Postural Assessment.

Introduction

Posture is the way we carry the body as a whole, defined by the body's attitude, balance between the difference parts on the space and the ability to behave biomechanically under the physical forces stressed on the body.

As humans, our posture is influenced by eccentric factors (gravity, clothing and shoeing, weight carriage, etc.) and by intrinsic factors (body composition, muscle strength, flexibility and stress on the connective tissues, etc.)

The importance on the postural evaluation at the beginning of the intake process might be of a high importance when it comes to understand patient’s current complaint from the perspective of his whole lifestyle at the time it will avoid wasting time treating a symptom instead of a dysfunction.

The process of the Postural Evaluation

When a patient comes over to the clinic complaining from some pain on the muscular system a series of exams and evaluation should be performed – usually from the macro to the micro – at first the whole body posture should be evaluated regardless the current complain, and as long as we discover different dysfunctions the need of checking specific injured areas is more accurate, while at the end of the assessment a whole picture is obtained in order to proceed with the therapeutic protocol which should include the primary injury following – but not limited, to improve the general well-being and the posture.

Patient’s preparation

To evaluate the posture in a regular way previous preparation is not needed. The patient is requested to come to the evaluation wearing a specific “dress code” to allow to the therapist to observe the landmarks that will determine the postural dysfunctions. This landmarks are certain protuberances along the body that draw a specific geometrical pattern that compared to the guidelines can show the differences between the right alignment of the body and the dysfunctions.

The landmarks to be observed are small protuberances which should be seen clearly in the following areas:

Skull and face,

Neck

Shoulders

Thorax and upper back

Spine

Hip (anterior, lateral and posterior)

Knees

Ankles

Feet

The "dress code" requested for this assessment

Men should wear shorts or running tights which don’t cover the knees. If possible, no upper coverage to allow the observation of the landmarks.

Women should wear the same pants as Men and cover their breast with a sports bra.

In this way the different points are visible and can be marked, measured and compared.

This is an easy and fast assessment with no need of touching the patient. In certain cases, though, the therapist might ask for the patient’s consent to make some marks in the body – for example when the rib cage’s limit is not clear due to visceral fat or some specific points to be compared afterwards with other assessments.

Use of technology

Modern times, luckily, provide us with advanced digital technology to evaluate at the most accurate way the posture of an individual. The use of software that measures the distances and make the calculation of the posture landmarks give as a result the most precise condition presented by the patient and the therapist can rapidly conclude on which areas are over stretched or over-active and build the therapy protocol accordingly. The use of software requires to take pictures of the patient. Usually the pictures are taken in two planes: Anterior (facing the camera) and Lateral (profile picture); but sometimes other pictures might be taken, especially on functional assessments, like ergonomic evaluations and physical activity postures (squat, for example).

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