Sports Screening: Postural Assessment

Original Editor - Wanda van Niekerk Top Contributors - Wanda van Niekerk, Lucinda hampton, Kim Jackson, Jess Bell and Tony Lowe

Purpose

The body posture of sportsmen is an area of interest for many researchers seeking to determine potential relations between body asymmetry and unilateral load accumulation, as well as specific injuries. In athletes postural assessment is important, because of the inter-relationship between the trunk and core musculature and the  lower quarter and upper quarter. Postural assessment as part of the screening process is relevant as there is evidence of correlations between injury and posture. Abnormal postures can influence muscle function.

Studies of various sports find load accumulation and uneven muscle tone can cause postural faults.

• Many sports over-strengthen some muscles e.g. the quadriceps. This leads to an unbalanced ratio of quadriceps-to-hamstring strength, which in turn pulls the front of the pelvis down. The result is anterior pelvic tilt. This alters the position of the spine resulting in a hyperlordosis, which then shuts down the hip flexor muscle group.
• Cyclists may develop a kyphotic thoracic spine.
• Volleyball is a discipline associated with high training loads. The sport involves a number of asymmetrical techniques, including the serve and the attack. Volleyball can result in an imbalance between the muscle tone and length and thus contribute to asymmetry of the spine.
• Lordosis in the power athlete is common.
• Kyphosis in the swimmer is also common.
  
• Soccer is an endurance sport with repetitive complex motion sequences, as well as a high risk of body injury. The frequency of injuries among adult male players is high with most injuries occurring in the lower limbs (the ACL in particular). The mechanics of the lumbar-pelvic-hip complex and the thoracolumbar fascia, participate in the transfer of loads between the lower and upper limbs, the spine and the pelvis. The analysis of possible pelvic asymmetries in posture measurements may stem from injuries in the lower limbs.

Technique

The athlete is barefoot and stands in a relaxed position/posture. There should be sufficient distance between the athlete and the assessing physiotherapist to adequately view the athlete's posture. The various components of the postural assessment is viewed anteriorly, posteriorly and from the side as well.

Examples of the various components that can be included in the postural assessment are:

• Head on neck position
• Shoulder:
  • Symmetry - are the shoulders level from anterior and posterior view
  • Roundedness -assessed anteriorly and from the side.
  • Are the shoulders in internal rotation?
  • Is there anterior translation of the humeral head?
• Thoracic spine:
  • Assessment from the side - Is an increased or decreased thoracic kyphosis present?
• General spinal curvature:
  • Assessed posteriorly - Is there a spinal scoliosis present?
• Lumbar spine:
  • Assessed from the side - Is there an increased lumbar lordosis or a flattened lumbar spine?
  • Assessed from the back - Any visible muscle spasm? Hinging at the thoracolumbar junction?
• Pelvis
  • Assessed from the front, rear and side.
  • Assess levels of ASIS and PSIS.
  • Assess levels of iliac crests.
  • Is pelvis in anterior or posterior tilt?
• Hips:
  • Symmetry - are hips level.
  • Are hips in internal or external rotation?
  • Is there a visible gluteal bulk?
  • Are the hips in extension or flexion - viewed from the side?
• Knees:
  • are the knees in hyperextension when viewed from the side?

Where possible, identify the overall postural type (e.g. Flat back, Sway back, Normal, Lordosis, Lordosis/Kyphosis) as this can provide clues to what structures are at risk.

Practical Implications

Analysis of body posture parameters is important to evaluate postural changes in players and to prevent injuries. Optical measurement systems (including 3D photogrammetric systems) can be useful, especially due to their ability to reveal errors in body posture, as well as individual compensation patterns.

Body asymmetries may be caused by e.g. one-sided training loads. The implementation of exercises to reduce myofascial imbalances in the musculoskeletal system and core stability is vital when these imbalances result in altered posture.

Evidence

Reliability:

A basic musculoskeletal postural assessment is sufficiently reliable when performed by trained clinicians. Posture, mobility and movement can be assessed with adequate reliabililty.

Singla and Veqar (2014) reviewed postural assessment methods (visual observation, plumbline, goniometry, photographic, radiographic, photogrammetric, flexiruler, electromagnetic tracking device) and found that postural evaluation studies based on the photogrammetric method were the most reliable. This method evolved from the photographic and digitization method. In this method, photographs of the subjects are taken in the frontal or sagittal planes with a camera which is mounted on a leveled tripod stand, which is placed at some distance from the subjects. The photographs obtained are transferred to a computer system. They are used to calculate postural angles. Angles are then drawn between the markers by drawing horizontal and/or vertical lines. With the use of this method, quantifiable and reliable data can be obtained. It is used in measuring e.g. head posture, shoulder posture, cervical lordosis, thoracic kyphosis, lumbar lordosis, lower limb posture and pelvic tilt.