In this blog we are going to break down a Postural Assessment to let you know what exactly we look at and why.  You might notice every time you see a Physiotherapist they ask you questions, lots of questions. We are looking for clues, patterns and reasons why somebody might be getting pain or discomfort.  Sometimes the answer is obvious, like tripping and spraining your ankle, and sometimes it takes a little digging and putting the picture together of what it is your body goes through everyday.  Posture is an important part of this.  As a society we have moved toward more sedentary jobs and activities, leading to more tightness and stiffness in our joints and muscles. This can cause our muscles and joints to pull different parts of our body out of alignment.

So the first part of the Postural Assessment is looking. It’s as simple as that.  Looking for differences from side to side, and differences to what we expect to see, comparing your body to the “normal”expectations.  We are looking for little things like muscles being slightly different shape and size from side to side, or joints sitting in positions that may cause biomechanical changes to the way the muscles pull on the joints, or may indicate instability.

Now using these observations we can categorise people into different postural groups:

Ideal or “normal”posture

Kypho-lordotic posture

Sway back


From the picture you can see the ideal posture, the imaginary plum line falls from the earlobe, through the tip of the shoulder, past the greater trochanter (outside hip bone), through the middle of the knee, down to the inside of the ankle. You can see the soft curve of the spine, where there appears to be no hard corners for forces to shear through, the weight of the head sits balanced on the top of the cervical spine and the shoulders are open.

The second picture shows a kypho-lordotic posture.  Here you can see that the head is now in front of the plum line, and to allow this the mid back rounds forward to try and keep the weight of the head on top of the neck.  As a result of this the muscles of the shoulder and chest shorten, and the muscles of the mid back lengthen, and over time, this limits their ability to pull the shoulder back and open up the chest. This then causes the lumbar spine to arch in the opposite direction in an attempt to bring the body’s centre of gravity back above the pelvis.  To do this the pelvis itself tips forwards, requiring the hip flexors to activate and pull the front of the pelvis forward.  At the same time the back muscles shorten and can be highly active as they try to stabilise the pelvis.  Additionally,  the tip forward of the pelvis has especially lengthened the lower abdominals, making them difficult to recruit.

The third picture is a flat back. Imagine a dancer, or military person with their overly straight backs rigidly trained positions.  This time although the head is forward of the midline, the natural curvature of the spine has flattened, with the pelvis tilting backwards to compensate for the neck position. This results in rigidity of the muscles either side of the spine, a shortening of the hamstrings and the lengthening of the hip flexors.

The final picture is a sway back.  Again here you will see the head forward of the midline and the upper back rounding forward to compensate with a shortening of the chest and shoulder muscles.  But unlike the kypho-lordotic posture, the lumbar spine does not arch or curve, rather appears to hinge, and the upper body “sways”back pushing the pelvis forward to bring the centre of gravity back to the midline. There is a lengthening of the abdominal muscles reducing their ability to activate and translate the weight of the torso forwards, and the knees hyper-extend due to the body weight being behind the pelvis.

You might recognise some of your own habits and positions in the descriptions above, but the good news is you can change! Length and strength are adaptable, so exercise, especially Pilates, can have a positive effect on improving your posture.

You should always get your posture assessed properly. Our team of Physio’s at Bend + Mend in Sydney’s CBD are specially trained to tailor our Pilates programmes and help people overcome these issues. Book in today and improve your posture!








Kirsty Wall

About Kirsty Wall

Kirsty graduated from the University of Otago in 2004, and has worked in private practice in New Zealand and England, before moving to Sydney. She has spent the last three years becoming a certified Pilates instructor alongside her physiotherapy work, and recently became a Master instructor on all apparatus. Kirsty really enjoys bringing Pilates and Physiotherapy together, as she feels they have a symbiotic relationship, guiding patients back to their pre-injury activities as well as preventing re-occurrence. As Kirsty is new to Sydney, she is spending her spare time get to know the city, going on big walks and generally just enjoying the sunshine.

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