1. Dr. Kaushik K Patel
MPT, PhD Scholar
Assistant professor
SPB Physiotherapy college
2. Posture is the attitude assumed by body
either with support during muscular
inactivity, or by means of co-ordinated action
of many muscles working to maintain
stability or to from an essential basis which is
being adapted constantly to the movement
which is superimposed upon it
4. Attitude adopted for resting or
sleeping
Minimum muscular activity.
Posture which make minimal
demand upon muscle
responsible to maintain body
function i.e. respiration and
circulation.
5. Used for training general relaxation fulfill
these conditions by allowing freedom of
respiratory movement and least possible
work for the heart muscle
6. Def: integrated action of many muscle is
required to maintain active posture, which
may be static or dynamic
Static posture: a constant pattern of posture
is maintained by interaction of group of
muscles which work more or less statically to
stabilise the joints and in opposition to gravity
or other forces
Erect posture they preserve state of
equilibrium
7. Dynamic posture:
This type of posture is required to form an
efficient basis for the movement
Pattern of posture is constantly modified and
adjusted to meet the changing circumstances
which arise as the result of the movement
8.
9. Muscles:
Intensity and distribution of the muscle work which
is required for the both static and dynamic posture
varies considerably with the pattern of the posture,
and the physical characteristics of the individual
who assume it.
10. The groups of muscles most frequently
employed to maintain the erect position are
working to counteract the effect of gravity
They are consequently known as the
antigravity muscle and their action with regard
to joints is usually that of extension
Antigravity muscle:
Multi pennate or fan shaped muscle
Constituting red fibers.
11. Postural reflex: a reflex is ,
by definition , an efferent
response to an afferent
stimulus
The efferent response in this
instance is a motor one, the
anti gravity muscles being
principal effector organs
12. Afferent stimuli arise from Variety of
sources:
1. The muscles
2. The eyes
3. The ears
4. Joint structure
The muscles: neuromuscular and
musculotendenious spindle with in muscles
record changing tension. Increased tension
causes stimulation and result in reflex
contraction of muscle
13. Visual sensation records in the position of the
body with regard to its surrounding
Form receptor for righting reaction
14. Stimulation of vestibular receptor
due to movement of fluid
contained in semicircular canal of
internal ear
Give knowledge of movement and
its direction in which it take place
15. Joint structure: weight bearing position
causes approximation of bone-stimulate
receptors –elicits reflex reaction to maintain
posture
Skin sensation especially that of sole of feet,
when body is in standing position
16. Impulses from all these
receptors are conveyed and
coordinated in central nervous
center
Cerebral cortex
Cerebellum
Red nucleus
Vestibular nucleus
17.
18. Both static and dynamic posture are built up
by the integration of many reflexes which
together make up the postural reflex
19.
20. Posture is said to be good when it fulfils the
purpose for which it used with maximum
efficiency and minimum effort
Precise pattern of good posture for individual
Erect posture: perfect balance of one segment
upon other
Esthetically pleasing to eyes
21. Dynamic posture involve constant
readjustment to maintain the efficiency of the
postural background throughout the progress of
the movement
Much difficult to assess
Alignment of different segment of body is
inclined or horizontal
Effect of gravity on segment is altered and
muscle work required to maintain the
alignment is adjusted accordingly
22. Essential mechanism should intact
Stable psychological background
Good hygienic condition
Opportunity for plenty of natural free
movement.
23. Emotion and mental attitude have a
profound effect upon the nervous system as
a whole, and this is reflected in the posture
of the individual.
Joy, Happiness and confidence are
stimulating and are reflected by an alert
posture in which position of extension
predominate.
Conversely unhappiness , conflict and feeling
of inferiority have just the opposite effect
and result in postures in which positions of
flexion are most evident.
24. These connections between mental and physical
attitudes has always been recognized and used in
dancing and on the stage.
It is certain that the mental attitude affect the
physical either temporarily or permanently.
Can not physical attitude adopted consciously affect
the mental attitude.
25. Good hygienic conditions, particularly with
regard to nutrition and sleep, are essential
for a healthy nervous system and for the
growth and development of bones and
muscles, which is ultimately reflected in
posture.
