each this by asking the client to perform a task such as squatting down while in a slumped over position to show them how inefficient this position is for m
Might not be a good idea to deliberately place your patient in a position which could result in harm...
nother reason it is important to teach proper body mechanics is for mobility
What do you mean?
forces o
What kinds of forces?
fairly easy for her to ge
Less easy to get out of due to the large base of support and added friction from contact with multiple surfaces.
here is a large base of support because the client is sitting on her bottom
The base of support is extended to the table since she is leaning her elbows and forearms on the stable desk.
curved,
flattened
hed forwa
Yes, I agree, BUT it results in neck hyperextension (which contradicts how you described her cervical curve, as normal).
lumbar curve is over exagg
The lumbar curve is flattened. To describe it as over-exaggerated implies that it is over-extended, because the lumbar curve extends the spine.
he arms are used for support rather than for free movem
Yes! Good!
humeri are shifting in different ways.
Not sure what this means.
The forward head position and posteriorly tilted pelvis make it hard to shift to a standing position
Yes! Good analysis.
The femur is rotating inward (medially) as the hip joint flexes.
Which one is rotating inward? Judging by the position of his feet, both femurs are in neutral in terms of rotation.
externally
also internally rotating
posterior position
There is no such description. Do you mean a posterior tilt?
scapulae are protracted
Could he still hover over the device with his scapulae retracted?
Rounded shoulders to see what's on his iPad clearly.
This does not make sense. His shoulders are rounded because the scapulae are protracted.
pinal rotati
to which direction?
Kyphotic cu
There are two naturally-occurring kyphotic curves--which one are you referring to? Is it exaggerated, flattened, or in its natural position? What about the other curves of his spine?
in extreme extension
The trunk is flexed forward; I don't see extreme extension--I see flattened lumbar curve (you correctly identified), a relatively natural kyphotic curve (correctly identified), and exaggerated cervical lordosis with forward head protrusion (head thrust forward). Feet are neutral; femurs are flexed at the hips.
Scapulae are retracted in this position as she pulls the barbell close to her body.
c spine.
What type of forces are acting on the vertebrae in this position?
her nec
Good observation, although this also means her cervical curve is exaggerated into extension while her head is thrust forward.
bral discs would be compressed in her thoracic and lumbar spine, while the posterior portions wo
Outstanding!
t would be across 8 chair legs in total: 4 chair legs for her lower back and 4 chair legs for her fee
Yes! however it is till somewhat unstable because the base is narrow and long.
displayed
splayed
t tibia is internally rotatin
Technically the tibia does not rotate with the exception of the screw-home mechanism; if it is rotating during knee extension to flexion, then it is rotating externally. The femurs do most of the rotation at the hips, which I think is what you were intending to describe.
the back is not getting a break which causes consistent pain since the body isn’t aligned
Good reasoning!
The upper extremities are being used for support.
Are they? If so, they expand the base of support. I am not sure you are correct but I can't see clearly due to the size of the picture. Also this contradicts your previous sentence
itional forces on
What kinds of forces?
hoc
Good!
he spinal curve is occurring
The lumbar curve is somewhat flattened as her spine is flexed forward; however the thoracic kyphosis does not appear exaggerated. Her cervical curve is exaggerated in extension because she is protruding her head forward.
femur is in an extended
Femurs are flexed at the hip
the hip joint knee joint
Which one? or do you mean both?
curs
Good!
sid
Good!
ght femur rot
R femur is flexed as well.
causing rotation
The rotation of the pelvis causes the rotation of the spine. The lateral tilt causes side bending of the spine--lateral flexion
war
You are describing a right lateral tilt (right side down)
downward lateral tilt
Describe the direction of the tilt--is the pelvis tilted to the left or right?
side-bending at the cervical vertebrae.
In which direction?
rve
The lumbar curve is flattened. Since you accurately stated her head is in the forward head posture, what is happening in her neck?
horacic and lumbar spines are being compressed
How are the joints being compressed? In spinal flexion, the anterior body becomes compressed. Also there is likely shear force in this position.
compressive
Leaning forward places additional shear forces on the vertebrae.
does not support joint compression
Do you mean joint alignment? Joint compression is not a desirable thing, you would not want to support it.
ort
Yes!
fairly small
Her BOS is very large and includes her forearms on the desk. Her COG is also lower (than if she were standing) and even though she is leaning forward bringing the COG forward (which results in more mobility and less stability), it is counterbalanced by the large BOS created by her forearms taking up a large space on the table.
her feet on the ground.
