Static postural assessment

What a postural assessment tells you

Posture isn't morality — but persistent postural deviations predict where movement will break down. Take a client through a static assessment in 5 minutes; use what you learn for the next 6 months.

The 4 standard views

Have the client stand barefoot in a neutral relaxed stance.

Anterior view (from front):

Are the feet pronated/supinated?
Knees: knock-knee (valgus) or bow-leg (varus)?
Hips level?
Shoulders level?
Head tilted?

Posterior view (from behind):

Same as anterior, plus:
Scapular position: protracted? Winged?
Spinal alignment

Lateral view (from the side):

Head: forward of shoulders?
Shoulders: rolled forward?
Thoracic kyphosis: excessive?
Lumbar lordosis: excessive (anterior pelvic tilt) or flat (posterior)?
Knees: hyperextended?
Ankle alignment

The plumb-line check: drop an imaginary plumb line from the ear lobe — it should pass through shoulder, hip, knee, and ankle. Deviations show where compensations live.

The 4 common posture syndromes

Upper-crossed syndrome — forward head, rounded shoulders, kyphotic upper back. Tight chest and upper traps, weak rhomboids and deep neck flexors. Common in desk workers. Lower-crossed syndrome — anterior pelvic tilt with lumbar lordosis. Tight hip flexors and low back, weak glutes and abs. Pronation distortion syndrome — flat feet, knees collapse inward, hip rotation. Affects squat and lunge mechanics significantly. Sway back — pelvis pushed forward of feet, swayed lumbar spine. Tight upper abs, weak glutes and hamstrings.

Translating to programming

You don't lecture clients about their posture. You program:

Upper-crossed → rows, face pulls, prone Y/T/W raises, chest/upper trap stretches, chin tucks. Lower-crossed → hip flexor stretches, dead bugs, glute bridges, planks. Limit deadlifts initially until pelvis can stay neutral. Pronation → glute medius work (band walks, single-leg work), arch-building exercises, possibly orthotics referral. Sway back → glute and hamstring activation, anti-extension core work, posture cueing.

What posture assessment can't do

It can't diagnose pain or pathology. A client with shoulder pain and rounded shoulders might have pain from rotator cuff issues, not from their posture. Refer pain to a physical therapist or physician — but use the postural findings to inform what's safe to load.

Re-assess every 8-12 weeks

Postural changes are slow. A monthly check is too frequent. Quarterly is realistic.

TL;DR

4 views (anterior, posterior, lateral, plumb-line). 4 common syndromes (upper-crossed, lower-crossed, pronation, sway). Use findings to direct corrective work and avoid loading patterns that exaggerate problems. Re-assess every 2-3 months.