Assessing Dynamic Posture (Movement Patterns & Positions)
What is dynamic posture (movement patterns and the position during them)
Dynamic posture is simply the position the body is in at any moment during a movement pattern. It’s essentially a snap shot of the body during a movement whereas with static posture the snapshot is always the same (because the person isn’t moving). Also, one snapshot will show you evidence of what had happened before and what is coming up – as there is a kinetic chain in motion with dynamic movement.
For example if you took a snapshot of someone falling over you would know from that position what positions/postures occurred immediately prior, and where the movement will likely end up.
Why assess movement
Okay, so assessing posture is fairly subjective and you would normally do it with a view to looking for improvement and establishing what state the musculoskeletal system might be in when the person arrives at the club to see you.
More importantly you would like to know how the brain has patterned the movements which are fundamental to the primary movements you may want to use in the gym. You assess movement because you are going to load it and if you load inefficient movements you simply increase the risk of injuring clients. So, assessing movement is key to improving client safety and results in the gym.
What to assess and how
We would suggest you look at the following assessments and in the following order because this order makes it easy for the client to complete:
- Your client putting their hands above their head
- Your client sitting down on the edge of a chair and getting off the edge and up again
- Your client standing on one leg
- Your client attempting any form of push up they think they are capable of
Each of these tasks involve some element or virtually all of a primary movement pattern and are common tasks that will also require little (if any) cueing and give you a good view of the natural movements of the client.
Also, when you do this be wary of instructing the client – refrain from repeated full demonstrations or explanations as to what you are looking at – just ask them to perform the movement and watch how they do it. If you tell them what you are looking at or show them a ‘good one’ the mimicry centres in their brains will kick in and you won’t get their patterned movement but rather their conscious mind will set an aim for the exercise of copying your demo and hey presto, they will produce whatever they can to please you.
Hands up
In this task you simply ask the client to put their hands by their side and then move them up to high above their heads in an arc coming out in front of them. Do it once to show them. Ask them to do it four times in a row. Take a look at them front on and then side on.
You should be looking for the following things when front on:
- The height of each shoulder – is one higher than the other or are they even?
- The position of the head with regard to an imaginary midline – is the head off line / tilted back on to the midline?
You should be looking for the following things when side on:
- The position of the head relative to where it was when the hands were at their sides – did it pop forward or stay put when the arms came up?
- The position of their lumbar relative to where it was when the hands were at their sides – did they sway or arch as the arms came up?
- The position of the hips relative to where they were when the hands were at their sides – did the hips tilt forward as the arms came up?
Once you’ve completed your observations you can mark up / take notes on what you are seeing and shade any muscles that you think might be tight and / or affected. (See the full example later in this page)
What you have just done is establish how the brain currently patterns getting the arms above the head either due to restrictions/tight muscles/injuries/weak muscles or because it simply doesn’t know what it’s supposed to do. That said, the brain of a three year old can perfectly complete this movement so it’s most likely the movement is restricted if it’s not looking good.
If there are restrictions you can go a little further by asking the person to do it ten times. Watch carefully. Then question them as to what they felt.
If they felt better and moved more freely as they did more then the restrictions are likely minimal and with a good warm up and some cueing and the right exercise selection you should be fine.
If they felt worse and the movement got even more out of hand as they went the restrictions are likely significant and if loaded will cause an injury eventually plus cause reinforcement of a dysfunctional pattern. Refer them out to a physiotherapist or osteopath or musculoskeletal doctor with suspicion of shoulder and/or upper back restrictions.
If there was no change to the movement over time, and the client didn’t feel anything untoward, then restrictions are likely and if loaded may cause injury eventually. Refer them out.
We will deal with how to prescribe exercise for each of these scenarios in the prescription section but primarily if the person is going to shoulder press (complete the pressing pattern) in any way their ability to freely raise their arms above their heads will influence what you do with them. There are some very risky press pattern exercises available in clubs and not many people should be doing all types of them.
Sitting on the very edge of a chair and getting up from that point
Now put a chair behind your client and ask them to sit on the very edge of the chair as gently as possible. Get them to sit and stand four times. Remember, don’t show them or instruct more than what is written above, and don’t tell them how fast to go or anything, just let them do it.
For the first few stand at the side and watch what they are doing with their body. By the third or fourth time they will be doing it as best they can. Now ask them to look at you when they are doing it and stand in front of them now to do your observations. This will allow you to see if they can stay upright and aligned.
In an ideal world your client will simply glance backward, see where the chair is and gently place their butt on the edge of it staying relatively upright through the torso, with a neutral spine, with control of the movement up and down.
Things to watch for;
1. Can your client get all the way to the chair edge without dropping themselves onto it at the last moment? If they drop onto the chair they may be used to turning off their stabilizers in deeper positions (and a chair isn’t that deep).
2. Can your client get off the chair easily without support? This is trickier for them as they have to turn on their stabilizers to initiate the movement or they have to brace somehow either by putting a hand on one of their thighs, or by holding on to something. Just watch and see what their default approach is.
3. When your client starts to sit what is the first movement they make? If it’s bum out and round the back then when you load them in the squat pattern that may be their tendency. They may even brace themselves on their thighs going down. They could shoot their head forward and their bum out but stay extended through the lumbar – again this is what they would do if you put a bar on their back so it wouldn’t be ideal.
4. When you are looking from the front do they lean to one side, or does one bum cheek hit before the other, this is evidence of rotation in their squat pattern.