Her upper extremities are also being supported by the desk. She is very stable due to multiple points of contact with support surfaces.
anterior pelvic
If she had an anterior pelvic tilt, her lumbar curve wouldn't be as flexed; she would have more extension in the lumbar spine. However, her sacrum and lumbar curves are both flexed, leading me to believe she is in a posterior pelvic tilt.
and hi
Spine is also rotated to the right.
over time which refers to poor mobility.
He is more stable than mobile, although leaning forward also brings his COG forward, which makes one less stable. The instability created by the forward COG is counterbalanced by his L arm being supported by the table. So, in general, this position is more stable than mobile.
lders are rounde
Position of scapulae?
excessive kyphotic curve of the spine
Which curve? Lumbar is flattened; thoracic is slightly exaggerated. What is going on with the cervical curve?
His back is out of the chair
Not sure what this means
vocate for accessibili
Lovely. As a runner, perhaps you would like to participate in the Navy Nautical 10-miler in June in Millington. It is the only race I have participated in which has a wheelchair division. I have tried in the past to get students interested in volunteering to check the course for accessibility or in any other capacity. Something to think about for PDP.
r at eye leve
Very good!
eavy backpack increases the strain of the muscles in her back and s
Yes!
position for 5-7 minutes
Perhaps one minute!
stability and mobility
This is not a stable position, she could easily fall over making it a more mobile position.
head is tilted
head is protruded forward. "Tilt" is used to describe the pelvis.
wn as kyphosi
Her lumbar curve is flattened and her cervical spine is also somewhat flattened by the forward head protrusion
unless they have this kyphotic curve as their natural spinal curve
Not sure what you mean--we all naturally have two kyphotic and two lordotic curves.
kyphotic cur
The lumbar curve is flattened; I would say the cervical curve is exaggerated with the forward head protrusion
neck flexion
Do you think the neck is in flexion or extension?
anterior
Posterior
your head, both of which are positions that would eventually lead to pain and disco
Great!
er joints.
Outstanding!
e cervi
Very nice analysis!
xtended arm
flexed shoulders and elbows...not sure which part is extended besides the wrists
urve
The lumbar curve is flattened as well.
maintaining forward head posture
No! Forward head posture is detrimental! It's not a good position.
https://www.medicalnewstoday.com/articles/forward-head-posture#what-is-it
nd she would need to shift a lot if she had to remain in this position for a long tim
It would be torture for anyone to stay in this position for longer than a few seconds!
maintain balance better
Nice!
stability
Is this a stable position?
her femur is extended as she is stan
Both femurs are flexed at the hips.
light tilt of the hip
Unclear what you are describing--tilt in which direction?
tivities.
Very nice!
iscomfort in her neck and lower back.
Agree! Unfortunately you did not describe what's going on in the cervical and lumbar areas which would result in discomfort over time.
tic curv
What's going on in the lumbar and cervical areas?
d is flexed forwa
The head is protruded forward---would you say they neck is flexed or extended?
der
Would you say they were slightly elevated?
rotracte
and upwardly rotated (relative to anatomical position)
nic. I would also critique them in a professional and understanding
How would you educate Warren on lifting his backpack?
start to give out
What does this mean?
on joints.
What forces are acting on his vertebrae in this position, especially when he rises to stand?
w
Capitalize proper names
murs are exten
The femurs are flexed at the hip and externally rotated; the knees are extended.
spine curvature as shown is most likely kyphosis
Lumbar lordosis is flattened; thoracic appears neutral and cervical lordosis appears slightly exaggerated because he is extending his neck to look at his hands.
right to my left le
vice versa
bility for free movemen
Very nice
more unstable.
Yes, because there would be less points of contact with a stable surface.
y left leg and taking most of the weight of my body causing pressure in the hip join
I disagree; it is relaxing while the left is bearing most of the body weight.
right femur is extended
The right femur is flexed
al tilt and would make my left shoulder and scapula slightly elevated
Very nice!
umber
lumbar
elvis has a slight anterior tilt and a right lateral tilt
Very nice
right
I see most of your weight on the left leg, in which the knee is extended to support the weight as opposed to the right knee which is slightly flexed, therefore less in a position to accept the body weight.
t; howe
Good. The tight fit also increases points of contact between his body and another surface creating friction, and therefore less mobility (more stability).
kin patc
Thanks for sharing! Cute pictures!
tilted
Tilt is used to describe the pelvis; the head is described as protruded forward
gnment
What is happening to the head? Is it rotated? Usually it is protruded forward.
