Pilates Postural Assessment – Rear

Elite Pilates & Yoga YMCA Teacher Training Course

I love Postural Analysis time when we run our Yoga or Pilates YMCA Level 3 Course. The anatomy section of ones training and biomechanics can actually come to life – its terrific seeing it all in action, as it were.

Students now, suddenly realise and start to notice, not just others peoples posture but their own, They then notice and are more aware of their own ‘abnormalities’.

Perhaps more importantly with the postural analysis, they can then link up what they are seeing and experiencing with, what muscles and or muscle groups are bringing this ‘abnormality’ into being.

Joseph Pilates original movements

From that they are encouraged to start thinking and linking up all of those Joseph Pilates original movements and the Contemporary movements, in an attempt to correct any postural abnormalities.

It is then that the ‘penny starts to drop’ and they seem to ‘get it’.

Below is a YouTube video of a Postural Analysis – Rear. Please remember that this is only aimed at our Level 3 Diploma Students – not advanced. There is so much to cover on this topic of posture, and of what is classed as ‘bad’ posture or as I have mentioned here ‘postural ‘abnormalities’.

Some (myself included) could give a good reasoning as to why there is no such things (per se) of ‘bad’ posture. Or indeed that so called good posture is a nonsense (I promise to do a blog re Evolutionary Biology and posture).  Suffice to say if Pilates Teachers and Physiotherapists were around over a million + years ago, man would not be walking upright now – because it is bad for the posture and structure of the bones are not designed to walk upright!).

One word of warning, just because you may find a postural ‘defect’ does not necessarily dictate that that so called defect necessitates being ‘fixed’ by you. Avoid the pitfall of professional arrogance – a blog to follow.

Quick analogy / example: if you were to perform a postural assessment on the Leaning Tower of Pisa, you would note that it needs to be pushed up straight. It has been that way since Circa 1173. If you were to suddenly put it into its correct upright position, I am sure you can imagine – bits would probably start to fall off and cause more problems than it fixed!

Elite Pilates & Yoga YMCA Teacher Training Course

“Hello and welcome to Elite Pilates & Yoga Teacher Training here in newton Abbot Devon. This is a YMCA Level 3 Diploma in Mat Pilates.

My name is Paul this is Tanja, it is alright we can edit the cellulite out. We can photo shop that out.

This part of the session / lesson is on postural assessment. This lesson is split into 3 sections. I always start with the posterior, the rear; then the lateral or side view, then the anterior or front view. This one is on the rear the posterior view.

Tanja I am just going to do a postural assessment on you. What I would like you to do, purely out of convention I do my postural assessments against this wall. And I do it looking at the back, the posterior view.

Standing in a Natural Posture

I need you to stand as your body honestly wants you to stand. One of the reasons for saying that is that:- some people walk in looking like Quasimodo. You tell them that you are going to perform a postural assessment and then they stand like Superman!

So I need to know how your body wants you to stand so we can find any ‘errors’ (Oh we have an interloper);  I need to know how your body wants you to stand and wants to make you stand – so that we can find any ‘errors’

So from the posterior view what am I looking for / at. What I look for, and you may well have a little check list that you have, What is the head doing? Head / neck – what is it doing. Is it over to one side (just put it over to one side – now move it into neutral). So what’s the head doing?

The Relevance of Anatomy

And I make a note of that. Now as Pilates Teachers, Pilates Instructors what you are looking for is (put your head to one side) is thinking now – anatomy!

Which muscles could be overly tight, pulling the head over to one side? Conversely which muscles may be weak on anywhere really, that can cause that. So basically look at your anatomy. What muscles attach to this area? What may be overly working, dominating, overly tight? Conversely which ones might be weak?

First thing we look for – what’s the head doing, what’s the neck doing? Some people, I don’t, go by the level of the ears to indicate if the head is tilted. But not everyone has the ears the same place, some have larger ear lobes one side. I don’t, I just look generally the head, and neck doing.

Next on the list what are these shoulders doing? Ideally we want the shoulders level. Before we go any further, whenever you do a postural assessment, make sure that the floor is actually level.

You need to take that into account otherwise, if the floor was up at an angle there then she is going to be up on one side. So are the shoulders level. If they are not, again, which muscles might be overly dominant and tight, conversely using this as an example:- the latissimus dorsi muscle on this side might be weak and ineffective, therefore the upper Trapezius  are dominating and pulling it out of position.

So don’t just think it is these (upper Traps) that are overly tight, and that is an anatomy skill, of knowing what muscles are involved.

So what is the head doing; what is the neck doing; what are the shoulders doing are they level?

Next what I look at, is what is the medial border of the scapula doing, in relation to the spine?  Now for people that tend to be (anterior) right dominant their right scapula might be rolled forward more.  Think muscles now! Anterior serratus, pectoralis major, pectoralis minor, head of the bicep, in particular the short head, because it attaches to the shoulder blade. And can pull it (scapula) out of position.

Tight vs Weak – Muscle groups

Conversely rhomboids might be weak – or weaker , or stretched out, elongated. Conversely the same can happen if you are left dominant. So I look at the spine, where is the medial border, is it the same each side?

What is the height of the inferior angle of the scapula? Are there different heights there? So that may not necessarily translate too much to the shoulder being up, but you might notice it being a little bit up, rotated around a little bit more than the other one.

Next I look at the spine. What in general is the spine doing? Ideally have as little on as possible, whilst doing the assessment (the client – NOT YOU) not always practical, especially in a group class. You cant always ask then to strip down into their bikinis, don’t just suddenly strip them naked!  But certainly on a one-to-one obviously get their permission.