The opportunities for performing plenty of
free movements also encourage development
of skeletal muscles.
26. Activity that is enjoyable or performing by
children such as running, jumping and
climbing in which active extension movement
predominates and there by leads to
development of good posture.
27. Inefficient posture
Fails to serve the purpose for which it
was designed
Unnecessary amount of muscular
effort is used to maintain it
Ligament strain or cramping of
thoracic movement
28. Aesthetically displeasing
Clothes do not fit properly
Unwelcome psychological reaction
Doesn’t serve the function properly
Reduces efficiency of movement
29. Mental attitude
Poor hygienic condition
General debility
Prolong Fatigue
Localized pain
Muscular weakness
Occupational stress
Faulty idea of good posture
30.
31.
32. DEFINITION:
Increased in the lumbosacral angle
Increased lumbar lordosis
Increased anterior pelvic tilt
Hip flexion
33. Lumbosacral angle:
It is an angle that the superior border of the first
sacral vertebral body makes with horizontal line..
It is approximately 30 degree.
34. It is often seen with increased thoracic
kyphosis and foreward head, it is called
Kypholordosis posture.
38. SYMPTOMES:
Stress to anterior longitudinal ligaments
Narrowing of posterior disk space
Narrowing of intervertebral foramen
This may compress the dura and blood
vessels of related nerve root or nerve itself
Eg. Degenerative conditions
40. Also called as sway back.
amount of pelvic tilting is variable
but there is a shifting of entire
pelvic segment anteriorly.
Anterior shifting of pelvic segment
– hip extension – posterior shifting
of thoracic segment – increased
lordosis in lower lumbar spine –
increased kyphosis in thoracic
region – head foreward.
41.
42. Mobility impairment :
Abdominal muscles
Upper segment of rectus abdominals and obliques
Internal intercostal
Hip extensors
Lower lumbar extensors
43. Stretched and weak muscles
Lower abdominal muscles (lower segments of the
rectus abdominis and obliques)
Extensor muscles of the lower thoracic region
Hip flexor muscles
44. STMPTOMES:
Stress to the
Iliofemoral ligaments,
The anterior longitudinal ligament of the lower lumbar
spine
The posterior longitudinal ligament of the upper
lumbar and thoracic spine.
45. With asymmetrical postures, there is also
stress to the iliotibial band on the side of the
elevated hip.
Narrowing of the intervertebral foramen in
the lower lumbar spine that may compress
the blood vessels, dura, and nerve roots,
especially with arthritic conditions.
Approximation of articular facets in the
lower lumbar spine.
46. CAUSES:
Relaxed posture in which the muscles are not
used to provide support.
The person yields fully to the effects of gravity,
and only the passive structures at the end of
each joint range (e.g., ligaments, joint capsules,
bony approximation) provide stability.
47. Attitudinal (the person feels comfortable
when slouching),
Fatigue (seen when required to stand for
extended periods),
Muscle weakness (the weakness may be the
cause or the effect of the posture).
A poorly designed exercise program—one that
emphasizes thoracic flexion without
balancing strength with other appropriate
exercises and postural training—may
perpetuate these
48.
49. Characterized by a
Decreased lumbosacral angle,
Decreased lumbar lordosis,
Hip extension, and
Posterior tilting of the pelvis.
50. Mobility Impairment:
The trunk flexor (rectus abdominis, intercostals)
and
Hip extensor muscles
Stretched and weak muscles
Lumbar extensor and
Possibly hip flexor muscles
51. SYMPTOMES:
Lack of the normal physiological lumbar curve,
which reduces the shock-absorbing effect of the
lumbar region and predisposes the person to
injury
Stress to the posterior longitudinal ligament
Increase of the posterior disk space, which
allows the nucleus pulposus to imbibe extra
fluid and, under certain circumstances, may
protrude posteriorly when the person attempts
extension
52. CAUSES:
Continued slouching or flexing in sitting or
standing postures;
Overemphasis on flexion exercises in general
exercise programs
55. FOREWARD HEAD :
increased flexion of the lower cervical and the
upper thoracic regions,
Increased extension of the upper cervical
vertebra, and extension of the occiput on C1.
