower (or pelvic) crossed syndrome

there is an anteriorly rotated pelvis, increased lumbar lordosis, and slight hip flexion.

The kyphosis-lordosis posture

this is basically the same as the upper and lower crossed syndromes.

Layer syndrome

there are alternate 'layers' of hypertrophic and hypertrophic muscles when viewed from behind. There is weakness of the lower stabilisers of the scapula, lumbosacral erector spinae, rectus abdominis, transversus abdominis, and gluteus maximus. There is hypertrophy of the cervical erector spinae, upper trapezius, levator scapulae, thoracolumbar erector spinae, and hamstrings.

Flat back posture

there is a slightly extended cervical spine, flexion of the upper thoracic spine, straight lower thoracic spine, absent lumbar lordosis, posterior pelvic tilt, hip extension, and slight plantarflexion of the ankle joint.

Sway back posture

there is a forward head posture, slightly extended cervical spine, increased flexion and posterior displacement of the upper trunk, flexion of the lumbar spine, posterior pelvic tilt, hyperextended hips, anterior pelvic displacement, hyperextended knees, and neutral ankles.

Handedness posture

for right handed individuals there is a lower right shoulder, adducted and depressed right scapula, thoracolumbar curve convex to the left, lateral pelvic tilt high on the right, right hip adduction with slight medial rotation, and left hip abduction with slight right foot pronation.

True Deformities

There are various true postural deformities.

Camptocormia

Camptocormia also known as bent spine syndrome is a usually organic disorder characterised by marked flexion (greater than 45 degrees) of the thoracolumbar spine that increases during the day and completely disappears when supine.

Scoliosis

Idiopathic Scoliosis is a three dimensional spinal deformity in frontal, sagittal, and axial planes. It is defined as a coronal spinal curvature of at least 10° with rotation of the vertebral bodies and has unknown aetiology.

Scheueremann's Disease

Scheuermann's disease (SD) is a developmental disorder in adolescence that causes a rigid or relatively rigid hyperkyphosis of the thoracic, thoracolumbar, or rarely lumbar spine and has specific radiographic findings.[1]

Pisa syndrome

Tilting of the trunk especially when sitting or standing. Seen mostly in Parkinson's disease.

Dropped head syndrome (antecollis)

Also seen in Parkinson's disease.

References

  1. Bezalel et al.. Scheuermann's disease: current diagnosis and treatment approach. Journal of back and musculoskeletal rehabilitation 2014. 27:383-90. PMID: 24898440. DOI.