Postural development Common spinal deformities Patient history Observation Examination

Correct posture
Position in which

minimum stress is placed on each joint. (Magee)

Faulty posture
Any position that

increases stress on joints

Birth
Entire spine concave forward (flexed) Primary curves x Thoracic spine x Sacrum

Developmental (usually around 3 mos.)

Secondary curves Cervical spine Lumbar spine

Factors affecting posture

Bony contours Laxity of ligamentous structures Fascial & musculotendinous tightness Muscle tonus Pervic angle Joint position & mobility Neurogenic outflow & inflow

Causes of poor posture

Positional factors x Appearance of increased height (social stigma) x Muscle imbalances/contractures x Pain x Respiratory conditions Typically can be managed

conservatively through ther ex & education

Causes of poor posture

Structural factors x Congential anomalies x Developmental problems x Trauma x Disease Not typically easily

managed s sx

Lordosis
Excessive anterior

curvature of the spine Exaggeration of normal curves in the cervical & lumbar spines

Lordosis causes:

Postural deformity Lax muscles (esp. abs) Heavy abdomen Compensatory mechanisms Hip flexion contracture Spondylolisthesis Congential problems Fashion (high heels)

Lordosis
Swayback deformity x Increased pelvic inclination (40) x Typically includes kyphosis

Kyphosis
Excessive posterior

curvature of the spine

x x x x Round back Humpback/gibbus Flat back Dowagers Hump

Scoliosis
Nonstructural x Functional x May be related to leg length discrepancy Structural x Lacks normal flexibility x Asymmetric movements

Scoliosis
Ideopathic x Approx. 75-85% of all structural cases are ideopathic x Stretch concave curve x Strengthen convex curve

History of injury? Any previous back or neck pain? Any positions of comfort? Family history? Previous illnesses, surgeries, or severe injuries? Hx of other conditions (connective tissue diseases such as Marfans Syndrome)?

Footwear? Patient age? Growth spurt? In females, related to menarche/menses? In males, related to voice change Deformity progressive or stationary?

Neurologic symptoms? Nature, extent, type, and duration of pain? Exacerbating activities or positions? Difficulty breathing? Dominant hand? Previous treatment? Did it help?

Body type
Ectomorph Mesomorph Endomorph

Anterior view
Head straight on

shoulders Shoulders level Clavicles/AC joints Sternum & ribs Waist angles & arm positions Carrying angles Iliac crests ASIS Patellae Knees Fibular heads

Malleoli level Arches Foot rotation Bowing of bones Diastematomyelia (hairy patches) Pigmented lesions

x Caf au lait spots x neurofibromatosis