So ideally as little as possible, so you can see what is going on in the spine. Is there a scoliosis there? Is there a lateral deviation in the spine?

Be cautious of people underwear or clothes that they may wear; can have an effect on soft tissues. Even on the scapula, some peoples bra especially if one side is really tight can pull. So you need to be aware and cautious of that. Is it their clothes that they are wearing which can pull the body out of position, certainly soft tissue.

So can you see an obvious deviation there? Next I look to the pelvis. Is the pelvis level? So then I have a little hands on palpate, just put you hands in on the top of the pelvis. Is one hip hitched up?  Or is it level? Now usually it is not always the case that the hip is hitched up per se – though that can happen, it is more a case of hip flexors being weak or strong. Either rotate the pelvis forward and thus giving that optical illusion that the pelvis is rising up, due to the shape of the pelvis, or is it rotated back?

So it is not always literally hitched up! It is more rotated giving it that appearance as if it is.

So what’s the head doing, what’s the neck doing, what’s the shoulders doing are they level, what’s the scapula doing, what about the medial border of the scapula doing in relation to the spine, what’s the spine doing – is it plumb or is there a lateral deviation anywhere? What is the pelvis doing, is the pelvis level?

Next I will just move this cuddly dog out of the way…and I look what are the knees doing, are they in genu valgus or out genu varus – are they bow legged or knock kneed?

I will be honest when I do my postural assessment, I do not worry too much about knees, a lot of it can be bone related rather than soft tissue.

Pes Planus or Flat Foot

The biggest one I look for is what are the feet doing?  Have they got a nice arch on them? Is it well supported? Or have they got a fallen arch, referred to as pes planus or flat foot?

Now on that note, most people seem to think that flat footed is just cosmetic. It is not it is very much functional.  Lets use an example, I have a very nice high arch so every time I land my foot it lands (lets assume I am normal – no such thing) then great everything else in the body is honky dory. If I have a flat foot, every single step I ever make (I will exaggerate it) as I land the foot the arch falls in and down and therefore the knee / leg is going to roll in, the femur is also going to roll in, putting extra stress on the knee joint.  It also affects the hip joint – think in terms of hip replacement or arthritis wear and tear on that joint.

The head of the femur and the acetabulum are not perfect spheres, so you wont get a nice smooth roll around in the joint as it does that. It is going to be more unnatural  movement. So it is very much a functional thing. And can rotate the pelvis slightly causing a lot of low back pain. Could be solved by a trip to the podiatrist and some insoles, and orthotics put in – if that is necessary for you.

Another thing with feet is something referred to as talus valgus, which is basically the talus bone, here, rolls in.  So you can argue (I am not a podiatrist, this is not my area of expertise) both talus valgus and pes planus causes a rolling in and this creates a kink in the Achilles tendon.

Now the Achilles tendon doesn’t run straight, but lets keep it simple, lets assume it runs straight. If you have a flat foot then you are basically putting a kink in it. And it is pure mechanics – it is not as efficient. Therefor there is imbalance in the sides of the body which is what causes problems. There is not going to be efficient movement. Which is not ideal if you are a sports person – well not for anyone really. But more so if you are into your sports.

And that is basically the postural assessment from the rear.

Trendelenburg

The one extra thing I do , and I am looking at the glute medius now, is I will stand back now and ask Tanja. Can you just lift your right leg up. When you lift it up just lift it nice and high to the floor, trying not to touch the wall as you do so. And then lower down.

If you touch the wall it just may alter what I am looking for. And now just the left. And now do it wrong, because you know what I am looking for. It is called Trendelenburg, Trendelenburg gait. What I am looking for is, as Tanja lifts her right leg up, her left glute medius should kick in and help keep that pelvis level.

If the glute medius is weak, you get one of two things happen. As you lift the right leg the pelvis dips to the right as the left glute medius is not strong enough to keep that pelvis up. So that might happen.

Conversely you might get, as you lift the right leg the body leans towards the weaker side. And that is the body compensating. The body the brain gets you to lean over to the other side to compensate for that being weak. The body, the brain gets you to lean over to the other side, to compensate for that being weak, not being strong enough to keep that pelvis level. The body just uses force, gravity to take the weight over to keep your balance.

Now you can get both. When you see people walk you some times get them leaning the top half over from side to side. Now that is referred to as Trendelenburg gait.

Now that is a sign – not that they have sexy hips – it’s a sign that they have weak glute medius one side or the other.

And that is the postural assessment. Actually a little bit more detail than you need to know.

To Sum Up

A summary and keeping it simple. 90% of people will have

A lot more clothes on than Tanja. Tanja just likes stripping off for some reason. So they will have a lot more clothes on.

• Get them to stand naturally
• What is the head doing?
• Is the head over to one side?
• Are the shoulders level?
• How far away from the spine is the medial border of the scapula?
• Any deviation in the spine?
• Is the pelvis level?
• What is happening with the knees?
• What are the feet doing are they flat footed and how does that affect the Achilles? I it one side or both. Again it is usually imbalance that causes the problems in the body.

You can be massively tight in one side of the body and the other side, that may cause less problems than if one is ‘normal’ one side yet tight on the other side.

One word of caution if you are working with top athletes. They may actually require imbalance for their respective sports, I will give the tennis player Rafael Nadal is left handed, take a look at almost any picture of him and take a look at his left sided dominance. If you were to work with him and balance him out I would suggest his tennis would possibly deteriorate. Likewise swimmers require longer more flexible anterior tibialis etc.

Much Love from Devon

Paul & Tanja x