IDEAL & FAULTY ALIGNMENT

OF POSTURE (ANTERIOR &

LATERAL VIEW)

PRESENT BYDr.Debanjan

INTRODUCTION

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.
S:-Stable joints;
T:-Tight abdominals;
U:-upright ribs;
R:-retracted shoulders and
E:-ear over shoulder.

Classification of posture

A.

Inactive Posture

B.

Active
A) Static Posture
B) Dynamic posture

POSTURAL
MECHANISM

Postural Reflex
1. Muscle
2. Eyes
3. Ears
4. Joint Structure

Skin sensation also plays a part, eg.soles of the feet, when the body in
standing position.
Impulses from all these receptors are conveyed and coordinated in the
central nervous system.

Good / Correct PostureGood 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.

Poor Posture / Faulty Posture

.

Faulty posture

Postural/Positional

Structural

Postural Development
Correct posture
Position in which
minimum stress is placed
on each joint. (Magee)
Faulty posture
Any position that
increases stress on joints

Postural Development
Birth
Entire spine concave
forward (flexed)
Primary curves
Thoracic spine
Sacrum
Developmental (usually
around 3 mos.)
Secondary curves
Cervical spine
Lumbar spine

Postural Development
Factors affecting posture
Bony contours
Laxity of ligamentous structures
Fascial & musculotendinous tightness
Muscle tonus
Pelvic angle
Joint position & mobility
Neurogenic outflow & inflow

Postural Development
Causes of poor posture
Positional factors
Appearance of increased
height (social stigma)
Muscle imbalances/ contractures
Pain
Respiratory conditions

Postural Development
Structural factors
Congenital anomalies
Developmental problems
Trauma
Disease

Postural Control

Maintenance of Body and its Segment

Stabilization of the Spinal Column by the

Muscle of Trunk

Standard Posture-

POSTURAL EXAMINATION
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
types:
(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.

Body type
Ectomorph
Mesomorph
Endomorph

ANTERIOR &
LATERAL VIEW

Anterior View

Lateral View

Correct Posture

Anterior view
Head straight on shoulders
Posture of jaw
Tip of nose
Upper trapezius neck line
Shoulders level
Clavicles/AC joints
Sternum & ribs
Waist angles & arm positions
Carrying angles

Anterior view
Iliac crests
ASIS
Pubic bone level
Patellae
Knees
Fibular heads
Malleoli
Arches
Foot rotation

Bowing of bones
Diastematomyelia (hairy
patches)
Pigmented lesions
Caf au lait spots
Neurofibromatosi

Lateral View The ear lobe

Spinal segment
Shoulder
The chest, abdominal &
the back muscles
No chest deformity
The pelvic angle
The knees.

NORMAL POSTURE

FAULTY POSTUERES

FAULTY POSTURE ANALYSIS AND

TREATMENT
*
*
*
*
*
*
*

Lordotic posture
Kyphotic posture / Round back
Scoliotic posture
Sway back posture / slouched posture
Flat back posture
Flat neck posture
Forward head posture

Types of Faulty
Posture

(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
intervertebral foramen.
() Approximation of the articular facets. The facets may become
weight bearing which may cause syonovial irritation and joint
inflammation.

Lordotic posture

Common Cause of Excessive

Lumbar Lordosis
Weakness of abdominals muscle
Tightness or contracture of hip flexor (iliopsoas)
Congenital problems such as bilateral congenital
dislocation of hip
Pregnancy
High heel shoes / foot wears
Spondylolisthesis
Anterior tilt of pelvis as a result of weak extensor of hip
and Abdominals
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
exercise
Spinal extension or hyper extension should be strictly
avoided.
Treat the cause of increase lumbar lordosis.

Faulty Posture
Kyphotic Lordotic
Posture

Exaggerated 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
tilt.
Ankylosing spondylitis.
Other congenital anomalies.

Treatment of kyphosis
Relaxation
Repeated stretching session
Posture of head, neck and shoulder
Mobilization of the whole spine
Resistive exercise for longitudinal and transverse back
muscle
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
concavity.

Potential Source of Pain

*Muscle fatigue and ligamentous strain on the side of
convexity.
*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
Relaxation technique
Repeated sessions of maintenance
General free mobility exercises
Deep breathing
Balance Exercises
Traction

CCP Curve correcting pad

Milwaukee brace

(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
extremity.