5. What are their knees doing when you look from the front? Do they buckle with weight going to the instep or do they stay inline. Again, if they wander the hip isn’t controlling flexion very well as it’s letting the femur medially rotate as they go up and down (this is what brings the knees together as they move).
Ask them how they feel doing that movement, and then specifically what they feel in their low back, hips, knees and legs. This allows you to identify areas that they feel are restricting them. Again, if movement can’t be improved with a good warm up, range of motion work, and cueing then they need to be referred out.
Now that you’ve seen the quality of their ‘sitting’ pattern which is one of their squatting patterns you can make a judgment of where to start your client on the squatting continuum (loaded or unloaded, full squat, half squat or partial squat etc).
Remember that there may be restrictions in their movement from joints, connective tissue, muscle tightness, imbalance or just poor patterning. Once you start working with them in the club you will find out what can be achieved and you’ll be able to judge what to do next.
If they are having trouble with stability sitting on a chair you will need to build range and control before loading them. If they can’t control hip flexion and keep a neutral lumbar spine then you will need to start teaching them that position immediately in a supported manner. If they complain of discomfort in the muscles and feel like they are being pushed over then it can be tightness and they should progress quickly by practicing the movement and increasing the range in a controlled position. If they complain of pain, discomfort in a joint or have dramatic shifts in their movement pattern you will likely need to refer out. Their may be a disc or spine problem or an issue at one of the joints in the leg. If it’s a joint in the leg they will likely complain specifically about it. If it’s the back they may not feel it distinctly but will complain of tightness in that area – this is because the muscles of the back will be protecting (bracing) that area.
You should also remember that none of these observations should be considered in isolation. You will be doing these movement assessments after you’ve conducted a consultation with your client so you will definitely know if they have injuries or recurring problems that put them in the physios office. It’s important to realize that no one piece of information will give you an answer, collectively all the clues will lead you to the most sensible course of action.
So, now you have some idea of what your client might squat like and you know what sort of squatting pattern they are reinforcing every time they sit.
One legged standing
Now have your client stand on one leg. This is a basic test to see how they stabilize the hip. Ask them to do one side and then the other, give them a few reps so they can get their balance. Watch what they do from front on.
Ideally they’ll just lift one foot and all the muscles will brace them in position through a series of contractions (usually the inner unit of the core, the gluteals, and the adductor of the leg still on the ground will work together).
Things you might see;
- They may ‘sling’ out to the side. This means the muscles aren’t currently patterned correctly to brace the hip in a one legged situation (such as phases of the lunge) and instead the hip is supported by the connective tissue (in this case the iliotibial band). This situation means they will have a sloppy sacroiliac joint when they step up or lunge and it also means there will be issues with squatting in terms of keeping the knees under control. They may be able to correct this just by knowing about it, or they may need some specific strengthening and awareness exercises to help.
Interestingly they may ‘sling’ (a lateral shift) on only one side rather than both. This can be because they’ve had an injury which has shut down the gluteals on one side to prevent force being generated around the lower back and hip or it could be because they have patterned in that movement through carrying a child on their hip, or having a standing posture which involves the lateral shift – a posture which they’ve had to adopt often due to long periods of standing.
So, now you know what capabilities your client might have to keep the hip in line when doing one leg movements and the squatting pattern. You will also know that unattended any dysfunction may cause knee and back issues and that loading the dysfunction will increase risk. So you know to address the pattern and provide stability, progressing the clients exercise to the point where they don’t sling and can then start loading.
Again, if improvements through cueing or specific conditioning aren’t evident or pain in a joint or a significant shift is present (dramatic when compared to the other side and/or normal) then referral to a physiotherapist or other specialist is necessary.
Push up
The push pattern is loaded in gyms all the time. It’s a good old favourite because you see the front of your body in the mirror 100 times more often than you see the back half.
Having a great front shouldn’t mean sacrificing the back of your body in some ritual of dysfunction. One way for a personal trainer to see what a client is ready to push is to assess their ability to do any form of push up they are willing to try.
Now a good push up is a rare thing – truly rare. With a push up of any kind you are loading the chest and shoulder girdle with significant forces and you are stabilizing three planes around the core (tummy) and neck and shoulder girdle.
To assess the current push pattern of your client ask them to do a push up of any type – the easiest they know. If they are very weak and out of condition then you can use a step box and have them push up from their knees.
What you are looking for when you observe any push up is;
- The position of the head – is it dropped forward or is the neck in extension with the chin out
- The curvature of the lumbar spine – is it saggy or flattened
- The curvature of the thoracic spine – is it very rounded or just gently curved
- Scapula control – are the scapula winged or sitting nicely on the back
As mentioned the more load on a structure (e.g. the body) the more the weaknesses are displayed so if the client attempts an advanced push up then you could see quite a mess. If that’s the case wind the task back and modify the push up. We recommend getting more involved with this assessment and making sure that if an out of condition client is shaping up to try a full push up you recommend the knee version or the step version in advance.
Once you are in the gym you can work on the push pattern more. The push pattern is used in daily life getting off the floor, getting out of a bath, and during some bracing movements where someone is using their arms to help lift their torso into position.
If someone has poor scapula control, poor control of their spine (neck and tummy area) then pushing lying on a bench (e.g. bench press) is not the best bet for them if you want to develop chest strength whilst protecting the shoulder and back from injury.
Teaching a client to work the chest whilst maintaining correct alignment is a useful way to get maximum bang for their buck. Assessing their current ability to complete the push pattern is a good starting point for the judgments you’ll need to make when prescribing for them.
The following sheet is a completed example of a movement assessment based on observations of the person used throughout this article.