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All advice provided is just that, advice. If you have any health concerns or questions, consult your physician before implementing.
 Table of Contents

Page 3: Chapter 1: Introduction to Posture

Page 6: Chapter 2: Posture Assessment Setup

Page 8: Chapter 3: Assessing a Client’s Posture

Page 26: Chapter 4: The Correction Process

Page 30: Chapter 5: How to Generate Greater Income

Income with Posture

Page 37: Author Bio and Contact Info

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 Chapter 1: Introduction to Posture
Welcome to the world of posture analysis and correction. Whether you are new to the fitness
industry or a veteran physical therapist, anyone that dabbles in the area of movement needs
to know how to analyze and correct posture.

My goal through this book is to show you:

• How to assess a client’s posture from head to toe utilizing a posture assessment form
that is included within this book
• How to begin correcting posture using a structured program that we developed
• How to increase business by providing proven steps to implement a posture assessment
program that works.

I’m sure you are curious about who I am and more importantly the National Posture Institute.
Firstly, the National Posture Institute has been working to change the industry with posture
analysis and correction education since 2006. We’ve strived to accomplish this through a
variety of outlets, including hosting posture workshops throughout the country as well as
internationally at national conferences and at colleges/universities. We’ve also presented at
numerous conferences and offer our programs through organizations such as ASCM, IDEA,
SCW, DCAC, ICAA, NIRSA, Club Industry, and Can-Fit-Pro to name a few.

We have also presented and partnered directly with colleges throughout the United States to
offer both our online and onsite curriculum. The National Posture Institute has partnered with
the following academic institutions to offer our classes and programs: University of Maryland,
San Diego State University, Chicago State University, Norfolk State University, and the State
College of Florida.

Have you heard of Ken Baldwin? He’s our Executive Director. He’s been in the fitness/health
industry for over 20 years and has been involved in online course and academic program
development for 15 years. He is currently an Associate Professor/Coordinator for an Online
Masters’ degree in Fitness and Wellness Leadership.

Now a little about myself, my name is Dimitri Onyskow. As NPI’s Director of

Academic Relations I have the privilege of being part of the leading posture
organization for health and fitness professionals that teaches posture and
body alignment analysis and education. In addition, we set the industry
standard in educating members of the public about daily posture
assessments and exercises to correct posture. We also have program
coordinators, instructors, and committee members on our board of advisors.

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They all are leaders in the industry that tirelessly provide valuable information to our students,
followers, and members of the public.

With all of that stated, you are probably wondering how and why posture works, not only
from a physiological standpoint, but also from a business standpoint. I think this is explained
best by one of our previous graduates.

We do like to keep up with our graduates to see how they are doing. When we got in touch
with Desiree Nathanson and asked her what her thoughts were on how posture has helped
her career, one of the things she stated really helps put everything into perspective.

“…they start feeling and seeing improvements in their posture quickly and they
are always incredibly excited and eager to pass along their newfound knowledge
of proper posture!”

Desiree brings up a great point. Posture is so powerful, so impactful on a person’s life that
their only course of action is to tell others about their achievements. Why is this important?
Word of mouth is the best and oldest form of marketing. I can guarantee they will mention
your name more than once when discussing their accomplishments with others.

This is why you need to keep reading; you can learn how to
analyze and correct posture, and how to turn it into untold
amounts of new profit. To get you there, I need to first show
you how to actually assess a person’s posture.

Keep in mind the depth and understanding behind analyzing and correcting posture that NPI
provides is unique. In our program, we provide detailed information on how to assess/correct
posture from head to toe (we leave nothing out). We are also one of the only organizations to
focus on daily, repetitive activities that lead to postural issues. We focus on teaching you how
to perform exercises and other daily movements in proper alignment to improve posture and
general wellbeing. We are one of a kind and our graduates agree that it’s effective.

As I walk you through how to assess and correct posture, keep our definition of posture in
mind:

“The position or attitude of the body or bodily parts that requires minimum muscular energy
to maintain mechanically efficient function of the joints with musculoskeletal balance”.

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This is our main goal as posture professionals; We need to help clients return their bodies to a
state of “musculoskeletal balance”. By doing this, posture abnormalities reverse and their
quality of life improves.

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 Chapter 2: Posture Assessment Set Up

Before you actually assess a person’s posture, first, you need to have the client follow a few
preparation steps. You must inform the client of this before they actually come for the
assessment. You also need to be sure that the client understands the following:

• They should wear minimal clothing and clothing should

be tight fitting to maximize joint structure visibility
• Put long hair in a pony-tail so the shoulders can be
seen/assessed
• No Shoes – Please note: If you are working with an
elderly client or someone with severe limited range of
motion, you could skip this step to reduce the risk of falling.

