k class 8 tg postural assessment 2013
TRANSCRIPT
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Posture:
◦ Upright position in gravity
◦ Involves a complex set of closed chain activities
◦ Reflects the strength, balance, equilibrium and
stability of multiple structural and functionalparts of the body.
Postural Assessment: observing the client‟sgravitation line, balance and symmetry in various
positions
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◦Tight muscles =
shortened
◦ Taut muscles =
stretched.
◦
The body works like a
pulley system. If
muscles on anterior
side are shortened and
tight, the muscles
opposite side must be
lengthened and taut.
The lengthened and
taut muscles still
need work for
possible trigger
points,
herapist‟s focus
needs to be to loosen
the shortened
muscles and to
reeducate them for
proper position and
function.
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◦ Some clients with
upper back and neck
pain will want nothing
but upper back and neck
work
◦
In doing a postural
analysis, the therapist
may find that the client
is internally rotated
(rounded shoulders)
which means that pecs,
lats, and other anterior
muscles must be
worked.
◦Trigger points may
exist in the lengthened
muscles (trapezius,
rhomboids, and serratus
posterior superior) that
need to be released.
◦ The focus of the work
would be on the muscles
of the rounded shoulder
posture.
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Most postural problems are functional andnot structural.
For ex: a person who sits or stands for long
periods of time tend to slouch, resulting inmuscle imbalances which cause positionalstrain.
Other influences include: age, traumas,
birth defects, systemic disease, ergonomics,postural habits, lifestyle, habits, hydration,and nutritional status.
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Spinal Curvatures
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Curves are developed as we grow
Curves are present during rest and activityand function as shock absorbers.
Concave anteriorly & convex posteriorly:thoracic and sacral
Convex anteriorly & concave posteriorly:cervical and lumbar
Pelvis should be level
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Lordosis or Hyperlordosis – increasedanterior curve or swayback
Kyphosis or Hyperkyphosis
–
increased
thoracic curve - hunchback
Flat back – decreased thoracic curve,decreased lumbar curve
Scoliosis
–
lateral curve of vertebral
column
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If a person has a
habitual posture that
increases a spinal
curve, the following
will result
◦The muscles on the
concave side tend to
shorten and tighten
◦
The muscles on the
convex side tend to
become long , taut
and weak.
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Ex: A client with lumbar lordosis (excessive
anterior curve) would be expected to have
tight and short back extensors and weak
and long abdominals.
Stretching is required for the short area andappropriate exercise for the long areas.
Massage can help by working the shortened
muscles on the concave side andstimulating the long, taut and weak muscleson the convex side of the curve.
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Standing Posture
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When we stand for
long periods of time
we shift between 2
stances.
◦
A: Symmetric stance is
with weight distributed
equally on both feet
◦ B: Asymmetric stance is
weight nearly all on
one foot
Asymmetric is the
most common
standing position
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Muscles that contractto resist the pull ofgravity and assist inmaintaining posture.
Examples include
muscles of the jaw thatkeep the mouth closed.
Muscles most involved: ◦
hip & knee extensors (including the quads)
◦trunk & neck extensors.
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Ankle plantar flexors &
dorsiflexors control
postural sway (back and
forth movements at the
ankle)
Other postural muscles
involved in the upright
position:
◦ Trunk & neck flexors
◦ Hip abductors &
adductors
◦Ankle evertors
(pronators) & invertors
(supinators).
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Upper trapezius Piriformis Levator scapula Oblique abdominals
SCM Adductor longus &magnus
Upper pectoralis major Tensor fascia latae
Latissimus dorsi Rectus femoris
Erector Spinae Medial hamstrings
Iliopsoas Soleus Gastrocnemius Tibialis posterior
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Head moves forward
The hips bend
The torso moves forward
Legs lift the body from a semi-squat
position to a standing position
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Should include an evaluation of at least the followingfunctional groups:◦ Top of head, ears & axis/atlas◦ C-6/C-7 vertebra & AC joint level: in posterior view,
shoulders should be level & medial borders of scapulaparallel & about 4” apart
◦ T-12 vertebra◦ T-12 & S1◦ Iliac crests & SI joints: in posterior view, pelvis should
be level◦ Greater trochanters
◦ Knee/patella & fibular head◦ Malleolus & ankles◦ Feet, arches & toes: in posterior view, feet parallel or
slight out-toeing
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To perform a
complete
postural analysis,
the client needs
to be observed
from 3 views:
◦ Lateral view
◦Anterior view
◦ Posterior view
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Client needs to be in symmetric stance with feet
about a shoulders-width apart.
