at?

friends'

Grammar.

signs), which must be even more challenging

Not sure what this meant

So glad you found value in this assignment! You write so well. Thank you.

Excellent

Which muscles would tighten and which would become stretched?

Flattened lumbar curve; exaggerated kyphotic thoracic curve; spine is rotated to the right; left scapula protracted, upwardly rotated and slightly elevated

Do you mean that her spine is laterally flexed to the left? "Tilt" is typically used to describe the pelvis.

Not sure what you mean here and how this relates to body mechanics.

Leaning forward reduces weight on pelvis, leading to strain on the back muscles (erector spinae) which contract to counteract the force of gravity.

Which joints? What type of force?

piercing?

posterior

?

What is going on with the spinal curves? Cervical? Thoracic? Lumbar? Are the neutral, flattened, or exaggerated?

Punctuation

flexing his trunk

?

And position of the left UE.

I am concerned about the position of the left GH joint; if this position was prolonged with the humerus hanging over the back of the chair, it would compress the axillary artery along with the brachial plexus, leading to injury.

The spine is rotated to the left as well

Good point

Good observations!

I don't understand. Did you mean tilted posteriorly? Rotation implies a direction (right or left).

Excellent!

And lower back due to the flattened lumbar curve!

Good analysis!

To move, the upper extremities have to overcome the friction from contact with the surface.

Yes! More points of contact results in more stability.

what about the cervical region?

femurs are flexed?

Head is thrust forward

Did you mean to say the pelvis is neutral? I don't understand what "hips forward" meant.

I don't understand this part of the sentence.

Her wrists are resting on the tabletop, providing additional points of stability via contact with a stable surface.

When the head is thrust forward, it results in exaggerated cervical hyperextension...contradicting your previous analysis that her back is mostly straight

Femurs are flexed and slightly externally rotated.

Agree

Scapulae are slightly protracted and elevated. Don't know what forward hunch means in terms of scapulae.

Please read about the slouch/overcorrect technique.

Might not be a good idea to deliberately place your patient in a position which could result in harm...

What do you mean?

What kinds of forces?

Less easy to get out of due to the large base of support and added friction from contact with multiple surfaces.

The base of support is extended to the table since she is leaning her elbows and forearms on the stable desk.

flattened

Yes, I agree, BUT it results in neck hyperextension (which contradicts how you described her cervical curve, as normal).

The lumbar curve is flattened. To describe it as over-exaggerated implies that it is over-extended, because the lumbar curve extends the spine.

Yes! Good!

Not sure what this means.

Yes! Good analysis.

Which one is rotating inward? Judging by the position of his feet, both femurs are in neutral in terms of rotation.

also internally rotating

There is no such description. Do you mean a posterior tilt?

Could he still hover over the device with his scapulae retracted?

This does not make sense. His shoulders are rounded because the scapulae are protracted.

to which direction?

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?

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.

What type of forces are acting on the vertebrae in this position?

Good observation, although this also means her cervical curve is exaggerated into extension while her head is thrust forward.

Outstanding!

Yes! however it is till somewhat unstable because the base is narrow and long.

splayed

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.

Good reasoning!

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

What kinds of forces?

Good!

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.

Femurs are flexed at the hip

Which one? or do you mean both?

Good!

Good!

R femur is flexed as well.

The rotation of the pelvis causes the rotation of the spine. The lateral tilt causes side bending of the spine--lateral flexion

You are describing a right lateral tilt (right side down)

Describe the direction of the tilt--is the pelvis tilted to the left or right?

In which direction?

The lumbar curve is flattened. Since you accurately stated her head is in the forward head posture, what is happening in her neck?

How are the joints being compressed? In spinal flexion, the anterior body becomes compressed. Also there is likely shear force in this position.

Leaning forward places additional shear forces on the vertebrae.

Do you mean joint alignment? Joint compression is not a desirable thing, you would not want to support it.

Yes!

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 upper extremities are also being supported by the desk. She is very stable due to multiple points of contact with support surfaces.

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.

Spine is also rotated to the right.

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.

Position of scapulae?

Which curve? Lumbar is flattened; thoracic is slightly exaggerated. What is going on with the cervical curve?

Not sure what this means

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.