Once you take care of the client setup you also need to consider the preparation for yourself
as the one providing the assessment. Be sure to:

• Have a digital camera or phone ready for photos

• Take clear and precise photos. The photos are critical for documenting the client’s initial
postural status. These photos are used when comparing before and after pictures during
follow up assessments. (We will discuss more on this later)
• Use a posture grid (if possible). This is not required, but helps greatly with providing
results to clients. The lines on the grid show the client the current state of their posture.
In addition, it helps provide more exact results when comparing before & after photos.
When the client arrives for their posture assessment, be sure to take 3 photos while client is
standing:

• Anterior (front)
• 2 Lateral-right/left side views
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It is important to take and review all 3 views as poor posture can develop in major anatomical
areas of the body, such as the shoulder complex. Poor posture can also vary from the left side
of the body to the right when comparing the two lateral images. Further, when a client first
comes to you they may feel nervous as you take their photos. Assure them that this process is
important because they will visually see the problem areas. Doing so should help them relax.
After you complete the process, compare your findings; look at each view to ensure you have
no conflicting results.

Save a copy of these photos on your computer in specific client

folders and always indicate the date they were taken. This will help
you stay organized; it will speed up the process of locating photos for
future assessments. Here is an example of how you can name the
image when saving it:

• JohnDo_Anterior Posture_1-1-16

In addition to saving the photos, print a copy of each so you can sit with the client and assess
their posture using the pictures. When sitting with your client, be sure to use a posture
assessment form. I’m going to provide you with one of these later in this book. After the
assessment, you can email the client a copy of the photos with your notes from the
assessment (more on this later as well).

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 Chapter 3 – Assessing a Clients Posture
There are several steps to assess someone’s posture and I am going to walk you through the
process in this chapter. I will break this chapter down into 2 Sections: Anterior (1) and Lateral
(2). Additionally, I will focus on the upper half of the body then the lower half as there is quite
a bit to cover for each. Lastly, I will present common anatomical considerations for why poor
posture is occurring to help give you a better understanding of what is going on in the body.

Before I discuss the assessing process, it is important to record your posture assessment
findings. Here is an example document we use to record the information (full assessment form
on next page):

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 STATIC POSTURE ASSESSMENT

NAME: ________________________________________________________ DATE: ________________

Anterior Posture Right/left Comments

Head Laterally Rotated R L
Palms Posteriorly Positioned
Shoulder Deviation R L
Depressed Chest
Lateral Pelvic Tilt R L
Genu Valgum (Knock Knees)
Genu Varum (Bowlegs)
Degrees Feet Turned

Lateral Posture Right/left Comments

Body Displaced Anteriorly
Body Displaced Posteriorly
Forward Head Protrusion
Depressed Shoulder R L
Excessive Kyphotic Curve
Excessive Lordotic Curve
Kypholordosis
Abdomen Protrusion
Flexed Knees
Hyperextended Knees
Foot Arch

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 Section 1: Anterior Posture – Upper Body
When assessing someone in this view, you will be
looking for the following:

! Head tilted in either direction and/or turned

! Shoulders same height
! Can you see the front of hands or thumbs?
! (ASIS) Two hip bones same height
! Anterior superior iliac spine
! Notice muscle fiber direction/development

Please note: We always recommend starting from the

head and working your way down the body. We say
this because a consistent, structured assessment will
make the client feel more comfortable when they
come back in for later assessments. Keep the method
and design consistent so the client will know exactly
what to expect each and every time they come for an
assessment.

Head tilted in either direction and/or turned

First, ensure that your client is looking straight ahead at you and that their head is neither
tilted in either direction nor turned. There are quite a few muscles that are involved in
moving/rotating the head, but here is one common example to help you better visualize what
can occur when poor posture is prevalent:
The sternocleidomastoid (SCM) muscle is involved in
flexing the neck/head down in addition to lateral
flexion of the head and head rotation. Looking at the
image above, Andrea standing in front of a posture
grid, it is ever so slight, but you can tell that her head
is turned to her left (our right). So, as posture
professionals, we need to first identify the issue, (her
head turned). Next, we need to identify what activity
of daily living has potentially caused this poor
alignment issue to occur. Next, we need to identify
what muscle structures could be affected.

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Finally, we are to teach the client about proper alignment and how to apply good posture
principles to their everyday activities that could be causing the problem.

After identifying the issue, you need to talk with the client and give them some examples of
what activities could be causing the problem. For Andrea, who at that time was attending
college, I assume her head rotation was caused by sitting in lecture rooms all day and always
sitting to one side/corner of the room. This would cause her to hold her head and neck in a
constant isometric contraction to keep her eyes on the instructor.
Over time, this would create enough strength/weakness differences within the SCM muscles
that when she is standing still her head naturally turns in the direction she is normally looking
when sitting in class.

