Since Pilates exercise emerged on the fitness scene in late 2001, it has made us all more aware of postural alignment and, most of all, neutral spine. Even though neutral spine is not exclusive to Pilates exercise, it was brought to life by the focus on the mind/body discipline. In the application of Pilates, the alignment is crucial, which is one reason that it can be the most frustrating form of exercise for newcomers. My goal in this article is to shed some light on neutral spine and postural assessment, so personal trainers can begin to utilize this knowledge for all exercise prescription.
I think one of the areas most misunderstood by fitness professionals is that the spine should have normal curves. When we hear the terms "lordosis" and "kyphosis," we instantly think of abnormal curvatures of the spine. However, a straight spinal column is not as strong or efficient as a spine with natural curvatures. In a normal, healthy spine, there should be a natural lordotic curvature of the cervical (neck) and lumbar (lower back) spine. In the thoracic (upper and mid back) spine, there exists a natural kyphotic curvature. Every healthy child is born with these natural curvatures. However, aging, activities and injuries can change these curvatures to become exaggerated. These exaggerated curves in the spine are when we would use the terms lordotic or kyphotic to define a postural imbalance.
In order to fully understand how to assess what is a natural or exaggerated curve, you must understand how to assess posture. This is the first step in developing an "eye" for the body. This visual assessment is what Pilates instructors do best. It is not necessary to learn a mind/body discipline in order to be good at assessing the body; however, it does require observing many different types of bodies. Pilates instructors do this every day when working with clients. They watch how their clients walk in the door to determine their gait pattern and examine clients' posture when relaxed. Try looking at your clients when they are not paying attention to you, and you will get a better idea of their real postural alignment (see Homework Assignment below).
Once you have started initial observations, then it is time to learn how to perform a full postural evaluation on a client. Ideally, it is best to take a photo of clients from all sides. This will allow you to show your client visible progress of their improved posture. This also makes it much easier for you to assess their postural needs when you have time to review the pictures. To begin the assessment, have your client stand in a relaxed way with feet hip distance apart. View the posture first from one side and then the other. Draw an imaginary line down the center of your side (this is called the sagittal plane). When the body is aligned properly, the line will pass through the following points:
- The center of the earlobe
- The tip of the shoulder
- Mid way through the chest
- Slightly behind or at the hip joint
- The back half of the knee joint
- The ankle bone
Once you have done the side view, you need to look at clients from the front and back. You should observe that their shoulders are the same height, check to see if their shoulder blades “wing” or stick out from the back and make sure their knees and buttocks are even. A thorough postural assessment will give you a lot of information about the body. Many times, a client will carry a heavy bag on only one side of the body, and over time, the shoulder of that side begins to drop, creating an imbalance. Imagine a stack of children’s building blocks placed one on top of the other. If one block is not aligned properly with the others, it causes the entire stack to be unstable. This is the same for your spine. The difference is that we don’t topple over like building blocks when we are out of alignment. What does happen is that our joints and muscles begin to compensate, which creates pain, weakness and instability. This can lead to injuries, stress-related conditions and fatigue. Let’s examine common postural faults to help understand how, as a trainer, you can help clients overcome their poor body mechanics.
Most postural imbalances can be seen visually when posture is assessed. The cause of those imbalances may not always be caused by a client’s activities. It may be the effect of certain conditions such as pregnancy, scoliosis, arthritis and osteoporosis. While certain conditions like pregnancy are temporary, the effects of the pregnancy on the woman’s postural alignment can be lasting. As a personal trainer, it is important that you help your clients to become aware of their postural alignment.
Listed below are some of the most common postural imbalances, starting with the cervical spine and ending with the lumbar spine. The muscle length and strength listed in the descriptions are a general assessment that fit into the scope of practice for a personal trainer.
- Cervical Lordosis - This is a posture where the chin is pushed forward, causing the cervical spine to be out of alignment. It is commonly referred to as “forward head,” and it causes the sternocleido mastoid to shorten while the muscles of the upper back lengthen. This can cause neck pain and fatigue.
- Thoracic Kyphosis - In this posture, there is an exaggerated curve of the thoracic spine. The muscles of the upper to mid back become weakened and lengthened, while the muscles of the chest shorten. This creates a rounded shoulder posture, which can inhibit respiration.
- Lumbar Lordosis - This is when there is an exaggerated curve in the lumbar spine. In this posture, the pelvis is tilted anteriorly (ASIS in front of the pubis). Generally in this posture, the hamstrings and abdominals become lengthened as the hip flexors and muscles of the lower back shorten. One common problem of this posture is lower back pain due to weakened abdominals, which can also affect digestion.
- Sway or Flat Back - In these two postures, the pelvis is tilted posteriorly (ASIS behind the pubis). In the flat back posture, there is no curve to lumbar spine, which lengthens the muscles of the back and can shorten the muscles of the chest. In the sway back posture, the ribcage is pressed forward as the back “sways,” creating imbalance and poor coordination. In both postures, there is a shortening the hamstrings and lengthening of the hip flexors due to the imbalances in the structure.
As a personal trainer, it is imperative that you program for posture by prescribing exercises to correct postural imbalances. Even if you are training an athlete with a sport specific training goal, part of your exercise prescription should be to provide him/her with exercises that will help the imbalances created by the particular sport. If you use the guide above, it explains general muscle length and strength. Start by assessing the body and then determine the postural type(s) that are present. This will then guide you to prescribe exercises based on specific muscle length or strength. Making your clients understand and become aware of their bodies can help them to correct their own posture by making them more aware of the activities that help to create these imbalances. The next step is to teach them how to improve the alignment of the body.
Take a photo of a client or co-worker from the side, front and back. Look at the photo to assess his/her posture. Note any imbalances in the body structure from the list below. This will help you to develop a better eye for the biomechanics of the body.
- Is the ear in line with the tip of the shoulder?
- Do the shoulders round forward or are they in line with torso?
- Is the pelvis in an anterior or posterior tilt?
- When viewed from the front or back, is one shoulder higher than the other?
- When viewed from the back, do the shoulder blades stick out from the back?
- Do the ankles turn inward or outward?