Best done with the eyes closed so client is unable tobalance the body visually.
Often the client will tip the head or rotate it slightly to
feel balanced; this indicates muscular imbalance &internal postural imbalance information relayed bypositional receptors.
Look for:◦ Bilaterally symmetry◦ Head forward posture◦ Locking of the knees
A full assessment will include evaluation of the major joints.
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Begin either from the head down or the feet up. The client should be without shoes or socks. Things to look for:
◦ Alignment of the Achilles tendon – Is the footpronated, supinated or neutral?
◦
Arches of the feet: You should be able to fit the tip ofyour index finger under the arch. If you are unable to get that much under the arch, the
client may have flat feet (pes planus); If more than that can go under the arch, the client may
have high arches (pes cavas).◦
Position of the feet: Are the hips medially or laterallyrotated?◦ Calf area: Is one larger than the other? Are they even?
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Popliteal fold: Is it level? If it is higher on thelateral side of the knee, it could indicate a tight ITBand/or anterior pelvic tilt.
Hips: Are they level?◦ If the hips are not level when he is standing but
are level when he is are sitting, the problem ismost likely below the hips.◦ Is there an anterior or posterior tilt? Check the
level of the right ASIS compared to the right PSIS.Also compare the left ASIS & left PSIS.
◦
If the ASIS is 5-10 degrees lower than the PSIS,she has an anterior pelvic tilt.◦ If the PSIS is lower than the ASIS at all, she has a
posterior pelvic tilt.
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Spine:◦ Is he kyphotic in the thoracic region (exaggerated
outward curve of the thoracic spine)?◦ Is she lordotic in the lumbar area (exaggerated
inward curve or sway back)?◦ Is she scoliotic (side-ways curve)?◦ If there are curves, is it due to an anterior or
pelvic tilt or high hip?
Shoulders/scapula:
◦ Are the palms next to the side of the legs or tothe front of the thigh? If to the front, this couldindicate an internal shoulder rotation.
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Achieve the most
accurate assessments
by using a plumb line
suspended from the
ceiling and/or with a
postural grid behind
the person
The plumb line is a
string or cord with a
weight attached to the
lower end. Because of
its weight, it hangs
perfectly straight in a
vertical line.
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An integrated functional unit Kinetic = force; chain = linked together
Composed of 3 systems:◦ Myofascial system (muscle, ligament, tendon and fascia)
◦
Joint system
◦ Nervous system
Each of these 3 systems work independently toallow movement in all planes.
If 1 or more do not work efficiently,
compensations & adaptations occur in the othersystems, leading to stress in the body &eventually to dysfunctional patterns.
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• All movements require:• Acceleration from concentric muscle action• Stabilization provided by isometric contractions• Decelerations provided by eccentric contractions
All 3 actions are occurring at every joint in the
kinetic chain & in all 3 planes with eachmovement. Muscles must react to gravity, momentum,
external forces, & forces produced by othermuscle actions.
Muscles cooperate in integrated groups duringmovement & can be categorized into:◦ Inner unit (stabilizers/postural muscles)
◦ Outer unit (movers/phasic muscles).
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Primarily consists of intrinsic muscles thatfunction at only one joint & are involvedmainly in stabilizing joints.
Definition of Intrinsic Muscles:◦ Muscles fully contained (origin, belly & insertion)
within the specific body part.
◦ For example, the interossei & lumbrical musclesare intrinsic muscles of the hand.
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Postural/core
stabilization
Joint support system
Consists of:◦ Lumbo-pelvic-hip
complex
◦ Thoracic spine
◦
Cervical spine Operates as a unit to
stabilize the kineticchain during limb &
head movements.