On the posture assessment form, make note of any rotation or tilt, and any muscle structures
that come to mind that could be affected. As I mentioned, there are quite a few muscle
structures involved, but you can help narrow the muscles that are potentially being affected
by making note of any muscle fiber development issues.

To better explain, poor posture develops when there are muscular strength and flexibility
differences. From the example above, the right SCM could be stronger and tighter then the
left. If it is stronger/tighter there could be a noticeable difference between the left and right
SCM. Always pay attention and stay abreast with your anatomy so you can make any
necessary observations when assessing posture!

Finally, to correct this and other postural abnormalities we will address this later in the
correction portion of the book.

Shoulders should be the same height

The next area you want to assess is the shoulder complex.

Typically, the issue we see the most in this area is what
Andrea has in her photo above i.e. dropped/depressed
shoulders. Here is a great image showing where her
shoulders/scapula are (the dotted lines) and where they
should be when properly aligned (the solid lines).

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The reason for this issue varies greatly. One thing to keep in mind about posture, it is very
dynamic and poor posture is caused by a variety of factors including:

• Mood
• Stress
• Geographic location
• Job
• Level of fitness
• Nutrition
• Family history

It is incredibly important to get to know the client and discuss with them what they
consistently do throughout the day. Often, repetitive motions cause the most harm. Activities
like wearing a back-pack, depressing our shoulders when we’re sad or working on the
computer in poor alignment can all have a similar adverse effect on the shoulder complex. If
someone carries a purse or back-pack on one shoulder it can also cause an additional strength
difference between the left and right sides, leading to a difference in shoulder heights.

The muscles that are typically involved in this area are the upper trapezius muscles and the
rhomboid muscles:

In short, the rhomboid muscles are more of a high endurance muscle, where they can hold
contractions for much longer periods of time when compared to the upper trapezius muscle.
The rhomboids play a major role in shoulder stabilization. When someone is in proper
alignment, their scapula should be retracted, like they are pinching a pencil between their
shoulder blades.
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This in turn helps take the strain off the upper trapezius muscle group. I say this because when
the shoulders are depressed, the rhomboids are deactivated and this allows for the scapula to
hang from the upper trapezius muscle, placing it in a constant isometric contraction. This is a
big reason why so many people complain about neck pain, or always want neck massages. The
next time a client complains about this, palpate (touch) their upper trapezius, it will probably
feel as hard as a rock. When the rhomboids are activated and retracting the scapula, it helps
take tension off the upper trapezius making them feel like jello when palpating.

Can you see the front of hands or thumbs?

For this section, keep in mind it also has an effect on the alignment
of the shoulder complex. In the original assessment photo of Andrea
(several pages back) you can clearly see the knuckles/front of her
hands. In other words, the palms of her hands are clearly resting on
the front of her legs (the quadriceps). When someone has their
shoulders properly aligned their hands naturally fall to the sides of
their body. Looking at someone from the front, you would only be
able to see their thumbs as their palms would be facing their hips,
physically touching them.

If the palms face the quadriceps, it’s due to having internal shoulder
rotation. In the image to the right, if her scapula were properly retracted, they would be
represented by the dotted lines. However, they are better represented by the solid lines:

Part of the reason for this problem is due to her rhomboids being weak and inactive. However,
the other part to this typically involves the pectoralis major muscle, represented in the image
below, on the next page.

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 In this case, the pectoralis major muscle is overdeveloped.
This can be from something as simple as over developing
this muscle group while in the gym (you see this in body
builders quite often) or from driving a car. Try this the next
time you are in your car with your car parked. Place one
hand on top of the steering wheel and try to move the
wheel. While doing this, use your other hand to palpate
your pectoralis major muscle of the side of the body that
you are using to move the steering wheel (so if using your
left hand to drive, palpate your left pectoralis major
muscle). What you will discover is pretty straight forward,
your pectoralis major muscle is heavily involved in driving
a car. If one of your clients is a truck driver this simple
activity can develop into a pretty severe case of internal
shoulder rotation.

(ASIS – Anterior Superior Iliac Spine) Two hip bones same height

This is one of the two parts of the entire assessment

process where you will need to be hands on. As stated
earlier, always print photos to use as reference when
assessing the client’s posture while sitting down with
them. However, to properly assess whether the ASIS are
properly aligned, you will need to palpate for these bony
landmarks, which are identified in the image to the right.

It will take some practice to be able to find these points.

What you are looking for is to make sure the right ASIS
and the left ASIS are the same height. In cases where
there is a lateral tilt of the pelvis, one ASIS will be higher
than the other side, as the pelvis is rotating up on one
side (the right as an example) and down on the other side
(the left). Similar to when you grab a round door knob, you have to twist the knob to open the
door. That similar twisting motion can be applied to the pelvis in this situation.

