Lesson
Anterior/Posterior Postural Analysis - continued
Assymetrical Waist: Look for leg length difference (might also be caused by scoliosis).
Leg, knee: Have assessee squat on heels, then duck walk 4 steps (illustration below), then stand up. The movement should be pain-free; heel-to-buttock distance should be symmetrical left-right; knee flexion should be symmetrical; rising should be straight up. Look for inability to fully flex either knee; inability to stand up without twisting, or bending to one side.
Knee: Genu valgum (knock knees) and genu varum (bowed knees) create stress in the knee joint and surrounding muscles. These are usually irreversible and any movement must take into consideration the person’s comfortable ROM. Look for swollen knees.
Ankle: Look out for swollen ankles.
Foot: Pes planus or flat foot can be a problem, as it internally rotates the hip, with a valgus knee situation and eventually a shoulder level drop on the contralateral side. The LOG of knee and hip joints is affected.
POSTERIOR EXAM:
Vertebral Column: Look for scoliosis, ie. lateral deviations in the spine. Look at the spinous processes to observe this, or at differences in arm-to-body space between the two sides. ALSO, have assessee back examiner. Look for symmetry of shoulders, waist, thighs, calves. High shoulder might indicate scoliosis; low shoulder > muscle loss; prominent rib cage > scoliosis; high hip or asymmetrical waist > leg length difference or scoliosis; small calf or thigh > muscle weakness from old injury.
Have assessee bend forward to touch toes. If assessee twists to side to achieve this > low back pain; if back asymmetrical (higher hump on one side) > scoliosis.
Have assessee stand on heels; stand on toes. Look for equal elevation both sides; symmetry of calf. Wasting of calf muscles might indicate achilles injury or old ankle injury