How a GREAT instructor will give you a tailored workout: Postural Assessment.
Brace yourself, this post is jam packed with a TON of anatomical information! This is a summarized version of how Pilates instructors & body movement specialists develop a workout prescription designed specifically for you!!
One of the first things most Pilates instructors do after meeting a first-time student is complete some variation of a postural assessment. This postural assessment helps indicate what’s going on with your body and where you are out of alignment.
Don’t freak out, everyone is out of alignment or in other words, “deviates from neutral.” In fact, typically the most athletic clients deviate from neutral because they continue to repeat movements for their sport over and over again.
Take a runner for example, they repeat the same movement repetitively during the length of their run. A runner will inevitably develop imbalances overtime due to repetition of their personal gait.
On the other hand, someone stuck at a desk for 8 hours a day, will also develop classic postural deviations. Commonly, the shoulders rolling forward, thoracic spine (upper back) rounding forward, tight hip flexors, and possibly elevated scapula on the right side from using the cursor all day. Sound familiar?
Once and instructor has this information from your body it gives them a general idea of how to begin creating a personalized program. This is SUPER important because no two bodies are the same. If you are getting a cookie cutter routine, you should get the heck out! When I’m teaching, I then teach the foundations to everyone so they can apply them into their personalized workout. (And P.S. I have made my foundations course free to you, because I love you, and I love saving you $65.00 😉 )
Usually assessments are a combination of static and dynamic. A dynamic test is often a functional body movement such as an overhead squat. The instructor can see muscle firing patterns and know where to address.
Today I’ll discuss a static assessment:
Start the postural assessment from the ground up:
…hello feet, the most important part of the chain!
Typically issues in the feet begin to work their way right up the kinetic chain into the knees and hips. While looking at the feet we want to see if they pronate (roll in towards the arch) or supinate (roll to the outside of the foot).
I like to check out how much “out-toeing” the foot presents, since about 8 degrees is normal, some feet turn out further in order to compensate for a medial rotation in the lower or upper leg. There is also the opposite situation, commonly called pigeon-toe.
All of this is taken into account, because special attention is required while performing exercises standing or during footwork on the reformer. The client needs to learn foot and ankle tracking, during such exercises to set up a happy kinetic chain!
For example, if you tend to pronate through the foot, and don’t pay close attention during a squat, the knees will often follow the pronation of the foot and start to roll inward. Eeek! Not a great place for those knees. The last video lesson in my free 6-day foundations course discusses proper foot & hand placement, so if you haven’t signed up yet click here to sign up right away.
Speaking of knees, let’s talk about those next.
Next in the assessment, we move to the knees:
Simply pretend the knee-caps have “eyeballs” on them and see where they are “looking.” If the knees are looking straight forward, that’s great!
Sometimes, the knee cap deviates from neutral (“looking” straight forward) for one of two reasons:
1. Due to tight muscles in the leg/hip, or tight fascial lines/IT band. These muscles may literally pull the patella, the knee cap, out of alignment.
2. Due to a femoral rotation, the “thigh bone” being rotation one direction or the other. Which may result from a bone-in-joint situation or a tight muscle around hip joint situation. Once your fitness professional has been working with you and seeing your movements dynamically, they will start to distinguish what the situation is.
Remember, you have two legs, so sometimes one knee is doing something different than the other 😉 Simply stand in from of a mirror with shorts on and look at your knee caps, you may be surprised by what they’re doing!
While at the knees, I also check for a “knock-knee” or “bow-leg.” I simply ask my clients to bring their knees and ankles all the way together to see if both will touch. If the knees touch and and ankles don’t, you have a “knock-knee.” If the ankles touch and the knees don’t, you have a “bow-leg.” Again, you have two legs and it sound crazy but sometimes they are different!
There are a lot of muscle imbalances that cause the femurs to go either direction (creating knock-knee or bow leg), along with the shape of bone structure within the hip joint. While creating an exercise Rx, muscles can be targeted to provide more support for the knee joint which suffers from either femur deviation.
Simple changes can be made to classic exercises to help create well rounded muscle firing if you are experiencing any of these deviations. For example, if you have a bow-leg position happening, placing something between the knees whiled doing footwork on the reformer will allow the adductors (inner thighs) to fire better during the exercise. On the opposite spectrum, typically the glute medius could use a little “wake-up call” if you are knock-kneed, so a band around the lower thighs during footwork helps there.
Once we are adults, the knee/femur positioning can’t really be reversed; however, I have seen it be reversed in pre-teen clients before hitting their growth spurt. Pretty cool!!!
Next up is the pelvis:
The pelvis is one crazy puzzle in the body, and can get a bit jumbled from time to time.
First, I check to see if there is a rotation in the pelvis, which would be turned clockwise or counter clockwise. You can place the hands on front of the hip bones, on the ASIS, which are the points that stick out the most on the from of the hip. You’ll see if one is more forward than the other. It always helps to check the back of the pelvis, on the PSIS, to confirm.
Then, I check if the hips are level from side to side. By the way, it is SUPER common to have one hip higher than the other. I think I see this in about 85% of clients (myself included). The hip difference will also create a leg length discrepancy as well.
Next, I like to see if the pelvis is tipped forward (anterior pelvic tilt) or backward (posterior pelvic tilt). You can look from the side and place one hand on the ASIS and one on the PSIS to see if there is a big difference in height between the two. In women, the ASIS should naturally be slightly lower than the PSIS.