Even just moving around in this position would be uncomfortable
Not sure I understand.
mobility becaus
This position is more efficient for mobility because the base of support is relatively small and there are no additional points of contact with support surfaces other than the feet.
reliable
Incorrect word
extra stress on the body
The whole body? Where specifically?
stain
stay in
ed positio
Yes
pelvis is being tilted in an upward directio
I don't understand. Pelvis is tilted either anteriorly or posteriorly. When someone has exaggerated lumbar lordosis, they typically have an anterior pelvic tilt. In a swayback posture, they lean back and the pelvis is tilted posteriorly.
pper extremity is being hyperextended.
I don't see this--both upper extremities appear to be slightly flexed at the shoulders. I can't see the right UE but the left elbow is flexed too.
tis
this
their patient
Great idea
d of time.
Do you think the lack of support of the lumbar spine will be tolerable for an extended period?
gnment.
I would disagree about hips being in alignment--they are adducted and internally rotated
traced
retracted
femurs extended
flexed and adducted. The knees are extended
flexed
extended
Her spine has a kyphotic curve.
The spine is flexed causing the lumbar lordosis to flatten and the thoracic kyphosis to be exaggerated. The cervical vertebrae are hyperextended and the head is forward. Scapulae are elevated.
In the spine is in flexion a
Which picture?
, this can become sort of a “default posture” over time as it may become a habit, thus also leading to poor posture.
You contradict your earlier statement that he is in good alignment. What would lead to poor posture?
The base of support is large because the UE alignment is over the trunk with weight equally distributed
The BOS is large because he has contact with a lot of surfaces: his back and thighs; his R wrist on the desk and his B elbows resting on the chair's armrests. This is a very stable position which does not allow for a whole lot of mobility.
His shoulders are anterior to his hips
In the picture it looks like his shoulders are posterior to his hips because he is slightly reclining. If he was sitting forward, with more hip flexion, I might agree with you, but that is not what the picture shows.
He has a neutral pelvis with a slight anterior tilt.
This sentence is contradictory: either the pelvis is neutral, or in an anterior tilt. However, I disagree with your description., From the picture it looks like he is more likely in a slight posterior tilt, because he is sitting with a large area of contact between his back and the back of the chair.
his spine is flexed
Need more specifics regarding the various curves of the spine
sheer force of the spin
The sheer force is between each adjacent vertebrae.
Proper body mechanics and posture could be integrated into an intervention for an older individual wanting to pick weeds out of their flower beds, or proper positioning of oneself when washing dishes.
This is too vague--what are the specific interventions you would use/teach?
ther than gravity
Good
hile glided posteriorly
Not sure what you meant here. If you are describing the arthrokinematics, then this is wrong, because the moving segment is the pelvis.
anteriorly rotated
I don't know what this means
y occupations:
Great pictures! I wish they came with an explanation!!
from her ey
Splitting computer screen from keyboard is also helpful.
compressive
and torque (rotational)
Both upper extremities are free for movement: one is on the laptop doing work, while the other is resting on her leg
The right is creating additional point of contact with a support surface; the left is being supported by her thigh.
compressive disk injury
Excellent list!
externally rotated
I would disagree; also, pronation usually goes along with internal rotation. However, it's hard to see in this picture. Just something for you to consider.
e body.
Excellent!
femur is slightly extended to create a wider base of support
Looks also like both femurs are abducted to create a wider, more stable BOS.
he left relative to his spine being rotated to the right.
Yes!
This puts his pelvis in an anterior tilt
The opposite is true: when the lumbar lordosis is decreased, the pelvis tilts posteriorly.
to marry him
How lovely. Thanks for sharing!
se. This would be an interactive way to get kids involved and start out a session in a well-postured positio
How creative! Thanks for sharing!
decrease pressure.
decrease pressure where?
mber
spelling
utral positions we were created to assume. This can have permanent effects on the body if not addressed prope
Good reasoning!
lumbar curve slightly exaggerat
Posterior pelvic tilt results in flattened lumbar lordosis, not exaggerated lumbar curve. Therefore, one of your descriptions is wrong.
n an intervention with a client, I would ensure that the client
This is a bit too vague.
mobility because his limbs can move freely
I would disagree because a large portion of his body is resting/reclining on a support surface--resulting in a lower COG than if he was sitting upright, increasing stability.
slight bend in your knee
Not sure what this means "slight bend"--not sure how you would flex hips with only a slight bend at the knees. Needs clarification.
base of support is smaller because Noah's feet ar
This is incorrect. Both UEs are in contact with support surface, making this BOS larger than just the two feet. The seat is also part of the BOS.
by standing up
Also because of what I mentioned in previous comment: LOG approaching edge of BOS
much mobilit
The LOG is approaching the edge of the BOS, which makes this position less stable.
very stable
What makes it stable?
m
Nice!
bad post
Good points!
