|


à ÷

à It is attitude or position of the body , the relative
arrangement of body parts for a specific activity,
or a characteristic manner of bearing one͛s body.
à It is attitude assumed by body either with
support during muscular inactivity or by means of
co- ordinate 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.
à  


  

ttitude adopted for resting or sleeping
0 

Integrated action of many muscles is required
to maintain active posture.




à
|

à ptatic posture refers to the body and its segments
are aligned and maintained in certain positions.
E.g. standing, sitting, lying, and kneeling.
à ÷ |

à ÷ynamic posture refers to postures in which the
body or its segments are moving
E.g. walking, running, jumping, throwing,
and lifting.
à |



2
à inimizing energy expenditure
à inimizing stress on supporting structures
à ny change in position or mal alignment of
one body segment will cause changes to occur
in adjacent segments, as well as changes in
other segments, as the body seeks to adjust or
compensate for the mal alignment
à |



 
2 it is defined as state of musculoskeletal
balance which protect the supporting structure of the
body against injury or progressive deformity
,irrespective of attitude in which these structure are
resting or working.
|

 it is defined as faulty relationship of the
various parts of the body which produces increased
strain on supporting structure & less balance of the
body over base of support.
by posture committee of american acedemy of
orthopedic surgeon
à |

 
à It is posture that deviate from normal
alignment but has no structural limitation.
à |


à It is posture that deviate from normal
alignment with adaptive shortening of soft
tissues & muscle weakness.
 è
 






à ge2

ostural pattern change during life cycle.
s position of lower extremity joints,development of
spinal curves.
à Gender2
igher % of fat & wide pelvis in women
à Nutritional factor2
equired for good structural & functional development
, affect the growth before maturation &lead to fatigue
after maturation , thus affect posture
à Emotional status2
à abits2 poor postural habits
à ÷isease & disability2
à ccupation& recreation2
 |


à ÷

à It is a person͛s ability to maintain stability of
the body and body segments in response to
forces that threaten to disturb the body͛s
equilibrium.
à aintenance and control of posture depend
on the integrity of the CNp, visual system,
vestibular system, and musculoskeletal system
à    

 
occur as reactions to external forces that
displace the body͛s Co .
à |
 

 
occur as reactions to internally generated
destabilizing forces that displace the body͛s
Co .
 




. To maintain the body͛s Co over the Bop,

2. To control the body͛s orientation in space,
3. To stabilize the head with regard to the
vertical so that the eye gaze is appropriately
oriented.
 |

à In the erect standing posture,
little or no acceleration of the
body occurs, except that the
body undergoes a constant
swaying motion called 


  
à ·ith 4 inches base,2 in the sagittal plane ,
 in the frontal plane sway
 ü  

|

à In response to perturbations ,active internal

forces employed to counteract the external forces
that affect the equilibrium and stability of the
body
à The 


 are inertia, gravity, and
ground reaction forces(Gs).
à The 


 are produced by muscle
activity and passive tension in ligaments,
tendons, joint capsules, and other soft tissue
structures
à 
  
 
à ·henever the body contacts the ground, the ground
pushes back on the body. This force is known as the
G.
à The vector representing it is known as the ground
reaction force vector è
à aving 
 
à  vertical component force (along the y-axis),
à two force components directed horizontally in a
medial-lateral direction (along the x-axis) & other
horizontal force in an anterior-posterior direction
(along the z-axis)
à    
à ·hen the LoG passes directly through a joint
axis, no external gravitational torque is
created around that joint.
à if the LoG passes at a distance from the axis,
an external gravitational moment is created.
à it is opposed by a counterbalancing internal
moment
à If the   


 

!, the gravitational moment will tend
to cause 


 

  
 "
à If the  

 !, the
moment will tend to   



 
  
 "
   
à
ostural board with foot prints
à
lumb line
à olding ruler with spirit level
à pet of blocks for limb length measurement
à arking pencil
à Tape measure
à Test for muscle length & strength
 
|

à ptanding posture2
à   " #
   
#dropped from the ceiling and passing
through the external auditory meatus of the
ear, used to represent the LoG.
 

 


Cervical
osterior Extension

Thoracic nterior lexion

Lumbar
osterior Extension

pacroiliacjoi nterior lexion

nt

ip joint
osterior Extension

Knee joint nterior extension

nkle joint nterior dorsi

lexion
à  
à In the optimal erect posture, the ankle joint is in
the neutral position, or midway between
dorsiflexion and plantarflexion.
à The LoG passes 

 

  
à creates an 


  moment &
opposed by an internal plantarflexion moment
à E G studies have demonstrated that   

  
à ü 
à In optimal posture, the knee joint is in full
extension.
à the LoG passes 

  
 
 

  .
à creates an 
  moment &
counterbalancing internal flexion moment
created by passive tension in the 


!  

