The Postural Analysis: Side Posture

After reading Part I you’re probably thinking to yourself, “Maybe my posture isn’t so great after all, but how do I know?” Well, if you completed your homework assignment from last week, you should have been waiting for this week’s update with a bunch of photos in hand. Time to put them to good use!

Essentially, we’re looking for straight lines and 90-degree angles. Let’s start with your side photos. You should be able to draw a straight line between the middle of your foot and take it up through the knee, hip, acromion process (the “bump” where your superior scapula meets the clavicle), and mastoid process (the nub just behind your ear); ideally, this line is also perpendicular to the ground.

Below are the four most common side postures seen. Figure #1 depicts an anatomically ideal posture, whereas Figure #2 shows a posture with the same ideal spinal curves but excessive anterior weight-bearing (i.e. the weight is on the toes). In Figure #3, the anterior tilt has a semi-normal lumbar curve, but compensatory exaggerated kyphosis in the upper back.

Figure #4 is the “Caveman Look” to which we’ve been referring. It’s highly prevalent in today’s society; can’t you just picture a computer screen right in front of that poor stickman with the club? In this fourth figure, you’ll notice the exaggeration of the spinal curves, coupled with the compensations that manifest themselves throughout the rest of the body (excessive lordosis, excessive kyphosis and a head forward posture).

Now before you go on, take out a blank sheet of paper and make six columns at the top. The columns will be labeled as follows:

• Excessive lordosis (includes anterior pelvic tilt)

• Excessive kyphosis

• Internally rotated humeri (yes, that really is the plural of “humerus”)

• Forward head posture

• Internally rotated femurs

• Externally rotated feet

Here’s a checklist of things to examine on your side-posture analysis, starting from the ground up:

1) Can you make a straight line between your feet, knees, hips, acromion process, and mastoid process? If so, is this line perpendicular to the ground? If you answered “yes” to both questions here, you’re doing far better than most! You should still check to see if there’s any exaggerated kyphosis or lordosis, however.

2) Examine your knees. Do they have a slight bend or are they locked? If they’re flexed, give yourself a check in the internally rotated femurs and externally rotated feet columns.

3) Check out your skivvies. Is the waistband parallel to the ground or is the front pointed towards the floor? If it points down, give yourself a check in the lordosis column. If you see “skid marks,” however, change your shorts.

4) Examine your lower back. Is there a minimal curve or is it exaggerated? (This one is more subjective, but chances are if you have an anterior pelvic tilt you also have an exaggerated lumbar curve). If it’s exaggerated, give yourself a check in the lordosis column.

5) Examine your arms. Are they carried alongside or in front of the body? (Be sure to look at each side independently; sometimes one side is tighter than the other). If they’re in front, give yourself a check in the internally rotated humeri column. If your knuckles are dragging the ground, give yourself a check in the “needs a full body wax” column.

6) Examine your upper back. Are your shoulders rounded forward? If “yes,” give yourself a check in the internally rotated humeri column.

7) Can you see any of your upper back? If “yes,” give yourself a check in the kyphosis column.

8) Finally, examine your head position. Can you draw a line straight up from the acromion process of your scapula to the mastoid process (anterior portion)? Or, is there a noticeable angle? If you answered “no” to the first question and “yes” to the second, put a check in the forward head posture column.

Front Posture

Now, let’s move on to our front photos. We’ll be examining not only the position of the legs, but of the arms and hands as well. Below we have the two most common lower body postures: #1 represents our ideal and #2 the more common knock-knee or valgus position (imagine the kneecaps practically facing one another).

Here’s a checklist of things to examine on your front posture analysis, starting from the ground up:

1) Can you make straight lines between your feet, knees, and hips? If you answered “yes” here, awesome! Go through the last couple of steps just to make sure everything else is okay.

2) Do your feet have arches or are they flat (excessively pronated)? If they’re flat, give yourself a check in the externally rotated feet column, and possibly one in the internally rotated femur column (correlate with #4).

3) From your knees down, do your lower legs and feet turn out? If “yes,” put a checkmark in the externally rotated feet column.

4) From your hips to your knees, do your legs turn in and the kneecaps point inward? If “yes,” put a check in the internally rotated femurs column.

5) Finally, examine the backs of your hands in the photo. Are they turned out to the sides or are they internally rotated and facing the camera? If they’re facing the camera, put a check in the internally rotated humeri and kyphosis columns.

Back Posture

Finally, let’s take a look at the photos of your back. This is usually the quickest test to perform because you’ve already examined the majority of the body. The most important thing we’re looking at is the position of your scapulae.

