*** still working on *** Gait and Posture OPP / Comlex / BRS lecture Flashcards
Posture is the formal expression of…?
Posture is the formal expression of…
the balance of power existing at any time between gravity
and the strength of the individual forces.
Skeletal-Arthroidal Response
-
Wolff’s Law – bones remodel over time due to the stress placed on them
- Bone spurs in vertebral bodies
- Increased calcium deposition on spinal facets
-
Degenerative changes
- Arthritis of the hip joint
- Decrease in total height as vertebral kyphosis and lordosis are exaggerated.
Normal Compensatory pattern (in 80% of healthy individuals)
- Lumbosacral – rotated ?
- Thoracolumbar – rotated ?
- Cervicothoracic – rotated ?
- Occipitoatlantal – rotated ?
Normal Compensatory pattern (in 80% of healthy individuals)
- Lumbosacral – rotated right
- Thoracolumbar – rotated left
- Cervicothoracic – rotated right
- Occipitoatlantal – rotated left
Upper Crossed Syndrome
Hypertonic muscles
Upper Crossed Syndrome
-
Hypertonic
- Upper trapezius
- sternocleidomastoid
- levator scapulae
- pec major (upper) and minor
- cervical erector spinae
- scalenes
Upper Crossed Syndrome
Inhibited muscles
Upper Crossed Syndrome
-
Inhibited
- mid and lower trapezius
- latissimus dorsi
- rhomboids
- deep cervical flexors
Lower Crossed Syndrome
Hypertonic muscles
Lower Crossed Syndrome
-
Hypertonic
- Iliopsoas
- quadratus lumborum
- thoracolumbar erector spinae
- hamstrings, rectus femoris
- piriformis
- short thigh adductors
- gastroc-soleus complex
Lower Crossed Syndrome
Inhibited muscles
Lower Crossed Syndrome
-
Inhibited
- glut muscles
- vastus muscles (NOT rectus femoris)
- rectus abdominis
- tibialis anterior
Ligamentous Response
Ligamentous Response
-
Poor posture puts stress on ligaments
- Iliolumbar
- Sacrotuberous
- Long posterior sacroiliac ligaments
- Attachments of the ligaments become tender when palpated if stressed
-
Functional changes include
- tenderness, edema and pain referred to the lower extremity.
Respiratory Response
Respiratory Response
- Vertebral lordosis and kyphosis decreases during inspiration
- and increases during expiration
- As a result, increased kyphosis and lordosis due to poor posture
- leads to impaired respiration as breathing mechanics are impacted
Nervous System Response
Nervous System Response
-
Thoracic kyphosis and lumbar lordosis will alter the function of the sympathetic nervous system
- leading to unbalanced autonomics
- Parasympathetic tone will predominate
somatization of the psyche
-
Posture can be a reflection of one’s inner emotions
- called somatization of the psyche.
Postural Assessment
Observation in a coronal / horizontal plane
- Observation in a coronal / horizontal plane
- Mastoid processes
- AC joints
- Inferior angle of the scapula
- Fingertips
- Iliac crests
- PSIS’s
- Greater trochanters
- Knee creases
Postural Assessment
Observation in a sagittal plane
- Observation in a sagittal plane
- External auditory canal
- Lateral head of the humerus
- Body of L3
- Anterior third of the sacrum
- Greater trochanter of the femur
- Lateral condyle of the femur
- Lateral malleolus*
The Gait Cycle:
overview
avg stride, cadence, speed ?
-
One ”gait cycle” or single cycle
- is from one heel strike to the next heel strike of the same foot.
-
Average stride** length is **28 - 32 inches
- Stride is same foot to same foot
- Changes** with **age, pain, disease, fatigue
-
Average cadence** is between **90 - 120 steps per minute
- Women higher by 6 - 9 steps per minute
- Average speed: 3 mph
The Gait Cycle:
The cycle
stance vs swing ?
-
Stance – Period when the foot is in contact with the ground
-
60% of the walking cycle is spent in the stance phase.
- Of this 25% is spent in double stance
-
60% of the walking cycle is spent in the stance phase.
-
Swing – Period when the foot is NOT in contact with the ground
- 40% of the walking cycle is spent in swing phase
- Both phases occur simultaneously on opposite sides of the body.
- Normal gait involves the smooth coordinated transition from one phase to the other, from one side of thebody to the other.
- Gait Cycle is made up of 8 segments…
The Gait Cycle:
The cycle
what are the 8 phases ?
Stance Phase - When the foot is in contact with the ground; divided into 5 phases:
- Initial Contact (Heel Strike)
- Loading Response
- Midstance
- Terminal Stance (Heel Off)
- Preswing (Toe Off)
Swing Phase – Period when the foot is NOT in contact with the ground; divided into 3 phases:
- Initial swing
- Midswing
- Terminal Swing
The Gait Cycle:
Function of Initial Contact or Heel Strike
-
Initial Contact or Heel Strike
- Establish contact** with **leading foot
- begin stance
The Gait Cycle:
Function of Loading Response or Flat Foot
-
Loading Response or Flat Foot
- Shock absorption
- Begin weight bearing
- Continue progression of forward movement
The Gait Cycle:
Function of Midstance
-
Midstance
- Limb and truck stability
- Progression over stationary foot
The Gait Cycle:
Function of Terminal stance or heel lift
-
Terminal stance or heel lift
- Progression past stationary foot
- Prepare** for **swing
The Gait Cycle:
Function of Pre-Swing or toe off
-
Pre-Swing or toe off
- Weight release from stationary foot
- Position** limb **for swing
The Gait Cycle:
Function of Initial swing or early swing
-
Initial swing or early swing
- Prepare for** foot **clearance
- Advance foot from trailing position
The Gait Cycle:
Function of Mid swing
-
Mid swing
- Foot clearance
- Limb advancement
The Gait Cycle:
Function of Terminal swing or late swing
-
Terminal swing or late swing
- Prepare for stance (positioning)
- Complete** limb **advancement
