Posture and Postural Assessment

Edited by Dr. Luca Franzon

POSTURE ....
"Make sure the foundations are well leveled and everything will be fine" A.T. STILL

In 330 AD Aristotle had already understood the position of the parts of the body in relation to each other as well as their position in relation to the environment, that is the body posture.
Sir Charles Scott Sherrington in his "Integrated action of the nervous system" wrote: "Most of the reflex actions expressed by skeletal muscles are postural." The skeletal system of the human body is maintained in certain postural attitudes in relation to the horizontality of the gaze, to the vertical axis; these attitudes are one in relation to the other.
Charles Bell in 1837 csi asked: "How does a man maintain a straight or inclined posture against the wind blowing against him? It is evident that he possesses a sense by which he knows the inclination of his body and that he possesses the ability to readjust and correct all the deviations in relation to the vertical ".

It is then due to

ROMBERG the role of sight and podal proprioception.
FLOURENS the role of the vestibule.
LONGET the role of proprioception of the paravertebral muscles
DE CYON the role of oculo-motor proprioception
MAGNUS the role of the sole of the foot. isi of many variables.

Jungmann, McClure and Backaches in 1963 in "postural decline, aging and gravity-strain" wrote "If we consider posture as the result of the" dynamic interaction between two groups of forces (the environmental force of gravity on the one hand and the force of " individual from the "other), then the posture is nothing but the form in which the balance of power that exists at any moment between these two groups of forces is expressed. Thus, any deterioration in posture indicates that the "individual is losing ground in his struggle with the environmental force of gravity."
The term "posture" comes from the Latin "positura" which means position, a term in turn derived from pònere. By posture we therefore mean the relationship with which the different body segments contribute to the implementation of any gesture or position

Posture is influenced by various factors that various parts of our body perceive and transmit to the nervous system, which in turn processes a series of responses. All this can be called the postural system. It appears as a very complex whole, formed by various structures of the central and peripheral nervous system, including:

the eye
the foot
the skin system
the muscles
the joints
the "stomatognathic system (occlusal system and tongue)
the inner ear

In assessing the degree of adaptation of the various subsystems of posture, clinical tests, instrumental examinations, as well as the history and observation of the subject are used. The individual will be analyzed in an orthostatic position (standing), in the three planes of space (frontal, sagittal and transverse) and can be positioned behind a posturoscope, an instrument made in a grid of the size of a man on which the vertical of Barrè or sagittal line will be traced. In the anterior posterior, in the absence of the posturoscope, the plumb line is used which coincides with the center line of gravity that passes through:

the center of gravity of the head which is located at the level of the posterior clinoid processes of the sella turcica of the sphenoid
forward to the odontoid process
the vertebral bodies of C3, C4, C5
the sacral promontory
half of the coxo-femoral joint
half of the knee
the scaphoid talus joint.

This line of gravity, when the subject is examined in profile, materializes with the following landmarks:

the tragus of the ear
the acromioclavicular joint
the greater trochanter
half of the external condyle of the tibia
the ankle in front of the external malleolus.

In addition to the Barrè vertical, during the postural evaluation of the subject, it is observed and evaluated whether various points are in balance and symmetry. Previously we will have as a reference point:

the bipupillary line
the biachromial line
the intermammary line
the line of the anterior superior iliac spines
the line of the wrists.

Always anteriorly it will be evaluated if the chin, the xiphoid apophysis of the sternum and the navel are positioned on the same line. A further point of evaluation will be the so-called size triangle formed by the hip line with the arm. Usually those with scoliosis have one shorter than the other.

Later we will have as a reference point:

the biachromial line
the line of the shoulder blades
the bis iliac line
the gluteal line
the line of the folds of the knees

Always posteriorly, it will be assessed whether the seventh cervical vertebra and the medial crest of the sacrum are positioned on the same line.

From the observation it will be possible to detect any changes in position with respect to an ideal model. We will also evaluate asymmetries and rotations of the skeletal segments as well as the presence of areas of altered trophism and / or muscle tone.

Parallel to the evaluation of the Barrè vertical, the various subsystems (eye, feet and the ones listed above) must be studied to understand which of them are in dysfunction, therefore the cause of postural problems. Leaving to the appropriate figures the evaluation of eyes and ears, the functionality of the foot must instead be evaluated. The latter must be evaluated both in static and dynamic conditions to ascertain the presence of paramorphisms such as flatness, cavism or excesses of pronation and supination.

In the 1970s, Prof. Martins da Cuhna, a physiatrist in Lisbon, described the postural deficiency syndrome as a set of signs and symptoms that configure a dysfunctional state of the subject.
The various symptoms may seem irrelevant to each other or poorly connected. If, on the other hand, the postural deficit is considered as a problem of a single system (the postural system), but capable of interacting directly or indirectly on different organs and systems, then it will be simpler and more logical to explain the considerable apparent diversity of the symptoms.
The symptoms manifested by the subject often means that medicine is unable to place the patient in a specific category as the symptoms migrate and affect the most varied systems.
Of course, the instructor should not take the place of the doctor, but once the latter has declared the client capable of physical activity, then, after a "careful postural evaluation, it is possible to try to solve the client's various problems through a" physics aimed at solving postural problems.

POSTURAL DEFICIENCY SYNDROME

ACHE

BALANCE TURBE

OPHTHALMOLOGICAL SIGNS

headache

retro-ocular pain

chest or abdominal pain

gastralgia

rachialgia

nausea

daze

vertigo