Postural Assessment Vancouver

Standard practice in postural testing is to test a standing person with a plumb line (line running straight down the body viewed from front and side on), some goniometres (these measure joint angles) and some palpating (touching) of bony landmarks to make judgments on alignment.  You can also take a picture of the person standing in front of a postural grid.

No matter how powerful and impressive you consider these tests to be though… they are fundamentally pointless stuff!

Realistically a fitness professional doesn’t have time to do all (or any) of these tests properly and unless you have orthopaedic training and can account for the actual differences within the skeleton of an individual, unless you can palpate, judge and adjust soft tissue and muscle tone, unless you can mobilise joints and use trigger points to affect the nervous system you actually end up casting stones in to the ocean.

So, the advice for fitness professionals is this – don’t bother with static postural assessments but do complete some base observations and know how to warm people up properly for their exercise, and how to stretch and strengthen muscles whilst the body is in a good postural position.

By far the most effective way of managing posture long term for clients is to put into practice consistent warm up approaches and to look at dynamic exercise posture (or movement patterns) and support ideal alignment when the client is under load.

So, because we can’t affect posture dramatically it’s best to simply observe and take stock of the postures of your client, and look at that over time.  We recommend that you simply complete the following blank diagram and make notes on your clients posture and some of their movement patterns to assist with your programming and session delivery.  (This form is an example – the full form with instructions on how to use it is covered when we look at assessing movement).

Now let’s pretend that you’ve told a client you are going to look at their posture and they instantly strike posture perfect (chest puffs out, they stand up straight and tall etc).  So you talk to them for a bit and just make some notes and take some personal details, ask them about their weekend and favourite foods.  Soon you see a postural shift where they relax into a normal standing posture – they may even relax into a listening posture which can result in them moving their feet, leaning, folding arms, or looking for a seat as their subconscious tells them they are going to be here for a while and they normally sit as soon as any conversation of duration is imminent.

Let’s just pretend they relax and adopt the ‘sway back’ posture.  So, now you know two things – they have a map somewhere back there of what they are supposed to stand like and they seem to be able to adopt that posture initially.  You also know that they’re used to standing with a sway back by default as their musculoskeletal system can cope with the forces required to stand most effectively in that posture.

If you want to wait a while longer until they break the standing position altogether – this is how long they can stand in a poor posture before they need to make a postural shift because the loads become unattractive to the brain and it slips the body into the most frequently used and patterned posture (which could be looking for a seat, leaning on a wall, or looking to sit on the ground, or slinging or whatever).

You have now tormented your client’s subconscious postural system enough.  Give them a break and ask them to take a seat and make themselves as comfortable as possible as you’ve got something to discuss that may take a while and see what they do.  The next move they make is their long term super comfy sitting/listening posture.  For me this is lounging back as far as possible in a chair, one ankle over the other knee, big ‘C’ shaped spine with my hands on my tummy or tucked in my jacket pockets.  I look like one of the guys off the Sopranos, but that’s what my brain tells me to do!

Okay, so now you have assessed a few things about your client without getting out plumb lines and goniometres or touching your clients bony markers and generally taking all manner of measurements which realistically you can do very little about directly.

Why is posture hard to improve

That last bit about not being able to affect static posture directly may have shocked you a wee bit.  To think you, a fitness professional, can’t affect your client’s posture dramatically by doing all manner of super tricky exercises and being an extra set of eyes is depressing.

Well, we hate to break it to you, but if you go down the road of trying to fix static postures through training in the gym you are doomed to lose.  The reason is the client has built this posture to cope with their environment and the state of their musculoskeletal system.  So, you’d need to fix their environment (good luck with that – as the most you may see a PT client is five hours a week, and they will then have 163 hours to sit, stand, walk and slump as they please) and their musculoskeletal system.

The best you can do is improve their musculoskeletal system and here’s the rub with that – they are not using the muscles and connective tissue to create static postures the way you will train them to use them when they overcome resistance in the gym.  Usually the tone of muscles during static posture is quite separate from the phasic contractions (on and off more readily) of the outer unit (agonists/prime movers) when completing a movement pattern.

  There are lots and lots of little (and some big) tonic muscles in our body with very low stimulus (a low firing threshold) required to keep them contracting and these are the muscles your body uses constantly to keep you from becoming a blob like lump.  They are ‘tonic’ in nature which means they can contract constantly, are slow twitch, use oxygen, tend to be relatively inflexible (particularly because they usually contain more fascia than the ‘phasic’ muscles) and are fatigue resistant.  But, just as with all muscles, if you don’t use them they can degenerate, stiffen and/or your brain can almost forget they are there.  This is why being in the modern world is so dangerous for these tonic muscles.  They seem to have become obsolete.  Adjacent is the latest way to walk your baby.

Think of what your deep spinal muscles are required to do whilst you stand versus your quadriceps.  The spinal muscles must control the 24 vertebral bones (and others that are fused) in the vertebral column so they sit truly upon one another in the correct alignment.  They are constantly active to ensure the spine is in alignment and any forces created by the movement of other limbs is controlled (even a wiggle of your finger will require some activity deep in your spine).  Conversely those lazy old quadriceps just sit there looking like boffins at the beach.

Why stretching and strengthening can only influence posture but not correct it

Okay, so we know that

• Posture is created from subconscious maps the brain has learnt and reinforced
• Posture is implemented as best as possible within the musculoskeletal system mainly by tonic muscles working constantly around joints.
• Joint pain or limitations, a lack of range of motion, poor stability or control of a joint and a lack of condition of the muscles will all affect posture both static and dynamic (e.g. movement)
• Tonic muscles tend to shorten, weaken, are more fascial in nature and are slow twitch and used for long duration, low intensity, multiplanar work.
• Phasic muscles tend to be used when overcoming loads, they tend to strengthen and shorten with use, they are more fast twitch and usually work for shorter periods of time.
• We know that movement patterns are separate from static posture and although both rely on the musculoskeletal system they have separate maps in the brain.

Given all of the above we need to acknowledge that typical gym training and the environment in which it is executed can only affect static posture by affecting the musculoskeletal system and conditioning the movement patterns used in the gym so that they occur with good alignment.

What opportunity do trainers have to affect static postures

Trainers can therefore affect static posture by

1. Cueing start position posture when standing to best represent ideal posture
2. Warm up and fully mobilise a client prior to exercise using patterns that encourage range and mimic the movements about to be undertaken in the workout
3. Ensure that good alignment of the spine is maintained whenever loads are lifted and particularly when fatigue becomes apparent
4. Stretch tight muscles and return those muscles that have been contracted substantially during the workout to a good relaxed resting length post exercise.
5. Avoid isolation exercises for the general population where a decrease in tonic muscle work may occur and phasic muscle work with poor spinal and joint alignment might prevail.