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Posture is a “position or attitude of the body a relative arrangement of body part
for a specific activity or a characteristic manner of bearing the body”.
POSTURE acronym for easy reference:
P:-Pelvis in neutral, with weight distributed
O:-on the whole foot.
R:-retracted shoulders and
E:-ear over shoulder.
Classification of posture
A. Inactive Posture
A) Static Posture
B) Dynamic posture
Postural Reflex –
4. Joint Structure
Skin sensation also plays a part, eg.soles of the feet, when the body in
Impulses from all these receptors are conveyed and coordinated in the
central nervous system.
Good / Correct Posture-
Good posture is the state of muscular and skeletal balance that protect
the supporting structures of the body against injury or progressive
deformity irrespective of the attitude.
A stable psychological background
Joy, Happiness- Posture in which position of extension.
Sad, Unhappy- In which position of flexion.
Good hygienic condition.
Opportunity for plenty of natural free movement.
Maintenance of Body and its Segment
Stabilization of the Spinal Column by the
Muscle of Trunk
The assessment of posture is in standing position. The whole posture is
asessed from head to toes in different views,
(a) Lateral views
(b) Posterior views
(c) Anterior views
The examiner should first determine the patient body type. There are three body
(i) Ecotomorph is a person who has a thin body builds characterized by a
relative prominence of structure developed from the embryonic ectoderm.
(ii) Mesomorph has muscular or sturdy body build characterized by a relative
prominence of structure developed by the embryonic mesoderm.
(iii) Endomorph has a heavy or fat body builds characterized by a relative
prominence of structure developed from the embryonic endoderm.
Head straight on shoulders
Posture of jaw
Tip of nose
Upper trapezius neck line
Sternum & ribs
Waist angles & arm positions
(1) Lordotic Posture – Lordosis is the normal curve
(anterior convexity) of cervical and lumbar spine which is found
all normal individual pathologically. it is an exaggeration of the
normal curve found in cervical and lumbar spine.
Potential Sources of Pain
• Stress to the anterior longitudinal ligament
• Narrowing of the posterior disk space and narrowing of
• Approximation of the articular facets. The facets may become
weight bearing which may cause syonovial irritation and joint
Common Cause of Excessive Lumbar
Weakness of abdominals muscle
Tightness or contracture of hip flexor (iliopsoas)
Congenital problems such as bilateral congenital
dislocation of hip
High heel shoes / foot wears
Anterior tilt of pelvis as a result of weak extensor of hip
Tightness or shortening of cervical extensor.
Treatment for Excessive Lumbar Lordosis
Mobilization of the lumbar spine.
Anterior stretching of the lumbar spine
Strengthening of the abdominals, glutei and hamstring.
Training in grade correction of pelvic tilt has to be
emphasized active backward or posterior pelvic tilting by
contracting abdominals and glutei in supine is initiated.
Toe touching in long sitting or forward bending sitting
Spinal extension or hyper extension should be strictly
Treat the cause of increase lumbar lordosis.
(2) Kyphotic Posture / Round Back –
It is a faulty posture in which lumbar spine and cervical spine
get hyper extended while thoracic spine get flexed and head
become slightly forward.
Potential Sources of Pain
* Stressed to the posterior longitudinal ligament.
* Fatigue of the thoracic erector spinae and rhomboid muscle.
* Thoracic outlet syndromes.
* Cervical posture syndromes.
Common Cause of kyphosis
Shortening or tightness of extensors of cervical spine and
lumbar spine and flexor of hip joint.
Weakness of neck flexors,upper back extensors (erector
spinae) and Hamstring muscle.
Bony anomaly generally in anterior tilt of pelvis,
abdominals get elongated but in this posture excessive
flexion of thoracic spine offsets the effect of anterior pelvic
Other congenital anomalies.
Treatment of kyphosis
Repeated stretching session
Posture of head, neck and shoulder
Mobilization of the whole spine
Resistive exercise for longitudinal and transverse back
Controlled pelvic tilt
(3) Scoliotic Posture- A lateral curvature of spine which exceeds
10 bending of the vertebral from the normal is tended as scoliosis
column to one side combined with rotation of the vertebral bodies
towards the convexity and the spinous process towards the
Potential Source of Pain –
*Muscle fatigue and ligamentous strain on the side of
*Nerve root irritation on the side of concavity.
Common Cause –
Structural scoliosis – Neuromuscular disease,osteopathic
disorder, and idiopathic disorder
Non structural – Leg length discrepancy,either structural
or functional, muscle guarding or spasm a painful stimuli
in the back or neck, and habitual or asymmetric posture.
