plumb line posture

2) Sitting Posture

2) Sitting Posture Hip and Pelvis: Observation: The pelvis assumes a posterior tilt with the posterior inferior iliac spines in the same horizontal plane as the superior pubic ramus. Common faults include: • Posterior pelvic tilt: The superior pubic ramus is superior to the posterior inferior iliac spines. It may be due to: - Lumbar vertebrae flexed excessively. - Tightness of the hamstring muscles. - Elongated low back extensors. • Anterior pelvic tilt: The superior pubic ramus lies inferior to the posterior inferior iliac spine. It may be due to: - Tightness of low back extensor muscles. - Lengthened hip extensor muscles. - Excessive lumbar lordosis.

6. Ankle and Foot: Plumb line: Common Faults include: Hallux valgus:

6. Ankle and Foot: Plumb line: Common Faults include: • Hallux valgus: Lateral deviation of the first digit at the metatarso-phalangeal joint. It may be due to: - Excessive medial bone growth of the first metatarsal head. - Joint dislocation. - Tight adductor hallucis muscle. - Stretched abductor hallucis muscle.

Pelvis and Hip: Plumb line: The line bisects the gluteal cleft and the posterior superior iliac spines are on the same horizontal plane; the iliac crests, gluteal folds and greater trochanters are level. Common faults include

: Lateral pelvic tilt Pelvic rotation * Lateral pelvic tilt: One side of the pelvis is higher than the other due to: - Scoliosis with ipsilateral lumbar convexity. - Leg-length discrepancies. - Shortening of the contralateral quadrates lumborum. - Tight ipsi-lateral hip abductor muscles on the same side and tight contralateral hip adductor muscles. - Weakness of the contralateral abductor muscles. * Pelvic rotation: The plumb line falls to the right or left of the gluteal cleft. It may be due to: - Tightness of medial rotator and hip flexor muscles on the rotated side. - Ipsilateral lumbar rotation. • Abducted hip: The greater trochanter is higher on the involved side. It may be due to: - Tightness of the hip abductor muscles. - Tightness of contralateral hip adductor muscles. - Weakness of contralateral adductors and ipsilateral abductors.

hip

Plumb line: Common faults include: • Lateral rotation: The patellae angle out. It may be due to: - Tightness of the lateral rotators and gluteus maximus muscles. - Weakness of the medial rotator muscles. - Femoral retroversion. - Internal tibial torsion (compensated). • Medial rotation: The patellae face inward. It may be due to: - Tightness of the ilio-tibial band and the medial rotator muscles. - Weakness of the lateral rotator muscles. - Femoral ante-version. - External tibial torsion (compensated).

lateral view 1. Head and neck: plumb line. where should the plumb line fall?

Plumb line: The line falls through the ear lobe to the acromion process.

trunk

Trunk: Plumb Line: The line bisects the spinous process of the thoracic and lumbar vertebrae. Common faults include: * Lateral deviation (Scoliosis): The spinous processes of the vertebrae are lateral to the midline of the trunk. - Intrinsic trunk muscles are shortened on one side. - Contralateral intrinsic trunk muscles are lengthened. - Compression of vertebrae on the concave side. - Structural changes in rips or vertebrae. - Leg-length discrepancy and obliquity. - Internal organ disorders.

b) Posterior view head and neck In a posterior view examination, the examiner's plumb line divides the body into equal left and right halves Plumb line: The midline bisects the head through the external occipital protuberance; head is usually positioned squarely over the shoulders so that eyes remain level Common faults include:

b) Posterior view 1. Head and neck: . Common faults include: Head tilt Head rotated * Head tilt: Subject's head lies more to one side of the plumb line. It may be due to: - Tightness of lateral neck flexors on one side. - Stretched lateral neck flexors contra-laterally. - Compression of vertebrae ipsi-laterally. * Head rotated: The plumb line is to the right or left of the midline. It may be due to: - Tightness of the sternocleidomastoid, upper trapezius, scalene and intrinsic rotator muscles on one side. - Elongated contralateral rotator muscles. - Compression and rotation of the vertebrae.

