Module 5 – Posture Angel Dysfunction

Primary Plane- Coronal (Frontal)

If the hip axis tilt is greater than 2 degrees to the Right or the Left then this is scored as a dysfunction.  A hip tilt of 1 or 2 degrees is considered within normal limits.

Significance

Hip “unleveling” can occur with impaired trunk proprioception and general weakness in the lateral chains of the body.  Zazulak and colleagues have found a correlation between the lack of trunk proprioception and the increased risk of knee injury in female athletes (Zazulak et. al, 2007).  Hip instability in the frontal plane is often correlated with a weakness of the gluteus medius muscles.  The gluteus medius provides the direct lateral stability of the hip complex in the frontal plane.

The lack of stability of the hips in the frontal plane will often cause the hyperactivation of the lateral stabilizers of the low back (i.e- quadratus lumborum) ”and the lateral stabilizers of the femur and tibia (i.e lateral quad and IT band).  Often there will also be a recruitment of compensatory muscles in the transverse plane and a rotation of joints of the lumbar spine and the knee will ensue, also affecting other segments above and below.

Corrective Strategies

1. Mobilize the lower extremity lateral chain of structures and muscles such as the TFL, IT band, lateral quadricep, peroneus longus) of the ipsilateral side of tilt.
2. Strengthen the frontal plane hip stabilizers such as the gluteus medius of the contralateral side of hip tilt.
3. Mobilize tissues such as the quadratus lumborum, iliolumbar ligament of the contralateral side of hip tilt.
4. Stabilize the hips in the frontal plane.

Module 4 – Posture Angel Dysfunction

If the low back does not maintain a neutral position and an anterior pelvic tilt occurs, therefore rounding the low back, then this is scored as a dysfunction.  This dysfunction must be identified by the practitioner or trainer by clicking on the dysfunction box that appears after the assessment is complete.

If there is an extension of the lumbar spine that occurs between the posture angel start and end position, then this dysfunction is to be selected.

Significance

Janda (2002) also found a trend in postural dysfunction the lower body region called lower crossed syndrome (LCS), which is closely related to upper crossed syndrome (UCS). The common pattern is tightness in the thoracolumbar extensors with the subsequent tightness of the iliopsoas and rectus femoris. Along with this pattern, the deep abdominal muscles are weak while on the back side the gluteus and maximus demonstrate weakness and poor activation.

Janda found that this pattern of dysfunction placed an increase of joint stress in areas such as the L4-L5 and L5-S1 segments, as well as the SI joint, and hip joint. The postural changes that often present along with these muscular imbalances is an anterior pelvic tilt, increased lumbar lordosis, lateral lumbar shift, lateral leg rotation, and hyperextension at the knee (Page, Frank, and Lardner, 2010). This may have implications in performing daily tasks, athletic performance, and health and longevity of the musculoskeletal system.

Kyphosis and tension of the thoracic spine will often cause hyperextension of the lumbar spine along with flexion of the iliofemoral joints.
For overhead athletes, specifically overhead lifters, the over-recruitment of the lumbar erector spinae can cause low back pain and tension.  These athletes will also commonly struggle with hip extension.

Corrective Strategies

1. Mobilize extension of the thoracic spine in the sagittal plane.
2. Mobilize the sacroiliac joints.
3. Stabilize the lumbar spine extensor complex (i.e lumbar erector spinae, quadratus lumborum).
4. Mobilize the shoulder girdle (external rotation and extension).
5. Mobilize the anterior tissues of the iliofemoral joints such as the anterior hip capsule, quad complex, iliopsoas, and iliacus.
6. Stabilize the lumbar spine in the sagittal plane.
7. Strengthen the hamstrings.

Module 4 – Posture Angel Dysfunction

Extension and Rotation at 90 degrees of Abduction

Primary Plane- Transverse, Sagittal

For this assessment, the KAMS system analyzes the degree of shoulder extension during 90 degrees of shoulder abduction. From the sagittal plane, the shoulder and the elbow are to be in line, if the elbow is in front of the shoulder this represents a dysfunction and is scored accordingly. KAMS also compares asymmetry from right to left.

The KAMS system analyzes the degree of shoulder external rotation of the right and left shoulders, while in the 90 degrees of abduction position. The system scores a dysfunction when the wrist(s) are not in line with the shoulder, this assessment is done by the system in the transverse (overhead view).

