Posture Assessment

Posture Assessment: what is it?

Posture assessment has a complicated reputation, and it deserves one. For decades it was taught as if a plumb line could explain a client's back pain and a corrective exercise could straighten them out. The evidence for that story is much weaker than the confidence with which it was delivered. What survives is still useful, just narrower: standing someone against a reference and looking carefully tells you where to start with exercise selection, gives you a repeatable image to compare later, and occasionally shows you something that belongs in front of a clinician rather than in your program.

How to run it

Stand the client against a gridded background or a plumb line, in fitted clothing, barefoot, feet at hip width. Ask them to march on the spot a few times and settle, which stops them arranging themselves into the posture they think you want. Then look from the front, from the side and from the back, working from the ground up each time.

Photograph all three views under fixed conditions: same spot, same camera height, same distance, same lighting. The photo is often more valuable than your notes, because in twelve weeks you can put the two side by side rather than relying on a written description of what you thought you saw.

• Front view: foot position, knee alignment, level of the hips and shoulders, head tilt.
• Side view: ankle, knee, hip, shoulder and ear relative to the reference line; pelvic tilt; thoracic curve.
• Back view: heel position, level of the pelvis and shoulder blades, spinal alignment.
• Let the client settle first, and take the photos before you say anything about what you noticed.

The patterns you will be taught to look for

These named patterns are useful shorthand and they do describe real, common presentations. They are not conditions, and finding one does not mean you have found the cause of anything.

Being honest about what posture predicts

The link between static posture and pain is far weaker than it is usually taught. Plenty of people with textbook-poor posture have never had back pain, and plenty with textbook-good posture do. Healthy postures vary a great deal between individuals, and there is no single alignment everyone should be pushed toward.

That should change how you talk about your findings. Telling a client their pelvis is tilted and that is why their back hurts is a claim you cannot support, and it tends to make people more anxious and more protective of their spine, which is rarely helpful. Describe what you observed, use it to inform exercise selection, and leave causation alone.

Where it stops being your call

Some findings are referrals rather than programming notes: a visible lateral spinal curve, a marked and unexplained asymmetry, pain reproduced by standing or by a position you tested, numbness or tingling, or anything the client tells you is new and getting worse. In those cases you write down what you saw and send them to a doctor or physiotherapist. You do not name a condition, and you do not treat one.

Everything else is ordinary coaching. A client who cannot get their arms overhead without arching will get their overhead pressing changed, not because you diagnosed anything, but because you watched them try and made a sensible programming decision.