Muscles that stabilizerather than move the
joint. The muscles attach to
the joint capsules sothey can stabilize the
joint by stiffening the joint capsule.
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Muscles that have their
proximal attachment
on the spine & include:
Deep erector spinae
Deep cervical muscles
Transverse abdominus
Abdominal obliques
Diaphragm
Lumbar multifidus
Muscles of pelvic floor
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There are also inner
units of muscles in the
joints of the shoulder,
pelvic girdle and limbs.
EX: Rotator cuff
muscles stabilizes the
glenohumeral joint by
keeping the head of
humerus in the glenoid
fossa.
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Muscles that are
primarily
responsible for
movement of trunk
& limbs
Superficial muscles
that attach from the
limbs, shoulder
girdle, & pelvic
girdle to the trunk
or core.
Muscles include:
◦Rectus abdominus
◦External obliques
◦Erector spinae
◦Latissimus dorsi
◦Hamstrings
◦Gluteus maximus
◦Thigh adductors
◦Quadriceps
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Muscle Groups With Dysfunctions
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Include:◦ Erector spinae
◦ Thoracolumbar fascia
◦ Sacrotuberous ligament◦ Biceps femoris (a hamstring muscle)
Dysfunction can lead to SI pain
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Includes:
Erector spinae
Psoas
Abdominals
Diaphragm
Lumbar multifidus
Pelvic floor muscles
Dysfunction can
lead to SI instability
and low back pain
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Allow rotation of pelvis
& contribute to walking
by swinging the leg
forward
Include:
◦
Internal oblique◦ Adductors
◦ External hip rotators
◦ Contralateral gluteus
maximus
◦ Latissimus dorsi
◦
Anterior & posterior
tibialis
◦ Soleus
◦ Gastrocnemius
◦ Peroneal group
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Dysfunction can lead
to SI joint problems
plus rotation strain in
lumbar region, pelvic
area, knee & ankle.
May also cause
increased tension in
hamstrings that can
cause hamstrings
strains
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Include:
Gluteus medius
Tensor fascia latae
Adductors
Quadratus lumborum
During single leg
movements, the same
side gluteus medius,
TFL & adductors work
with the opposite side
quadratus lumborum
to control the pelvis &
femur
Dysfunction can cause
instability and strain
during walking,
running and jumping.
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Two segments provide postural stability in adiagonal counterbalancing function:◦ Muscles located between base of skull & top of
shoulders
◦ Muscles located between the last thoracicvertebra & the top of the hips
Compensation & dysfunction can occur hereas well.
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If right hip is elevated from tense back
muscles, there is usually a compensationpattern in the anterior muscles on the left
between C7 & T12.
Pain in the quadriceps on the left show acompensation pattern in:◦ The calf on the right side
◦ Between the hips & SI on the right
◦ There could also be tension on the top of the left
foot.
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Postural Dysfunctions
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Standing and walking are closed kinetic chain
activities and because of the tensegretic nature of the
body, the position or motion of one joint affects the
positions or motions of other joints.
Tensegrity refers to structures that maintain theirintegrity primarily because of a balance of continuous
tensile forces through the structure. Tension forces naturally transmit the shortest
distance between 2 points, so components oftensegretic structures are positioned to withstandstress best.
The bones, muscles and fascia create a tensegreticstructure. The bones are the compression membersand the myofascial is the surrounding tensionmember. Muscles are required to hold the skeletonupright.
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The bones are „spacers‟ pushing out into the softtissue and the tone of the tensile myofascialdetermines the balance of the body. The bones arelike islands floating in a sea of tension. The bonespush outward against the tension of the myofascial.
Ex. Tent made of canvas, cables and poles. As long
as the two sets of forces are balance, the structure isstable. Load one corner of the structure and thewhole structure gives a little to accommodate.
Because the structure spreads strain throughout the
structure along the lines of tension (or the body parts
move in the same direction as the applied stress), thestructure may give way at some weak point awayfrom the application of the strain.
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In massage we look for the symptoms of the weakpart and look elsewhere for the cause or the origin ofthe strain.