To check the ASIS, you need to locate them with your thumbs, or have your clients locate them
for you. You can also locate it on your body to help them understand where the ASIS are
located.

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Once you find the area, you need to compare the height of your thumbs (or their thumbs if
they are locating their own ASIS) to see if there are any noticeable differences both in the
overall height, as well as any pelvic rotation; a rotated pelvis can cause the spine to rotate. A
tilted pelvis can cause the spine to laterally deviate. This can have a great effect on those who
have scoliosis, as their spine is already deviated laterally. If they had a rotated pelvis, one
thumb would appear to be closer to you, while the other is further away. With a tilted pelvis,
one thumb would appear to be higher than the other thumb.

A tilt in the pelvis can occur naturally. One leg being longer than the other places uneven
stress on the pelvis. Typically, the side of the body with the longer leg will have the ASIS that is
higher (closer to the upper body) than the side with the lower leg. However, this can also
develop over time. Activities like sitting with one leg crossed over the other all day, or
standing on one foot when waiting in line for something (a common activity I find myself doing
when not paying attention), can overdevelop and tighten the muscles in the standing leg,
causing a strength difference. This can cause any of the muscles identified in the image above
to develop differently when compared to the other side. Bigger muscle groups like the
quadriceps and hamstrings can also play a role.

Section 2: Anterior Posture – Lower Body

When assessing the lower body in the anterior view, the main points
to review with the client are:

! Knee cap direction

! Varus (bow legs) or valgus stress (knock knees)
! Feet turned max 10 degrees
! Foot arch

Knee cap direction & varus/valgus stress

This is one joint structure in the body that can be heavily affected by each client’s unique
anatomy. I think the best way to shed light on this is by understanding that only a small
percentage of humans, less then 5%, have naturally straight knees. The rest of us (myself
included), are born with some form of knock knee or bow leg.

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This, in part, is due to reasons such as the medial
condyle (image on the right) developing into a
greater size when compared ot the lateral condyle,
where visually it would be “sticking further down”
when compared to the lateral condyle.

This is just one of several examples why most of our knees cannot be
considered “straight”. Keep this in mind when assessing the knee joint.
We can’t always get the knee joints back to 100% from whatever
current state of poor posture they are in.

However, we can do two things:

1. Correct it so it is 100% of the knee joint’s natural preferred
alignment
2. Prevent the natural/developed knock knee/bow leg from
getting worse.

Abnormal development in muscle strength can and does contribute to

the alignment of your knees. Lateral and medial stresses and knee
rotation affect the area.

A good example involves the sartorius muscle. This muscle helps to

externally rotate the hip. Let’s say your client drives their car for work and has to get in and out
of the car 20 times a day. As they exit their car (as an example) they do so one foot at a time.
They first place their left foot outside the car and onto the ground and begin shifting their
weight onto their left leg. They perform a sort of lunge to get in and out of their car. Once they
are out of the car, they then place their right foot on the ground to complete exiting the
vehicle. This movement is then reversed when entering the vehicle.

Doing this multiple times a day, where they have to externally rotate their left hip to get in and
out of the car, would lead to a over-strengthed sartorius. This would show up in the posture
assessment because the knee would be externally rotated, or look like it is pointing away from
the midline of the body.

Make note of this and other possible activities the client is performing that could cause this
posture issue.

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When you work with them in a fitness/exercise setting you can educate the client on how to
perform the movement properly, and also ensure they are performing the exercise movements
in proper alignment (i.e. not externally rotating when doing lunges, squates, etc).

Feet turned (max 10 degrees)

When assessing the client’s feet, make note for any external
rotation past 10 degrees. One of the reasons why we have a
max degree of rotation for our feet is due to the ankle joint.
When the feet are rotated more than 10 degrees, this
places additional stress on the medial ligament, which is the
ligament typically injured in an eversion sprain.

The body is connected via the kinetic chain. If someone has

externally rotated hips/knees, you can bet they will also
have an issue with over rotation past 10 degrees in the feet.

An example of a muscle that could be affected is the flexor

digitorum longus (image on the left). Its function is to help
with foot inversion. When this muscle is weak it cannot
counteract the eversion forces when the foot is rotated past
10 degrees. Be sure to pay attention to this muscle when
working with them.

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 Section 3: Lateral Posture – Upper Body

There are several key features you need to note when

assessing someone from the side:

! Body displaced (forward/back?)

