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Set it Straight!

Set it Straight! | American Council on Exercise | Exam Preparation Blog | 10/1/2012


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Because every human body is different and varies in shape, size and type, as well as muscularity, flexibility and fat-deposition patterns, it is not surprising that few people actually exhibit an “ideal” posture. There are various types of deviations from neutral spine position, which may be either temporary or permanent, and that can sometimes be alleviated through exercise. When assessing your adult clients, look for common indicators of postural deviations, such as head tilt, shoulder tilt, hip tilt and forward-tilted head, which can lead to low-back pain, neck pain, increased wear on joint tissues and, in older adults, a hunched-over posture.  

Here are two important definitions to be aware of:

  • Posture is the biomechanical alignment of the individual body parts and orientation of the body.
  • Balance is to maintain the body’s position over its base of support (BOS) within stability limits.

With all the movements we perform on a daily basis, our bodies are constantly performing muscle contractions to maintain balance. Keeping a neutral spine and good posture takes practice and repetition, and we can help our clients by encouraging them to perform exercises that strengthen the muscles along the trunk and spine.

You can assess a client’s posture by having them stand in the anatomical position and observe him or her from the back and from the side. Here are some examples of typical postural deviations to look for, as well as important takeaways from each one:

Lordosis: An increased anterior lumbar curve

  • Practice: Ask the client to stick his or her bottom out and then the belly out. You'll see that this deviation is concentrated on the lower spine.
  • Remember: An easy way to remember this would be to think of a big “lord” with a big belly.
  • Key Point: The anterior tilting of the pelvis will lead to tension on the spine, resulting in low-back pain.

Kyphosis: An increased posterior thoracic curve 

  • Practice: Instruct the client to round the shoulders like a hunchback. 
  • Remember: Kyphosis is the only deviation with an “h” in the word, which can stand for hunchback.
  • Key Point: This deviation is commonly seen in older adults with osteoporosis and gives an appearance of hunchback.

Flat Back: A decreased anterior lumbar curve

  • Key Point: There is a decrease in the normal inward curve of the back, while the head exhibits a forward tilt.

Sway Back: A decreased anterior lumbar curve and increased posterior thoracic curve; often seen with rounded shoulders, a sunken chest and a forward-tilted head 

  • Key Point: Note how the femur and head are farther forward than what is seen in a kyphosis deviation, and there is typically a greater posterior deviation.

Scoliosis: An excessive lateral spinal curvature

  • Key Point: Scoliosis is more prevalent in women and may cause the pelvis and shoulders to be slightly uneven.

Fatigue Postures: These occur when people are experiencing stress, pain, injuries or even exhaustion from everyday activities; results in temporary lordotic or kyphotic postures.

postural deviations

DISCLAIMER: If your client cannot actively assume a neutral spine posture during your assessment, it is recommended that you refer him or her to a physician. As fitness professionals, do not diagnose medical issues, but instead refer your client to a medical professional if they are experiencing symptoms.