Postural Assessment (PT3) o Level scapular spine and inferior angle,

equidistant from vertebra

Posture o Straight spine
 Relative disposition of the body at any given o Symmetric ribs
time o Level waist angle
 Summation of positions of different joints of the o PSIS level
body at that time o Gluteal folds and knee joints are level
 Changes as one changes positions o Achilles tendon descend vertically
 Correct posture o Calcaneus are straight or angled in
 Position at which minimal stress is  Too many toes (more than 2
applied to each joint toes) = out-toeing
 Faulty Posture  No toes = in-toeing
 Any point that increases stress to each
Ideal static postural alignment (Anterior View)
joint; may cause pain
 Causes o Head in midline
o Positional/Postural o Proper jaw position (mouth closed,
 Muscle imbalance, teeth slightly open, tongue rests at
pain, respiratory upper teeth)
conditions, weakness, o Nose in line with sternum, umbilicus
weight o Shoulders level
o Structural (bony problems) o Protrusion of ribs
 Hemivertebra, Leg o Equal waist angle
length discrepancy o Equal carrying angle (15°)
o Habit o Iliac Crest, ASIS are level
 Prolonged static o Patellae point forward
positioning, “Peer o Knees are straight
Pressure” o Fibular heads are level
o Malleoli are level
Ideal static postural alignment (lateral view)
o Normal out toeing (8-15°)
o External auditory meatus
McKenzie’s 3 Postural Syndromes
o Bodies of cervical vertebra
o Acromion process (tip of shoulder) Postural Syndrome
o Midway through the thorax
o Bodies of lumbar vertebrae  Normal healthy tissues
o Slightly posterior to hip joint  Pain is induced by end-range static loading
o Anterior to knee joint axis  Pain is not referred and never constant
o Anterior to lateral malleolus  “pain will go away when corrected”

Dysfunction Syndrome
Ideal static postural alignment (posterior view)
 Shortened soft tissue have reduced elasticity
o Shoulders level, head in midline  Pain at end-range when shortened tissues are
 Sprengel’s deformity (scapula tensed
did not descend)  Pain is never felt on movement and is not
 Scapular winging referred
Derangement Syndrome Base of Support (BOS)

 Misalignment of IV disc materials/bony  Area on which an object rests and that provides
alignment support for the object
 Symptoms are affected by movement  BOS = stability
 May be referred and often are constant

Development of Posture
Importance of Good posture
o Primary curve
 Protects the joints and other structures from
 Spine concave anteriorly at birth
injury
 Persists throughout life, but only in
 Promotes good muscle balance and flexibility
specific areas (thoracic and sacral spine)
 Kyphosis  Allows greater precision and endurance in
o Secondary Curve performing a task
 Present at 3 months (when child learns  Allows for adequate respiration
to lift his head)  Improves general appearance and uplifts
 Cervical spine convexity emotional well-being of a person
 Lordosis
Dangers of Poor Posture
 Important so that the
child may observe his  Predisposes the soft tissues and the spinal
surroundings structures and even the organ system to injury
 6-8 months (when child learns to sit and  May block food and air
walk; keeping trunk upright)
 Lumbar spine convexity
 Lordosis
Principles of Proper Posture
 This frees the hand of the child
for manipulation  Stand with your body erect so your shoulders
o Old age and Spinal Curvatures and hips are level; avoid slouch or “round back”
 As one ages, the curvatures go back to positions
the ones in an infant (returns to C  Sit with knees and hips flexed to 90° with your
curved shape or kyphosis) feet flat with the floor/stool. Your knees should
 Due to disc degeneration, ligamentous be same levels as your hips with pelvis rolled
calcification, vertebral wedging, forward
osteoporosis  Arms should be supported; either relaxed on
the thigh or at arm rests
 Use a lumbar roll during prolonged sitting
 Avoid standing/sitting in one position for a
Center of Gravity (COG) prolonged period of time
 Stand with your ankles, knees, hips and
 Imaginary point in the body where all the force shoulders aligned; keep your head over your
acting upon it are balanced body
 Changes as the body moves (inside or outside
the body)
Adults: 1 inch anterior to S2
Infants: Xiphoid processes
  Walking Lower Crossed Syndrome
 Always stand erect
 Face the direction of movement
always
 Use a heel to toe gait pattern
(absorbing excessive force)
 Walk with your normal stride