Tensegretic structures rearrange themselves inresponse to a local stress. As the applied stress
increases, more the components come to lie in the
direction of the applied stress, creating a line oftension or stiffness.
An injury at any given site can be caused by longterm strain in other parts. Discovering the tensionpathways and relieving chronic stress help return the
body to a position of more ease and prevent futureinjuries. Full body massage can address those areas of strain.
Less effective is spot work only in the area thatproduces the symptom of pain.
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Figure 10-32 Upper & Lower Crossed Syndrome
Flow Chart
Figure 10-33 Upper & Lower Syndrome
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Predictable neuromuscular chain reactions 2 of the most common dysfunction postural
patterns. The muscular response occurs inconsistent and predictable patterns.
Causes can include: poor posture, excessivephysical demands, joint blockage, habitualmovement patterns, painful or noxiousstimuli, CNS malregulation, and psychological(emotional) stressors.
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Some upper crossed muscles when stressedtighten and become neurologicallyfacilitated. These muscles are postural.
Other upper crossed muscles actually
weaken when exposed to the samestressors. These muscles are phasic ordynamic.
There is shoulder elevation and scapulaprotraction and inhibition in the deep neckflexors and lower shoulder stabilizers.
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Forward head is most common postural fault in US.The tight line travels thru pectorals, levator scapulaand upper trapezius. The sustainedhypercontraction in these typically tonic muscleselevate and protract scapula. The weak line travelsthrough the deep neck flexors and lower shoulderstabilizers.
Stretching pectoralis major and minor, levatorscapula, upper trapezius, teres major, SCM,
scalenes, and rectus capitis is beneficial.
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The tight line travels thru iliopsoas and lumbarerectors which pull and hold this abnormalswayback posture.
Reciprocal inhibition weakens the abdominals andgluteals and the weak line travels through these.
The short iliopsoas anteriorly tilt the pelvis,creating excessive lumbar lordosis while erectorspinae myofascial contractures hold the „bowing‟pattern.
The weak abdominals and gluteals are unable tostabilize the pelvis.
Stretching hip flexors (psoas and rectus femoris)and low back (erector spinae) is beneficial.
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Our population has moved from being movers to asedentary group of sitters. Davis‟s Law emphasizes that if muscles are lax for
extended periods of time, reciprocal inhibition willtake up the slack.
This is true for the hip flexors. As the psoas andrectus femoris neurologically shorten from prolongedsitting, the ilia are pulled in an anterior/inferiordirection which results in excessive lumbar lordosiswhen standing.
Compensations from this swayback posture often
lead to thoracic hyperkyphosis, forward headpostures, and upper crossed syndrome. It is estimated that 75 of neck/back pain clients
have 1 or both of these patterns.
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Side-to-side imbalances can also occur such as a lowshoulder, short leg or cocked head. These asymmetries are often the result of powerful
unilateral myofascial forces tugging on the body‟sbony framework, jamming spinal facet joints andirritating sensitive joint receptors.
Facets are possibly the most innervated structures inthe spine.
When the joint‟s axis of rotation is disrupted due tomyofascial shortening, the sensitive joint receptorsprovoke a sympathetic spasm in neighboring
muscles, causing the body to twist and torque in aneffort a pain avoidance. As gravity as added to the situation, unilateral
distortions quickly become chronic pain generators.
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Rhomboids, posterior deltoid and
infraspinatus test inhibited. What is
demonstrated?
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Compensation: process of counterbalancing a defect in bodystructure or function;
Compensation patterns are the result of a person adjusting tosome sort of dysfunction. Most compensation patternsdevelop to maintain a balanced posture & even though the
posture becomes distorted, the overall result is a balancedbody in the pull of gravity.
Resourceful compensation:
◦ common action of the body
◦ adjustments the body makes to manage a permanent or
chronic dysfunction Ex: A protective muscle spasm (guarding) around a
compromised disk. The splinting action of the spasmsprotects the nerves & provides additional stability in the area.
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When resourceful compensation is present, themassage needs to support the altered pattern andprevent any increase in postural distortion than isnecessary to support the body change(compensation).