Treatment of scoliosis
Active Correction with postural adaptation
Passive Correction by Hanging
Educate the patient by active effort
Repeated sessions of maintenance
General free mobility exercises
(4) Sway Back Posture/Slouched –
* It is faulty posture in which head becomes slightly forward
there is extension of cervical spine, flexion of thoracic and
loss of lordosis of lumbar spine extension of hip and knee
joint during standing are also the feature of sway back
posture pelvis rotates posteriorly.
* In this there is increased pelvic inclination up to 40.When
standing for prolonged period the person usually assumes
an asymmetric stance.
* In which most of the weight is borne on one lower
extremity with periodic shifting of weight to the opposite
Potential Source of Pain –
Stress to iliofemoral ligament, the anterior longitudinal
ligament of lower lumbar spine and posterior longitudinal
ligament of upper lumbar and thoracic spine.
Narrowing of intervertebral foramen in lower lumbar spine
that may compress the blood vessel dura & nerve root.
Approximation of articular facets in to lower lumbar spine
Common Cause of Sway Back
1)Tightness of hamstring and abdominal muscle.
2)Weakness of one joint iliopsoas
Treatment of Sway Back
• Stretching of hamstring and abdominal muscle
• Relaxation of the body
• Strengthening of iliopsoas
• Maintain position of head is backward, extension of
• Maintain normal lordosis of lumbar spine
• Always standing in erect position
5) Flat Back Posture –
Flat back is faulty posture in which whole lumbar
and thoracic spine gets flattened. Although the cause and
symptom of both flat back and sway back are common but
can be differentiated by excessive flexion and back ward
deviation of the upper thoracic spine in sway back posture
while in flat back posture spine become almost straight. It is
reverse a lumbar lordosis. There is flattening of normal
Potential Source of Pain
• Lack of the normal physiologic lumbar curve which reduces
the shock absorbing effect of lumbar region and predisposes
the person to injury.
• Stress to the posterior longitudinal ligament.
• Increase of the posterior disk space which allow the nucleus
pulposus to imbibe extra fluid and under certain
circumstance may protrude posteriorly when the person
Common Cause of Flat Back
1) Tight trunk flexor (rectus abdominis and
intercostal) and hip extensor muscle.
2) Stretched and weak lumbar extensor and
possibly hip flexor muscle.
Treatment of Flat Back
• Increase lumbar lordosis which results in forward tilting
• Maintance of arch by active holding and also passive
support in sitting are effective in maintaining lordosis.
• Mobility and strengthening exercise of lumbar extensor
• Stretching of trunk flexor and hip extensor muscle.
6) Flat Neck Posture –
It is an abnormal posture which is characterized by
any increased upper flexion of the occiput on atlas
and decreased lordosis of the cervical spine. It may
be seen with an exaggerated military posture. There
may be tempomandibular joint dysfunction with
protection of the mandible.
Potential Source of Pain
• Temporomanibular joint pain and occlusive changes
• Decrease in the shock absorbing function of the
lordotic curve which may predispose the neck to injury.
• Stress to ligamentum nuchae.
Common Cause of Flat Neck Posture
• Short anterior neck muscle
• Activity which require straightening of cervical spine
predisposes to this type of posture such as –
* soldier keep their upper back straight(attention
position) for prolonged period of time,
* using high pillow under the head and spasm of
Treatment of Flat Neck Posture
• Relaxed passive movement this includes manipulation
and mobilization of cervical spine.
• Strong isometric are indicated when mobility is
contraindicated but strength,endurance,and tone of the
cervical muscle are maintained or improved.
• Stretching the anterior neck muscle.
• Strengthening exercises of levator scapulae,
strenocledomastoid and scalene muscle.
• Improvement of the posture and function of neck.
7) Forward Head Posture –
It is faulty posture which is characterized by excessive
extension of uppegr cervical spine and flexion of the lower
cervical and upper thoracic. There also may be
temporomandibular Joint (TMJ) dysfunction with retrusion
of the mandible.
Potential Source of Pain
• Stress to anterior longitudinal ligament in the upper
cervical spine and posterior longitudinal ligament in the
lower cervical and upper thoracic spine.
• Muscle tension or fatigue.
• Irritation of facet joint in upper cervical spine
• Narrowing of the intervertebral foramina in the upper
cervical region which may impinge on the blood vessel
and nerve roots, especially if there are degenerative
• Impingement on the neurovascular bundle from
anterior scalene muscle tightness.
• Impingement on the cervical plexus from levator
scapulae muscle tightness.
• Impingement on the greater occipital nerve from a tight
or tense upper trapezius muscle leading to tension
• TMJ pain from faulty head, neck and manibular
alignment and associated facial muscle tension.