à ÿ
à In optimal posture,
the hip is in a neutral position.
à ·hen the   

 

 !, through the greater
trochanter
à creates an 
  moment at the hip
& opposed by internal flexion moment.
à E G studies have shown activity of the 
muscle
à | 
à in the optimal position, the pelvis is level with
no anterior or posterior tilt
à In a level pelvis position, lines connecting the
symphysis pubis and the anterior-superior iliac
spines(pIps) are vertical, and the lines
connecting the pIps and posterior-superior
iliac spines (
pIps) are horizontal.
à

$
à in the optimal position, the   


 
!
à The external gravitational moment cause the


 



 


 

 


, whereas the
posterior inferior portion tends to move
posteriorly and superiorly
à opposed by    
à "
 $
à The average lumbosacral angle measured
between the bottom of the L5 vertebra and the
top of the sacrum (p) is about 30
à In the optimal posture, the   
 
 "
 

 "

 "
 & creates a
slight extension moment at L5 to p
à opposed primarily by  

 
   "
 .
à  è
 "
 
à the   
  " 
 
 "


 "
 


 

 "
  

à the gravitational moments tend to increase
the natural curves in the lumbar, thoracic, and
cervical regions.
à ÿ 
à The  
   




for flexion
and extension of the head
à creates an 

  
counteracted by internal moments generated
by activity of the    

 ÷ 

  

à  
 | 

à  
à  
à The toes characterized by hyperextension of the
metatarsophalangeal ( T
) joint & flexion of the
proximal interphalangeal (
I
) and distal
interphalangeal (÷I
) joints
à ÿ
 
à hyperextension of the T
joint, flexion of the

I
joint, and hyperextension of the ÷I
joint.
à ü 

à   ü |

à The LoG passes posterior to the knee joint axes.

à ther consequences of a flexed-knee erect
standing posture are related to the ankle and hip.
Because knee flexion in the upright stance is
accompanied by hip flexion and ankle
dorsiflexion.
à ÿ
   ü 
à    
 

à The LoG is located anterior to the knee joint

axis.
à Increase in the external extensor moment at
the knee and puts the posterior joint capsule
under considerable tension stress &
consequently, result in a more unstable joint.
à | 
à   

| 
à pelvis is excessively tilted anteriorly, the lower lumbar
vertebrae are forced anteriorly.
à The upper lumbar vertebrae move posteriorly to keep
the head over the sacrum, thereby 
 
 "


 
à The posterior convexity of the 

 
 
and becomes kyphotic to balance the lordotic lumbar
curve and maintain the head over the sacrum.
à pimilarly, the 

 
 

 
increases to bring the head back over the sacrum.
à è
 "
 

à 
 ü
à The term lordosis refers to the normal sagittal
plane anteriorly convex curves in the cervical and
lumbar regions of the vertebral column.
à The term kyphosis refers to the normal sagittal
plane posteriorly convex curves in the thoracic
and sacral regions of the vertebral column.
à ÿ 
à 

ÿ |

à the head is positioned anteriorly and the

normal anterior cervical convexity is increased
 
|   

à 

 
à
asses through middle of the forehead, nose and chin.
à
asses through the middle of the xyphoid process.
à
asses through the umbilicus (navel).
à
asses on a line equidistant from the right and left
anterior superior iliac spines.
à
asses through the symphysis pubis.
à
asses between knees equidistant from medial femoral
condyles.
à
asses between ankles equidistant from the medial
maleoli.
à |

 
à
asses through middle of head.
à
asses along vertebral column in a straight line.
à
asses through gluteal cleft of buttocks and
should be equidistant from posterior superior
iliac spines.
à
asses between the knees equidistant from
medial joint aspects.
à
asses between ankles equidistant from the
medial malleoli.
 ÷ 

  
 

 
à  
à |  |  
à characterized by a reduced or absent medial
arch
à |   
à The medial longitudinal arch of
the foot is unusually high.
à      
à the mechanical axes of the lower extremities are
displaced laterally.
à The patella may be laterally displaced and
therefore predisposed to subluxation.
à   
 " 
à knees are widely separated when the feet are
together and the malleoli are touching.
à the patellae may be displaced medially.
à


   
à patella that faces medially
à 

   
à refers to a high, laterally displaced position of
the patella in which the patella faces upward
and outward.
à In both,patella tracking may be affected
à è
 "
 
à

à the vertebral column is vertically aligned and
bisected by the LoG.
à lateral deviations of a series of vertebrae from
the LoG in one or more regions of the spine
indicate the presence of a lateral spinal
curvature in the frontal plane called a 
 
 %
" 
 