Compensation can also be set up for temporary orshort-terms situations. Ex. Having a leg in a castand walking on crutches for a time. The bodycatching itself in an „almost‟ fall is another classicsetup pattern.
Unfortunately the body often habituates these
patterns and maintains them beyond theirusefulness. Overtime the body begins to showsymptoms of pain or inefficient movement or both.
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A guideline for resourceful vs. non-resourcefulcompensation is:◦ If after massage there is at least a 50%
improvement in mobility that remains after 24-48 hrs, the pattern is likely reversible
◦ If after massage there is immediate improvementbut 24-48 hrs later symptoms return at same orincreased intensity, this is most likely resourcefulcompensation.
◦ If immediately after massage the client has nosignificant reduction in symptoms, this is notreversible since the body has exhausted itsadaptive capability.
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A client experienced a car accident 4 years ago thatresulted in a bulging disk at L4. The injury hashealed with minimal difficulties.
During assessment, palpation indicated a moderatedegree of pliability of the lumbar dorsal fascia and
mild shortening in lumbar muscles. Forward flexionand rotation of the lumbar area are mildly impaired.
Massage was focused to reduce the muscleshortening in the lumbar area and increaseconnective tissue pliability.
Immediately after the massage, the client reportedincreased mobility but within 15 min began tocomplain of lower back pain. Explanation?
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Destabilization of resourcefulcompensation in lumbar areaaround past injury.
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Client experienced an episode of severe low back
pain 3 years ago. The diagnosis was a
compressed disk at L4. The condition has
stabilized and pain is experienced only
occasionally.
Assessment indicates shortened lumbar fascia,
increased lateral flexion to the right, and a high
shoulder on the right.
The therapist addressed those areas and noted
improved improvement following the massage.
The next day the client called complaining that
the low back was in spasm. Why?
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esourceful compensation
patterns were disturbed
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A regular client has a grade 2 left ankle
sprain and is using a crutch to maintain
balance when walking.
During assessment of posture, the massage
therapist notices an elevated right shoulder.
What is the cause?
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The body is displaying
compensation patterns
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When standing barefoot, the perpendicularline of the erect standing body creates a 90degree angle with the floor.
On a 2-inch heel, were the body a rigid
column and forced to tilt forward, the anglewould be reduced to 70 degrees and a 3-inchheel would result in a 55 degree angle.
For the body to maintain an erect posture, awhole series of joint adjustments (ankle,knee, hip, spine and head) are required tomaintain an erect stance and equilibrium.
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The slope or slant from the heel, rear to front, iscalled the heel wedge angle. With bare feet, there is no wedge angle. With a heeled shoe, the wedge angle shifts the body
forward. With a low heel, body weight is shared 40% heel, 60%
ball, and with a high heel, it is 90% ball and 10% heel. High-heeled shoes throw the entire weight of the
body forward, demanding additional effort tomaintain an upright balance.
Women wearing high heeled shoes must use extra
muscular effort to keep from falling forward. A great deal of this effort is concentrated in the low
back, producing an exaggerated arch, which caneasily lead to back pain.
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Specific Postural Dysfunctions
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Also called hyperlordosis Pelvis is positioned forward and downward
(anterior pelvic tilt). Hips are slightly flexed andlumbar spine is excessively hyperextended.
Increased risk of low back injury during standingor lying, weighted overhead activities, and inactivities involving hip flexion and extension.
Short and tight/strong: erector spinae, hip
flexors
Long and weak: may include abdominals,hamstrings, gluteus maximus
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Also called hyperkyphosis
Exaggerated anterior-posterior curvature of the
vertebral column, most often involves an excessive
forward bending in the thoracic region.
Occurs in older adults, particularly in women with
osteoporosis and osteoarthritis. Sometimesaccompanied by other posterior problems includingposterior pelvic tilt and protracted shoulder girdle.
