A postural analysis chart is most effective when used in conjunction with a plumb line, which is a straight line that suspends a weight or “Bob” on its end. This system has been used since the time of the Egyptians to ensure that structures were being built perfectly upright. When the weight is made of lead (plumbum in Latin), it is referred to as a lead weight or Plumb Bob.
The benefits of using a plumb line during a postural analysis, will:
- ensure the posture chart is hanging straight;
- guarantee the client is viewed from a 90-degree angle;
- determine the placement of the client’s feet prior to taking postural analysis photos; and
- supply a visual reference of the midsagittal and coronal planes in the posture photos.
Hang the plumb line from the ceiling, approximately 3 feet in front of your posture analysis chart. This distance will allow clients of all sizes to stand between the posture chart and the plumb line without touching either one. The Plumb Bob should be suspended from the ceiling and hang approximately ¼-inch from the floor. To get the plumb line out of the way and conserve space when the posture chart is not in use, simply hook it over one of the pins holding the chart on the wall. If you are using the door version of the chart, hook the plumb line behind the hinges.
The use of a construction-grade plumb line to suspend the Plumb Bob will prevent a lot of problems—just make sure the line is securely attached to the ceiling. A professional Plumb Bob kit comes with ceiling anchors and a construction-grade line attached to a professional Plumb Bob.
Have the client stand between the postural analysis chart and the plumb line. Be sure his/her body is not touching the plumb line or the posture chart. It is important for the client’s feet to be placed in the identical position from one photo to another to guarantee consistency. Use tape, a template or a piece of Plexiglas on the floor to mark the client’s position.
Anterior and Posterior Views
There are a few things to remember when taking anterior and posterior posture analysis photos. First, place the medial (inside) aspects of the client’s heels shoulder-width apart and equally spaced from the plumb line (Photo 2). This position allows the plumb line to indicate the midsagittal plane of the body in your photos. Then you can also use postural analysis photos to show the client that his/her body is to the right or left of the midsagittal plane (Photo 1). Second, position the back or posterior aspect of the client’s heels the same distance away from the posture chart to avoid creating the illusion of a twist, torque or rotation in the body.
By positioning the feet using the medial and posterior aspects of the heels, the client is free to laterally rotate the lower extremities, thereby revealing more postural distortions.
For lateral views, position the client so that the plumb line is immediately anterior to the lateral malleolus. (Photo 5) This position allows the plumb line to represent the coronal plane of the body. Ask the client to place his/her hair behind the ears to expose the external auditory meatus: an anatomical landmark used as a reference point to determine the position of the head on the coronal plane.
Camera and Photos
The camera you use does not have to be elaborate. Simply use a cell phone camera. If using a cell phone camera, however, make sure to implement the necessary safeguards to protect your client’s privacy, such as setting security codes or downloading the photos to a secure computer for storage and retrieval.
Once you have taken the photos, keep it simple. The easiest way to review your findings with the client is on the screen of the camera. If you wish, you can download and print the photos later for the patient’s file.
Anterior and posterior view photos can reveal a number of issues, including a high shoulder (Photo 3) or high hip, the space between the torso and the upper limb, the positions of the hands, an externally rotated lower limb, a fallen arch, or if the head and/or torso are held to the right or left of centerline, to name just a few. (Photo 1)
Lateral view photos make it easy to point out a forward head (Photo 6), rounded shoulders, and a slumped abdominal posture, as well as the angle of the innominate bones and the position of the knees; they are also helpful in identifying a twist or rotational pattern. (Photo 4)