Claw toes:

• Claw toes: Hyperextension of the metatarso-phalangeal joint and flexion of the proximal interphalangeal joints, associated with pes cavus. It may be due to: - Tightness of the long toe flexors. - Shortness of the toe extensor muscles.

. Elbows: A line bisects the upper limbs and forms an angle of 5° to 15° laterally at the elbow with the elbow extended. This angle is normal and is referred to as the carrying angle. Common faults include:

• Cubitus valgus: The forearm deviates laterally from the arm at angle greater than 15° (female) and 10° (male). It may be due to: - Elbow hyperextension. - Distal displacement of trochlea in relation to capitulum of humerus. - Stretched ulnar collateral ligament. • Cubitus varus: The forearm deviates medially (adducts) from the arm, at an angle of less than 15° for females and 10° for males. It may be due to: - Fracture about the elbow joint. - Inferior displacement of the humeral capitulum. - Stretched radial collateral ligament

Shoulders: Plumb Line: A vertical line bisects the sternum and xiphoid process. It may be due to:

• Dropped ore elevated shoulder: See section on posterior view. • Clavicle and joint asymmetry: It may be due to: - Prominences secondary to joint trauma. - Subluxation or dislocation of sterno-clavicular or acromio-clavicular joints. - Clavicular fractures.

5. Knee: Plumb Line: The legs are equidistant from a vertical line through the body. Common Faults include:

• External tibial torsion: Normally, the distal end of the tibia is rotated laterally 25° from the proximal end. Excess of 25° rotation is an increase in torsion and is referred to as lateral tibial torsion (toeing out). It may be due to: - Tightness of the tensor fasciae latae muscle or ilio-tibial band. - Bony mal-alignment. - Cruciate ligament tear. - Femoral retroversion. • Internal tibial torsion: The feet face directly forward or inward. - Tightness of the medial hamstring and gracilis muscles. - Structural deformities of the tibia (traumatic or developmental). - Anterior cruciate ligament tear. - Femoral ante-version. - Foot pronation. - Genu valgus.

5. Knee: Plumb Line: The plumb line lies, equidistant be¬tween the knees. Common faults include:

• Genu varum: The distal segment (leg) deviates to¬ward midline in relation to the proximal segment (thigh); the knee joint lies lateral to the mechanical axis of the lower limb. It may be due to: - Tightness of medial rotator muscles at the hip with hyper-extended knees, quadriceps and foot evertor muscles. - Compression of medial joint structures. - Femoral retroversion. - Elongated lateral hip rotator muscles, popliteus and tibialis posterior. • Genu Valgum: The mechanical axis for the lower limbs is displaced laterally. It may be due to: - Tightness of ilio-tibial band and the lateral knee joint structures. - Femoral ante-version. - Lengthened medial knee joint structures. - Compression of lateral knee joint. - Foot pronation.

Hammer toes

• Hammer toes: Hyperextension of the metatarsophalangeal joints and distal interphalangeal joints and flexion of the proximal interphalangeal joints. It may be due to: - Shortness of the toe extensors. - Lengthened lumbricals.

c) Anterior View Relationships can be posturally assessed from the anterior view with the plumb line bisecting the body into equal left and right halves. 1. Head and Neck: Plume Line: The line bisects the head at the midline into equal halves. Common faults include:

• Lateral Tilt: See section on posterior view. • Rotation: See section on posterior view. • Mandibular asymmetry: The upper and lower teeth are not aligned and the mandible is deviated to one side. It may be due to: - Tightness of the mastication muscles on one side. - Stretched mastication muscles on the contralateral side. - Mal-alignment of temporo-mandibular joints. - Mal-alignment of teeth.

