Postural Assessment

Did You Know

Static and dynamic postural assessments can reveal two different types of hip dysfunction—hip shift and weight shift?

Hip shift (hike) occurs when the pelvic girdle is tilted to one side, making one side higher than the other, and is often referred to as a lateral pelvic tilt. A hip hike is commonly observed in a static postural assessment or a gait assessment.

Potential causes include scoliosis; overactivity of the tensor fascia latae and adductors (same side); overactivity of the glutes, piriformis, hamstrings, and calf complex (opposite side); and underactivity or weakness in the glutes (same side) and anterior tibialis and adductors (opposite side).

Weight shift occurs when the weight of the body is shifted laterally to one side more than the other and is often referred to as a lateral weight shift. The weight shift can be observed in static postural assessments and in dynamic assessments like the squat or overhead squat.

Potential causes include uneven leg length; existing lateral pelvic tilt; excessive anterior or posterior pelvic tilt (like lordosis or flat back); overactivity of piriformis, hamstrings, and glutes (opposite side); overactivity of adductors and tensor fascia latae (same side); and underactivity or weakness in the adductors (opposite side) and glutes (same side).

Static Posture Assessment

The static posture assessment is a simple way of quickly assessing the client’s typical positioning of their body in space. A coach should not be looking for perfect posture but for abnormalities influencing performance that may cause or worsen an injury. Any observations should be recorded for later review and used during movement.

Here are the steps for a static posture assessment:

1. The subject should stand in a relaxed stance.

2. If the subject appears to be standing in a position showing awareness of being assessed rather than a natural posture, the subject can be asked to march in place for 10–20 seconds and then relax to find a more natural, rather than practiced, posture.

3. The client should be observed for 20–30 seconds maximum from each of four viewpoints: anterior, lateral left view, lateral right view, and posterior.

4. Abnormalities from anatomical neutral should be noted for the following five kinetic checkpoints:

a. Head and neck b. Shoulders c. Hips d. Knees e. Ankles

Common Static Postural Deviations

• Lordosis: increased inward curving of the lower spine

• Kyphosis: excessive forward rounding of the back

• Flat back: reduction of the normal curve in the lower spine

• Scoliosis: sideways curvature of the spine

• Upper crossed syndrome (UCS): combination of overactive and underactive muscles in the shoulder, chest, and neck regions. UCS typically consists of rounded shoulders, curvature in the neck and upper back, and forward head (in front of the body).

• Lower crossed syndrome (LCS): combination of overactive and underactive muscles in the lower back, abdominals, and hips. LCS typically consists of a forward pelvic tilt and excessive arching of the lower back.

• Knee/ankle valgus: knee or ankle angle toward the midline of the body.

• Knee/ankle varus: knee or ankle angle away from the midline of the body.

• Asymmetrical hip shift (hike): pelvic tilt causing one side of the pelvic girdle to be elevated higher than the other.

Dynamic Posture Assessments

Dynamic assessments require movement through a range of motion to look for potential postural deviations and dysfunctions resulting from muscular deviations. A fitness professional can identify muscular strengths, weaknesses, and potential overactivity. However, it is outside the scope of practice for a personal trainer to diagnose structural deviations such as skeletal deformities or orthopedic issues. If structural dysfunctions are likely or directly observed, the client should be referred to a physician or orthopedic specialist.

The following are several widely accepted dynamic assessments a trainer can use to effectively assess the major joints and muscles in the body and the individual’s ability to control them:

• Gait assessment

• Standard squat assessment

• Overhead squat assessment

• Lunge assessment

During dynamic postural assessments, several factors determine an individual’s performance. Previous injury and variations in motor control and coordination (especially with youth) will have a major effect on assessment performance. Range of motion, overall body composition as it relates to potential movement limitations, and overall balance will also have a major effect.

GAIT Assessment

Gait assessment requires a coach to observe the client while walking and is ideally performed with the client in bare feet. The coach should observe gait movement from the lateral position as well as anterior and posterior. The goal is to observe anatomical functions such as arm swing, shoulder position, head position, pelvic tilt, hip range of motion, knee motion, ankle motion, heel position, and rear foot position when not in contact with the ground.

Common dysfunctions to look for include forward head, rounding of the shoulders and upper spine, asymmetrical hip shift at any point in the stride, knee varus or valgus, foot turn in or out, and flattening of the arches of the foot.

The normal alignment of the knee is shown on the left. Knee valgus (knock-kneed) occurs when the knee angles toward the midline. Knee varus (bowlegged) occurs when the knee angles away from the midline.

