Postural Assessment

My first post is about a topic that has been well covered, and for good reason.  Both static and dynamic posture is of utmost importance in regards to maximum performance no matter what your performance measure.  Optimal postural alignment is a well sought after goal by fitness professionals, personal trainers, athletic trainers, physical therapists, and the like. Instead of discussing specific postural topics such as the implications of spinal coupling mechanism on scoliosis or rear foot valgus (perhaps topics for a later date), I will give a quick and cost efficient way to objectify postural mal-alignments.  This technique is very simple, yet it takes a keen eye to identify the origin of the mal-alignment.  In addition, it is by far more difficult to identify the cause.

The are many ways to assess posture, but this technique uses a plumb line (a fishing sinker and yarn), which gets a little help from gravity, and subsequently hangs perpendicular to the ground.  One of the benefits of this technique is that within a few easy snapshots, the assessor can display his/her work, and allow the client to view their progress.  The plumb line makes it easier for the untrained eye  (i.e. the client) to view postural faults.  I believe that in most instances, allowing the client or patient to view themselves will help build rapport and hopefully help the client feel that their money is being well spent.  The basis for the entire technique is that the plumb line is to dissect or pass within a certain proximity to a predetermined set of ‘reference points’–bony landmarks that differ based on the position of the subject.  The patient or client is placed in three different positions, and assessed in a standing.  Below is a list of these reference points, cephalad to caudal, in each of the three positions.

Anterior (Frontal) View                           Sagittal (Lateral) View          

  1. Through Center of Nose                          1.  Through Ext. Auditory Meatus
  2. Though Xiphoid Process                         2.  Through Acromion
  3. Umbilicus                                                      3.  Through Greater Trochanter
  4. Between Knees                                            4.  Between Knee Axis and Patella
  5. Midway between Ankles                         5.  Just Anterior to Lateral Malleoli
 Posterior (Back) View                    
1.  Center of Occiput
2.  Through Spinous Process of Vertebrae
3.  Through Intergluteal Cleft
4.  Between Knees
5.  Between Medial Malleoli

To the left is an example of “good” and “poor” postures in a sagittal (Lateral) View.  The dotted line in the middle view represents the plumb line, and it can be easily seen that one or more landmarks are out of alignment in the “poor” posture views.  With that said, and somewhat stated in the image, abnormal postures can contribute to weak or inhibited musculature in some places, and overactive soft tissue in others.  To aid in the understanding of this concept, I will go into a little further detail regarding forward head posture, a common postural fault in our society.  To be quite honest, you are most likely donning this position while reading this.  Some athletes that suffer from it are cyclists, baseball pitchers, and hockey players.  In short, forward head posture is a flexed lower cervical and hyper-extended upper cervical spine.  As seen in the picture to the right, hyper-tonicity 
on one side of the body (ex. upper trap, levator, suboccipitals), usually leads itself to hypo-tonicity on the opposite (ex. deep neck flexors).  The therapeutic goal is to restore some kind of balance by returning these tones to ‘neutral’.
As stated before, there are many ways to assess posture.  It can be done statically, dynamically, in a structured manner, or just by assessing someone during exercise.  With that said, this technique is not meant to be an ultimate or an all-inclusive, but merely a tool in one’s professional toolbox.  If nothing else, my hope is that it can give someone a reference to understand how the body should align.  Even without taking the time to set up the entire technique, one could, for example, note that a client’s ear is not centered over the acromion, and therefore hypothesize forward head posture.

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