Asymmetry of the lumbar musculature is common. Muscle wasting following long-term pain may occur, while short-term pain may result from muscle spasm.

Where spinal extensor muscle asymmetry is noted, side bending is likely to be restricted away from the thicker side (left-side muscles tight, right-side bending reduced). Tightness and shortness in the soft tissues on one side of the body may also pull the spine away from the vertical position, altering the position of the shoulders relative to the pelvis.

Tightness that extends into the quadratus lumborum muscles will also anchor the lower ribs down, reducing the gap between the pelvic rim and lower ribs. Again, compare one side with the other: the thicker and shorter muscle is normally on the side of reduced space.

Moving up to the thoracic region, each scapula should lie approximately one hand’s width from the spine. A closer position can indicate shortening in the rhomboid muscles, while a position further away normally indicates tightness in the pectoral muscles of the chest and laxity of the shoulder retractor muscles. The contour of the shoulder shows the relative condition of the upper trapezius, with a rigid cord-like contour indicating an overly tight, thickened muscle. A line drawn between the acromion processes of each side should be horizontal. Tightness of the trapezius and sternocleidomastoid muscles can cause the shoulder to raise, while laxity of these muscles and poor scapular stability can cause

the scapula and clavicle to drop, a common feature in thoracic outlet syndrome, a condition giving neurological pain referred from the shoulder into the arm.

USING THE POSTURE CHARTS The posture charts (Figure 2) help you to record the patient’s static posture from the side (sagittal plane) and behind (frontal plane). For each body segment the line figure reminds you of what to look for. You can score the patient’s posture as 3 (good to optimal), 2 (intermediate to slightly suboptimal) or 1 (poor to gross changes). Although subjective, the numbering system gives the patient a “posture value”, with a maximum value of 48 and a minimum of 16; this can be converted to a percentage by dividing the value by 48 and then multiplying by 100.

For example, a patient who scores a total of 24 has a posture value of 50% (24/48 . 100), while a patient scoring 35 has a value of 73% (35/48 . 100). The posture value can then be used to track progress to optimise the patient’s posture.

THE AUTHOR

Christopher Norris is a physiotherapist specialising in musculoskeletal treatment. He is an external lecturer and external examiner to several universities and runs

postgraduate continuing professional development courses (listed on his website at www.norrisassociates.co.uk). He is the author of ten therapy books.

ANSWER THE FOLLOWING QUESTIONS

ON-LINE TO EARN CPD POINTS Please log in to the members area of the REPs website to give your answers

Q1 Q2 Q3

Which of the following is a common side-effect of suboptimal posture? Is it: a. Soft-tissue imbalance b. Soft-tissue atrophy c. Soft-tissue wastage

What are the two types of posture analysis? Are they a. Proactive and reactive b. Regular and irregular c. Static and dynamic

What is the rough distance that each scapula should lie from the spine? Is it? a. Two fingers b. One-hand’s width c. One-hand’s length

This article has been adapted from an article published in sportEX dynamics. sportEX dynamics is published quarterly and aimed at people working in sports massage, therapy and fitness conditioning. Visit www.sportex.net

22 The REPs Journal 2011;22(September):20-22 The REPS Journal 2009;00(Month):00-00

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