6. Ankle and Foot: Plumb line: The line is equidistant from the malleoli, a line (Feiss') is drawn from the medial malleolus to the first metatarsal bone and the tuberosity of the navicular bone lies on the line. Common faults include:

• Pes planus (Pronated): There is decreased medial longitudinal arch, the Achilles tendon is convex medially and the tuberosity of the navicular bone lies below the Feiss line. It may be due to: - Shortened perennial muscles. - Elongated posterior tibial muscle. - Stretched plantar calcaneo-navicular (spring) ligament. - Structural displacement of the talus, calcaneus and navicular bones. • Pes Cavus (supinated): The medial longitudinal arch is high and the navicular bone lies above Feiss' line. It may be due to: - Shortened posterior and anterior tibial muscles. - Elongated peroneal and lateral ligaments.

Shoulder and scapula: Plumb line: It falls midway between shoulders. Common faults include:

Dropped shoulder Elevated shoulder Shoulder medial rotation Shoulder lateral rotation Adducted scapulae Abducted scapulae * Dropped shoulder: One shoulder is lower than the other. It may be due to: - Hand dominance (dominant shoulder is lower). - Lateral trunk muscles are short and hip is high and adducted. - Tightness of the rhomboid and latissimus dorsi muscles. * Elevated shoulder: One shoulder is higher than the other. This may be due to: - Tightness in the upper trapezius and levator scap¬ulae muscles on one side; hypertrophy may be no¬ticed on the dominant side. - Elongated and weak lower trapezius and pectoralis minor. - Scoliosis of the thoracic vertebrae. * Shoulder medial rotation: The medial epicondyle of the humerus is directed posteriorly. It may be due to: - Joint limitation in lateral rotation. - Tightness of the medial rotator muscles. * Shoulder lateral rotation: Olecranon process faces posteriorly. It may be due to: - Joint limitation in medial rotation. - Tightness of the lateral rotators. * Adducted scapulae: The scapulae are too close to the midline of the thoracic vertebrae. It may be due to: - Shortened rhomboid muscles. - Stretched pectoralis major and minor muscles. * Abducted scapulae: The scapulae have moved away from the midline of the thoracic vertebrae. It may be due to: - Tightness of the serratus anterior muscle. - Lengthened rhomboid and middle trapezius muscles. * Winging of the scapulae: The medial borders of the scapulae lift off ribs. It may be due to: - Weakness of the serratus anterior.

The plumb line lies posterior to the vertebral bodies. It may be due to: Excessive Lordotic curve

Excessive Lordotic curve

The plumb line lies anterior to the vertebral bodies

Flattened lordotic

lateral view 1. Head and neck if The head lies anterior to the plumb line?

Forward head: The head lies anterior to the plumb line.

Ankle: Plumb line: The line lies slightly anterior to the lateral malleolus, aligned with tuberosity of 5th metatarsal. Common faults include:

Forward posture Forward posture: The plumb line is posterior to the body; body weight is carried on the metatarsal heads of the feet. It may be due to: - Ankles in dorsiflexion with forward inclination of the legs; posterior musculature stretched. - Tightness of dorsal musculature. - Posterior muscles of the trunk remain contracted.

shoulder Plumb line: It falls through the acromion process The acromion process lies anterior to the plumb line

Forward shoulders

. Knee: Plumb line: The line passes slightly anterior to the midline of the knee, creating an extension moment. Common faults include

Genu recurvatum: Knee is hyperextended and the gravitational stresses lie far forward of the joint axis plumb line anterior to knee flexed knee The plumb line falls posterior to the joint axis

plumb line video

https://www.youtube.com/watch?v=Zp5iC3Ioq7U

Lumbar vertebrae: Plumb Line: The line falls midway between the abdomen and back and slightly anterior to the sacroiliac Joint. Common faults include: lordotic posture sway back flat back

lordotic posture -plumb line posteior to greater trochanter sway back -plumb line posteior to greater trochanter flat back-posteior to greater trochanter