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
3)Bony anomaly

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
thoracic Spine
Maintain normal lordosis of lumbar spine
Always standing in erect position

Flat Back Posture

Sway Back Posture

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
lumbar lordosis.

FLAT BACK POSTUERE

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
attempts extension.

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
of pelvis.
Maintance of arch by active holding and also passive
support in sitting are effective in maintaining lordosis.
Mobility and strengthening exercise of lumbar extensor
are important.
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.

FLAT NECK
POSTURE

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
cervical spine.

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
change

 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
headaches.
TMJ pain from faulty head, neck and manibular
alignment and associated facial muscle tension.
Lower cervical disc lesion from the faulty flexed
posture.

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
posture.
Using of high pillow under the neck
Tight levator scapulae,Sternocledomastoid,Scalene and
Sub-occipital muscle.
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
effect selectively.
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

Name Date
Height cm.
Masskg.
Handedness Age Sex
Leg Length: Left Right..

Plumb Alignment
Lateral view:
Left
Right
Back view:
Deviated Left
Deviated Right

EVIDENCES

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.
METHODS
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

Instrumentation- inclinometer
Procedure
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
adhesive markers.
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.

Reliability
Testing of abdominal muscles
RESULTS
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.

DISCUSSION
Lumbar Lordosis
Pelvic Tilt
Abdominal Muscle Function
Relationship of Abdominal Muscle Function,
Lordosis, and Pelvic Tilt
CONCLUSION
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

Healthy Subjects
KATHERINE T. RATLIFFE

PURPOSE- investigate the effect of approximation provided by a

weighted belt on postural sway in healthy subjects.
METHOD
Subjects- studied 20 subjects, 6men and 14 women, between the
ages of 23 and 30 years.
Inclusion criteria- healthy subjects

Exclusion criteria 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
three months
Currently had ataxia,vertigo, or nausea
Permanent musculoskeletal abnormalities
Taking any drugs

Equipment
standing platform

weighted belt

Procedure
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
selected trial.
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
calculated.

Subject with
mandible, hip, and
knee markers
positioned on
standing platform.

RESULTS

Data AnalysisA one-sample t test was used to determine the

significance(p < .02) of the mean weight effect (d) at
each bony landmark.

DISCUSSION
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.

CONCLUSION
A significant decrease in postural sway was measured
at the mandible when subjects wore a pelvic weighted
belt.
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
populations

3)Effect of Pelvic Tilt on Standing Posture

JAMES W. DAY
PURPOSETo use an objective noninvasive method to determine the
effect of the pelvic tilt on the spinal curves in the sagittal plane.
METHOD
Subjects
Thirty-two healthy subjects and 15 patients with chronic low
back dysfunction (CLBD) were studied.

Inclusion criteriaHealthy Group

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
Exclusion criteriaSpinal fusions, herniated intervertebral disks
Lateral curvatures of spine
Muscle atrophic diseases.

Anatomical Position System

A noninvasive computerized method, Iowa Anatomical
Position System(IAPS)
Pelvic Tilt Instructions
Data Acquisition Process
Variables Measured
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.

RESULTS No significant differences between the DL for the Healthy Group

and Patient Group flexed knee position tended to flatten the
lordotic curve.
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.

DISCUSSION Tilting the pelvis posteriorly decreased the absolute depth of the
lumbar curve.
Tilting the pelvis anteriorly increased the absolute depth of the
lumbar curve.
A person properly trained in a pelvic tilt maneuver can voluntarily
rotate his pelvis a sufficient amount to alter the lumbar lordotic
curve.

4) Thoracic Kyphosis Affects Spinal Loads and Trunk

Muscle Force
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
unsubstantiated.
Subjects
Forty-four subjects (mean age [SD]=62.37.1 years) were
dichotomized into high kyphosis and low kyphosis groups.

Methods
Lateral standing radiographs and photographs were captured and
then digitized.These data were input into biomechanical models to
estimate net segmental loading from T2L5 as well as trunk muscle
forces

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
for each
participant.

Results
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
kyphosis group.
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-ofgravity (COG) stability
Subjects- Data from 27 subjects with vestibular hypofunction and 26
subjects without vestibular impairment were analyzed.

Method
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.

Results
The subjects with vestibular hypofunction demonstrated less
stability than the subjects without impairment, but there were no
postural differences.
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
neck.
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
standing stability.