! Head hanging down/Dowagers hump?
! Shoulder (medial deltoid) directly below ear
! Middle of hip directly below ear/shoulder
! Curvature of lower back
! Pelvic area neutral (no posterior/anterior tilt)

Keep in mind, when assessing someone from the lateral

view you want to envision, and draw on the photos, a
straight line through 5 anatomical landmarks. This is to see
if they are in perfect alignment. The red line in the image
to the right is an example. The anatomical landmarks that the red line cross when in proper
alignment are:

• Through the external auditory meatus (ear)

• Passes through acromion (shoulder)
• Continues through S2 (low back)
• Slightly posterior to hip joint
• Anterior to midline of knee joint & posterior to patella
• Anterior to lateral malleolus (ankle)

When the above locations are in a perfect straight line it is considered optimal alignment from
the lateral view. Whenever one of the anatomical structures are deviated from this line make
note of this and work to correct it.

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Body displaced (forward/back?)

This first point is one that throws many people off when first assessing
posture. Before you begin assessing the individual anatomical locations/joint
structures in the lateral view, you need to confirm first if the client’s entire
body is displaced forward’s or back.

In the image on the left there are two lines, one a dotted line, the other a solid
line. The dotted line represents exactly where the above anatomical locations
(ear, shoulder, etc) should be located/aligned. However, if the body is displaced
forward even if they have proper head, shoulder, and hip alignment, they are
leaning forward on their toes and it throws off their alignment and overall
analysis. As a result of the body being displaced in this manner, the chin/head
is now aligned in front of the toes. This is a great danger for older adults as it
increases the risk of falling. Clients could also lean their entire body backwards,
in this casee more force is placed on their heels.

Environment can be a large contributing factor to this postural deviation. Client’s that live in
cities such as San Fransicso, where there may be numerous hills that they have to walk up and
down throughout the day can lead to this.

Head hanging down / Dowager’s hump

“Forward head protrusion” (image on the right), is a

common postural abonormality and you will become very
familiar with it in part due to cell phones and computers.
Next time you are out in public or at a coffee shop take a
look around at anyone on a phone or computer. Most likely,
a minimum of 95% will have forward head protrusion People
do not think of this as a problem so they do not ensure the
phone or computer screen is at a height/location that helps
reduce the action of looking down with the entire head.

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Two muscles I’d like to highlight that play a role in this are the scalenes (cervical flexion) and
the semispinalis capitis (cervical extension). The scalenes (Image A), when over-
developed/shortened and the semispinalis (Image B), when weakened/lengthened from
looking down with the whole head, will lead to a more permanent forward head protrusion.

ImageA Image B

If left unchecked, forward head protrusion can lead to what is commonly referred to as
“dowager’s hump”. It is a condition where the C7 vertabrae begins to protrude from the spinal
column causing a hump in the cervical spine.

Shoulder (medial deltoid) directly below ear

Before After

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When assessing from the lateral view your main goal is to confirm the degree of severity from
any internal shoulder rotation that may have been identified while assessing the anterior view.
While you can see if a client has internal shoulder rotation from the anterior view you can
document the degree of severity from the lateral view. The left image above depicts internal
shoulder rotation while the image on the right shows proper alignment.

Using the lines on the posture grid you need to locate the approximate location of the middle
of the medial deltoid. Using the lines on the posture grid (which are 2 inch x 2 inch squares)
you can now determine the total inches of deviation the client’s shoulder is away from proper
alignment (the center line in the images above). This is important for confirming results in
future assessments when you are looking for signs of improvement the previous number
should change. In the before photo above, the center of the red dot currently shows where the
middle of her shoulder is aligned.

The purple line is our preferred posture alignment for the 5 anatomical landmarks. When you
do a follow up assessment, the center of the red dot should be closer to the purple line. If so,
this indicates that your posture correction program is working.

As I mentioned earlier, the pectoralis major muscle and rhomboids

play a clear role in the reason why internal shoulder rotation can
occur. However, the deltoids (image to the right) are a muscle group
that can also be affected by this postural abnormality.

First, please note for the “before/after” images, Andrea does not
have 100% perfect alignment. Even in the after photo you can see
she does have minor forward head protrusion. However, this brings
up a much needed point; correcting posture takes time. When we
took these photos many of the individuals we worked with, like
Andrea, have never worked on their posture.. Your clients will be
the same and you will see initial immediate improvement, but it will
take time to see substantial results.

With that said, In the “before/after” images above there is a green and a red dot. The green
dot indicates the preferred alignment of the medial deltoid. The red indicates where the
medial deltoid is currently located when in poor alignment. Essentially, the medial deltoid is
moving forward when in poor alignment. Retracting the shoulder blades helps rid the body of
this abnormality.

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Middle of hip directly below ear/shoulder - curvature of lower back

The curvature of the lower back/lumbar spine

directly correlates with the alignment of the pelvis.
In the image on the left you can see 3 typical
pelvic alignments. When the pelvis has a
“posterior tilt”, that typically causes the pelvis to
roll under the body.

