Postural Scan

Question 1

when observing anterior posture of head and neck look for:

Answer 1

1. cervical lateral tilt by bisecting the throat
2. head tilt and rotation (look at ears)
3. AC joint levels (see-feel)
4. clavicle orientation (horizontal, elevation of AC end may suggest greater trap dev)

Question 2

when observing anterior posture of upper body look for:

Answer 2

1. gap between trunk and arm (greater gap may be due to elevated shoulder girdle or trunk lat flexion)
2. direction of cubital fossa (inwards suggest more int rot of humerus)
3. fingertips levels (may be due to lat flexion of trunk, elevation of shoulder girdle, or greater muscle mass/heavier on one side hang lower)

Question 3

when observing anterior posture of lower body look for:

Answer 3

1. palpate for symmetry of illiac crest from above, ASIS (groove) from below
2. genu valgus/varus (normal should be straight line from center of knee to foot), varus can also be tibial (structural) where apex of bow is below knee
3. femoral rotation look at patellar position (neutral patella is forward facing, can be due to structure or hip postition
4. check tibial position by rotating toes until patella faces forward, see if tibia compensating for femur
5. muscular atrophy, hypertrophy, swelling
6. left-right body weight distribution (draw line from navel down midline and check space between feet and line

Question 4

when observing sagittal posture of head and neck look for:

Answer 4

1. upper cervical spine positioning (how tucked [UCS flexion] or forward [UCS extension] the head is on neck by checking how horizontal the bottom of orbit to tragus is
2. lower cervical spine inclination (line to bisect neck or horizontal offset of tragus to C7 spinous process to check flexion, often more shallow lordosis with greater LCS flexion, may compensate for lower POV with greater UCS extension)
3. direction of acromion process to find where shoulder sits (follow the spine scapula and clavicle up the acromion, pinch grip to check where acromion sits, straight out in sagittal plane is neutral, forward can be due to protraction or thoracic rotation)

Question 5

sagittal posture of the upper body

Answer 5

1. look at sternum and the top ribs for thoracic spine orientation (sternum more lifted is greater extension, sinking greater flexion)
2. look at lower ribs for lumbar orientation (flaring is deeper lordosis, tucked is more shallow lordosis)
3. run hand down the spine to check how shallow/deep kyphosis/lordosis is

Question 6

sagittal posture of the hip and pelvis

Answer 6

1. PSIS to ASIS orientation for pelvic tilt, check both sides since they may differ (normally ASIS is slightly lower than PSIS but fairly horizontal)
2. more ASIS drop for ant tilt leading to deeper lumbar lordosis, greater hip flexion (smaller crease on ant hip)
3. greater PSIS drop for post tilt, shallower lumbar lordosis, greater hip ext (more opening of crease on ant hip)

Question 7

sagittal posture for lower body

Answer 7

1. check femur relative to tibia for knee flex/ext (draw line from greater trochanter to middle of knee to lateral malleolus, 5 deg hyperextension normal)
2. ankle PF/DF as tibia relative to floor (angle of line through bottom of foot with tibia line, usually 90 deg, knee hyperextension may result in greater ankle PF)
3. pes cavus (caved)/planus (flat) curvature of the foot indicate the supination, navicular height from bottom of foot usually 1/3 of the foot

Question 8

posterior posture of scapula

Answer 8

1. protraction/retraction (check for distance from root of spine to vertebral column but may be flawed due to deg of thoracic lat flex or scoliosis
2. scapular height (check inf angle levels)
3. scapular rotation (check orientation of spine, medial border, and inferior angle)
4. winging (check for prominent medial border) and ant tilt (check prominent inf angle)

Question 9

posterior posture of the spine and pelvis

Answer 9

1. lateral flexion of thoracolumbar spine (check by running fingers down spine to look for scoliosis)
2. ribcage to pelvis offset (vertical line from bottom of ribcage to horizontal pelvic line, check if lines up)
3. iliac crests and PSIS levels (left and right tilts may be compensated with lat flexion, can be due to limb length difference which may be structural or functional muscular weakness)

Question 10

posterior posture of rearfoot alignment

Answer 10

1. line bisecting calcaneus to check degree of inv/evr
2. intermalleolar line, normally lateral lower, medial side drops with evr, raises with inv
3. check how stacked the talus is on calcaneus, talonavicular prominence and seeing toes indicates greater pronation