Understanding a patient’s posture is a major goal for a Physical Therapist for many conditions. A physical therapist performs postural analysis or posture assessment to determine proper anatomical alignment or posture to identify any abnormalities. A proper/ normal posture ensures an even balance of the body and prevents a specific set of core muscles from getting overworked. You may have heard about poor posture or an incorrect posture, and I also published a series of articles talking about different stretches to correct the upper body posture (neck, scapula, and chest). Physical therapists always look for abnormalities to determine the imbalances that need a fix.
Our body is amazing, it automatically finds a way to compensate for a weakness, imbalance or pain. It starts favoring one side vs other, or few muscles vs others. When this happens, our posture gradually changes. Over time, this becomes obvious. In addition, using few muscles more than other starts to become uncomfortable and painful. The postural imbalance also causes problems like a muscle spasm, and or bony changes (in chronic cases).
So, let’s talk about what a correct or ideal posture looks like.
A postural analysis is done mainly in two ways, front, and back (anterior-posterior) and from the side (medial and lateral). If you are analyzing on a healthy person, assessing a posture in standing position is enough. However, you may have to check posture in sitting or lying position depending on your patient. In the cases I see on a daily basis, sitting posture is more important than any other position. So depending on the case, a therapist sees or lifestyle of the patient, the type and number of assessments vary.
Line of Gravity:
The line of gravity (also called as Plum line) passes through the center of our body. This line explains many things about our positioning and dispositioning. In ideal cases, this line passes through the middle of earlobe, mastoid process, shoulder joint (acromion process), hip (greater trochanter), (anterior to) knee and (anterior to) ankle joint. For postural analysis, this is tested best in a side view.
A-P view for Postural analysis :
For this view, a PT usually looks for positioning and compares it with the other side for symmetry. So the positions of both eyes, both earlobes, both shoulders need to be checked. They should be at the same height and in symmetry. You also need to check the symmetry of both knees and ankles. For lower body position, assess for ASIS (anterior superior Iliac Spine) and PSIS (posterior superior Iliac Spine), iliac crest, the high point of the patella, knee joint, ankle joint, medial and lateral malleolus, etc.
From the posterior view, you can check for spinal curvature, the symmetry of ears, shoulder, scapula, hip joints, gluteal fold, popliteal fossa, and ankle joints. This is a good position to check for bony landmarks like C7, T3, T 12, S 2. The position of other landmarks like rib cage, sternum, umbilicus needs to be assessed as well.
The figure below demonstrates a few major bony landmarks that can be checked in a different position.
Side view (Medio-lateral view) for Postural analysis:
This is important to check spinal curvature. The view defines normal or exaggerated kyphosis or lordosis. From the side view, you can also check the angel of ASIS and PSIS (hip angle) and Iliac crest (bony prominent on side of the hip), etc..
Movement Specific Postural Analysis:
To make this topic a one step further, you can analyze a posture for a particular movement or activity. For example, if a golf player, constantly complains of elbow pain, back pain or knee pain, you want to check his/her position while golfing. In 95% of cases, patients are not using a correct posture. This can just be because of not knowing the difference or not being aware of the wrong posture. It can also happen due to muscle weakness or any prior injury etc. Movement specific postural analysis can apply to any specific movement. For instance, a swimmer complaining of back pain, a dancer complaining of the sole of foot pain, or a computer engineer complaining of neck pain. You can check their postures while performing those specific movements. This will tell us we need to educate our patients to change any positions etc.
I have also found that people are going into wrong postures due to poor or wrong ergonomics. So it is not always that there is a weakness or muscle imbalance in the body. Sometimes, the height of the chair, the height of the computer screen are culprits as well.
The other thing is the fatigue level. This plays a huge role. I have done this to myself several times. So experience speaks :). I see it a lot with students, or new grads who are going to appear for an exam. When they are tired, they go into poor positioning while studying. A day or two later, they are complaining of pain in similar areas. It is very similar to someone having neck pain due to sleeping in a wrong posture, or back pain due to carrying a baby or some heavy object in the wrong posture as they were tired. So we need to consider this as well.
This article summaries very basic postural analysis. For clinicians, posture is crucial, as it tells us a full story about what is going on to the muscles. It is like our personal conference call with all the muscles and bones in the body. Nowadays, there are high tech machines that can analyze a posture, gait cycles, etc. in many different ways and very efficiently. Stay tuned for my next series on proper ergonomics for correct posture!!