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Posture Evaluation
Martha Macht Sliwinski PT PhD
Posture
The alignment and positioning of the body
in relation to gravity, center of mass and
base of support
The physical therapist uses posture tests and
measures to assess structural abnormalities
in addition to the ability to right the body
against gravity
Correct Posture
Maximal physiological and biomechanical
efficiency
Minimize stress and strains
Segments aligned vertically with gravity
line through axis of all joints
Balanced strength and length of muscles
Balance is based on a force couple
Good Posture
A state of
musculoskeletal
balance that protects
the supporting
structures of the body
against injury or
progressive deformity
Postural Analysis
View from different positions
Use dominant eye
Identify bony landmarks
Assess with and without orthotic devices
and shoewear
Assess in ideal and real-life postures
Note relevant medical history
Endomorphs
The naturally large
person characterized
with a round face,
wide hips, big bones,
slow metabolism and
high number of fat
cells.
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Mesomorphs
The naturally
muscular person with
wide shoulders, small
waist, athletic build,
low body fat
percentage with an
increased metabolism
Ectomorphs
The skinny person
with a linear
appearance, small
muscles, ultra fast
metabolism, low body
fat, narrow shoulders,
hips and waist.
Postural Tests & Measures
Analysis of resting (static) posture or
preferred in any position
Analysis of dynamic posturing/functional
movements
Analysis of static and dynamic postures,
using computer-assisted imaging, posture
grids, plumb lines, still photography,
videotape, visual analysis
Clinical Indications for Postural
Tests & Measures
Abnormal bony alignment
Impaired aerobic capacity
Impaired joint integrity/mobility
Impaired motor function
Impaired muscle performance
Impaired sensory integrity
Pain
Ideal Posture lateral view
Ear lobe
Dens
Cervical vertebral bodies
Tip of the acromion
Mid trunk
Lumbar bodies/sacral
promontory
Greater trochanter
Slightly anterior to knee
Slightly anterior to lateral
malleolus
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Ideal Posture
Head
Cervical Spine
Scapulae
Thoracic Spine
Lumbar Spine
Pelvis
Hips
Knees
Ankle
Muscle Balance
Abdominals
Hip Flexors
Erector Spinae
Hip Extensors
Poor Posture (AAOS 1947)
Increases strain on supporting
structures (ie, ligaments, cartilage,
bone-tendon interface, etc)
Less efficient balance of body
over its base of support
Alteration of the normal
arthokinematics/kinetics of
affected joints irrespective of
position (eg, standing erect,
lying, squatting, etc)
Poor Posture
Anatomic impairments
Physiologic impairments
Psychosocial impairments
Bony structure abnormalities
Habitual Posturing
Development of Posture Lordosis
A marked anterior
pelvic tilt
A marked lordosis
Marked anterior pelvic
tilt and lordosis
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Hyperlordotic and Kypholordotic Kypholordotic Posture
Head: forward
C-spine: hyperextended
Scapulae: abducted
T spine: flexion
L spine: hyperextended
Pelvis: anterior tilt
Hips: flexed
Knees: slightly hyperextended
Ankles: slight plantar flexion
Military Type
Head: neutral
C-spine: normal, slightly
anterior
T spine:normal, slightly
posterior
L spine: hyperextended lordosis
Pelvis: anterior tilt
Knees: slightly hyperextended
Ankles: slightly plantar flexed
Sway Back
Head: forward
C-spine: slightly extended
T spine: flexion
L spine: flexion, flattening
Pelvis: posterior tilt
Hips: hyperextended
Knees: hyperextended
Ankles: neutral
Sway Back and Flat Back Flat Back
Head: forward
C-spine: slightly extended
T spine: flexion upper
part, lower part, straight
L spine: flexed, straight
Pelvis: posterior tilt
Hips: extended
Knees: extended
Ankles: slight plantar
flexion
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Ideal Alignment: Posterior View
Head
Cervical Spine
Shoulders
Thoracic Spine
Lumbar Spine
Pelvis
Hips
Lower Extremities
Feet
Faulty Alignment: Posterior View
Head
C spine
Shoulders
Scapulae
T and L spine
Pelvis
Hips joints
Lower Extremities
Feet
Faulty Alignment: Posterior View
Head
C spine
Shoulders
Scapulae
T and L spine
Pelvis
Hips joints
Lower Extremities
Feet
Faulty Postures: Side & Back Views
Figure A; posture
appears good from the
posterior view but is
faulty from the side
Figure B faulty
posture both front and
side views
Anterior View
Lower Extremity
Torso
Shoulder
Head and Neck
Measuring Leg Length
Structural Leg Length
Test (or true):
measure from ASIS to
medial malleolus
Functional Leg Length
Test (or apparent):
measure from medial
malleolus to umbilicus