There are many postural misalignments that occur as a result of today’s lifestyle habits, in particular the need to be seated at work for long periods of time. Even the fittest of clients could still have potential misalignments of the spine that have developed as a result of training or perhaps they were born with a condition. In order to train clients effectively and prevent any further muscle imbalances, you need to perform a postural assessment, even a basic one will benefit both you and them.

If you’ve done some postural training before then you should be able to perform a more extensive assessment. If you haven’t then there are things to look out for in order to spot these 3 skeletal conditions: kyphosis, lordosis and scoliosis. Osteopath Cameron Reid is running a Postural Assessment Workshop to give instructors more hands on ways to assess clients and determine the best exercises to help them. You can find out more here.

Today, I will re-address the 4 types of spinal misalignments and highlight some tips for spotting them.


Kyphosis is a skeletal condition which affects the thoracic part of the spine causing an excessive curve and rounding of the shoulders. This impacts the lumbar spine too causing a posterior pelvic tilt. This condition is more prevalent in the older adult population but can also affect individuals with low confidence (due to the way they stand with closed body language) , people that work at desks for long periods of time and strength training individuals who focus heavily on chest muscles. When people start to develop this condition it is due to muscle imbalances and therefore we can provide support as fitness professionals to help prevent this developing further. In this case, the muscles which are tight include the pectorals and sternocleidomastoid, then the muscles which are weak are the rhomboids and trapezius. Since it can also cause a posterior pelvic tilt we also see tighter abdominal muscles and hamstrings with weaker erector spinae and quadricep muscles.

In order to spot someone that may be demonstrating signs of kyphotic posture, look for:

  • A difference in shoulder height
  • The chin position being closer to chest
  • The ear being extended forward of shoulder joint (acromion process)
  • Stiffness in spine
  • inability to stand with back flat against wall
  • Tight hamstrings

A client demonstrating these signs would benefit from a programme that focus’s on stretching the tight muscles and strengthening the weak muscles. Ensure every functional exercise performed is done so with these imbalances in mind.


Lordosis is the second common skeletal condition we are discussing, this time affecting the lumbar spine causing an arch in the lower back. This condition affects people who are sedentary and sit with poor posture, obese individuals, pregnant women and potentially people who have osteoporosis. In the case of this condition we see an associated anterior pelvic tilt and the severity of the lordotic curve can vary greatly between people. People that present with lordosis also have muscle imbalances, this time we see weak muscles in the abdominals and hamstrings whilst the tight muscles are the erector spine, hip flexors and quadriceps.

In order to spot someone that may be demonstrating signs of lordotic posture, look for:

  • A visibly excessive arch in their lower back
  • Tightness in the hip flexors, erector spinae and quadriceps
  • Decreased range of movement in the lower back

Perform this simple test to help you assess them: get your client to stand upright against a wall or door. Ask them to place their heels, bottom and shoulders against the wall and remain upright. Use your hand to determine how significant the gap is in their lower back by placing your hand through the gap (palm against the wall). Someone with minimal lordosis will only have a gap big enough for you to get the length of your fingers through, whereas someone with more significant lordosis will have a gap that allows for your whole hand or even arm to fit through. Just like kyphosis, in order to improve a client with this condition you need to strengthen the weak muscles and stretch the tight muscles on a regular basis.

By Gunel Malikova (Own work) [CC BY-SA 4.0 (], via Wikimedia Commons


Scoliosis is the final skeletal condition we are covering today and this is demonstrated by a ‘S’ shape to the spine when looking at the person from behind. This condition can be genetically inherited and therefore children can be born with the condition; for others it is a case of imbalanced stress being placed on their spine over a period of time. The deviation of the curve can occur in the thoracic region of the spine or lumbar. Depending on the area it will affect what signs you would see.

In order to spot someone that may be demonstrating signs of scoliosis, look for:

  • Uneven shoulders – one more forward than the other
  • Aching, discomfort or pain in their back
  • A shoulder blade which stands out as more prominent
  • Un-level hips
  • Clothes not sitting straight

If you ask clients to stand with their hands resting by their sides, you may also find one of their hands are closer to the thigh than the other, indicating a spinal twist. Exercise isn’t quite as effective at improving scoliosis compared to the other skeletal conditions but it is definitely important to ensure good posture, muscle balance and to manage pain or discomfort. Unilateral exercises could prove beneficial to improving the strength differences either side of the spinal curve too.

By Gunel Malikova (Own work) [CC BY-SA 4.0 (], via Wikimedia Commons

Hope you have found this beneficial. If you would like further training on this topic then find out more about our Postural Assessment Workshop with Osteopath Cameron Reid.