The red arrow pointing down indicates the

direction the spine is being pulled. As a result, it
lengthens/straightens the lumbar spine causing a
flat back.

Normal Posterior Anterior

Tilt Tilt

When you have an anterior tilt, it causes the upper pelvis to rotate forward and pulls the spine
in the same direction as the horizontal red arrow. This places the lumbar spine in a state of
excessive hyperextension.

When you have anteior tilt this causes the middle of the hip to fall in front of the preferred
postural line. When you have a posterior tilt it can cause the hip to fall behind the postural
line.

The muscles that can lead to this kind of a postural deviation is quite extensive as there are
numerous muscle groups that attach to and can have an effect on the pelvis. These muscles
include but are not limited to:

• Hamstrings
• Quadriceps
• Erector spinae
• Gluteus maximus
• Latisimus dorsi
• Abdominals
• Obliques

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To provide a solid example of how the pelvis can be affected by abnormal muscular
strength/flexibility issues, take a look at the abdominals and lower erector spinae muscle
groups:

Abdominals Erector spinae

This as a pretty common issue, both inside and out the gym. Here are some reasons for this:

1) Inside the gym: People are obsessed with trying to get the perfect “6-pack”. They do
not understand that most of what gets you a desirable tummy is good nutrition and
cardio, not just weight training. As a result, countless numbers of crunches and sit-ups
are performed. While the lower spinae erector muscles are ignored (Has anyone ever
heard someone comment on someone’s sexy lower back?). As a result, the lower back
can no longer “compete” with the strength the abdominals have developed due to the
favortism. This begins to elicit pain in the lower lumbar spine as you start to develop a
posterior tilt.

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 2) Outside the gym: Too much slouching while sitting. I’ve personally witnessed, seen and
been a culprit when younger during the seemingly endless bouts of video game playing
with my friends. We would play for 10-13 hours, only moving to use the facilities or grab
a slice of pizza. Slouching is a self-induced pelvic tilt. Over time, this
shortens/strengthens the abdominals and stretches/weakens the lower lumbar muscles
which both lead to the same issue as those mis-guided gym goers.

Only when proper strength and flexibility are obtained in both muscle groups can a neutral
pelvic alignment be obtained.

Section 4: Lateral Posture – Lower Body

When assessing the lower half of the body in this view there are a
few key points you need to note:

! Knees are not hyperextend or locked

! Knees are not excessively bent
! There is an arch in both feet

While the upper body’s alignment can play a great role in affecting the overall health of the
muscle structures that surround and support them, I
want to highlight the importance of the health of the
joint structures. The knee is a major area where joint
health is a concern. Many people experience torn
ligaments such as the ACL (anterior cruciate ligament,
image to the right). Consistent hyperextension of the
knees can lead to an injured ACL or PCL (posterior
cruciate ligament).

If a client does have hyperextended knees the best

thing to do is recommend they begin working on very slightly bending their knees while
standing. This helps to engage the muscle structures, taking the stress off of the knee joint
itself.

Muscles are your support structures. Think of a bridge, which is typically comprised of the road
cars drive on, and either pillars the road sits on and/or cables above the road, both support
and maintain the road’s position over a river or valley.

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The pillars that the road sit on and the cables that are above can be considered the body’s
muscle structures, and the road the joint structure. Without the pillars and cables, there is no
way the road would survive as a bridge. The pillars and cables are meant to handle the stress
of the weight of the road, as it flexes and moves when being used, as wind blows, etc.

Likewise, if the knees are excessively bent, this can begin to shorten and tighten the
hamstrings. This issue arrises from excessive sitting. Keeping the knees bent for long periods
can shorten the hamstring muscles over time. One way to counteract this is to have your
clients stand and walk around more often. You also want them to stretch their legs.

The last item I would like to share is the arch of the foot. While the foot itself is actually
incredibly complex (hence why there are podiatrists), I will not get too detailed about it.
However, it is important to note the state of the arch of your client’s feet. No arches can lead
to lower back pain so you need to note if they have flat feet and if they identify pain
originating from their feet or low back. You can, and should, recommend them to a podiatrist
to ensure they get the proper arch support necessary before they continue working with you.

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 Chapter 4: The Correction Process
To completely correct a person’s posture will take more than working with a client in the gym
and performing “corrective exercise training movements”. When considering the difference
between a posture correction program and a corrective exercise training program that is meant
to improve posture, please keep these three points in mind:

1) Corrective exercise movements are often taught and performed in poor alignment.
We see this all the time. Someone has low back pain so the fitness professional asks
them to focus on re-strengthening the lower back muscles (example: erector spinae),
but while performing the movements, the trainer does not correct their client when
they round their lower back. So, even though muscular strength is being obtained the
effect is reinforcing poor alignment which sets the client up for future injuries.

