Postural Assessment.doc
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1、Postural AssessmentThe ability to perform a postural evaluation accurately and thoroughly requires many skills on the part of the individual. The examiner must be able to separate the parts of the body from the whole and in turn assess the sum of these parts, in reference to their interaction in the
2、 entire anatomical structure. In correct posture, the gravity line passes through the axes of all joints, with the body segments aligned vertically. The gravity line is represented by a vertical line drawn through the bodys center of gravity, located at the second sacral vertebra (S2). The gravity l
3、ine is an ever-changing reference line that responds to the constantly altering body position during upright posture. Although the gravity line generally does not pass through all joint axes of the human body, persons with excellent posture may come close to fulfilling that criterion. Therefore, the
4、 closer a persons postural alignment lies to the center of all joint axes; the less gravitational stress is placed on the soft tissue components of the supporting system.Assessment:The strength and length of muscles involved in joint motion must be balanced. The balance is based on force couple (two
5、 or more translatory forces that in combination produce rotation) principle among muscles involved in the three cardinal planes of motion. When a force couple is out of balance, the segment moves off its axis of rotation and there is faulty joint motion. The head, trunk, shoulders and pelvic girdle
6、serve as the foundations, from which forces are directed to the limbs.Postural faults can be used as guidelines for identifying alterations in muscle and ligament length. This may occur when one muscle groups becomes tight and the antagonist elongated. Synergistic muscles around a joint may be unbal
7、anced as well as the agonists.Minor alignment faults in posture limit motion and lead to tightness of muscles and other soft tissues. Muscles that are elongated often develop their maximal force in the stretched position and are weak in the normal physiological position. Kendall calls this condition
8、 stretch weakness.Alignment of body segments should be observed while the person is standing still and during such movements as walking, to detect faulty patterns of muscle activity and joint mobility. The better the quality of movement and the better the alignment of gravitational forces through jo
9、ints axes, the better is the sequence of motion. When postural alignment improves, imbalances are minimized.Analysis: A systematic approach to postural analysis involves viewing the bodys anatomical alignment relative to a certain established reference line. This reference (gravity) line serves to d
10、ivide the body into equal front and back halves and to bisect it laterally. In preparing to carry out postural assessment, the examiner should be aware of factors that will enhance the success and validity of the examination process. These factors are:1. Postural assessment must be performed with th
11、e subject minimally clothed, in order to ensure a clear view of the contours and anatomical landmarks used for reference.2. The examiner should instruct the subject to assume a comfortable and relaxed posture.3. Subjects who use orthotic or assistive devices should be assessed with and without them
12、to determine their effectiveness in correcting posture.4. The examiner should note relevant medical history and other information that may account for certain postural abnormalities. Important information includes:- Any history that accounts for present postural abnormalities.- A complete descriptio
13、n of present symptoms.- All previous treatments for the presenting postural complaints, including orthopedic and neurological therapy.- The upper limb dominance of the subject, which is often responsible for symptomatic postural deviations. Postural examination is most commonly performed by assessin
14、g the bodys alignment in lateral, posterior and anterior views.1) Standing Posturea) Lateral ViewLateral postural assessments should be performed from both sides to detect and rotational abnormalities that might go undetected if observed from only one lateral perspective. Ideally, the plumb line sho
15、uld pass through the ear lobe and shoulder joint.1. Head and neck:Plumb line: The line falls through the ear lobe to the acromion process. Common faults include:* Forward head: The head lies anterior to the plumb line. It may be due to:- Excessive cervical lordosis.- Right cervical extensor, upper t
16、rapezius, and levator scapulae muscles.- Elongated cervical flexor muscles.* Flattened lordotic cervical curve: The plumb line lies anterior to the vertebral bodies. It may be due to:- Stretched posterior cervical ligaments and extensor muscles.- Tight cervical flexor muscles.* Excessive Lordotic cu
17、rve: The gravity line lies posterior to the vertebral bodies. It may be due to:- Vertebral bodies and joints compressed posteriorly.- Anterior longitudinal ligament stretched.- Tightness of posterior ligaments and neck extensor muscles.- Elongated levator scapulae muscles.2. Shoulder:Plumb line: It
18、falls through the acromion process. Common faults include:* Forward shoulders: The acromion process lies anterior to the plumb line; the scapulae are abducted. It may be due to: - Tight pectoralis major and minor, serratus anterior and intercostal muscles. - Excessive thoracic kyphosis and forward h
19、ead.- Weakness of thoracic extensor, middle trapezius and rhomboid muscles.- Lengthened middle and lower trapezius muscles.* Lumbar Lordosis: The lumbar region is flat as the subject raises arm overhead. It may be due to:- Tightness of the latissimus dorsi muscle and thoraco-lumbar fasciae.3. Thorac
20、ic vertebrae:Plumb line: The line bisects the chest symmetrically. Common faults include:* Kyphosis: Increased posterior convexity of the vertebrae. It may be due to:- Compression of inter-vertebral disks anteriorly.- Stretched thoracic extensors, middle and lower trapezius muscles and posterior lig
21、aments.- Tightness of anterior longitudinal ligament, upper abdominal and anterior chest muscles.* Pectus excavatum (Funnel chest): Depression of the anterior thorax and sternum. It may be due to:- Tightness of upper abdominal, shoulder adductor, pectoralis minor and intercostal muscles.- Bony defor
22、mities of sternum and ribs.- Stretched thoracic extensors, middle and lower trapezius muscles.* Barrel chest: Increased overall antero-posterior diameter of rib cage. It may be due to: - Respiratory difficulties.- Stretched intercostals and anterior chest muscles.- Tightness of scapular adductor mus
23、cles.* Pectus cavinatum (Pigeon chest). The sternum projects anteriorly and downward. It may be due to:- Bony deformity of the ribs and sternum.- Stretched upper abdominal muscles.- Tightness of upper intercostal muscles.4. Lumbar vertebrae:Plumb Line: The line falls midway between the abdomen and b
24、ack and slightly anterior to the sacroiliac Joint. Common faults include:* Lordosis: Hyperextension of lumbar vertebrae. It may be due to: - Anterior pelvic tilt.- Compressed vertebrae posteriorly.- Stretched anterior longitudinal ligament and lower abdominal muscles.- Tightness of posterior longitu
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