Very good!

Yes!

Perhaps one minute!

This is not a stable position, she could easily fall over making it a more mobile position.

head is protruded forward. "Tilt" is used to describe the pelvis.

Her lumbar curve is flattened and her cervical spine is also somewhat flattened by the forward head protrusion

Not sure what you mean--we all naturally have two kyphotic and two lordotic curves.

The lumbar curve is flattened; I would say the cervical curve is exaggerated with the forward head protrusion

Do you think the neck is in flexion or extension?

Posterior

Great!

Outstanding!

Very nice analysis!

flexed shoulders and elbows...not sure which part is extended besides the wrists

The lumbar curve is flattened as well.

No! Forward head posture is detrimental! It's not a good position.

https://www.medicalnewstoday.com/articles/forward-head-posture#what-is-it

It would be torture for anyone to stay in this position for longer than a few seconds!

Nice!

Is this a stable position?

Both femurs are flexed at the hips.

Unclear what you are describing--tilt in which direction?

Very nice!

Agree! Unfortunately you did not describe what's going on in the cervical and lumbar areas which would result in discomfort over time.

What's going on in the lumbar and cervical areas?

The head is protruded forward---would you say they neck is flexed or extended?

Would you say they were slightly elevated?

and upwardly rotated (relative to anatomical position)

How would you educate Warren on lifting his backpack?

What does this mean?

What forces are acting on his vertebrae in this position, especially when he rises to stand?

Capitalize proper names

The femurs are flexed at the hip and externally rotated; the knees are extended.

Lumbar lordosis is flattened; thoracic appears neutral and cervical lordosis appears slightly exaggerated because he is extending his neck to look at his hands.

vice versa

Very nice

Yes, because there would be less points of contact with a stable surface.

I disagree; it is relaxing while the left is bearing most of the body weight.

The right femur is flexed

Very nice!

lumbar

Very nice

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.

Good. The tight fit also increases points of contact between his body and another surface creating friction, and therefore less mobility (more stability).

Thanks for sharing! Cute pictures!

Tilt is used to describe the pelvis; the head is described as protruded forward

What is happening to the head? Is it rotated? Usually it is protruded forward.

Not sure I understand.

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.

Incorrect word

The whole body? Where specifically?

stay in

Yes

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.

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.

this

Great idea

Do you think the lack of support of the lumbar spine will be tolerable for an extended period?

I would disagree about hips being in alignment--they are adducted and internally rotated

retracted

flexed and adducted. The knees are extended

extended

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.

Which picture?

You contradict your earlier statement that he is in good alignment. What would lead to poor posture?

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.

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.

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.

Need more specifics regarding the various curves of the spine

The sheer force is between each adjacent vertebrae.

This is too vague--what are the specific interventions you would use/teach?

Good

Not sure what you meant here. If you are describing the arthrokinematics, then this is wrong, because the moving segment is the pelvis.

I don't know what this means

Great pictures! I wish they came with an explanation!!

Splitting computer screen from keyboard is also helpful.

and torque (rotational)

The right is creating additional point of contact with a support surface; the left is being supported by her thigh.

Excellent list!

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.

Excellent!

Looks also like both femurs are abducted to create a wider, more stable BOS.

Yes!

The opposite is true: when the lumbar lordosis is decreased, the pelvis tilts posteriorly.

How lovely. Thanks for sharing!

How creative! Thanks for sharing!

decrease pressure where?

spelling

Good reasoning!

Posterior pelvic tilt results in flattened lumbar lordosis, not exaggerated lumbar curve. Therefore, one of your descriptions is wrong.

This is a bit too vague.

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.

Not sure what this means "slight bend"--not sure how you would flex hips with only a slight bend at the knees. Needs clarification.

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.

Also because of what I mentioned in previous comment: LOG approaching edge of BOS

The LOG is approaching the edge of the BOS, which makes this position less stable.

What makes it stable?

Nice!

Good points!

She would have to uncross her legs...not so sure it would be that easy--but it is all speculation!

Very good analysis!

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!

Excellent!

Good analysis!

Does not make sense considering the rest of the sentence.

He is more stable in this position because he is leaning his pelvis on the counter for additional support.

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.