All of the muscles that attach to the pelvis pull in a different direction, and sometimes only on one side. I use the analogy of “tug of war” a lot when I’m explaining this. Which ever muscle is tighter will pull the bone in that direction over the counter muscle.
However, don’t make the mistake of automatically thinking tight means strong. Often tightness in a muscle is actually weakness in the muscle. A strong muscle is also very supple and doesn’t “lock up” the way a weak muscle does.
A lot of times the imbalanced pelvis and trunk can be easily re-aligned with simple oblique engagements. My how-to video of this is in video lesson #3 of my 6-day foundations course, which is free by the way. So no excuses, click on that link now if you’ve been procrastinating because there is no reason to not be exercising in the smartest way possible.
Moving up the body, we’ll next run into the ribcage:
After looking at the hips I check out the ribcage and then sometimes end up correlating a pelvic deviation with some torso funky-ness which goes right into the ribcage.
By placing the hands on the lowest rib, often one side will be pulled closer to a hip that was higher. It appears the side of the waist is synched.
I also look for rotations here, the exact same way as the hips will present a clockwise or counter clockwise rotation. Place the hands on the front side of the ribs and see if one is closer towards you than the other. It’s best to compare to the back side as well to see if it’s showing the same rotation.
Sometimes I see differences in the development of the erector spine in that thoracic region. A big deviation in the musculature is often present in someone with scoliosis or someone who does a lot of one-sided heavy lifting.
Back up and look at the core from the front of the body:
The bigger “core picture” can be seen super quickly. I’ve started stepping away and just looking at the person’s trunk in a bigger picture.
Try this: stand in front of the mirror with your arms hanging down by your side.
- Look at the shoulders to see if one is higher than the other.
- Look down and find the space between your waist and the arms. The side that has more space if often a shortened side.
- Also note, if you have a bit of a baggier shirt the wrinkles created under each breast which sweep down and laterally to the side, sometimes they are different from side to side indicating a shorter side of the trunk.
These trunk deviations can be a number of things ranging from a difference between obliques, lats, QLs, etc. Remember they are all playing tug of war, and the goal is to make everything tug evenly.
On the back of the rib cage we have the scapulas (shoulder blades):
Moving up the chain I look at the scapulas, where all kinds of crazy things are happening. By the way, the scapula is the same thing as the “shoulder blades,” the bones that look like angel wings on the upper back.
The scapula are plopped on the back of the rib cage without any boney attachment except for way over on the edge of the shoulder at the clavicle. For that reason, these bones can be all over the place.
First, I see if they are protracted, retracted or neutral. I check this by standing behind the person, and measuring how far away from the spine the innermost edge of the scapula is. I measure by fingers, 2-3 fingers is normal, 4 or more is quite protracted, less than 2 is retracted and is rather rare. I also check the front of the shoulder for tightness or a rolled forward appearance in the shoulders where the chest and humerus (upper arm) meet.
Next, I check to see if the top and bottom edge of the scapula are in line with one another. If one is higher than the other it may be elevated. I can’t jump to conclusions though, remember our big trunk picture in the last section, if one side of the trunk is higher the shoulder may just appear higher due to a trunk deviation.
I also keep an eye out for “winging.” Winging is when the scapulas are not laying flat on the upper back, they pop out like angel wings. Winging is usually a strong indicator that the serratus anterior muscle is not firing during the exercise or is weak.
Moving up to the head and neck:
Up top, we check out the neck and head positioning. I can glance at the entire head in relation to the neck or shoulders and also look at the nose to see more “direction.”
First, I check to see if the head is tipped to one side or the other, or even side-sliding to one side or the other.
Next, I’ll observe if the head is rotated clockwise or counterclockwise. This is easily done by simply visually checking as opposed to palpating. Visually I can see if the nose is pointing left or right.
Lastly, I’ll check from the side view, to see if the neck is shifted forward or backward in relation to the trunk of the body. I also like to observe the curvature of the neck in relation to the thoracic spine (upper back). Sometimes it is really extended (curved forward in a “c” shape with the round part of the “c” going towards the front of the body. A big extension would indicate tight neck extensors and will usually indicate a pillow of some kind will be necessary for any exercises while laying on the back.
Spinal “S” Curve from the side view:
Last, but certainly not least, the curvature of the spine is one of the MOST important aspects of the postural assessment.
The spine should have a natural “S” curve when you look at it from a side view. It goes towards the belly button on the low back and away from the heart in the upper back, creating an “S” if you looked from the side. The “S” shape curves are important for shock absorption and we definitely want to keep them there. A stick straight spine would not be helpful for absorbing any shock, so no more smooshing the low back down to the mat during abdominal exercises on the floor!
Sometimes the curves get a little too curvy. The low back may curve inward too much which we call lordosis. Similarly, upper back may curve out way too much which we call kyphosis. A spine doesn’t always have both in combo, so it’s important to check the spine out and see if one or both are present.
Lateral curvature of the spine is called scoliosis. This would be if an “S” were present when I were looking at the back of the body. However, we’re not here to diagnose, just observe 🙂 There are TONS of exercises that can be done to help with scoliosis, we’ll save that information for another blog post. Be sure to sign up for the mailing list so you don’t miss that post when it comes out.
In the meantime, grab a buddy or place yourself in front of a mirror to see if you can observe any of these postural assessment aspects on yourself!