Figure #1 shows us the ideal posture for our scapulae; the medial, inferior borders are both retracted and depressed. Figure #2 is an example of scapular winging, where the scapulae are “pulled” up and to the outside. Finally, Figure #3 shows us a classic example of someone with overactive/hypertonic upper traps coupled with weak and inhibited middle/lower traps.

Here’s our back posture view and what we need to examine. As a note, make sure to examine both sides in unison, as well as each side independently. For example, many people only have scapular winging or elevation on one side (typically their dominant one), so be sure to look for imbalances side-to-side as well.

1) Do the medial, inferior borders of the scapulae remain down and back (somewhat close together), or do they “wing out?” If “yes” on the second question, put checkmarks in the internally rotated humeri and kyphosis columns.

2) Do the superior scapular borders point upward or do they seem to “disappear” and point forward (anterior tilt)? If “yes” on the second question, put a check in the kyphosis column.

Now that you’ve completed the postural analysis, add up how many checkmarks you have in each column. This is pretty simple stuff; the more checks you have under each column, the more signs you have of that specific postural condition!

Additional Tests

If the results of the postural analysis haven’t already given you a pretty good idea of which postural afflictions you’re battling, we have a few more tests that can help to answer any remaining questions you might have. Some of these tests require a partner.

Yardstick Test

You should be able to rest a yardstick across the clavicular portion of your pectoralis major without it touching the head of your humerus on either side. If the yardstick makes contact with your humeral heads first, you’re dealing with internally rotated humeri and probably kyphosis.

Doorway Test

When you enter a room, which passes through the door first: the chest or head? If it’s the head, you’re dealing with forward head posture.

Supine Leg Lowering Test

This test is widely utilized, and Don Alessi described it in detail (including performance norms) in a previous Iron Dog. If you haven’t tried this before, check it out and see how your core strength stacks up. If you perform poorly, chances are you have anterior pelvic tilt and exaggerated lordosis.

Squat Test

This is an easy test that assesses the functional capacity of the lower body. Start with the feet at shoulder-width, toes pointing straight forward, and your arms held in front of the body. From here, perform a full squat (and yes, your thighs have to be at least parallel to the ground!) Look in the mirror if necessary; do any of the following occur?

• Do your heels lift? If yes, you have tight plantar flexors and/or poor posterior chain strength (especially glutes).

• Is there excessive arching of the low back? If so, it’s indicative of overactive hip flexors.

• Do your knees come closer together at any point during the movement? If so, you have poor glute medius recruitment/strength, and this is probably coupled with tightness and overactivity of the TFL/ITB and adductor complex.

• Do the arches in your feet completely collapse at any point during the movement? If so, you have externally rotated feet and/or internally rotated femurs.

Hip Extension Test

Another test that’s quite revealing is the hip extension test. This test will give you an idea of how your lower extremity is functioning, along with other muscle groups that may be trying to substitute for the prime movers.

Lay prone on a table or bed with the ankles hanging just off the end. From this position and keeping the leg straight, lift the leg up several inches. You’ll probably need someone to monitor you, but here are a few things they should be looking for:

• Is there a deepening of your lumbar curve when you initiate the movement? This deepening indicates tightness of the lumbar erectors and hip flexors.

• Does the leg stay straight or does it bend at the knee? Flexion at the knee (especially in the first 10-20 degrees of movement) indicates overactive hamstrings. This is usually coupled with the next question…

• Do the glutes fire immediately or is there a delay from the onset of movement? If they’re delayed, your glutes are inhibited and/or weak.

Trunk Curl Test

This is just a basic sit-up test, but the results will give you an idea of how your trunk flexors and hip flexors are working. Lay on a table or the ground in a supine position with a slight bend in the knees. Place the arms out in front of the body and then curl-up slowly. Have your partner notify you if he or she sees any of the following:

• Are you unable to get your shoulder blades off the ground? This indicates weakness in the trunk flexors.

• Do you have to “rock” to get your body going (e.g. do you use body English to initiate the movement?) Again, this is indicative of weakness of the trunk flexors.

• Is there a deepening of the lordosis throughout the course of movement? If so, you have overactive/hypertonic lumbar erectors and/or hip flexors.

• Finally, do the heels rise or come up off the ground? Once again, this indicates overactive hip flexors.

Conclusion

If you took a close look at your photos and used the above tests, you’re guaranteed to have some insight into how good (or bad) your posture really is. Next week, we’ll show you how us anatomy enthusiasts (read: dorks!) apply these analyses to real-world situations.