Temporomandibular joint dysfunction with
retrusion of the mandible.
56. MOBILITY IMPAIRMENT:
Mobility impairment in the muscles of the
anterior thorax (Intercostal muscles),
Muscles of the upper extremity originating on the
thorax (pectoralis major and minor, Latissimus
dorsi, serratus anterior).
57. Muscles of the cervical spine and head that
attached to the scapula and upper thorax
(levator scapulae, sternocleidomastoid, scalene,
Upper trapezius)
Muscles of the suboccipital region (rectus capitis
posterior major and minor, obliquus capitis
Inferior and superior).
58. Stretched and weak muscles:
Lower cervical and upper thoracic erector spinae
and scapular retractor muscles (rhomboids,
middle trapezius),
Anterior throat muscles (suprahyoid and
infrahyoid muscles), and
Capital flexors (rectus capitis anterior and
lateralis, superior oblique longus colli, longus
capitis).
59. Stress to the anterior longitudinal ligament in
the upper cervical spine and posterior
longitudinal ligament in the lower cervical
and thoracic spine
Fatigue of the thoracic erector spinae and
scapular retractor muscles.
Irritation of facet joints in the upper cervical
spine.
60. Narrowing of the intervertebral foramina in
the upper cervical region, which may
impinge on the blood vessels and nerve
roots, especially if there are degenerative
changes.
Impingement on the neurovascular bundle
from anterior scalene or pectoralis minor
muscle tightness.
61. Strain on the neurovascular structures of the
thoracic outlet from scapular protraction.
Impingement of the cervical plexus from
levator scapulae muscle tightness
Impingement on the greater occipital nerves
from a tight or tense upper trapezius muscle,
leading to tension headaches.
Lower cervical disk lesions from the faulty
flexed posture
62. The effects of gravity,
Slouching, and
Poor ergonomic alignment in the work or home
environment.
Occupational or functional postures requiring leaning
forward or tipping
Faulty sitting posture
Relaxed Posture
63.
64. DEFINITION:
Decrease in the thoracic curve,
Depressed scapulae,
Depressed clavicles, and
Decreased cervical lordosis with increased
flexion of the occiput on atlas.
65. It is associated with an
exaggerated military
posture but is not a
common postural deviation.
There may be
temporomandibular joint
dysfunction with
protraction of the
mandible.
66. MUSCLE IMPAIRMENT:
Anterior neck muscles,
Thoracic erector spinae and
Scapular retractors, and potentially restricted
scapular movement, which decreases the
freedom of shoulder elevation
67. STRETCHED / WEAK MUSCLES:
Scapular protractor and
Intercostal muscles of the anterior thorax
68. SYMPTOMES:
Fatigue of muscles required to maintain the
posture
Compression of the neurovascular bundle in
the thoracic outlet between the clavicle and
ribs
Temporomandibular joint pain and occlusive
changes.
Decrease in the shock-absorbing function of
the kypholordotic curvature, which may
predispose the neck to injury.
69.
70. Scoliosis usually involves the thoracic and
lumbar regions.
Typically, in right-handed individuals, there is
a mild right thoracic, left lumbar S-curve, or
a mild left thracolumbar C-curve.
There may be asymmetry in the hips, pelvis,
and lower extremities.
71. Irreversible lateral curvature with fixed
rotation of the vertebrae.
Rotation of the vertebral bodies is toward
the convexity of the curve.
In the thoracic spine, the ribs rotate with the
vertebrae so there is prominence of the ribs
posteriorly on the side of the spinal
convexity and prominence anteriorly on the
side of the concavity.
72. posterior rib hump is detected on forward bending
in structural scoliosis
73. Reversible and can be changed with forward
or side bending and with positional changes
such as lying supine.
Realignment of the pelvis by correction of a
leg-length discrepancy with muscle
contractions.
It is also called functional or postural
scoliosis.
74. Mobility Impairment:
In structures on the concave side of the curves.
• Stretched / Weak muscles : on the convex side of
the curves.
If one hip is adducted, the adductor muscles
on that side have decreased flexibility and
the abductor muscles are stretched and
weak.
The opposite occurs on the contralateral
extremity.