2) Ancillary/Non-corrective exercise movements are also often taught and performed in

poor alignment. Posture is more than just spinal alignment. Additional posture related
injuries involving other joint structures can develop when any kind of exercise
movement is done in poor alignment. Here’s an example: let’s revisit the lower back
pain issue from above. Let’s say the trainer is now asking the client to perform shoulder
shrugs, which strengthens the upper trapezius muscles, but the trainer is unaware of
when the client does the following: 1) bends their head forward, and 2) does more of a
circular shoulder movement rather than a straight up and down motion. The client is
reinforcing poor movement patterns and postural issues.
Over time this can reinforce “forward head protrusion” and also foster rotator cuff
damage. The client would have to contend with additional issues on top of their lower
back pain.

3) An over emphasis of corrective exercise movements with no transition back to

balance. Instead of focusing on an overall balance of strength within the body, clients
may begin to predominantly focus on doing the corrective exercise movements because
initially these helped them feel better. Unfortunately, they were not told those
movements should only be their focus for a short time. As soon as the pain is resolved,
the next step, should be adjusting the exercise program so the client is now focused on
achieving balanced strength throughout their entire body.

Our approach is more holistic and geared toward lifestyle change. Where we believe improving
posture means working with the client in and outside of the gym. The first step towards
correcting posture is by implementing what we call the 4 Points of Posture TM Program.

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This program provides 4 simple steps a client can take to place their body in proper alignment.
They are then instructed to practice this several times weekly over a four week period. To fully
understand this, please review the below handout and you can use it for your clients
(presented on the next page so you can print it out as a handout):

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 4 Points of Posture Handout - The 4 Steps to Proper Alignment

1) Stand tall
a. Imagine string attached to top of head
2) Hold chest high
a. Puffing your chest out
3) Retract shoulders
a. Like your pinching a pencil between your shoulder blades
4) Contract abdominals
a. Tighten/squeeze your stomach

4 Week Implementation Process:

Practice each time for 5 minutes

Week 1: 3 times a day (breakfast, lunch and dinner)

Week 2: 6 times a day (each meal and in-between meals)
Week 3: Once an hour
Week 4: Once every half hour

Before and after Example

Tip:
The 4 Points can be practiced when sitting, standing, walking, and driving.
They are meant to be incorporated into your current lifestyle, not change it.

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This is the first step you can take to help your clients improve their posture. Without knowing
the detailed biomechanics on how to implement these posture concepts into exercise
movements and activities of daily living (ADLs), you can implement this program. In addition,
you can use this program to bring in new clientele.

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 Chapter 5: How to Generate Greater Income with Posture
You can perform several follow up activities to help generate new clientele by using our 4
Points of Posture TM program. By using call and email follow up strategies you can increase the
chance of your client’s purchasing various training packages with you. The best part? We have
it all structured for you. Please keep the following in mind when implementing what we like to
call:

4 Weeks to Better Alignment Program

Step 1: Offer Free 10-15 Minute Assessment
• This gives potential/current clients something of value for free that leads to your paid
services
• Use this time to pinpoint major posture problems, discuss the issues it is causing
anatomically, and how working with you can help reduce their pains and improve their
quality of life
• Main postural abnormalities to lookout for:
o Forward head protrusion
o Should height/rotation
o Excessive kyphosis/rounded shoulder
o Excessive lordosis
o Knock knee/bow leg
• Take photos for them, and write notes with your observations focused on the points
above. Print the photos and draw lines and use arrows to identify the posture issues.

Overall process for free assessment:

o Step 1: Welcome the client and explain how you will take photos and print them
then go over their posture problems using the photos.
o Step 2: Explain the entire process, including why you are taking photos.
! Tell client that it is important to document current posture with photos as
it helps record progress and helps the client understand where their
posture needs improvement. Also, mention you can use these photos later
for comparison if they choose to do a follow up assessment with you.
o Step 3: Take photos of their anterior and one lateral view only.
! You don’t want to give everything away that you can do for free, just give
them a taste.

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 o Step 4: Sit with client and review photos.
! You will want to print photos so you can make notes and/or draw on the
photos for the clients’ reference. Then, give the photos to them so they
have something to reference when trying to improve their posture.
! Also, begin asking if they have any pains in the areas that are poorly
aligned.
o Step 5: Provide 4 Points of Posture handout.
o Step 6: Explain how your services are needed.
! Take the last minute to provide a quick pitch about how you can help them
further remove the pain/issues they mentioned in conversation by working
with you.
! Schedule a follow up call at the end of the 4 weeks.
o Step 7: Email photos and basic notes right after the session ends.
! As an initial follow up, send them a digital copy of their photos with your
notes. This helps leave the door open for communication and extra
interaction with them.
o Step 8: Follow up to touch base and increase engagement.
! Over the next 4 weeks, starting from when they first come in, send several
follow up emails; the templates are provided below.

