Nicole Thompson by Nicole Thompson
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Postural assessments can provide information that guides exercise programming. As an exercise professional, understanding how to identify and potentially improve postural deviations may help individuals prevent injury, improve balance, and increase strength.

Proper posture helps us stand, walk, sit, and lie in positions that do not strain supporting muscles and ligaments and allows muscles to function optimally. Keeping joints in correct alignment reduces the stress on the ligaments and minimizes the likelihood of injury, while allowing muscles to work more efficiently.

Deviations from a neutral spine are caused by many factors, including repetitive movements, awkward positions (such as a habitual slouched posture), side dominance, fatigue, or a lack of joint stability and/or mobility—all of which are correctable factors. Non-correctable factors include congenital conditions, some pathologies, structural deviations, or traumas (e.g., surgery, injury, or amputation). Any deviation can lead to pain, compensations, and/or dysfunctional movement patterns.

For healthy joint mechanics, it is important to reduce tightness or overactive muscles and work toward adequate flexibility, muscle strength and endurance, and balance (i.e., balance on each side of the joint and from right to left sides of the body). Below are some examples of typical postural deviations, as well as possible exercises for promoting improved posture.

Lordosis: An increased anterior lumbar curve with an associated tilting of the pelvis. This typically leads to tension on the spine, which could result in low-back pain.

Exercise Considerations: Focus on strengthening abdominal and hip extensor (hamstrings) muscles, while stretching the hip flexors and spine extensors (erector spinae).

Supine Hollowing

Cat-Cow 

Hip-flexor Stretch

Kyphosis: An increased posterior thoracic curve with associated rounded shoulders, depressed chest, and forward-head posture with neck hyperextension.

Exercise Considerations: Rounded-shoulders posture may be caused by weakness or lengthening of the muscles that control scapular movement—the rhomboids and trapezius. Excessive tightness or shortening of the chest muscles can also contribute to rounded-shoulder posture. 

Chest Stretches

Cobra

Prone Scapular Stabilization

Flat Back: A decreased anterior lumbar curve or a reduced normal inward curve of the lower back with the pelvis tilted posteriorly and head exhibiting a forward position.

Exercise Considerations: The rectus abdominis and upper-back extensors may be shortened while the hip-flexors and lumbar extensors may be lengthened. Focus on strengthening the erector spinae and multifidus while promoting lumbar stability and thoracic mobility.

Bird-dog

Hamstring Stretch

Contralateral Limb Raises

Sway Back: A decreased anterior lumbar curve and increased posterior thoracic curve. Sway back is often seen with rounded shoulders, a depressed chest and a forward-tilted head. The femur and head are farther forward than what is seen in a kyphosis deviation.

Exercise Considerations: Hamstrings and lumbar extensors may be shortened while the hip flexors and upper-back extensors may be lengthened. Focus on strengthening the muscles in the upper back while stretching the chest and promoting lumbar stability and thoracic mobility.

Chest Stretches

Strengthening Obliques

Prone Scapular Stabilization

Scoliosis: An excessive lateral spinal curvature often accompanied by vertebral rotation.  While scoliosis is a congenital or non-correctable condition, exercises can be implemented to help manage the deviation.

Exercise Considerations: Implement exercises aimed at improving strength and range of motion of the muscles on both sides of the vertebral column.

Exercises for Scoliosis

Regularly performing exercises that create balance between opposing muscles along the trunk and spine are helpful for promoting optimal posture.  The key focus is on stability and mobility.

PLEASE NOTE: If your client cannot actively assume a neutral spine during your assessment, it is recommended to refer him or her to a physician. Exercise professionals do not diagnose medical issues, but instead refer clients to medical professionals if clients are experiencing severe pain or a possible injury.

Additional Reading:

5 Lower Back Bodyweight Exercises to Ward Off Low Back Pain

Low-back Rehab Exercises 

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