Getting Comfortable With Postural Analysis

By David Kent, LMT, NCTMB
May 29, 2009

Getting Comfortable With Postural Analysis

By David Kent, LMT, NCTMB
May 29, 2009

We all recognize the importance of getting our cars serviced regularly so they run at their optimal level. Not surprisingly, the same is true of the human body. In fact, there is a very useful car-related analogy we can use when it comes to describing postural analysis: front-end alignment and wheel balance.

The word posture is derived from the Latin verb ponere, meaning "to put or place." The word analysis comes from the Greek word analyein, meaning "to break up." Therefore, postural analysis is simply the process of "breaking up" the body to determine where it should be "put or placed." This article reviews body positioning for the purpose of taking a standing (static) postural analysis so you can custom-design your clients' therapy sessions.

When a vehicle's alignment is off, it manifests as uneven tread wear and loss of tire life. Likewise, when a car's tires are not balanced properly, ride quality is diminished, tire life is shortened, and bearings and shock-absorber performance suffer. When one's posture is off, the human body also experiences a range of problems: restricted range of motion, pain, organ dysfunction, and joint, tendon, ligament and muscle stress, to name a few.

The body, like tires, has an ideal position. It also must be balanced to run smoothly and last a long time. For a mechanic to assess and adjust the front end of a vehicle, they must first check wheel positioning for deviations from the norm. To do this, they set the wheels in a standard position and conduct an evaluation. In massage terms, this is the equivalent of taking a postural analysis. A mechanic's objective findings also are reported in terms we can relate to the body. For example, what the mechanic refers to as "toe-in or toe-out" is what we call "internal or external rotation." What a mechanic calls "camber," we call "tilt."

When we report to a mechanic that the tire tread on our vehicle is wearing unevenly and the steering wheel is vibrating, we have given our subjective complaints. The mechanic hears this complaint frequently and knows exactly what needs to be done. Before they can conduct their evaluation, however, they need to use the proper equipment to access and design a repair plan according to the car model's specifications.

In the same way, clients often make subjective complaints to us about headaches and neck and back pain. Just like a mechanic, we need to use the proper equipment to access and design a customized therapy session to meet each individual client's needs, focusing on both short- and long-term goals.

The "manufacturer specifications" for the human body include the anatomical planes that show us the ideal positioning of joints and bones. While individuals are not expected to be positioned perfectly, we want to facilitate the best posture possible through massage therapy. According to Muscles: Testing and Function, "Ideal skeletal alignment ... involves a minimal amount of stress and strain and is conducive to maximal efficiency of the body." Moreover, "the intersection of the sagittal and coronal midplanes of the body forms a line that is analogous to the gravity line. Around this line, the body is hypothetically in a position of equilibrium. Such a position implies a balanced distribution of weight, and a stable position of each joint. When viewing a posture in a standing [position], a plumb line is used to represent a line of reference. ... Since the only fixed point in the standing posture is at the base where the feet are in contact with the floor, the point of reference must be at the base," or the foundation of the body.1

Whether you work in spa, clinic, medical office, fitness center or some other venue, there are certain things you must do to conduct an effective postural analysis.

Postural Analysis Checklist

[ ] Hang a plumb bob approximately 3 feet in front of a postural analysis grid chart. The plumb bob should be approximately a quarter inch off the floor.

[ ] The client should be:

  • in bare feet;
  • wearing clothing that allows for visual observation of body contours;
  • standing between the postural chart and the plumb line, but their body should not be touching the plumb line or chart; and
  • with their hair behind the ears, as the external auditory meatus is an anatomical landmark used as a reference point.

[ ] Position the feet in relation to the plumb line:

  • For anterior and posterior views, the heels are equally spaced from the plumb line and posture chart. See #1 and #2 in the image above.
  • For a lateral view, the plumb line is immediately anterior to lateral maleous. See #4 and #5.

Now, stand a few feet back from the plumb line. Using a digital camera, move from side to side (right to left) until the plumb line is lined up with the center line of the grid chart. Take a photo of the client and make any necessary notes for your objective findings.

We all know the saying "A picture is worth a thousand words." In images #1 and #3, it's easy to see how the right shoulder is higher then the left. We see the torso and head are to right of the mid-saggital plane. In the image (#4 and #6), it's easy to see the forward head posture and the right shoulder posterior to the coronal plane. These deviations have numerous origins. A muscle-movement chart will help quickly determine which muscles are shortened and which ones are lengthened, helping you design a customized treatment plan.

There are many advantages of taking postural photos including:

  • documenting posture before and after a series of treatments;
  • educating clients about their postural distortions and demonstrating causes of pain, muscle weakness, etc.;
  • showing clients, physicians and other relevant parties, a client's treatment progress;
  • presenting clients with clear treatment solutions;
  • recording and documenting the client's postural changes;
  • customizing treatment plans; and
  • confirming your objective findings via trigger-point charts. (See my article, "Charting Progress: Visuals for Success," in the February issue for more information.)

When you take the time to administer a precise posture evaluation for your clients and devise a customized treatment plan, you will gain their respect and earn a reputation as a top massage therapist. Your clients also will appreciate how you utilized the information to educate them.

Don't let the idea of conducting a postural analysis intimidate you. There are many things we do every day that we once learned to do for the first time. Once you get comfortable with posture, it will be easier to think about each client as an individual and know how to develop special treatment plans for each person. Over time, posture analysis becomes easy - second nature. You just need to start doing it.


  1. Kendall FP, McCreary EK, Provance PG. Muscles: Testing and Function, 4th ed. Baltimore: Williams & Wilkins, 1993: pg 71.