Before diving into the program, a certified trainer should create a unique workout and training plan for their clients. These assessments allow the trainer to identify areas for improvement while also understanding the limitations of their client.
These assessments are often used to test the five most common components of health-related physical fitness: body composition, flexibility, muscular endurance, muscular strength, and cardiorespiratory endurance (American College of Sports Medicine, 2022). These assessments test five of the most common components of physical fitness for health: flexibility, muscular endurance and strength, cardiorespiratory capacity, and body composition (American College of Sports Medicine 2022).
Other components, like muscular power, speed, agility and quickness (SAQ), have been added to the health and fitness assessment. There are also various movement and postural assessments, such as the LEFT test, pro agility test, 40-yard dash, etc.
In the past decade, posture assessment has become a popular component of fitness and health assessments. The National Academy of Sports Medicine defines posture as "the relative arrangement of body parts with respect to the physical position such as standing up, lying down or sitting".
These assessments and test can be subjective and even between health and fitness professionals. This raises questions about the reliability of these assessments and testing. Static posture is one assessment that can be subjective.
Perform a static postural assessment
The first step in a health and fitness assessment is to collect valuable subjective information, from athletes and clients. Forms like the PARQ+, the Lifestyle and Health History Questionnaire and other important objective measurements, such as vitals and body composition, are used.
The next step in the health and fitness assessment puzzle often involves the assessment of posture. Static posture is defined as the "positioning of the musculoskeletal systems while the body remains motionless" (National Academy of Sports Medicine 2022a).
In a relaxed, standing position without shoes, static posture can be visually assessed from the anterior, lateral and posterior views (Figure 1). From the three different views, the certified health and wellness professional assesses the five kinetic chains checkpoints: feet and ankles; knees; the lumbopelvic-hip-complex or LPHC; shoulder complex and head and neck.
The National Academy of Sports Medicine (2022a) lists three common postural distortions that health and fitness professionals should be looking for. These are the pes planus syndrome, lower crossed and upper crossed syndrome. The presence of any deviations from a client's or athlete's ideal posture could indicate the presence of muscular imbalances. This can increase the risk and lead to chronic and acute musculoskeletal pain and conditions.
Visually Assessing the Static Position of the LPHC
It can be difficult for a certified health and fitness professional, to determine if a static posture is ideal or optimal, based on the lateral view. The lateral view of the LPHC can make it difficult for certified fitness professionals to perform a static postural assessment.
It can be difficult to determine the position of the anterior superior spine (ASIS) compared to the posterior superior spine (PSIS), or to assess the lumbar spinal level when the client, athlete, or patient is wearing loose clothing. Or, if the health and fitness professional is not familiar with the ASIS and PSIS landmarks.
Visual assessment of the ASIS and PSIS bony markers has been shown to have poor inter-rater consistency amongst various health care professionals, including chiropractors, physical therapy, physiatrists and orthopedic surgeons (Fedorak, et al. 2003).
The issue of invalid results is important because postural deviations below the LPHC, such as the lower-crossed disorder, can lead to postural deviations above the LPHC, like the upper-crossed disorder, and common musculoskeletal disorders, including neck and upper back problems, shoulder pathologies and knee conditions.
WHAT IS THE "IDEAL" STATIC PELVIC POSE? IS THERE A PERFECT POSTURE?
In a static posture of standing, neutral position is achieved when the ASIS and the symphysis Pubis are in the same vertical plane (McKendall et. al., 2005). Humans should have a natural anterior/lordotic curvature and extension of the lumbar spinal column, but it should not extend excessively.
In this position, the ASIS can be inferior anteriorly compared to the PSIS, which results in an anterior tilt. Multiple research studies have shown that an anterior pelvic angle can be as high as 27 degrees in asymptomatic normal individuals.
In Figure 1, the anterior/lordotic curvature of the lumbar spinal spine can be reduced when the ASIS is level with the PSIS. This results in a flattening of the spine.
The certified health and fitness professional will check if the pelvis has a neutral posture, is anteriorly or posteriorly tipped. McKendall et. al., as stated previously, state that the pelvis is in a neutral position when the ASIS is on the same vertical line as symphysis pubis. According to (2005), when the ASIS and the pubis symphysis are in the same vertical plane, the pelvis will be in neutral position.
If the ASIS lies anterior to the pubis, the pelvis will be anteriorly tilted. Conversely, the pelvis will be posteriorly tilted (McKendall et. al., 2005). What should certified health and fitness professionals do to determine pelvic position and assess the LPHC?
TRUSTING THE COMPLETE ASSESSMENT PROCESS
It is crucial that health and fitness professionals are aware that even asymptomatic people can have an anterior pelvic bend, even when measuring the ASIS or PSIS on a horizontal plane to determine pelvic position.
When assessing static posture, health and fitness professionals should look for obvious deviations or deviations from ideal or optimal static posture. An exaggerated anterior tilt of the pelvis, excessive lumbar deformity, and flexed joints in the hips, such as lower crossed syndrome, are examples.
If certified health and fitness professionals try to examine closely for any postural deviations that are static, they will be much more likely find something even if it is insignificant. It is important that certified health and fitness professionals view the static posture assessment as a teaser to the rest of their assessment process.
The health and fitness professional should allow the results from subsequent assessments such as the single-leg squat, overhead squat, pressing, pulling and pushing assessments and mobility assessments (such as those included in NASM's Corrective Exercise Specialization) to confirm the presence of any muscular imbalances suspected during the static posture assessment.
The certified health and fitness professional should be confident that any muscular imbalances caused by static postural deviations, such as an excessive anterior pelvic inclination and lumbar delordosis, will become more evident when the client or athlete performs a subsequent assessment.
