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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
25、dinal ligaments, lower back extensor and hip flexor muscles.* Sway back: Flattening of the lumbar vertebrae (the pelvis is displaced forward). It may be due to:- Thoracic kyphosis.- Posterior pelvic tilt.- Stretched anterior hip ligaments-hips hyperextended.- Compression of vertebrae posteriorly.- S
26、tretched posterior longitudinal ligaments, back extensors and hip flexors.* Flat back: Flattening of the lumbar vertebrae. It may be due to:- Posterior pelvic tilt.- Tightness of the hamstring muscles.- Weakness of the hip flexor muscles.- Stretched posterior longitudinal ligaments.5. Pelvis and hip
27、: Plumb Line: The line falls slightly anterior to the sacroiliac joint and posterior to the hip joint, through the greater trochanter, creating an extension moment. Common faults include:* Anterior pelvic tilt. The anterior superior iliac spines lie anterior to the pubic symphysis. It may be due to:
28、- Increased lumbar Lordosis and thoracic Kyphosis.- Compression of vertebrae posteriorly. - Stretched abdominal muscles, sacro-tuberous, sacroiliac and sacro-spinous ligaments.- Tightness of hip flexors.* Posterior pelvic tilt. The symphysis pubis lies anterior to the anterior superior iliac spines.
29、 It may be due to:- Sway back with thoracic kyphosis.- Compression of vertebrae anteriorly.- Stretched hip flexors, lower abdominal muscles and joint capsule.- Tightness of hamstring muscles.6. Knee:Plumb line: The line passes slightly anterior to the midline of the knee, creating an extension momen
30、t. Common faults include:* Genu recurvatum: Knee is hyperextended and the gravitational stresses lie far forward of the joint axis. It may be due to:- Tightness of quadriceps, gastrocnemius and soleus muscles.- Stretched popliteus and hamstring muscles at the knee.- Compression forces anteriorly.- S
31、hape of tibial plateau.* Flexed knee: The plumb line falls posterior to the joint axis. It may be due to:- Tightness of and hamstring muscles at the knee.- Stretched quadriceps and tight gastrocnemius muscles.- Posterior compression forces.- Bony and soft tissue limitations.7. Ankle: Plumb line: The
32、 line lies slightly anterior to the lateral malleolus, aligned with tuberosity of 5th metatarsal. Common faults include:* Forward posture: The plumb line is posterior to the body; body weight is carried on the metatarsal heads of the feet. It may be due to:- Ankles in dorsiflexion with forward incli
33、nation of the legs; posterior musculature stretched.- Tightness of dorsal musculature.- Posterior muscles of the trunk remain contracted.b) Posterior viewIn a posterior view examination, the examiners plumb line divides the body into equal left and right halves.1. Head and neck:Plumb line: The midli
34、ne bisects the head through the external occipital protuberance; head is usually positioned squarely over the shoulders so that eyes remain level. Common faults include:* Head tilt: Subjects head lies more to one side of the plumb line. It may be due to:- Tightness of lateral neck flexors on one sid
35、e.- Stretched lateral neck flexors contra-laterally.- Compression of vertebrae ipsi-laterally.* Head rotated: The plumb line is to the right or left of the midline. It may be due to:- Tightness of the sternocleidomastoid, upper trapezius, scalene and intrinsic rotator muscles on one side.- Elongated
36、 contralateral rotator muscles.- Compression and rotation of the vertebrae. 2. Shoulder and scapula: Plumb line: It falls midway between shoulders. Common faults include:* Dropped shoulder: One shoulder is lower than the other. It may be due to:- Hand dominance (dominant shoulder is lower).- Lateral
37、 trunk muscles are short and hip is high and adducted.- Tightness of the rhomboid and latissimus dorsi muscles.* Elevated shoulder: One shoulder is higher than the other. This may be due to:- Tightness in the upper trapezius and levator scapulae muscles on one side; hypertrophy may be noticed on the
38、 dominant side.- Elongated and weak lower trapezius and pectoralis minor.- Scoliosis of the thoracic vertebrae.* Shoulder medial rotation: The medial epicondyle of the humerus is directed posteriorly. It may be due to:- Joint limitation in lateral rotation.- Tightness of the medial rotator muscles.*
39、 Shoulder lateral rotation: Olecranon process faces posteriorly. It may be due to:- Joint limitation in medial rotation.- Tightness of the lateral rotators.* Adducted scapulae: The scapulae are too close to the midline of the thoracic vertebrae. It may be due to:- Shortened rhomboid muscles.- Stretc
40、hed pectoralis major and minor muscles.* Abducted scapulae: The scapulae have moved away from the midline of the thoracic vertebrae. It may be due to: - Tightness of the serratus anterior muscle.- Lengthened rhomboid and middle trapezius muscles. * Winging of the scapulae: The medial borders of the
41、scapulae lift off ribs. It may be due to: - Weakness of the serratus anterior.3. Trunk:Plumb Line: The line bisects the spinous process of the thoracic and lumbar vertebrae. Common faults include:* Lateral deviation (Scoliosis): The spinous processes of the vertebrae are lateral to the midline of th
42、e trunk.- Intrinsic trunk muscles are shortened on one side.- Contralateral intrinsic trunk muscles are lengthened.- Compression of vertebrae on the concave side.- Structural changes in rips or vertebrae.- Leg-length discrepancy and obliquity.- Internal organ disorders.4. Pelvis and Hip:Plumb line:
43、The line bisects the gluteal cleft and the posterior superior iliac spines are on the same horizontal plane; the iliac crests, gluteal folds and greater trochanters are level. Common faults include:* Lateral pelvic tilt: One side of the pelvis is higher than the other due to:- Scoliosis with ipsilat
44、eral lumbar convexity. - Leg-length discrepancies.- Shortening of the contralateral quadrates lumborum.- Tight ipsi-lateral hip abductor muscles on the same side and tight contralateral hip adductor muscles.- Weakness of the contralateral abductor muscles.* Pelvic rotation: The plumb line falls to t
45、he right or left of the gluteal cleft. It may be due to:- Tightness of medial rotator and hip flexor muscles on the rotated side.- Ipsilateral lumbar rotation. Abducted hip: The greater trochanter is higher on the involved side. It may be due to: - Tightness of the hip abductor muscles.- Tightness o
46、f contralateral hip adductor muscles.- Weakness of contralateral adductors and ipsilateral abductors.5. Knee:Plumb Line: The plumb line lies, equidistant between the knees. Common faults include: Genu varum: The distal segment (leg) deviates toward midline in relation to the proximal segment (thigh)
47、; the knee joint lies lateral to the mechanical axis of the lower limb. It may be due to:- Tightness of medial rotator muscles at the hip with hyper-extended knees, quadriceps and foot evertor muscles.- Compression of medial joint structures. - Femoral retroversion.- Elongated lateral hip rotator mu
48、scles, popliteus and tibialis posterior. Genu Valgum: The mechanical axis for the lower limbs is displaced laterally. It may be due to:- Tightness of ilio-tibial band and the lateral knee joint structures.- Femoral ante-version.- Lengthened medial knee joint structures.- Compression of lateral knee joint.- Foot pronation.6. Ankle and Foot:Plumb line: The line is equidistant from the malleoli, a line (Feiss) is drawn from the medial malleolus
