Do you have clients who complain about lower back pain, cervical pain, or knee or hip pain? If so, these clients may be suffering from a postural problem. Before designing any fitness program, a trainer should teach each client proper posture.

Directing a client through more advanced exercise training can only happen when the client has a full understanding of total body postural awareness. This should include some of the more noticeable aspects of stance and muscle tension. Some examples are how far apart his or her feet should be, the slight tightening of the abdominal muscles, the natural curve in the lower back, the palms of the hands facing the thighs, etc.

Steps to Ensure Proper Posture

1. At the initial meeting, the trainer should have the client complete a health history questionnaire form. In addition to a personal medical history, this questionnaire should include questions about your client's daily activities.

Below are some sample questions to include in such a questionnaire:

• What is your occupation?
• Does your work require a lot of sitting, a lot of standing, or a combination of both?
• Do you work at a desktop computer? If so, how many hours a day?
• Do you carry a hand bag or backpack? If so, on which shoulder? 
• Do you play sports? If so, which ones?

2. After reviewing the questionnaire, it will be necessary to conduct some assessment tests. This will enable you to design an effective program for your client. As part of the assessment, you will want to observe your client standing from the back, from the front and from the side.

The following are just some of the observations that should be noted: 

• the head is balanced/the chin does not jut forward 
• the chest is raised slightly
• the abdomen does not protrude
• relaxed knees (not locked)
• the shoulders are level
• the kneecaps point straight ahead
• the feet are directly beneath the knees, facing forward, and are neither inverted nor everted.

3. Next, the trainer should conduct some activities to determine the client's posture in his or her daily routine. Remember to take notes on your client's body posture (i.e., positioning of the hands, hips and shoulders, curve of the lower back).

The following are some examples of preliminary tests to do with a client.

• Have your client walk 10 feet away from you. Then have your client turn around and walk back towards you. Observe the client's entire body as he or she walks back and forth. If your client carries a shoulder bag, have your client perform the exercise above with the bag on the shoulder.

The following are just some of the observations that should be noted:

• is one shoulder higher or lower than the other shoulder?
• does your client walk with their feet pointed out?

If your client's occupation requires computer work in a seated position, have your client sit and type a few paragraphs. 

• The following are just some of the observations that should be noted: is their seat too high or too low in relation to the key board, does your client cross their legs under the desk or have a foot stool to rest their feet on squarely.

Similarly, if your client's occupation requires extensive  telephone operation, have have him or her sit and talk on the telephone for five to ten minutes. Such occupations commonly furnish a headset microphone and headphones. Ask your client if this applies to his or her work situation and adjust the test accordingly.

The following are just some of the observations that should be noted:

• how does your client sit: does the client cradle the phone on the shoulder?
• If using a headset, does the client's head and neck tend to lean to one side?

If your client's occupation requires a lot of driving, observe his or her driving position and the distance between the seat and the steering wheel.  

The following are just some of the observations that should be noted:

• is your client reaching to hold the steering wheel, slouching in the seat or hunched over the steering wheel?

Does your client participate in any sports. If so, which ones?

For example if your client plays golf, have your client set-up as though he or she were going to tee off.

The following are just some of the observations that should be noted:

• does the posture appear to be hunched?
• does the lower back have an excessive curve?

The above examples should be thought of a starting point. The list of potential tests to observe everday posture is practically endless. 

The goal should be to observe each client's posture in the activities that they perform daily. Efficient and effective performance for both everyday activities and sports is directly related to proper body alignment. By correcting existing muscle imbalances, it is possible to help your client achieve better posture.

4. Program design should be the final step. Your client's regimen should include conditioning exercises and stretches to help correct any muscle imbalances.

The following are some exercises to help improve posture.

Scapular Retraction

This exercise is designed to reinforce scapular stability to help maintain proper alignment throughout the day. The exercise can be performed standing, sitting or for the more advanced - lying supine on the stability ball.

• Sitting or Standing:
  • Sit or stand. Straighten your arms in front of you. Then draw your shoulder blades down and together.
  • Lying supine on the stability ball: Sit on the ball. Walk your legs out so that your head, upper back and shoulders rest on the ball. Straighten your arms towards the ceiling. Then draw your shoulder blades down and together into the ball. Perform this exercise five to ten times, in the morning, afternoon and evening. Inner

Thigh Squeeze

This exercise is designed to strengthen the inner thigh muscles, creating a stable internal base for the pelvis. Lie on the floor on your back. Place the ball between both of your knees. Squeeze the ball. Hold for 3-5 seconds. Perform this exercise five to ten times, in the morning, afternoon and evening.

Parting Thoughts

Remember that poor postural habits are developed over time, and that they can take time to correct. Teaching your client important postural cues and including exercises in his or her regimen to establish body alignment will cause the client to be more aware of their body positioning throughout the day and during exercise. Over time, your client will stand, walk and sit with proper body alignment. He or she will feel more energetic and efficient at work and will fatigue less when playing sports.

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