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Size of the supporting surface

Direction of motion of the


supporting surface
Location of the perturbing force
Magnitude of the applied force
Initial posture at the time of
perturbations
Velocity of perturbation

POSTURE

Maintaining a static posture requires little


energy expenditure in the form of muscle
contraction.
Bones, joints & ligaments provide major
torque to counteract gravity.

POSTURAL CONTROL

Refers to a persons ability to maintain


stability of the body & body segments in
response to forces that threaten to disturb
the bodys structural equilibrium.
Static Control maintenance against
gravity.____
Dynamic Control maintenance during
movements of body or changes in supporting
surface.
Control depends on the integrity of the
ff.

CNS
Visual System
Vestibular System
Musculoskeletal System
Inputs from joint, tendon & ligaments
sensory receptors

External forces to be considered include


Inertia, Gravity, and Ground Reaction
Force.
Internal forces are produced by muscle
activity and passive tension in the ligaments,
tendons, joint capsule and other soft tissue
structures.
Equilibrium all internal and external

forces must be equal to zero.


INERTIAL FORCE

Altered/impaired systems

Postural responses are task-specific


and varies with:

Ankle strategy
Hip strategy
Stepping patterns

Not considered in static posture.


Body undergoes a constant swaying motions
In normal standing with feet 4in. apart

Body sways 12 degrees in


the sagittal plane, and 16
degrees in the frontal plane.

Force created by swaying is ignored

GROUND REACTION FORCE

EXTERNAL & INTERNAL FORCES

Three patterns of muscle activity in


response to perturbations:

Forces that act on the body as a result of


interaction with the ground
Equal in magnitude but opposite in direction
to the gravitational force
Point of application is at the bodys center of
pressure between feet in normal standing

COMBINED ACTION FORCE


In ideal erect posture, body segments are
aligned so that the torques and stresses
are minimized throughout the kinematic
chain
The combined action line is referred as
LOG
LOG shifts continuously because of
postural sway
Receptors detect these changes and CNS
makes an appropriate response
SAGITTAL PLANE
Effect of forces is determined by the
location of the LOG relative to the axis of
a joint
Through the joint no gravitational
torque is created

The magnitude of torque increases as the


distance between the LOG and axis
increases
OPTIMAL POSTURE

Ideal posture is one in which the body


segments are aligned vertically and the LOG
passes through all joint axes

This posture is almost impossible to


attain, but it is possible to attain a
posture close to the ideal optimal
posture
Gravitational forces are counteracted by
ligaments and minimal muscle activity
ANALYSIS OF POSTURE

Analysis involves identification of the


locations of the body segments relative to
the LOG
A plumbline is used to represent the LOG
Evaluators must determine any deviations by
using observational skills

LATERAL VIEW ANALYSIS ANKLE

In optimal posture the ankle is in neutral


position
LOG falls anterior to the lateral malleolus
Moment produced
Counteracting force
TA, TP and Peroneal action

LATERAL VIEW ANALYSIS KNEE

In the optimal position the knee is in full


extension
LOG falls just anterior to midline of the knee
Moment produced
Counteracting force

Little or no muscle activity is required to


maintain in knee extension

LATERAL VIEW ANALYSIS HIP

LATERAL VIEW ANALYSIS HEAD

In the optimal position the hip is neutral and


pelvis is level without Post. or Ant. tilt

Vertical line: ASIS and Pubic Symphysis


Horizontal line: ASIS and PSIS
LOG passes posterior to the hip joint
Moment produced
Counteracting force (Normal vs Relaxed
standing)

LATERAL VIEW ANALYSIS SI & LS


In the optimal position lumbosacral angle
is 30 degrees
LOG passes anterior to the SI joint
Moment produced
Counteracting force
LOG passes through the body of L5,
posterior to the axis
Moment produced
Counteracting force

LATERAL VIEW ANALYSIS VERTEBRAL


COLUMN
In the optimal position the reference line will

pass through the midline of the trunk


LOG will pass posterior to the cervical and
lumbar axis and anterior to the thoracic
Maximal torque occurs at the apex of the
curve

Moment produced
Counteracting force

LOG passes through the external auditory


meatus
It falls anterior to the AO joint
Moment produced
Counteracting force

LATERAL VIEW ANALYSIS DEVIATIONS


Reduction of energy expenditure and
stress is the primary goal of any posture
Structures is shortened position may lose
sarcomeres
Abnormal posture = Reduced ROM
Structures in lengthened position may
add sarcomeres
Alter length-tension = Decrease stability
FLEXED KNEE POSTURE

Location of COG
Moment produced
Counteracting force
Complications

EXCESSIVE ANTERIOR TILT

Location of COG
Moment produced
Counteracting force
Complications

AP VIEW ANALYSIS

In the optimal position the LOG bisects the


body into two symmetrically

Joints of LE are equidistant from the LOG and


it transects the vertebral bodies
Gravitational torque of one side is opposed
by the torque of the other side

AP VIEW KNEE DEVIATIONS

Stretching of spring ligament

Feiss line Severity of Pes Planus


Complications

PES CAVUS High arch


More stable position of the foot
than Pes Planus
More weight on the lateral toes
Stretched Peroneals and lateral
ligaments
Inability to adapt to supporting
surfaces

GENU VALGUM
Mechanically axes of femur and tibia are
displaced laterally
Complications on the knee structure
Complications on the foot

AP VIEW FOOT & TOE DEVIATIONS

LOG is equidistant from the 2 malleoli


and malleoli should appear to be of equal
size
PES PLANUS Malleolus is more
prominent
Talus is displaced anterior, medial
and inferior
Depression of navicular

HALLUX VALGUS - Lateral deviation of


big toe
Bone forms on the medial side of
1st MT
CLAW TOES Hyperextension of MTP
and flexion of the IP joints
Associated with PES CAVUS
Effect of restrictive shoes, muscle
imbalance, ineffective intrinsics
flexors, age-related
HAMMER TOES Hyperextension of
MTP and DIP and flexion of PIP
Callosities on the MTP and prox IP
joints

AP VIEW SPINE DEVIATIONS


Normally the column is vertically aligned
and bisected by the LOG
If structures fall to provide support, the
column will bend to the side
SCOLIOSIS Lateral spine curvature
with rotation
Idiopathic Structural curves
Changes in vertebral bodies,
spinous processes, IV discs,
ligaments and muscles
Functional non-structural curves
Result of imbalance such as LLD,
muscle weakness, spasticity or
spasm
Naming is based on direction of
convexity
If more than one curve, name the
superior curve first
Complications