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Does Static Postural Assessment Matter?

10/17/2015

0 Comments

 
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I was recently reading a 2012 article from the Forward Thinking PT titled, "Drop the plumb line...static posture assessments were so last decade." In the post, the author discusses how he does not use static postural assessments because the abnormalities that clinicians find are not truly abnormalities, but rather differences. Additionally, he states that visual examination and assessment are insufficient to make clinical decisions. The author sites several research articles that support the belief that habitual patterns are not related to musculosketal pathology. The most profound article (in my opinion) that he cites recommends that physical therapists should not perform abdominal muscle strengthening in individuals with chronic low back pain based solely on relaxed standing posture.   

Reading the Forward Thinking PT article may seem daunting for many physical therapists. Almost every therapist I encounter assesses static posture. Many follow the notion that good posture will minimize microtrauma across the joints and decrease the incidence of musculoskeletal injury. In theory, an individual's static posture will alter muscle length and tension, which will alter their movement patterns. Shirley Sahrmann founded much of her Movement Impairments Syndromes off this belief. For example, an individual with increased lumbar lordosis likely have weak abdominal muscles and will need motor control exercises to control the lumbar spine during functional movements. If that patient chronically rests in lumbar lordosis, one would assume they are at an increased risk of injury. Changing the static posture would be a logical starting point to affecting their pain. 
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My Thoughts on the Subject
Based on the cited research, the Forward Thinking PT article is correct. A pure static assessment has not shown to be a reliable measure for choosing your treatment options. Fortunately, we rarely treat based off static movement assessment alone. The articles provided do not address functional movements. I agree with the author that clinical decisions should not be based on a static snapshot. Personally, I am more concerned with how the patient moves. With that said, I often use static postural assessment as a baseline to guide which functional tasks I want the patient to perform. For example, if a patient has a forward head, rounded shoulder posture, I know I want to see their overhead flexion. The forward head presentation cues me to assess the mobility of the CTJ, the strength of the DNF, and strength of the low trap. These impairments are likely the biomechanical contributors to the pain. Addressing the biomechanical contributors is often successful, BUT not always. As the Forward Thinking PT points out, we also need to address the patient's perception of pain. We need to change the patient's perceived threat of pain and reprogram the brain to decrease the threat of injury. This can be addressed by performing repeated motions, manual therapy, graded exercises, and neuroscience education. Along with these interventions educating on proper posture is essential, especially during the acute phases.

In conclusion, we need to combine the biomechanical approach with the biopsychosocial and pain matrix approaches. Normalizing postural mechanics both statically and dynamically will decrease the stress placed across the musculoskeletal system and prevent re injury from occurring. Additionally, we must change how the brain perceives pain. If we do not change the perception of pain, we will not be successful. 

Thank you Forward Thinking PT for the thought provoking article! I enjoy reading all your content.

Jim  


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  • Home
  • About Us
  • Insider Access
    • About Insider Access
  • Online Courses
    • Hooper's Knee
    • Physical Therapist Entrepreneur Course
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    • Orthopedic Management of the Cervical Spine
    • Return to Sport Essentials Course
  • Resources
    • Newsletter
    • Business Minded Sports Physio Podcast
    • Day in the Life of a Sports PT
    • Residency Corner
    • Special Tests >
      • Cervical Spine >
        • Alar Ligament Test
        • Bakody's Sign
        • Cervical Distraction Test
        • Cervical Rotation Lateral Flexion Test
        • Craniocervical Flexion Test (CCFT)
        • Deep Neck Flexor Endurance Test
        • Posterior-Anterior Segmental Mobility
        • Segmental Mobility
        • Sharp-Purser Test
        • Spurling's Maneuver
        • Transverse Ligament Test
        • ULNT - Median
        • ULNT - Radial
        • ULNT - Ulnar
        • Vertebral Artery Test
      • Thoracic Spine >
        • Adam's Forward Bend Test
        • Passive Neck Flexion Test
        • Thoracic Compression Test
        • Thoracic Distraction Test
        • Thoracic Foraminal Closure Test
      • Lumbar Spine/Sacroiliac Joint >
        • Active Sit-Up Test
        • Alternate Gillet Test
        • Crossed Straight Leg Raise Test
        • Extensor Endurance Test
        • FABER Test
        • Fortin's Sign
        • Gaenslen Test
        • Gillet Test
        • Gower's Sign
        • Lumbar Quadrant Test
        • POSH Test
        • Posteroanterior Mobility
        • Prone Knee Bend Test
        • Prone Instability Test
        • Resisted Abduction Test
        • Sacral Clearing Test
        • Seated Forward Flexion Test
        • SIJ Compression/Distraction Test
        • Slump Test
        • Sphinx Test
        • Spine Rotators & Multifidus Test
        • Squish Test
        • Standing Forward Flexion Test
        • Straight Leg Raise Test
        • Supine to Long Sit Test
      • Shoulder >
        • Active Compression Test
        • Anterior Apprehension
        • Biceps Load Test II
        • Drop Arm Sign
        • External Rotation Lag Sign
        • Hawkins-Kennedy Impingement Sign
        • Horizontal Adduction Test
        • Internal Rotation Lag Sign
        • Jobe Test
        • Ludington's Test
        • Neer Test
        • Painful Arc Sign
        • Pronated Load Test
        • Resisted Supination External Rotation Test
        • Speed's Test
        • Posterior Apprehension
        • Sulcus Sign
        • Thoracic Outlet Tests >
          • Adson's Test
          • Costoclavicular Brace
          • Hyperabduction Test
          • Roos (EAST)
        • Yergason's Test
      • Elbow >
        • Biceps Squeeze Test
        • Chair Sign
        • Cozen's Test
        • Elbow Extension Test
        • Medial Epicondylalgia Test
        • Mill's Test
        • Moving Valgus Stress Test
        • Push-up Sign
        • Ulnar Nerve Compression Test
        • Valgus Stress Test
        • Varus Stress Test
      • Wrist/Hand >
        • Allen's Test
        • Carpal Compression Test
        • Finkelstein Test
        • Phalen's Test
        • Reverse Phalen's Test
      • Hip >
        • Craig's Test
        • Dial Test
        • FABER Test
        • FAIR Test
        • Fitzgerald's Test
        • Hip Quadrant Test
        • Hop Test
        • Labral Anterior Impingement Test
        • Labral Posterior Impingement Test
        • Long-Axis Femoral Distraction Test
        • Noble Compression Test
        • Percussion Test
        • Sign of the Buttock
        • Trendelenburg Test
      • Knee >
        • Anterior Drawer Test
        • Dial Test (Tibial Rotation Test)
        • Joint Line Tenderness
        • Lachman Test
        • McMurray Test
        • Noble Compression Test
        • Pivot-Shift Test
        • Posterior Drawer Test
        • Posterior Sag Sign
        • Quad Active Test
        • Thessaly Test
        • Valgus Stress Test
        • Varus Stress Test
      • Foot/Ankle >
        • Anterior Drawer
        • Calf Squeeze Test
        • External Rotation Test
        • Fracture Screening Tests
        • Impingement Sign
        • Navicular Drop Test
        • Squeeze Test
        • Talar Tilt
        • Tarsal Tunnel Syndrome Test
        • Test for Interdigital Neuroma
        • Windlass Test