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NASM CES Chapter 8: Static Assessments 1

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    Chapter Goals:

    • Know the function of a static postural alignment.
    • Know the relationship that is found between postural alignment, neuromuscular function, and performance. 
    • Explain the dynamic between lifestyle factors and postural alignment.
    • Find the steps for performing static postural assessments.
    • Be able to classify the common postural conditions based upon the static postural assessment. 
    • Relate the common posture assessment condition to muscular imbalances. 

    Introduction

    The analysis of posture is part of the corrective exercise assessment process.

    Posture is an observable assessment of how the client puts their body in various positions.

    Posture is observed both statically and dynamically.

    Static posture and its assessments are going to be covered throughout this chapter.

    This is the second process in the CES assessment flow roadmap. 

    Importance of Posture as it Relates to Injury

    Static posture assessments are the first step in finding the muscle imbalances, also known as the alterations in length-tension relationships.

    They may not find the root cause, but it will give insight into which muscles are being held chronically in shortened or lengthened positions and shed light on related impairments in other parts of the body that contributes to dysfunctions.

    One common example is a strong relationship found between a rounded shoulder posture and a degree of forward head posture that someone exhibits.

    This would lead to identifying Janda’s upper crossed syndrome and that will inevitably lead to a musculoskeletal injury. 

    Muscle Imbalance

    There may be various factors causing changes in the alignment of joints, the mobility of myofascial tissues, and the function of muscles.

    Whatever reason it is, the body will adapt continuously in an attempt to produce the functional outcome requested by the CNS.

    Pattern overload is often a reason for these soft tissue problems.

    A desk worker may have a forward head posture for a significant time during work, and this could cause neck pain, and this could lead to damage past dysfunction and into tissue damage and pathology.

    The muscles adapt to the chronic positioning that we expose them to. We end up with less efficient cervical stabilizer muscles.

    Make sure to not the common overactive and underactive muscles that we see. 

    Factors Relating to Postural Imbalances

    Altered Movement Patterns from Chronic Suboptimal Postures

    Many people have developed their own poor habits of posture and they didn’t even realize it.

    This is very true for the office workers constantly sitting and at their desk. 

    Altered Movement Patterns from Habitual Repetitive Movement

    Reps of the same movement may lead to overuse and injury at some point, and these things will lead to changes in the mobility of the myofascial tissues.

    Poor postures and lacking daily movements are considered to be a contributing factor. 

    This is not just true for athletes, but for the average people and their everyday life.

    A construction worker that hammers all day with the same hand would be an example of a specific person affected.

    Postural imbalance may happen in the gym when people only focusing on certain muscle groups and missing others. 

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    Altered Movement Patterns from Acute Injury

    This may result in chronic muscle imbalances.

    It may be as part of healing from an injury, we see adaptive postures for the attempts to avoid pain.

    And this causes alterations throughout the kinetic chain or just showing in other compensating body parts. 

    Altered Movement Patterns After Surgery

    The body repairs itself with scar tissue after a surgery.

    These scars can lead to dysfunction and result in compensations of patterns of movement and changes in posture. 

    Systematic Approach to Assess Static Posture

    Static posture assessments need a strong skill in visual observation from the practitioner.

    This is found with time and practice.

    These assessments generally begin at the feet and travel all the way up to the head.

    Alterations found lower down will affect things higher up. 

    Kinetic Chain Checkpoints

    The major joints and regions of the body that make up the five kinetic checkpoints are the foot and ankle, the knee, LPHC, shoulders and thoracic spine, and the head and cervical spine. 

    In the Anterior View

    The foot and ankle from this view should be straight and parallel, not flat and also not externally rotated.

    The knee should be in line with the second and the third toes.

    The LPHC should have the pelvis level to the horizon.

    The shoulders and the thoracic spine should be level, not elevated or rounded. 

    The head and the cervical spine should be in a neutral and non-tilted or rotated position. 

    From the Lateral View

    The foot and the ankle should be in a neutral position with the leg vertical at a right angle to the sole of the foot. 

    The knee should stay in a neutral position and shouldn’t be flexed or hyperextended.

    The LPHC should have the pelvis in a neutral position and not rotated posteriorly or anteriorly. 

    The shoulders and the thoracic spine should be in line with the hips and the ears.

    The head and the cervical spine should be in a neutral position and not in cervical extension.

    From Posterior View

    The foot and the ankle should have the heel straight and parallel and not overly flattened.

    The knee should be neutral and not adducted or abducted.

    The LPHC should have the pelvis level to the horizon.

    The shoulders and the spine should be level and not elevated or rounded forward.

    The head and the cervical spine should be in a neutral position and not tilted or rotated. 

    Common Patterns of Postural Distortion

    Everything in the body is connected in a regionally interdependent way, so the impairments found will usually be present in multiple forms.

    Because of this, we have grouped them into patterns based on their relation.

    The most popular classifications are the Janda’s syndromes, which describe three distortion patterns.

    Kendall’s postures describe four distortion patterns, and this is the second most popular. 

    Janda’s Syndromes

    Lower Crossed Syndrome

    People that have spent a lot of time sitting will often have this due to the chronic positioning of their hips.

    This is a combination of excessive lumbar lordosis and an anterior tilt of the pelvis.

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    There is also a show of lumbar shift laterally, the knees flexed or hyperextended, and the feet plantar flexed.

    Make sure to read over the muscle activity to know the overactive and the underactive muscles that are caused by this condition.

    Upper Crossed Syndrome

    People with this may have a forward head posture, their hyperextended cervical spine, and their rounded shoulders.

    They can have excessive thoracic kyphosis, elevation of the shoulders, rotation or abducted shoulders, and winging of the scapula.

    Make sure to read over the muscle activity to know the overactive and the underactive muscles that are caused by this condition.

    Layered Crossed Syndrome

    This may have components of both the upper and lower crossed syndromes.

    Make sure to read over the muscle activity to know the overactive and the underactive muscles that are caused by this condition.

    Kendall’s Posture Types

    Lordotic Posture

    People that have lordotic posture may have excessive lumbar lordosis and an anterior pelvic tilt.

    People may assume other compensations like a lateral lumbar shift, lateral leg rotation, and a knee that slightly flexes or is hyperextended.

    Make sure to read over the muscle activity to know the overactive and the underactive muscles that are caused by this condition.

    Flat Back

    This may show both upper and lower posture issues.

    All of the main problems discussed throughout janda’s syndromes may be present.

    Make sure to read over the muscle activity to know the overactive and the underactive muscles that are caused by this condition.

    Sway Back

    This is seen by a possible extended cervical spine in the upper body and kyphosis.

    For the lower body we see flattening of the lumbar spine, tilted pelvis, and extended hips.

    Make sure to read over the muscle activity to know the overactive and the underactive muscles that are caused by this condition.

    Kyphosis Lordosis 

    Forward head, excessive kyphosis, and elevated and rounded shoulders.

    In the lower body we see excessive lumbar lordosis, lateral lumbar shift, anterior pelvic tilt, flexed hips, hyperextension of the knee, and plantar flexed ankles.

    Make sure to read over the muscle activity to know the overactive and the underactive muscles that are caused by this condition.

    Pes Planus Distortion Syndrome 

    This is similar to the impairments in the lower crossed syndrome we discussed.

    It is focused on the lower body with slight changes.

    Make sure to read over the muscle activity to know the overactive and the underactive muscles that are caused by this condition.

    NASM CES Chapter 8: Static Assessments 2
    NASM CES Chapter 8: Static Assessments 3
    NASM CES Chapter 8: Static Assessments 4

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