Posture is commonly assessed using a grid or plumb line, with the patient in a static standing position; however, within the aging population, this becomes more difficult because of the age-associated increase in postural sway. This can be seen in the two photos in Figure 15.1 of a 98-year-old man taken only moments apart. The postural control mechanisms produce minor shifts in weight in order to avoid fatigue, excessive tissue compression and venous stasis. Hence, a photographic assessment of posture represents a fixed instant of a postural set. Thus, posture is actually a relative condition requiring full body integration and both static and dynamic balance control, as shown in Figure 15.2.

Degenerative joint disease is a common age-related pathology involving bony and joint surface changes (see Chapters 19 and 24). The osteophytes that result from arthritis may prevent normal joint motion, cause pain and possibly encroach on nerves with a subsequent radiculopathy that includes muscle weakness and imbalance. Postural adjustments may be the result of attempts to unload weight from an osteophyte in order to reduce pain or to accommodate a radiculopathy.

The common age-associated postural changes in the axial skeleton and their clinical implications are enumerated in Table 15.1 and may be seen in Figures 15.3 and 15.4. The idiosyncratic effects of 20 years of aging can be seen by comparing the images of the 78-year-old man in Figures 15.3B and 15.4B with the photographs in Figures 15.1 and 15.5, which were taken when the man was 98 years old. In the lateral view, note the large increases in trunk kyphosis and hip flexion. By comparing images of the posterior view at different ages (Fig. 15.4B and Fig. 15.5), the kyphoscoliosis with upper extremity extension, increased hip and knee flexion and loss of muscle mass in all four extremities and trunk are evident. A different individual, aged 93 years and shown in Figure 15.3C, also demonstrates extension of the upper extremities. The 98-year-old man’s postural set (Figs 15.1 and 15.5) may be affected by his complaints of right hip pain, and decreased sensation and strength in the lower extremities. He lives in assisted living and uses a wheeled walker for most ambulation.