75. With advanced structural scoliosis,
cardiopulmonary impairment may restrict
function
76. SYMPTOMES:
Muscle fatigue and ligamentous strain on the
side of the convexity
Nerve root irritation on the side on the
concavity
77. CAUSES: (STRUCTURAL)
Neuromuscular diseases or disorders (e.g.,
cerebral Palsy, spinal cord injury, progressive
neurological or muscular diseases),
Osteopathic disorders (e.G., Hemivertebra,
osteomalacia, rickets, fracture),
Idiopathic disorders in which the cause is
unknown are common causes of structural
scoliosis.
78. CAUSES (NON STRUCTURAL)
Leg-length discrepancy (structural or functional),
Muscle guarding or spasm from a painful stimuli in
the back or neck
Habitual or asymmetrical postures
79. Before developing a plan of care and
selecting interventions for management,
evaluate the findings from the examination of
the patient, including the history, review of
systems, and specific tests and measures, and
document the findings.
80. Postural alignment (sitting and standing),
balance, and gait
ROM, joint mobility, and flexibility
Muscular strength and endurance for
repetitions and holding
Ergonomic assessment if indicated
Body mechanics
Cardiopulmonary endurance/aerobic
capacity, breathing pattern
82. A systematic approach to postural analysis
involves viewing the body’s anatomical
alignment relative to a certain established
reference line.
This reference (gravity) line serve to divide
the body into equal front and back halves
and to bisect it laterally.
This line is called as plumb Line.
83.
84.
85.
86. HEAD AND NECK:
PLUM LINE: It passes through the acromion
process.
Common faults includes,
Foreward head – head lies anterior to the plumb line
due to excessive cervical lordosis.
87. Flattened lordotic cervical curve – plumb line lies
anterior to the vertebral bodies.
It is due to – stretched posterior cervical ligaments
and extensor muscles.
Excessive lordotic curve – plumb line lies posterior
to the vertebral bodies.
Due to – vertebral bodies and joints compressed
posteriorly and anterior longitudinal ligament
stretched.
88. SHOULDER:
PLUMB LINE – it falls through the acromion process.
Common faults includes,
Foreward shoulder – acromion process lies anterior
to the plumb line. And scapula abducted.
Due to tight pectoralis major and minor, serratus
anterior and intercostal muscles.
Excessive thoracic kyphosis and forward head.
89. Lumbar lordosis : lumbar region is flat as the
subject raise arm overhead,
It is due to – tightness of latissimus dorsi
muscle and thoraco lumbar fasciae.
90. THORACIC VERTEBRAE:
PLUMB LINE : line bisect the chest symmetrically.
Common faults includes,
Kyphosis : increased posterior convexity of the
vertebrae.
This may be due to - compression of inter vertebral
disk anteriorly. And stretched extensor , middle and
lower trapezius , posterior ligaments.
91.
92. Tightness of anterior longitudinal ligaments.
PECTUS EXCAVATUM (FUNNEL CHEST) : depression
of anterior thorax and sternum.
Tightness of upper abdominal, shoulder
adductors, pectoralis minor and intercostals.
Stretched thoracic extensor , middle and lower
trapezius.
Bony deformities of sternum and ribs.
93.
94. BARREL CHEST : increased overall
anteroposterior diameter of the chest.
Due to - respiratory difficulties
Stretched intercostals and anterior chest
muscles
Tightness of scapular adductors muscles.
95.
96. PECTUS CARINATUM (PIGEON CHEST):
Sternum projects anteriorly and downward.
Due to – bony deformities of ribs and sternum.
Stretched upper abdominal muscles.
Tightness of upper intercostal muscles.
97. LUMBAR VERTEBRAE:
PLUMB LINE – fall midway between the
abdomen and back and slightly anterior to
the SI joint.
COMMON FAULT INCLUDES,
Lumbar Lordosis: hyper extension of lumbar
vertebrae.
Anterior pelvic tilt , compressed vertebra
posteriorly.
98. Stretched anterior longitudinal ligament and
lower abdominal muscles
Tightness of posterior longitudinal ligament ,
lower back extensor and hip flexors.