Kyphosis makes it difficult to do overhead activitiesparticularly when combined with winged scapula or
inflexible lateral rotators of the shoulder. Short and tight/strong: neck extensors, pectorals
Long and weak: Upper back erector spinae, neckflexors, external obliques
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Includes a forward head position Short and tight/strong: neck extensors,
pectorals, hip flexors
Long and weak: upper back erector spinae,
external obliques Hamstrings slightly elongated but may or
may not be weak
Low back muscles are strong but may or maynot develop shortness
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Excessive lateral curve
Which muscles are short or elongated willdepend on curvature pattern
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An anterior pelvic tilt is normal postural position withthe tilt being between 0-5 degrees in men & 7-10degrees in women.
Excessive anterior pelvic tilt causes the thigh bonesto rotate inward, causing increased stress of themedial portion of the knee.
Along with the internal rotation of the thigh, there isincreased weight bearing on the inside of the footwhich puts strain on the muscles that supinate(invert) the foot.
Fallen arches are a common result of excessive
anterior pelvic tilt. However, flat feet can contributeto anterior pelvic tilt. Body weight tends to be on balls of foot & therefore
may be tender.
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Anterior pelvic tilt also causes a postural distortion. Thepelvis controls the amount of curve in the lumbar region.If the pelvis tilts too far anteriorly, the arch in the back
increases significantly (swayback).
We have found that what happens in the low back will alsohappen in the neck.
This shared dysfunction is a result of our reflexes to keepour eyes, ears and jaw level with the horizon. As the neckextends, it will tend to jut forward creating the forwardhead position. (Sitting for long hours at a desk can
contribute to an anterior pelvic tilt.)
Short and tight/strong: iliopsoas, sartorius, quadriceps,quadratus lumborum, tensor fascia latae and Iliotibialtract, tibialis anterior,
Long and weak: may include abdominals, hamstrings,gluteus maximus
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Inferior angle of
scapula protrudes
slightly from the
body; may be
accompanied by a
protracted shoulder
girdle.
Short and
tight/strong:
pectoralis minor
Long and weak:
serratus anterior,rhomboids
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Facet joints are paired synovial joints that joinone vertebra to another. Facet joints are highly innervated including the
presence of pain receptors. During normal movements, the facet joint are
exposed to numerous forces. These forces candamage the joint capsule or the surroundingmuscle tissue.
Compression from faulty posture can generate apain response.
With disk narrowing from compression, as muchas 70% of the force can be spread across thefacets. The force may be strong enough tostretch the capsule and trigger a pain stimulus.
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Another possible irritation to the facet joints is „locking‟ ofthe joint. This frequently occurs when a personstraightens up after a deep flexion and isn‟t fully able toachieve a full upright position.
When deep movement is made in any direction, a smallgap is created between the facet joints. The gap canentrap soft tissue when the person is returning to anormal position. The entrapped tissue can be the jointcapsule or other soft tissue structures.
Pain is usually unilateral and very sharp and localized,causing significant muscle spasms that reinforce thelocking.
Massage and mobilization of the joints can help with facet joint irritation and especially joint locking.
Stretching of the low back, hip, and anterior trunk can beof benefit. Avoid stretches that cause hyperextension ofthe spine.
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“The sacroiliac joint continues to be one of mostmisunderstood joints in the body” (Cibulka, 2002).
It is classified as synchrondrosis which is animmoveable joint but it is subjected to the sameinflammatory and infectious conditions that affect
synovial joints. “There are 35 muscles that attach directly to the
sacrum and/or innominate bones” (Thompson, 2001).
The SI joint functions primarily as a shock absorber.It also completes the pelvic ring and spreads the load
from the upper body to the legs. It is estimated that 15 -30 of people with low back
pain have a SI dysfunction.
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Mechanoreceptors in the ligaments of thearea are important for their role in activity themuscles for postural control. The restrictionof movement by these ligaments plays an
important role in stability. Sustained isometric contractions for stability
can produce muscular weakness and lead tooverstretching of these ligaments and
inflammation as well as a pain-spasm-paincycle.
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The only 2 possible movements of these joints are◦ A nodding movement of the sacrum
◦ An anterior or posterior pelvic tilt
Decreased mobility of the SI due to aging, overuse, orunderuse, results in an increased movement of
lumbar spine. This also works in reverse, decreasedmovement in the lumbar spine leads to increasedmovement of the SI joints.
