OBJECTIVE ASSESSMENT

Posture – examination
Dr. Tsabeeh Alfadil
PHYSIOTHERAPY ASSESSMENT:
1. Subjective examination
 Interview
 Listening to the patient’s story

2. Objective examination
 Measuring
 Special tests

3. Interpretation
 Evaluation and Functional diagnosis
 Goals
PURPOSE OF THE ASSESSMENT

• ”Assessment is the judgement that is necessary to

make sense of these findings; hence to identify a
relationship between the symptoms reported and the
signs of disturbed function”
Grieve
1981
BEFORE STARTING....

Before moving on to the objective examinitation:

 It should be very clear to you:

 WHY is the patient here?
 WHAT is the problem?

 WHERE is the problem?

 HOW does it behave?

 Any RED flags?

POSTURE
”the arrangement of the body and its limbs”

”a position of the body or of body parts”

 Standing posture
 Sitting posture

 Lying posture
 Supine or prone
POSTURE INSPECTION
 Ask the patient to undress
 The patient should stand with the feet a little apart (same
as the distance between the hips)

 Inspect the posture from the posterior, anterior and

lateral views
POSTURE INSPECTION, CONTINUE

 Observe how the different parts of the body rest on each other
 Is this a relaxed position for the patient

 Observe centre of gravity

 In standing position
 Observe line of gravity
 Like a plumb line
 From mastoid process, through shoulder joint, through trochanter major to

base of 5th metatarsus

POSTERIOR Normal
VIEW
Feet  Calcaneus in neutral alignment with the 
Achilles tendon
 Medial malleoli equal height
Knees  Popliteal fossa of equal height
 Normal valgus of 13-18 degrees
Hips / pelvis  The greater trochanters equal heights
 Gluteal folds equal
 Illiac crests equal height
 PSIS in horizontal plane
Trunk  Spine straight without lateral curves
(scoliosis) – alignment of spinous
processes
Upper  Scapulae equal distance from the spine
extremities and flat against the ribs
 Inferior angels and spines of scapulae
equal heights
 Shoulders equal heights (dominant)
 Arms hang equally from trunk
Head / neck  Head in the midline
 Neck straight without lateral tilt or
rotation
Abnormal
Pes planus or cavus
 Equinus deformity
 Calcaneal valgus (or varus)
 Atrophy or edema
 Varus or valgus deformity
 Hyperextensibility of knee joint (genu
recurvatum)
 Inceased flexion in hip joint
 Pelvic asymmetry
 Leg length difference
 Muscle guarding or spasm
 Scoliosis or kyphosis
 Forward or laterally flexed
 Scapulae winging
 Muscle atrophy
 Sprengel’s deformity (one scapulae sits
higher than the other)
 Protraction / retraction of head
 Lateral tilt or rotation of head
 Muscle atrophy / inbalance
ANTERIOR VIEW Normal Abnormal

Feet  Angled slightly outward  Feet medially or laterally rotated

 Arches present  Pes planus / pes cavus
 Navicular tuberosity on Feiss line  Hammertoes / claw toes
 Malleoli level  Hallux valgus
 Unhealthy toenails
 Signs of poor circulation (colour, hairs)

Knees / lower  Fibular heads level  Squinting patellae

legs  Patellae facing forward  Bullfrog eyes patellae
 Knees slightly apart and with slightly  Varus / valgus
valgus

Hips / pelvis  Pubis symphysis level  Hip flexion contracture

 ASIS level  Pelvic asymmetry
 Illiac crest level

Trunk  Rib cage symmetrical  Asymmetry of rib cage or sternum when

patient is breathing
Upper  Arms hang equally from trunk  Asymmetry in upper limbs
extremities  Elbows in 5-15 degrees flexion
 Symmetrical clavicles and shoulders
(dominant side might be slightly lower)

Head / neck  Head in midline  Head tilted or rotated (torticollis)

 Nose in line with sternum an umbilicus  Asymmetry in jaw line
LATERAL VIEW Normal Abnormal

NOTE:
Line of gravity should be like a plumb line
 From mastoid process, through shoulder joint, through trochanter major to base of 5 th metatarsus

Lower  Knees slightly flexed  Flexion contracture

extremities  ASIS and PSIS in same horizontal plane  Hypoextensibility in knees (genu
recurvatum)

Trunk  Cervical lordosis

 Thoracic kyphosis
 Lumbar lordosis
 Pelvic cavity tipped slightly anterior
 Shoulders in proper alignment

Head / neck  Head in neutral position