Significance

The Posture Angel isolates shoulder mobility by restricting the mobility of the spine in the sagittal plane. Many will compensate for a reduction in shoulder extension by moving the lumbar spine into extension. Individuals that have tension in the anterior chain of the body will often struggle with this assessment. Paradoxical breathing patterns that recruit extrinsic muscles to elevate the rib cage, such as the scalene, sternocleidomastoid and the pectoralis minor, causing a tension in these muscles and restricting movements such as shoulder extension.

A restriction in shoulder extension at 90 degrees is often accompanied by a lateral shift in the frontal plane shoulder axis.
The tension in the anterior shoulder structures, such as the pectoralis major/minor, anterior deltoid, bicep, and the latissimus dorsi, can limit shoulder extension in this assessment.
When there is an imbalance between the anterior shoulder structure and the posterior chain structure of the shoulder, external rotation of the shoulders is often limited. When paired with thoracic kyphosis, a common pattern that will present is lumbar extension.  For overhead athletes with these restrictions, it is common for them to over-recruit the lumbar erector spinae, and as a result, may struggle with low back pain.

It is common to see increased shoulder external rotation in athletes that are involved with overhead throwing. Regarding overhead weight lifting, the ability to have symmetric mobility in the shoulders allows for the body to be centrated under the weight and recruit the proper muscle firing pattern.
When assessing shoulder external rotation, one often finds restrictions that are not found when performing shoulder external rotation away from the foam roller. The isolation of the thoracic spine and lumbar with the vertical foam roller can show compensation, as it is common for individuals with reduced shoulder external rotation to over-recruit the lumbar and thoracic spine.

Corrective Strategies

1. Mobilize anterior shoulder flexors such as the pectoralis major/minor, anterior deltoid, bicep.
2. Mobilize shoulder internal rotators such as the latissimus dorsi, teres major, subscapularis.
3. Mobilize scapular elevators such as the upper trapezius, levator scapulae.
4. Strengthen the scapular retractors such as the low/mid trapezius, serratus anterior.
5. Mobilize the thoracic spine in extension (sagittal plane)
6. Strengthen the shoulder girdle external rotators such as the teres minor, posterior deltoid, infraspinatus.

Module 3 – Upper Crossed Syndrome

The posture angel is an excellent posture screen to identify common postural faults or to identify areas of discomfort when the musculoskeletal system is placed in a position of tension. Janda (2002) concluded that there are muscular imbalance commonalities often seen in individuals.

Upper crossed syndrome (UCS) often results due to poor posture and muscular imbalance and may result in pain, discomfort, or decreased athletic performance. Upper crossed syndrome presents with an anterior head carriage due to weak cervical flexors and tight sub-occipitals, upper trapezius, and levator scapula. Similarly, the shoulders appear to be rounded forward and an increased kyphosis may be observed due to tight pectorals causing protraction of the shoulders. This finding is also associated with weak rhomboids and lower trapezius (Page, Frank, and Lardner, 2010).

Research conducted by Dr. Hansraj, (2015) has found that the average human head weighs 10-12 lbs. with ideal posture. As the head is translated forward the weight increases and stress on the cervical spine increases significantly resulting in an increased risk of degeneration and neck pain. In addition, upper crossed syndrome has been associated with an increased occurrence of cervicogenic headaches (Moore, 2004).

Module 1 – Posture Angel Overview

This Posture Angel test can reveal many different muscular compensatory tendencies, which are described in Janda’s upper and lower cross syndrome. This test will show mobility imbalances in the entire musculoskeletal system. The Posture Angel isolates the different areas of the body where compensation often occurs. Isolation of the spine along the wall can reveal compensations in the upper and lower limbs. The Kinetisense system gives objective data on the body’s biomechanics during this test. Kinetisense provides data on the lateral shifting of the planes of the head, shoulder, and hip of the frontal plane as well as the transverse data and sagittal data of multiple joints.

The Kinetisense Posture Angel is much more than a postural screen. It provides valuable insight into key core and limb dysfunctions when compensations are reduced by means of activation of the core spinal muscles. Some of the compensations that are revealed in this screen reveal themselves in other complex movement patterns of the KAMS screen including the overhead squat and lunge to kneeling and return and return.

The Posture Angel allows for analysis of upper body mobility, which has implications for the following:

1. Posture
2. Squatting
3. Ergonomics
4. Overhead lifting
5. Throwing
6. Swinging (golf, baseball)
7. Headaches
8. Shoulder tension/pain
9. Back pain
10. Shoulder pain
11. Swimming