• Lower cervical disc lesion from the faulty flexed
Cause of Forward Head Posture
• Working on computer which is slightly higher than the
position of head.
• Enthusiastically watching match on television for
prolonged time also predisposes to this type of faulty
• Using of high pillow under the neck
• Tight levator scapulae,Sternocledomastoid,Scalene and
• Stretched and weakened anterior throat muscle and
lower cervical and upper thoracic erector spinae muscle.
Treatment of Forward Head Posture
• Stretching of levator scapulae, Sterocledomastoid,
Scalene and Sub-occipital muscle.
• Avoid pillow or small pillow under the neck.
• PNF (Proprioceptive Neuromuscular Fasciculation)
technique ideally combines all the four above mentioned
• Strong isometric and indicated when mobility is
contraindicated but strength, endurance and tone of the
cervical muscle are to be maintained or improved.
Postural Examination Chart
Handedness …………… Age…………… Sex…………
Leg Length: Left…………… Right……………..
1)Relationships Between Lumbar Lordosis, Pelvic Tilt,
and Abdominal Muscle Performance
MARTHA L. WALKER, et al
Purpose- The purpose of this study was to examine the relationships
between measurements of lumbar lordosis, pelvic tilt, and
abdominal muscle performance during normal standing.
Subjects-The subjects were 31 healthy physical therapy students, 23
women and 8 men, between the ages of 20 and 33 years, with a mean
age of 23.9 years (s = 3.8 years).
Inclusion criteria- ages between 20 and 33years
Exclusion criteria- acute or chronic back pain
scoliosis of greater than 15 degrees
Measurements of pelvic tilt and lumbar lordosis were taken before
testing the abdominal muscle function
Location of bony landmarks
Examiner palpated the right ASIS and PSIS
Palpated spinous processes of S2 and L3 and marked them with
Measurement of pelvic tilt
Examiner placed the arms of the inclinometer on the marked
ASIS and PSIS, and the second examiner (S.D.F.) read and
recorded the angle of inclination.
Measurement of lumbar lordosis
The points that intersected L3 and S2 were marked, and a line
was drawn between them.
Testing of abdominal muscles
The ICC values for repeated measures (ie, reliability) of pelvic
tilt and lordosis were .84 and .90, respectively.
The Spearman's rho correlation coefficient for
repeated abdominal muscle tests was .71.
The Spearman's rho correlation of abdominal muscle test
values with pelvic tilt measurements was. 18 and with lumbar
lordosis measurements was .0
Pearson product-moment correlation of lumbar lordosis
measurements with pelvic tilt was .32.
Abdominal Muscle Function
Relationship of Abdominal Muscle Function,
Lordosis, and Pelvic Tilt
Lumbar lordosis, pelvic tilt, and abdominal muscle
function during normal standing are not related.
This study demonstrates the need for a reexamination of
clinical practices based on assumed relationships of
abdominal muscle performance,pelvic tilt, and lordosis.
2)Effects of Approximation on Postural Sway in
KATHERINE T. RATLIFFE
PURPOSE- investigate the effect of approximation provided by a
weighted belt on postural sway in healthy subjects.
Subjects- studied 20 subjects, 6men and 14 women, between the
ages of 23 and 30 years.
Inclusion criteria- healthy subjects
History of ear surgery
Central or peripheral nervous system disorder
Injury of the spine, hip, knee, or ankle that required
immobilization or surgery during the past 10 years
Respiratory illness within five days before data collection.
Pregnant or had undergone childbirth within the previous
Currently had ataxia,vertigo, or nausea
Permanent musculoskeletal abnormalities
Taking any drugs
Twenty subjects between the ages of 23 and 30
years stood on a polyurethane foam platform that
amplified their postural sway and were filmed from a
lateral view. All subjects wore markers over their
mandibles, hips, and knees and were filmed three
times with the weighted belt worn on a randomly
Frames from a 10-second interval of film from each
trial were studied, and the summed displacement at
each bony landmark between each frame of film was
mandible, hip, and
A one-sample t test was used to determine the
significance(p < .02) of the mean weight effect (d) at
each bony landmark.
Further study is indicated to determine the factors
influencing exaggerated sway in patient populations and
to assess the clinical benefits of using both manual pelvic
approximation and pelvic weighted belts on healthy
subjects and patients.
A significant decrease in postural sway was measured
at the mandible when subjects wore a pelvic weighted
A significant decrease was not seen in postural sway at
the hip or knee.
Additional research is needed to assess the effectiveness
of both manual pelvic approximation and approximation
through the use of a pelvic weighted belt in patient
3)Effect of Pelvic Tilt on Standing Posture
JAMES W. DAY
To use an objective noninvasive method to determine the
effect of the pelvic tilt on the spinal curves in the sagittal plane.
