Posture and Postural Assessment

    Posture and Postural Assessment

    "Make sure the foundations are well leveled and everything will be fine" AT STILL


    In 330 AD Aristotle had already understood the position of the parts of the body in relation to each other as well as their position in relation to the environment, that is the body posture.
    Sir Charles Scott Sherrington in his "Integrated action of the nervous system" wrote: "Most of the reflex actions expressed by the skeletal muscles are postural." The skeletal system of the human body is maintained in certain postural attitudes in relation to the horizontality of the gaze, to the vertical axis; these attitudes are related to each other.
    Charles Bell in 1837 csi asked: "How does a man maintain a straight or inclined posture against the wind blowing against him? It is evident that he possesses a sense by which he knows the inclination of his body and that he possesses the ability to readjust and correct all the deviations in relation to the vertical ".

    It is then due to

    • ROMBERG the role of sight and podal proprioception.
    • FLOURENS the role of the vestibule.
    • LONGET the role of proprioception of the paravertebral muscles
    • DE CYON the role of oculo-motor proprioception
    • MAGNUS the role of the sole of the foot. isi of many variables.

    Jungmann, McClure and Backaches in 1963 in "postural decline, aging and gravity-strain" wrote "If we consider posture as the result of the dynamic interaction between two groups of forces (the environmental force of gravity on the one hand and the force of individual on the other), then posture is nothing more than the form in which the balance of power that exists at any moment between these two groups of forces is expressed. Thus, any deterioration of posture indicates that the individual is losing ground in its struggle with the environmental force of gravity. "
    The term "posture" comes from the Latin "positura" which means position, a term in turn derived from pònere. By posture we therefore mean the relationship with which the different body segments contribute to the implementation of any gesture or position


    Posture is influenced by various factors that various parts of our body perceive and transmit to the nervous system, which in turn processes a series of responses. All this can be called the postural system. It appears as a very complex whole, made up of various structures of the central and peripheral nervous system, including:

    • the eye
    • the foot
    • the skin system
    • the muscles
    • the joints
    • the stomatognathic system (occlusal system and tongue)
    • the inner ear

    In evaluating the degree of adaptation of the various subsystems of posture, clinical tests, instrumental examinations, as well as the history and observation of the subject are used. The individual will be analyzed in an orthostatic position (standing), in the three planes of space (frontal, sagittal and transverse) and can be positioned behind a posturoscope, a human-sized grid instrument on which Barrè's vertical will be traced. or sagittal line. In the anterior posterior, in the absence of the posturoscope, the plumb line is used which coincides with the center line of gravity that passes through:

    • the center of gravity of the head which is located at the level of the posterior clinoid processes of the sella turcica of the sphenoid
    • ahead of the odontoid apophysis
    • the vertebral bodies of C3, C4, C5
    • the sacral promontory
    • half of the coxo-femoral joint
    • half of the knee
    • the talus scaphoid joint.

    This line of gravity, when the subject is examined in profile, materializes with the following landmarks:

    • the tragus of the ear
    • the acromioclavicular joint
    • the greater trochanter
    • half of the external condyle of the tibia
    • the ankle in front of the external malleolus.

    In addition to the Barrè vertical, during the postural evaluation of the subject, it is observed and evaluated whether various points are in balance and symmetry. Previously we will have as a reference point:

    • the bipupillary line
    • the biachromial line
    • the intermammary line
    • the line of the anterior superior iliac spines
    • the line of the wrists.

    Always anteriorly, it will be assessed whether the chin, the xiphoid apophysis of the sternum and the navel are positioned on the same line. A further point of evaluation will be the so-called size triangle formed by the hip line with the arm. People with scoliosis usually have one shorter than the other.

    Later we will have as a reference point:

    • the biachromial line
    • the line of the shoulder blades
    • the bis iliac line
    • the gluteal line
    • the line of the folds of the knees

    Always posteriorly, it will be assessed whether the seventh cervical vertebra and the medial crest of the sacrum are positioned on the same line.


    From observation it will be possible to detect any changes in position with respect to an ideal model. We will also evaluate asymmetries and rotations of the skeletal segments as well as the presence of areas of altered trophism and / or muscle tone.

    Parallel to the evaluation of the Barrè vertical, the various subsystems (eye, feet and the ones listed above) must be studied to understand which of them are in dysfunction, therefore the cause of postural problems. Leaving to the appropriate figures the evaluation of eyes and ears, the functionality of the foot must instead be evaluated. The latter must be evaluated both in static and dynamic conditions to ascertain the presence of paramorphisms such as flatness, cavism or excesses of pronation and supination.

    In the 70s, Prof. Martins da Cuhna, a physiatrist in Lisbon, described the postural deficiency syndrome as a set of signs and symptoms that configure a dysfunctional state of the subject.
    The various symptoms may seem irrelevant to each other or poorly connected. If, on the other hand, the postural deficit is considered as a problem of a single system (the postural system), but capable of interacting directly or indirectly on different organs and systems, then it will be simpler and more logical to explain the considerable apparent diversity of the symptoms.
    The symptoms manifested by the subject often means that medicine is unable to place the patient in a specific category as the symptoms migrate and affect the most varied systems.
    Of course, the instructor must not take the place of the doctor, but once the latter has declared the client capable of physical activity, then it will be possible, after a careful postural evaluation, to try to solve the various problems of the client through an activity physics aimed at solving postural problems.







    retro-ocular pain

    chest or abdominal pain






    inexplicable falls


    blurred vision

    monocular or binocular diplopia

    directional scotomas

    bad localization of

    objects in space






    errors of appreciation of one's own body scheme

    joint syndrome


    stiff neck





    motor control defects in the extremities




    paresthesia of the extremities

    Raynaud's phenomenon










    foreign body sensation in the glottis




    lack of concentration

    memory loss





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