Standard Squat Assessment

The squat assessment is an incredibly functional assessment for clients of all ages. Everyone sits and stands multiple times in a day. For this assessment, a client will complete a basic squat with little to no instruction from the trainer. The goal is not to coach them into proper form (yet) but to observe their habitual form during the range of motion.

The squat should be completed unloaded to prevent influence from external forces and with a moderate, controllable tempo. Three to four reps are ideal to observe a repetition from each of the angles without causing fatigue that may exacerbate deviations in the client’s posture.

Understanding what a squat should look like when done properly is key for a fitness professional. The assessment should be observed from the anterior and posterior positions and laterally to look for spinal alignment, rounding of the spine (kyphosis or lordosis), hinging at the hips (or lack thereof), angles at the knees and ankles, forward lean, knee varus or valgus, and ankle inversion or eversion.

Overhead Squat Assessment

The overhead squat assessment is very similar to the standard squat assessment with the addition of arm range of motion during the movement. The client will complete an unloaded squat while holding their arms overhead.

From the start position, the desired state is to keep the elbows back by the ears with arms extended straight overhead and shoulders down in the socket. If a client is unable to achieve this position, it should be noted.

As with all other dynamic postural assessments, this overhead squat should be observed from a lateral, anterior, and posterior position. During the squat, a coach should look for the same potential deviations as the overhead squat as well as movement of the arms from the starting position relating to head position, forward lean, and, specifically, flexion and extension of the spine from the lateral view. This assessment is highly effective in identifying core musculature and shoulder girdle dysfunctions.

Lunge Assessment

The lunge assessment can be completed as a dynamic lunging movement (forward or backward) or as a static lunge (split squat) based on the client’s ability and balance. For example, an elderly client who has recently fallen may not feel comfortable moving (or be able to dynamically move) through a reverse lunge or walking-lunge range of motion.

For this assessment, a coach will observe the appropriate lunge movement with little or no coaching. Again, the goal is to observe the habitual movement pattern and assess the client instead of coach the client through the movement.

Potential deviations a coach will look for include (but are not limited to) head position, shoulders, forward lean, balance, width between the feet, hip asymmetry, knee varus or valgus, ankle inversion or eversion, and spinal flexion and extension. If the client is completing a forward or reverse lunge or a walking lunge, their ability to move into and out of the standing position will also be carefully scrutinized.

With information derived from the static and dynamic postural assessments, a certified professional can use their knowledge of anatomy and physiology to establish potential injury risks as well as identify muscles to stretch and strengthen during exercise programming or as part of a corrective exercise (exercises geared toward injury prevention and optimal movement patterns focusing on reducing muscle adhesions, strengthening weak musculature, stretching overactive muscles, and improving functional movement) routine.

Cardiorespiratory Assessments

A strength and conditioning coach should ideally conduct a cardiorespiratory assessment (tests assessing anaerobic and aerobic physical fitness). These assessments, in terms of cardiovascular strength, will determine how efficiently a client is able to function when placed under physical stress.

The goal of a cardiovascular test is to determine an individual’s VO2 max—the maximum amount of oxygen a person can use during intense exercise. VO2 max is measured in liters of oxygen per minute or as milliliters of oxygen per minute per kilogram of body weight. The Rockport walk test and the Cooper run test are two effective ways a trainer may test a client’s VO2 max.

In the Rockport one-mile walk test, the participant walks as fast as they can for one mile, at the end of which their heart rate is measured. It is best practice to use a heart rate monitor, but if one is unavailable, the trainer or participant can take the pulse on the neck, near the carotid artery. The method of measurement (manual or monitor) used should be documented to ensure consistency with subsequent testing. Then the heart rate can be entered into the following equation to determine approximate VO2 max:

VO2 max = 132.853 - (0.0769 x weight) - (0.3877 x age)

+ (6.315 x gender variable) - (3.2649 x time) - (0.1565 x heart rate)

Gender variable: female = 0; male = 1

The Cooper 12-minute run test also measures long-term endurance. A coach tracks how far a person can run in 12 minutes and then enters the result into the following formula:

VO2 max = (35.97 x miles ran in 12 minutes) - 11.29

These tests provide generally accurate VO2 max scores used for general populations. More accurate testing measures are available to higher-level athletes (and in some fitness facilities with the right equipment), but these are generally offered in laboratory and research settings.

Cardiorespiratory fitness tests like the three-minute step test (an assessment in which an alternating step up is completed for three minutes, and the time to return to a resting heart rate is measured upon completion) have also been used for basic fitness assessments in the past. In this assessment a participant completes repetitions of an alternating step up at the fastest-possible maintainable pace for three minutes and measures the length of time required for the heart rate to return to a normal range. However, the Rockport and Cooper tests are more effective and have a higher percentage of participant completion than the three-minute step test and are therefore used more frequently.