Posture Angel Dysfunction – Lateral Hip Axis Tilt (L and R)

Posture Angel


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.

Lower Crossed Syndrome – CLINICAL SIGNIFICANCE

Posture Angel


Module 5 – Lower Crossed Syndrome

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

Janda found that this pattern of dysfunction placed an increase of joint stress on 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, 53-54). This may have implications in performing daily tasks, athletic performance, and health and longevity of the musculoskeletal system.

Posture Angel Dysfunction – Low Back Hyperextension

Posture Angel


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.

Posture Angel Dysfunction – Lateral Shoulder Axis Tilt

Posture Angel


Module 4 – Posture Angel Dysfunction

Primary Plane- Coronal (Frontal)

If the shoulder frontal axis tilt is greater than 2 degrees to the Right or the Left, then this is scored as a dysfunction.  Lateral tilt is automatically scored by the KAMS system.

Significance

Lateral shoulder axis tilt is a compensatory pattern that is often seen when there is a restriction in the lateral neuromuscular chains of the body.  Restrictions on shoulder extension and external rotation will often be compensated for by dropping the ipsilateral shoulder and rotating the trunk to the ipsilateral shoulder.

The unilateral tension in the latissimus dorsi will often cause an ipsilateral tilt of the shoulder axis during arm extension and shoulder external rotation.  This can often lead to low back pain on the ipsilateral side of tilt as the posterior chain structures are recruited to accommodate for this dysfunction.

Lateral shoulder axis tilt is often accompanied by shoulder axis rotation.

Corrective Strategies

  1. Mobilize core (lateral chain-frontal plane) of ipsilateral side of the tilt.
  2. Stabilize core (lateral chain-frontal plane) of contralateral side of tilt.
  3. Mobilize shoulder girdle external rotators/extensors of ipsilateral side of tilt.
  4. Stabilize shoulder retractors of contralateral side of tilt.
  5. Mobilize shoulder elevators such as upper trapezius, levator scapulae, posterior scalene) of contralateral side of tilt.
  6. Mobilize cervical spine.

Posture Angel Dysfunction – Reduced Right and/or Left Shoulder

Posture Angel


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.

Posture Angel Dysfunction – Foreward Head Position/C0-C1 Hyperextension

Posture Angel


Module 4 – Posture Angel Dysfunction

Plane- Sagittal

If there is the presence of anterior head carriage (forward head position) at any point of the assessment, then the forward head position check box must be selected by the practitioner.
Patients/clients that present with C0-C1 hyperextension while performing the posture angel test, will present with an anterior head carriage and are unable to perform an adequate movement. The patient/client must have enough mobility at occiput-C1 and enough strength of the deep neck flexors to maintain a neutral position throughout the movement.

Significance

The weakness of the deep cervical neck flexors and tension in the suboccipital muscles, and longer spanning superficial neck muscles (i.e- upper trapezius, longissimus capitus), are often the causes of hyperextension at occiput-C1. Thoracic hypomobility is often a key contributor. The tension in the suboccipital triangle of muscles can often cause chronic neck pain and headaches.
Shortening of the suboccipital muscles and fascia from chronic poor posture and ergonomics will often present as a forward head posture in the posture angel assessment.  A patient/client with tension in the suboccipital region will have difficulty activating the anterior deep cervical flexors and will often present with an anterior head posture.

Suboccipital tension, paired with weakness in the deep cervical neck muscles, can be the cause of cervicogenic headaches as structures such as the vertebral artery (third part), suboccipital nerve and the suboccipital venous plexus can become impinged.
The ability to properly engage the deep cervical neck flexor muscles creates core stability of the cervical spine and allows for the mobility of distal joints.

Corrective Strategies

  1. Lengthen anterior cervical muscles such as the scalenes and sternocleidomastoid.
  2. Strengthen the deep core cervical stabilizers such as the Longus Capitis and Longus Colli muscles.
  3. Mobilize extension at the occiput-C1 joint.
  4. Mobilize the suboccipital triangle muscles.
  5. Mobilize extension at the cervicothoracic joint (C7-T1).

Upper Crossed Syndrome – CLINICAL SIGNIFICANCE

Posture Angel


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).

Using the Kinetisense System for the Posture Angel Test

Posture Angel


Module 2 – Using the Kinetisense System for the Posture Angel Test

  1. Have the patient standing in a neutral position. This includes a shoulder-width stance with neutral, comfortable posture.
  2. Once the patient/client is properly positioned, instruct him/her to position the upper arms to 90 degrees of abduction, with the elbows at 90 degrees of elbow flexion with their fingers facing forwards.
  3. Instruct the patient/client to slowly externally rotate both arms towards the wall, maintain 90 degrees of elbow flexion for this position. Ideally, the elbow position should be in line or posterior to the anterior surface of the foam roller or in line with the shoulders. The wrists should also be in line with the shoulders and elbows along the vertical, sagittal line. Conclude the movement once they have externally rotated as far as possible or until the fingers are pointing towards the ceiling as seen in the video.
  4. Click “Stop” once the patient/client have finished this movement.
  5. Re-analyze the patient positioning and note any changes in position with the knees, lumbar position, elbow position, hand position and head position. Click “spinal extension” if their low back arches at all during the movement.
  6. If “pain is verbalized” at any time during the assessment record this dysfunction the KAMS scoring rubric (pain indicates a score of 0 for the entire assessment).
  7. Select the “save button” on the bottom right of the screen.
    All data is stored in the patient/client section for that individual and can be viewed once the KAMS workflow is finished.

Posture Angel Overview

Posture Angel


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

Overhead Squat Dysfunction

Overhead Squat


Module 3 – Overhead Squat Dysfunction

Ankle Hyperpronation

Primary Plane- Transverse Plane, Coronal (Frontal)
During the squat movement, if the ankle(s) collapses inwards, this is considered as hyperpronation and is scored as a dysfunction. This dysfunction requires the clinician or trainer to select the dysfunction box.

Significance


Hyperpronation is often caused by a lack of stability in the ligaments, muscles, and tendons that surround the ankle. The lack of proprioception can be a key contributor to ankle instability, often causing hyperpronation. Studies have shown that soccer players that have a history of ankle or knee sprains demonstrate a fivefold increase in the recurrence rate of injury at the same location. This is in comparison to athletes that do not have this history of injury (Arnason et. al, 2004). Athletes that lack proper proprioception and stability in the ankle will often collapse in on the arch and cause abnormal valgus forces on the medial structures of the ankle. This not only increases the likelihood of ankle and foot injury, but also increases the likelihood of knee, hip, and low back injury.

Corrective Strategies


Strengthen the tibialis anterior. Strengthen the plantar arch (medial longitudinal arch, lateral longitudinal arch, transverse arch). Strengthen the the glute complex (glute max, glute medius). Mobilize external rotation at the talocrural joint. Mobilize external rotation at the iliofemoral joint. Lengthen the hip adductors.

  1. Toe Crunches
  2. Three Point Balance
  3. Monster Walks
  4. Glute Bridges
  5. Foam Roll glute complex and adductors