This position would be easy to change out of.
She would have to uncross her legs...not so sure it would be that easy--but it is all speculation!
hone.
Very good analysis!
raising the computer to eye level
True! I would recommend a separate keyboard rather than a laptop which combines the keyboard and display monitor (as seen in the second picture). Good job with this blog post!
een to eye level
Excellent!
the posterior portions of the intervertebral disc.
Good analysis!
put his head forward
Does not make sense considering the rest of the sentence.
If I were to apply force, I do not think they would be able to maintain the current position so it would not be efficient for stability
He is more stable in this position because he is leaning his pelvis on the counter for additional support.
cause
There is no cause and effect--he has a posterior tilt of the pelvis most likely due to the forward head posture and excessive thoracic kyphosis.
forward head tilt.
Tilt is used to describe the pelvis, not the head.
Thus, I think it would be pretty easy for her to change out of this position
Larger BOS is more stable and therefore more difficult to come out of.
head tilted down
Neck flexed?
head is tilted up and forward
Not sure what this means. Be precise in descriptions.
Because she has such a large base of support,
What is the BOS?
(tilting anteriorly
Head does not tilt. Tilting is a descriptor for the pelvis.
scapulae are also rounded
there is no such description
it of kyphosis to the curve
There are two kyphotic curves--which one?
tilted anteriorly
Incorrect
nt keep balanced, efficiency of their body, and improve their progress in learning new rout
Very good! Another potential intervention is stretching muscles that are typically concentrically contracted during climbing, to promote flexibility and prevent tightness which could translate into an abnormal resting posture.
By teaching the client, that would advocate for injury prevention and or improve the clients efficiency.
Grammar--not sure what you mean in this sentence.
cur fast.
Outstanding!
lignment.
Excellent
otating within the transverse plane, and flexing as he looks down to see where to place his foo
This is a great analysis overall.
Spinal curve exhibits kyphosis
Be specific--which one? There are two kyphotic curves in the spine.
otion for hip flexion as he draws that right leg u
Great analysis!
eaching Nephew's to Lift Nephew Fixing B
Such cute pictures! Thank you!
time length
Good idea!
I would tell her to straighten her back to where she was only in slight thoracic kyphosis, therefore her shoulders would be symmetrica
Another intervention is to separate the screen from keyboard to better position BUEs and allow a more neutral (less kyphotic) thoracic curve.
f falls is greatly decreased.
Great!
tain relief by straightening their back, reducing kyphosis, and retracting their shoulders into a neutral positi
Great!
gluteus maximus, therefore it is a good amount of support and very stable
No cause and effect here. The muscle doesn't make it stable. The size of the BOS and relative position of the COG, and therefore the LOG, is what make this a stable position. Also, her COG is very low, which increases stability.
On the other hand, the stability of this position is good. It would be rather hard to knock someone over in this position, especially when they have the use of their upper extremities. I would say it is medium difficulty to change out of this position. Her lower extremities are very fixed and intertwined with one another, making changing their position more difficult
Nice reasoning.
Does this posture support joint alignment or place additional forces on joints
Different size font?
using a peanut ball
What is this? Citation?
both feet to provide a more stabilized base of support, as it will release stress on other body structures during sink-tasks
There is a different intervention in your notes.
are all
grammar
The base of support for her position is large and includes her two feet, as well as the cabinet that her pelvis is leaning on
Good observation
would be relatively to
missing word
slight posterior tilt of the pelvis
This is incompatible with what you described regarding the lordotic curve (of the lumbar vertebrae).
a lordotic curve is obviou
Be specific. There are 2 lordotic curves--which one are you referencing?
head
Neck. There is no such thing as an anterior tilt to the head. Anterior tilt is a descriptor for the pelvis.
Genea
spelling
positio
Lovely!
nd the front paws and backside of our dog
Great!
It is relatively easy to move from this position, especially for a 4 year old
As soon as he lets go of the dog, he will become much less stable.
lung
lunge?
internal rotation in the right leg
Looks like slight external rotation of the left and possible internal rotation of the right. Hard to tell from this angle.
rience in the ICU,
See previous comment
HIPAA
Spell out
I would often co-treat with PT, or we would come close together during the day
Still don't understand what you mean