Conditions/Clinical notes

 Step deformity
 dislocation of Acromioclavicular joint;
sticking out of clavicle
 Sulcus sign
 anglulation o the end of shoulder, excessive
pull of gravity (common in patients with
stroke)
 Carrying angle
 Cubitus Varus – elbow near body Extension  Abdominals Erector spinae
 Cubitus Valgus – elbow out
 Squinting Patellae
 Both patella are directed to each other
 Grasshopper eye
 Both patella are directed outside flexionHip flexors (Iliopsoas) Glutes, Hamstrings
 Patella Alta
 Patella that rides higher than the other *when one is tight, the other one is weak
 Patella Baja
 Patella that rides lower than the other
 Genu Varum Upper Crossed Syndrome
 *ask patient to have their feet together
 Present with space in between knees
(<2 fingers is significant)
 Genu Valgum
 *ask patient to have their feet together
 Knees stick together before the feet do
 In-toeing (Pigeon’s toe)
 Caused by rotation of tibia; squinting of
patella (cause of hip probs) will cause
this
 Flatfoot (Pes Cavus)
 Flexible – upon lifting foot, an arch will
appear
 Rigid – upon lifting foot, there is no arch
Malalignments viewed Anteriorly

Malalignment Possible Correlated Motions or Postures Possible Compensatory Motions or

Postures
Out-Toeing Tight Achilles
Talipes Calcaneovalgus
Convex Pes Planovarus
Lateral tibial Torsion
Hypoplastic (absence of) fibula
Lateral femoral torsion
Abnormal femoral retroversion
Tight lateral rotators
Flaccid Medial Rotators
Acetabular dysplasia (facing posteriorly)
*Tight IRs/Weak ERs
In-Toeing Pronated foot
Medial tibial torsion
Metatarsus Varus
Talipes Varus or equinovarus
Tibia or Genu Varum
Medial Femoral Torsion
Excessive femoral Anterversion
Tight medial hip rotators
Acetabular dysplasia (facing anteriorly)
*Tight Ers / Weak IRs
Flat-footedness* Pronated foot
 Rigid/Flexion Excessive femoral anteversion

 8-15°

Hallux Valgus Forefoot Valgus Excessive tibial; tibial and femoral; or

Subtalar pronation and related rotation tibial, femoral and pelvic lateral rotation,
along the lower quarter or all with ipsilateral lumbar spine
rotation

Metatarsus Adductus Hallux Valgus

Medial Tibial Torsion
Flatfoot
Toeing-in

Forefoot Valgus Hallux Valgus Excessive midtarsal or subtalar

Subtalar pronation and related rotation supination
along the lower quarter Excessive tibial; tibial and femoral; or
tibial, femoral and pelvic rotation, or all
with ipsilateral lumbar spine rotation
*Pes equines – plantarflex
*Pes Calcaneus – dorsiflex
*Pes Valgus – evert
*Pes Varus - invert

Ankle Equinus Hypermobile first ray

Subtalar or midtarsal excessive
pronation
Hip or knee flexion
Genu recurvatum

Bowleg deformity of the tibia Medial tibial torsion Forefoot valgus

(tibial varum) Excessive subtalar pronation

Inadequate tibial retroflexion Altered alignment of Achilles tendon

(bowing of the tibia) causing altered association joint motion

Lateral tibial (malleolar) torsion Out-toeing Functional forefoot varus

Excessive subtalar supination with related Excessive subtalar pronation with
rotation along the lower quarter relaxed rotation along the lower quarter

Medial Tibial (malleolar) In-toeing Functional forefoot valgus

torsion Metatarsus adductus Excessive subtalar supination with
Excessive subtalar pronation with related relaxed rotation along the lower quarter
rotation along the lower quarter

Genu Varum Excessive lateral angulation of the tibia in Forefoot valgus

the frontal plane; tibial varum Excessive subtalar pronation to allow
Medial Tibial Torsion the medial heel to contact the ground
Ipsilateral hip lateral rotation Ipsilateral pelvic medial rotation
Excessive hip abduction
Genu Valgum Pes Planus Forefoot varus
Excessive subtalar pronation Excessive subtalar supination to allow
Lateral tibial torsion the lateral heel to contact the ground
Lateral patellar subluxation In-toeing to decrease lateral pelvic sway
Excessive hip adduction during gait
Ipsilateral hip excessive medial rotation Ipsilateral pelvic lateral rotation
Lumbar spine contralateral rotation
*Patella Alta – high rising
patella
*Patella Baja – Patella
excessively placed low

*Lateral Patellar Subluxation Genu Valgum

Pes Planus

Lateral Femoral torsion Excessive subtalar supination Excessive subtalar pronation

Out-toeing Functional forefoot varus
Lateral-facing or tilted patella
(“grasshopper eyes” or “frog eyes”
patella)

Medial Femoral torsion Excessive subtalar pronation Excessive subtalar supination

In-toeing Functional forefoot valgus
Medial facing or tilted patella (“squinting”
patella)

Coxa Valga Supinated Subtalar joint Ipsilateral subtalar pronation

Lateral rotation of leg Contralateral subtalar supination
Long ipsilateral leg Contralateral plantar flexion
Posterior pelvic tilt Ipsilateral genu recurvatum
Ipsilateral hip and or knee flexion
Ipsilateral anterior pelvic rotation and
contralateral lumbar rotation

