Would you like to identify poor posture? In the article, I show you how you can perform a postural assessment to identify deviations from the “norm”. It’s about how you can analyze habitual static posture fairly comprehensively. Poor posture or poor posture, such as a hunched back, can be observed in many people. The causes for postures deviating from “the norm” can be very diverse – age, bony changes, illnesses, one-sided strain, and muscle tone.1,2
A static posture assessment can be used to see how a typical stance differs from what is considered “normal.” As a result, you can also use posture analysis in combination with a comprehensive medical history (including medical history and everyday habits) to identify muscular imbalances. I will address muscular imbalances and their consequences in future posts. This article covers the basics first. Good posture assumes that the neuromuscular system can function optimally and carry out desired actions with the least possible expenditure of energy3. Accordingly, posture is, of course, contextual. Competitive athletes may have deviations from the norm in certain body areas to function optimally in their sport.
Nonetheless, it seems essential to the overall functioning and health of the body that the alignment of each body region follows what is considered an optimal range. This protects the musculoskeletal system from excessive forces. In addition, the optimal alignment of the body, described later in the article, creates a basis necessary for utilizing various joints’ full range of motion. “Bad” posture can contribute to many musculoskeletal problems.3 As a result, you can also use posture analysis in combination with a comprehensive medical history (including medical history and everyday habits) to identify muscular imbalances. I will address muscular imbalances and their consequences in future posts. This article covers the basics first.
Postural assessment – Static posture
Body posture can be assessed statically (without movement) and dynamically (with specific movements). To comprehensively evaluate poor posture and possible compensation mechanisms or deviations from other causes, it makes sense to carry out static and various dynamic examinations.4,5 In the article, I present the static assessment of posture in more detail. In separate articles, I’ll show you how to study body alignment under dynamic conditions.
Under static conditions, i.e., standing, the usual alignment of the spine, including the pelvic and shoulder girdle, can be easily determined. For this purpose, the person to be examined should typically take their usual stance but place their feet hip-width apart and hold their arms at their sides.4,5 Then you usually look at the body from 3 sides – front, side, and behind. The different perspectives provide a comprehensive impression of the posture under immobile conditions. To assess posture well, it makes sense to proceed systematically. Since, as with building a house, a solid base forms the foundation, assessing posture typically begins with the feet and ends with the head.4 You can start with the head/neck area and work down to the feet.3 Visual assessment can be challenging at first, but you can expect to improve with enough practice. Using a video or photo camera with a tripod to evaluate the images afterward and at your leisure is also advisable. In addition, reference lines can also be inserted into the image with the help of appropriate software (e.g., Kinovea is suitable for photos and videos and is freely available).
Postural assessment – Anterior view
You often get a first impression of posture by looking at it from the front. The figure below shows you what to look for when examining from the front. To identify deviations from “normal”, one can imagine different lines. A central line divides the body from head to toe into two equal halves – left and right. Then, a horizontal straight line connects both shoulders and both sides of the pelvis. And finally, a line divides both legs into left and right. The characteristics of a “normal” posture can be seen in the figure. You can notice that the respective sides are typically at the same height, and usually, no rotation or sideways tilt can be seen.4
Static posture – Lateral view
The view from the side is very important for diagnosing many typical incorrect postures (hollow back, hunchback, etc.). Here, too, one can imagine “normal value” lines, as can be seen in the figure, which help to assess posture. An ideal line goes from the external auditory canal through the middle of the shoulder, then centrally through the hip joint and the thigh, and ends just before the ankle. More significant differences from this seem to be regarded as deviations from a normal posture.4 The figure also shows that an “auxiliary straight line” is drawn horizontally through the lumbo-pelvic-hip-complex – from the bony prominence at the anterior superior border of the iliac crest (“anterior superior iliac spine” or ASIS) to the bony prominence at the posterior superior border of the iliac crest (“posterior superior iliac spine” or PSIS) runs.4,6,7 If the two areas are at the same level, one speaks of a neutral pelvic position. If the front area is further down, the pelvis is tilted forward. If the rear area is below the front area, the pelvis is accordingly tilted backwards6. Pelvic alignment can depend on many factors. Even in asymptomatic individuals (no pain or problems in the lumbo-pelvic-hip region), forward or backward tilting can be observed. Forward tilt seems more common than backward tilt.7 As a result, a slight anterior pelvic tilt can be considered more typical5, and up to 6-7° tilt is still considered normal7. The pelvis position can be assessed with the help of different measurement methods. The reliability and validity of the different methods can vary quite a bit. I am happy to refer to Suits et al. (2021).
Static posture – Posterior view
Looking from behind, one imagines a central line and several auxiliary lines again. As shown in the figure, the main line divides the body into two equal halves – left and right. The auxiliary lines are based on the shoulders or shoulder blades, pelvis, legs, and feet. When viewed from behind, posture is also assessed for excessive lateral bending or rotation. In addition, the distance and alignment of the shoulder blades are assessed.4
- Roghani, T., Khalkhali Zavieh, M., Dehghan Manshadi, F., King, N. & Katzman, W. Age-related hyperkyphosis- update of its potential causes and clinical impacts—narrative review. Aging Clin Exp Res 29, 567–577 (2017).
- Katzman, W. B. et al. Study of Hyperkyphosis, Exercise and Function (SHEAF) Protocol of a Randomized Controlled Trial of Multimodal Spine-Strengthening Exercise in Older Adults With Hyperkyphosis. Phys Ther 96, 371–381 (2016).
- American College of Sports Medicine. Clinical Exercise Physiology. (Lippincott Williams & Wilkins, 2019).
- Clark, M. A. & Lucett, S. C. NASM’s Essentials of Corrective Exercise Training. (Lippincott Williams & Wilkins, 2011).
- Cook, J. B. C. Brukner & Khan’s Clinical Sports Medicine: Injuries. (Mcgraw-Hill , 2017).
- Suits, W. H. Clinical measures of pelvic tilt in physical therapy. International Journal of Sports Physical Therapy 16, 1366–1375 (2021).
- Herrington, L. Assessment of the degree of pelvic tilt within a normal asymptomatic population. Manual Therapy 16, 646–648 (2011).