Thirty-two healthy subjects and 15 patients with chronic low
back dysfunction (CLBD) were studied.
–No complaints of back dysfunction within six
months preceding data collection
-Not undergone back surgery
Chronic low back dysfunction (CLBD)
-At least a threeyear history of low back pain
-Who had experienced low back pain within three
months of the laboratory assessment
Spinal fusions, herniated intervertebral disks
Lateral curvatures of spine
Muscle atrophic diseases.
Anatomical Position System
A noninvasive computerized method, Iowa Anatomical
Pelvic Tilt Instructions
Data Acquisition Process
Data Analysis - We analyzed the ratios and angles using an
analysis of variance (ANOVA) test with split level, three-factor,
Randomized block design
Accuracy of Measurement System
Fig. 1. Body reference points and sagittal
plane for standing posture.
Orientation is anterior to the right.
5M = base of 5th metatarsal,
LM = lateral malleolus, K = lateral femoral
epicondyle, GT = tip of greater trochanter,
ASIS = anterior superior iliac spine, S2
= 2nd sacral vertebra, S = distal point on
sacrum, T = tragus of ear, E = superolateral
corner of the eye orbit, A = ankle angle,
K = knee angle, PF = pelvifemoral angle,
GT = pelvic orientation with respect to
vertical line, SAS = pelvic orientation with
respect to horizontal line, S = sacral angle,
and H = head angle.
No significant differences between the DL for the Healthy Group
and Patient Group flexed knee position tended to flatten the
Both the Healthy Group and Patient Group were able to rotate
their pelvis a sufficient amount to change the thoracolumbar
curve Pelvic rotation or pelvic tilt did not alter the configuration of
the thoracic spinal curve.
For the extended knee position,the postures of anterior and
neutral pelvic tilt were not significantly different.
Tilting the pelvis posteriorly decreased the absolute depth of the
Tilting the pelvis anteriorly increased the absolute depth of the
A person properly trained in a pelvic tilt maneuver can voluntarily
rotate his pelvis a sufficient amount to alter the lumbar lordotic
4) Thoracic Kyphosis Affects Spinal Loads and Trunk
Andrew M Briggs
Background and Purpose
Patients with increased thoracic curvature often come to physical
therapists for management of spinal pain and disorders. Although
treatment approaches are aimed at normalizing or minimizing
progression of kyphosis, the biomechanical rationales remain
Forty-four subjects (mean age [±SD]=62.3±7.1 years) were
dichotomized into high kyphosis and low kyphosis groups.
Lateral standing radiographs and photographs were captured and
then digitized.These data were input into biomechanical models to
estimate net segmental loading from T2–L5 as well as trunk muscle
Participants with (A) high kyphosis and (B) low kyphosis in a standing
posture with their respective lateral thoracic radiograph.
Sequential steps in
estimating net segmental
loads and muscle forces
The high kyphosis group demonstrated significantly greater
normalized flexion moments and net compression and shear forces.
Trunk muscle forces also were significantly greater in the high
A strong relationship existed between thoracic curvature and net
segmental loads (r.85–.93) and between thoracic curvature
and muscle forces (r.70 –.82).
Discussion and Conclusion
This study provides biomechanical evidence that increases in
thoracic kyphosis are associated with significantly higher
multisegmental spinal loads and trunk muscle
forces in upright stance.
These factors are likely to accelerate degenerative processes
in spinal motion segments and contribute to the development of
dysfunction and pain.
5) Relationship Between
Standing Posture and Stability
David E Krebs
Background and Purpose
This study determined whether persons with
stability impairments have postural aberrations.
We investigated wholebody posture and its relationship to center-of-
gravity (COG) stability
Subjects- Data from 27 subjects with vestibular hypofunction and 26
subjects without vestibular impairment were analyzed.
An optoelectronic full-body system measured kinematics.
Force plates measured ground reaction forces while subjects stood
with their feet 30 cm apart and eyes open and with their feet
together and eyes closed.
The subjects with vestibular hypofunction demonstrated less
stability than the subjects without impairment, but there were no
Subjects with vestibular hypofunction had more weight on the left
lower extremity during standing with feet apart.
In all subjects during standing with feet apart, the COG was anterior
to the ankle, knee, back, and shoulder and posterior to the hip and
Subjects had an anterior pelvic tilt, extended trunk and head, right
laterally flexed trunk and pelvis, and flexed.
Conclusion and Discussion
Posture and stability had a low correlation.
Subjects with bilateral vestibular hypofunction did not
demonstrate a forward head or backward trunk lean, as
has been reported anecdotally.
Changing from standing with feet apart to feet together
increased whole-body movement patterns to control