Ipsilateral gluteal pain, typically around the PSIS, isthe most common complaint and is often
accompanied by a palpable soft tissue nodule overthe PSIS.
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The pain and discomfort can radiate into thegroin and legs and cause numbness, clicking,or popping in the posterior pelvis.
In the early stages of a SI pain episode, aprotective muscles spasm develops as thesacrum gets stuck in a side-bent and rotatedposition usually from an incident thatinvolved a forward-bending and rotatingmovement.
Using stretches for the iliopsoas, hip flexorsand gluteals can benefit this condition.
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Anterior positioning of the cervical spine Can be aggravated by a too high pillow at
neck.
Can be caused by hours of a flexed head
position such as using a sewing machine.
Short and tight/strong: neck extensors
(including trapezius)
Long and weak: anterior neck flexors
Neck rotators are long
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The shoulders are pulled forward. The medialborders of the scapula may protrude slightlyfrom the body in winged scapula.
Increased risk of shoulder injury duringhorizontal adduction/abduction especially when
elbow travels behind shoulder. Can be aggravated by side sleeping with the arm
down.
Short and tight/strong: subscapularis, pectoralis
minor, pectoralis major, serratus anterior, SCM,and scalenes
Long and weak: upper trapezius and rhomboids
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Greek. Ergon “work” and nomo “by natural laws”; theapplication of scientific information to the needs ofpeople in the design of objects, systems andenvironments for human use.
Incorporates information from anatomy, physiology,
kinesiology, psychology and design to maximizehuman performance while recognizing limitations andsafety concerns.
Ergonomic concerns for a workspace are the height ofthe items, adequate lighting, sharp corners sticking
out, and things placed where they are the mostaccessible without you having to twist or bend.
Massage therapists generally see clients whenincorrect ergonomics are used and problems occur.
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All work activities should allow the workerto assume several different, but equallyhealthy and safe postures
When muscular force has to be exerted, it
should be exerted by the largestappropriate muscle group available
Work activities should be performed withthe joints at about the midpoint of theirROM. This applies particularly to the head,neck, & upper limbs.
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Good computer
workstation
◦ Monitor at or below
eye level
◦Phone headset
◦Chair has armrests
Incorrect computer
workstation
◦ Computer in a corner
on a platform
◦Phone on shoulder
◦Feet propped up on
chair legs
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Good sitting posture which requires the leastexpenditure of muscle energy
◦ 90 degree angle for hips and knees
◦ 10 degree of incline for the back of the chair
◦ Armrests at proper height Too high and shoulders are pushed upward
Too low and arms won‟t have propersupport
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Workspace can have a
separate keypad and
gel pads for wrist
support.
Other good tools are
an adjustable footrest
and adjustable monitor
stand.
Positioning keyboard
and mouse so that
wrists are straight in a
neutral position can
help prevent carpal
tunnel syndrome.
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Good chair is adjustable
chair with lumbar
support, has clearance
between the back of the
knees and the edge of
the chair to avoid putting
pressure on sciatic nerve,
armrests at correct
height to loosely support
arms near the torso.
Chair height should place
hips at about same
height as knees to avoid
putting undue pressure
on legs and gluteals.
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Good mechanics improves the strength andeffectiveness of massage, keeps the therapistfrom getting tired, and enhances the client‟sexperience.
Work from center of your pelvis and let your
legs to do most of the work. Keep elbows closeto the body and wrists relaxed. Use elbowsand forearms for pressure work or deep glidingstrokes.
If a particular movement is causing you pain,make the necessary adjustments to yourposture or technique.
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Check the massage table height Wear comfortable attire so you can easily move Warm up and stretch before and after giving
massages Use a variety of strokes Position your pressure so that you are behind
your work Maintain proper body mechanics Breathe Move smoothly Get in tune with your body
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Tell male clients to not carry wallet in backpocket since this can cause sciatic pain.
Children with heavy backpack can havebiomechanical problems.
Women who always carry heavy purses ortheir toddlers on the same hip arecontinually out of balance.