Sway back – flattening of lumbar vertebra
Pelvis displaced foreward
Due to - thoracic kyphosis and posterior pelvic
tilt.
99. Flat back – flattening of the lumbar vertebra
Due to – posterior pelvic tilt
Hamstring tightness and weak hip flexors
100. PELVIS AND HIP:
PLUMB LINE : line falls slightly anterior to the SI
joint and posterior to the hip joint through GT.
Common faults includes,
Anterior pelvic tilt – ASIS lie anterior to the pubic
symphysis.
Due to – increased lumbar lordosis and thoracic
kyphosis.
101. Posterior pelvic tilt.: symphysis pubis lies
anterior to the ASIS.
Due to – sway back with thoracic kyphosis.
102.
103. KNEE – line passes slight anterior to the midline of
knee.
Common faults includes,
Genu Recurvatum – hyper extension of the knee.
Plumb line lies foreward to the joint axis.
Tightness of quadriceps, gastrocnemius and soleus.
Stretched popliteus and hamstrings
Compression force anteriorly.
104.
105. Flexed knee:
Plumb line falls posterior to the joint axis
Due to – tightness of hamstring muscles
Stretched quadriceps and tightness
gastrocnemius
Posterior compression force.
106. ANKLE:
PLUMB LINE : Line lies slightly anterior to the
lateral malleolus, aligned with tuberosity of
5th metatarsal.
Common faults includes,
Foreward posture – line is posterior to the
body
Body weight is carried on metatarsal heads of
the feet.
Due to – posterior muscles stretched and
tightness of dorsal muscles.
107. HEAD AND NECK:
PLUMB LINE – bisect the head through the
external occipital protuberance.
Common faults includes,
Head tilt
Head rotated.
108. SHOULDER AND SCAPULA:
PLUMB LINE – falls midway between shoulders
Common faults includes,
Dropped shoulder – hand dominancy, lateral trunk
muscles are short and hip is high, tight rhomboid
and latissimus dorsi.
Elevated shoulder. – tight upper trapezius and
levator scapulae., weak or elongated lower
trapezius and because of scoliosis of thoracic
vertebrae.
109. Adducted Scapula: scapula are too close to
the midline of thoracic vertebra
Due to short rhomboid and stretched
pectoralis.
Abducted scapula : scapula moved away from
the midline.
Due to tightness of serratus anterior and
elongated rhomboid and middle trapezius.
110.
111. Winging of scapula:
Medial border of the scapula lift off ribs
Due to – weakness of serratus anterior muscle
112. TRUNK:
PLUMB LINE: line bisects the spinous process
of the thoracic and lumbar vertebra.
Common faults includes,
Lateral deviation (Scoliosis): spinous process
of the vertebrae are lateral to the midline of
the trunk.
113. Trunk muscles are shorted on one side
Stretched on opposite side.
Structural changes in ribs and vertebra
Leg length discrepancy.
114. PELVIS AND HIP
PLUMB LINE: line bisect the gluteal cleft and
PSIS.
Common faults includes,
Lateral pelvis tilt
Pelvic rotation
Abducted hip
115. KNEE:
PLUMB LINE – equidistance between the
knees.
Common faults includes,
Genu Varum
Genu Valgum
117. ANKLE AND FOOT
PLUMB LINE – equidistance from both
malleoli.
Feiss line – line drawn from the medial
malleolus to the first metatarsal bone and
the tuberosity of navicular bone lies on the
line.
Common fault includes,
Pes planus (pronated) – low medial longitudinal
arch
Pes Cavus (supinated) – high medial longitudinal
arch.
118.
119. HEAD AND NECK – line bisect the head at the
midline.
Common fault includes,
Lateral tilt
Rotation
Mandibular asymmetry – upper and lower teeth
are not aligned. (tightness of mastication
muscles)
120.
121. SHOULDER - line bisect the sternum and
xiphoid process.
Common deviation includes,
Dropped and elevated shoulder
Clavicle asymmetry – due to trauma.
122. ELBOW: - Line bisect the limbs and form an
angle of 5 to 15 laterally at the elbow with
the elbow extension.