Coxa Vara Pronated subtalar joint Ipsilateral subtalar supination

Medial Rotation of leg Contralateral subtalar pronation
Short ipsilateral leg Ipsilateral plantar flexion
Anterior pelvic rotation Contralateral genu recurvatum
Contralateral hip and or knee flexion
Ipsilateral posterior pelvic rotation and
ipsilateral lumbar rotation

Excessive (femoral) anteversion Toeing-in Lateral tibial torsion

Subtalar pronation Lateral rotation at knee
Lateral patellar subluxation Lateral rotation of tibia, femur, and/or
Medial tibial torsion pelvis
Medial femoral torsion Lumbar rotation on same side
Excessive (femoral) Toeing-out Medial rotation at knee
retroversion Subtalar supination Medial rotation of tibia, femur, and/or
Lateral Tibial torsion pelvis
Lateral Femoral torsion Lumbar rotation on opposite side

*Pelvis Rotation Anteriorly rotated (ASIS lower PSIS)

Posteriorly rotated (ASIS higher PSIS)

*Pelvis Slips Upslip (bony landmarks higher on 1 side)

Downslip (bony landmarks lower on 1
side)

*Pelvis Flare Outflare (ASIS farther from umbilicus)

Inflare (ASIS closer from umbilicus)

Lateral Pelvic Tilt (pelvic drop – Right hip adduction Right lumbar lateral flexion
right leg stance) Weak right abductors (positive Tight left adductors
Trendelenburg’s)

Lateral pelvic tilt (pelvic hitch – Right hip abduction Left lumbar lateral flexion
right leg stance) Weak left adductors Tight right abductors

Forward rotation of 1 ilium on Right hip medial rotation Left lumbar rotation
sacrum (right leg stance) Medial-facing patella Scoliosis – concavity to left
In toeing Knee flexion
Pronation of foot
Long leg

Scoliosis Side flexion to convex side limited

Rotation to convex side limited
Rib hump on convex side

Torticollis “stiff neck” Rotation to same side limited

Side flexion to opposite side limited

*notes from Sir X

Malalignments viewed laterally

Malalignment Possible Correlated Motions or Possible Compensatory Motions or Postures

Postures
Forward head posture Extension of cervical spine Increased kyphosis in thoracic spine
Protracted scapula Increased lordosis in lumbar spine
Medially rotated humerus
Round back Extesion of cervical spine Forward head posture
Protracted Scapula Hips flexed
Knees extend
Flat back Posterior Pelvic tilt Hips extended
Knees extended
Forward head posture

Swayback Pelvic neutral or posterior tilt Pelvis slides anterior

Kyphosis
Hips extended
Knees extended
Pathological Lordosis Pelvis anteriorly tilted Knees extended
Tight hip flexors Ankles plantar flexed

Anterior Pelvic tilt Hip flexion (tight hip flexors) Lumbar extension (increased Lordosis)
Hyperextended knees
Poking chin (cervical extension)
Rounded shoulders (protracted scapula)
Thoracic kyphosis
Ankles plantar flexed
Posterior pelvic tilt Hip extension Lumbar flexion (flat back)
Hips extended
Knees extended
Forward head posture

Backward rotation of one ilium Right hip lateral rotation Right lumbar rotation
on sacrum (right leg stance) Lateral facing patella Scoliosis – concavitiy to right
Out-toeing Knee extension
Supination of foot
Short leg
Genu Recurvatum Ankle plantar flexion Posterior pelvic tilt
Excessive anterior pelvic tilt Flexed trunk posture
Excessive thoracic kyphosis

Excessive tibial retroversion Genu recurvatum

(posterior slant of tibial
plateaus)

Inadequate tibial retrotorsion Flexed knee posture

(posterior deflection of proximal
tibia because of hamstrings pull)
Malalignments viewed Posteriorly

Malalignment Possible Correlated Motions or Possible Compensatory

postures
Scoliosis Side flexion to convex side
limited
Rotation to convex side limited
Rib hump on convex side
Rear-foot varus Tibial; tibial and femoral; or Excessive medial rotation along the lower
Excessive subtalar tibial, femoral, and pelvic lateral quarter chain
supination(calcaneal varus) rotation Hallux Valgus
Plantar-flexed first ray
Functional forefoot valgus
Excessive or prolonged midtarsal pronation
Rear-foot valgus Tibial; tibial and femoral; or Excessive lateral rotation along the lower
Excessive subtalar pronation tibial, femoral, and pelvic medial quarter chain
(calcaneal valgus) rotation Funtional forefoot varus
Hallux Valgus
Forefoot varus Subtalar supination and related Plantar-flexed first ray
rotation along the lower quarter Hallux valgus
Excessive midtarsal or subtalar pronation or
prolonged pronation
Excessive tibial; tibial and femoral; or tibial,
femoral, and pelvic medial rotation, or all with
contralateral lumbar spine rotation

MCT2017