à |2 from stress to sensitive structure & from
muscle tension
à ÷ 
 
 
2 rom flexibility
imbalance
à u    
   
 2
rom sustained faulty posture or disuse
à 
  
 


 
2 from prolonged faulty
postural habits
 
 



  |


elieve pain & muscle tension External postural support if necessary.

uscle relaxation

estore range of motion ppecific stretching & flexibility exercise

estore muscle strength , endurance & ppecific resistive exercises

function Endurance exercises

etrain kinesthetic awareness & einforcement techniques

control of normal alignment
Kypho-lordotic posture
|
  u   u   
 

  
! 
      
 
orward Cervical spine Cx spine Cx spine flexor
head hyperextension extensors, pteretching of
upper trepezius
&levator
tight muscles &
orward pcapulae perratus iddle & lower
strengthening of
shoulder abducted &
elevated
anterior,
pectoralis
trapezius weak muscles
minor,
upper trapezius
kyphosis Thoracic spine phoulder iddle & lower
flexion adductor, Trapezius,
pectoral minor, thoracic spine
upper tapezius, extensor
inter costal

lordosis Lumber spine Lower back bdominals,

hyperextension, erector spinae, hip extensor
pelvis anterior hip flexor
tilt,hip joint
flexion
lat back posture
|

   u   u   
 

! 
      
 

lat back Lumber spine abdominals, Lower back Lower back &
posture flexion hip extensor erector spinae, hip flexor

elvis posterior hip flexor strengthening
tilting
ip joint
extension
pway back posture
|

   u   u   
 

 
      
!  
pway back lumber spine upper Lower Lower
posture flexion abdominals, abdominals, abdominals &

elvis posterior hip extensor, hip flexor hip flexor
tilting, Inter costal strengthening
ip joint
extension
à |



 


 
à ||  
# 
"  
à   

à

" !&
à "&
à  

"&
à 

  

à  

 

illitary/lordotic posture
|

   u   u   
 

! 
      
 

yperextended Knee Qudriceps, hamstring ptrengthening of

f knee hyperextension soleus hamstring
nkle planter
flexion

lexed knee Knee hamstring Qudriceps, Check length of hip

flexion,ankle soleus flexor,stretching of
dorsiflexion knee flexor if tight
|

   u   u   
 


 
 
      
!  

ronation oot eversion
eroneal & Tibials Inner wedges

toe extensor posterior on heels &
& long toe strengthen
flexor inverters

pupination oot inversion tibialis peroneal uter wedges

on heels
&strengthen
everters
à Eyes and ears should be level and symmetrical.
à ight and left angles between shoulders and neck should
be symmetrical. Clavicles also should be symmetrical.
à ibs on each side should be symmetrical.
à ight and left waist angles should be symmetrical.
à nterior superior iliac spines should be level.
à
atella should be symmetrical and facing straight ahead.
à alleoli should be symmetrical, and feet should be parallel.
à Toes should not be curled, overlapping, or deviated to one
side.
à In anterior view of the human body, the LoG, in optimal
posture, divides the body into two symmetrical parts.
à ead should be straight with no lateral tilting. ngles
between shoulders and neck should be equal.
à rms should hang naturally so that the palms of the hands
are facing the sides of the body.
à pcapulae should lie flat against the rib cage, be equidistant
from the LoG, and be separated by about 4 inches in the
adult.
à The posterior superior iliac spines should be level.
à The gluteal folds should be level and symmetrical.
à Look to see that the knees are level.
à The heel cords should be vertical and the malleoli should
be level and symmetrical.
‰   



à u  

 % 

 
à pynergies are centrally organized patterns of
muscle activity that occur in response to
perturbations of standing postures
à they are  


à 

"
à It is sudden change in conditions that displaces
the body posture away from equilibrium.
à The perturbation can be  

 .
 u  

 
 



 
à
atterns of muscle activity in which the Bop
remains fixed during the perturbation and
recovery of equilibrium.
à ptability is regained through movements of
parts of the body, but the feet remain fixed on
the Bop .
à   

à The  
consists of discrete bursts of muscle
activity on either the anterior or posterior aspects of
the body that occur 

in
response to forward and backward perturbation.
à  

à The 
consists of discrete bursts of muscle
activity on the side of the body opposite to the ankle
pattern 


 in
response to forward and backward perturbation.
0  



  
à The change-in-support strategies include
  (forward, backward, or sidewise) and

(using one͛s hands to grab a bar or
other fixed support)
à nly synergies that are maintaining stability in
case of a large perturbation
  ÿ 
"'

  
à used to maintain the head during dynamic
tasks
à modification of head position in responce to
displacements of the body͛s CoG.
à  ÿ


 is one in which the  

   


à  ÿ

 is one in which the