Common faults includes,
Cubitus valgus – forearm deviated laterally from
the arm. Due to stretched ulnar collateral
ligaments
Cubitus varus – forearm deviated medially from
the arm. Due to stretches radial collateral
ligaments.
123.
124. HIP
Common faults includes,
Lateral rotation
Medial rotation
125. KNEE:
Common faults includes,
External tibial torsion – normally distal end of tibia
is rotated laterally from the proximal end.
Excess of 25 degree rotation is lateral tibial torsion
(toeing out)
Internal tibial torsion – feet face foreward and
inward.
126. ANKLE AND FOOT
Common faults includes,
Hallux valgus – lateral deviation of 1st toe at MTP
joint.
Claw toes – hyperextension of MTP and flexion of the
proximal IP joints.
Hammer toes – hyper extension of MTP and distal IP
joint and flexion of Proximal IP joints.
127.
128. Find out the cause of abnormal posture by
thorough assessment of the subject.
Posture which results from unsatisfactory
mental attitude and poor hygienic
conditions, corrected by alteration in
habitual mental attitudes by improving
hygienic condition.
129. The measure taken by PT to combat poor
posture and to train efficient good posture
depends upon the cause
Success of treatment depends upon ability to
gain cooperation of patient
Posture which is result of poor mental attitude
and poor hygienic condition can be remedied
by permanent change in mental attitude and
improvement of hygienic condition
130. Postural defect- structural
changes- muscle and
ligament adopt its length
according to habitual
posture- limitation of normal
ROM
131. Relaxation
Mobility exercise
Repeated presentation of satisfactory postural
pattern helps in improvement of posture
During instruction…
cheerful atmosphere
spirit of enjoyment
judicious praise
helps in re establishment of satisfactory postural
pattern
132. Generalized debility and fatigue is cause- pt
should be first treated with relaxation
Relaxation helps in
1. Reliving tension
2. Assist in remembering satisfactory
alignment of the body
133. Localised pain treated with appropriate means
Muscular weakness treated with strengthening
exercise to improve muscle power
Localised tension can be removed by relaxation
method
Faulty idea of good posture can be cured by
giving pt the idea of correct posture and by
teaching him how to assume it habitual by
repeated voluntary effort
136. General relaxation
Local relaxation
contract and “ letting go”
General relaxation
Crook lying ,supine lying
Prone lying
137.
138. Crook lying
shoulder to
supporting surface
and expiration
Forehead prone
raising and
lowering
Sitting shoulder
retraction
139. Normal mobility is essential
Abnormal mobility – additional muscle force
to control it- contribute to poor posture
General mobility exercise
Rhythmic free exercise in full ROM
140. Emphasis on Extension except shoulder and
lumber spine
Stiffness of joint lead to increase mobility of
adjacent segment
Stiff shoulder flexion compensated by lumber
hyperextension
Hanging position- helps in maintaining
alignment
142. No ideal method
PT should have faith in the method she
adopted
Explain the importance of good posture
Feedback: mirror, photographs
143. Videotapes helps in training of dynamic
posture: lifting
Provide sufficient repetition and precision…
till new pattern of posture become habitual
and no longer require voluntary control
144. Head upward thrust of vertex in erect
position
Crook lying: body lengthening
Standing: head stretching upwards
145. Voluntary control of pelvic tilt teaches the
patient to recognize any deviation from the
normal, trains him to be able to adjust and
correct it
Crook lying: AP movement of pelvis
Contraction of hip extensor and abdominals
followed by hallowing of lumber spine.
146. Low wing sitting or standing: pelvis tilting
Movement felt by putting hands on ASIS
147. Painless, mobile and strong feet form a stable
base on which weight of body is balanced and
supported
Exercise of arches should be practiced
Sitting : pressing toes to floor
Standing: standing on medial border, lateral
border of foot
148. Complete pattern of good posture build up
gradually and progressively from complete
relaxation
A state of balanced tension and much co-
operation (efforts) is required first, but the
effort and tension are progressively reduced
by repetition
149. With sufficient repetition and precision, the
new and satisfactory pattern of posture
becomes habitual
Therefore no longer requires voluntary
control, as it is maintained by a conditional
reflex (part of postural reflex)