Once you have completed the initial free posture assessment use the following email
templates on the next page to increase interaction with potential clients. One sure fire way to
increase sales is to increase overall interaction with clients. By reaching out to them each week
over the four week posture correction time period it keeps you on their mind. As their posture
improves and as long as they follow the 4 Points program, they will begin to link feeling better
with you directly. This leads to increased new client enrollment.

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 Email Templates for Posture Assessment Follow Up
Email for Week 1 (Immediately sent after free posture assessment):

Subject Heading: Follow Up Regarding Your Posture Assessment with (Your Name)

Hi (Client Name),

Thanks again for coming and trusting me with your posture correction needs. I’ve attached
copies of your assessment photos just in case you lose the printed copies I gave you during the
free assessment.

Also, here are the main pointers/notes from our conversation; I wanted to make sure you had a
copy:
(Enter your notes/observations/recommendations here).

The next 4 weeks are going to be critical if you want to truly improve your posture and overall
quality of life. Be diligent about working on the 4 Points of Posture Program TM and let me
know if you have any questions.

Yours in health and in proper alignment,

(Your name).

PS: I’ll be touching base with you next week about your posture progress. Be sure to let me
know how it’s going. I can’t help unless you give me honest feedback.

(Week 2 email on next page)

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Email Week 2 asking them about their progress and include a personal tip/pointer

Subject Heading: How’s Your Posture, Improving or the Same?

Hi (Client Name Here),

Well, you’ve gone through the first week of the four weeks to improve your posture using the
National Posture Institute’s 4 Points of Posture Program TM. What do you think so far, have you
been able to use the program 3 times daily as suggested?

Starting tomorrow, to stay on track, you will need to begin doing your 4 Points of Posture six
times daily. It’s definitely a step up from 3 times a day, but you have made it this far, what’s
another 3 times? Especially if it leads to getting rid of that {ENTER AN ISSUE THEY ARE
STRUGGLING WITH THAT YOU DISCOVERED}. It will be completely worth it.

I know when I was working on improving my posture I found that I liked to work on the 4
Points when I was driving back and forth to work. I’m not doing much in the car anyway, so I
just placed a little sticky note on my dashboard to remind myself to practice the 4 Points while
driving. If you’re struggling to find the time to even think about it, try this when you’re driving.

Remember, I am here for you, get a hold of me if you need any help.

Yours in health and in proper alignment,

(Your name).

(Week 3 email on next page)

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Email Week 3 reminding them about the need to increase practice and provide success
testimonial (when applicable)

Subject Heading: You’re Half Way Done to the Best Alignment of Your Life!

Hi (Client Name),

Great job! It’s been two weeks and you are officially half way there! I’m so excited to hear
about your progress. Shoot me an email as soon as you get a chance to let me know if you’ve
been noticing any improvements in how you feel, or if you have seen an improvement in your
alignment when looking in the mirror.

(NEXT PART OPTIONAL)

Not sure if correcting your posture can really help? Then take into consideration one of my
other clients and his/her experience: (ENTER TESTIMONIALS WHEN YOU GET THEM)

Yours in health and in proper alignment,

(Your name).

Email Week 4 – Final Progress Check In and sale opportunity

Subject Heading: You Made it! How Does it Feel Having Better Alignment?

Hi (Client Name),

Congratulations! You made it to the end of the 4 weeks! And if you were diligent and stuck to
the ‘4 Weeks To Better Posture’ program, I can guarantee you have better alignment and are
feeling way better than ever before.

Just a quick reminder of our upcoming follow up call, scheduled (enter day/time here). I am
excited to hear about your progress and discuss your future involving posture correction.

Yours in health and in proper alignment,

(Your name).

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Possible Phone Call Script (sales pitch):
I wanted to point out something important. You may not realize it, but posture is very dynamic
and ever changing. You might be thinking about how you can start applying the 4 Points of
Posture to your daily activities. Trying to move in a different way to maintain proper
alignment/protect yourself is great! Posture should always be on your mind when doing any
kind of activity, like picking up a laundry basket, lifting weights, or mowing the lawn. It has a
positive or negative effect on your body. With that said, I want to be sure you are not
potentially developing any other postural abnormalities while you begin to adjust to
incorporating proper posture and want to make myself available to further help you with your
posture correction needs.

First, keep in mind it is very important to schedule a follow up posture assessment with me.
Documenting your progress and also being able to further critique your posture will help you
improve your alignment even faster.

In addition, if you were to schedule with me, I would be able to perform a full/complete
posture assessment, ensuring every aspect of your alignment is considered and improved. If
you’re interested in a scheduling a time with me, let me know. Once we re-assess your posture
we can begin to discuss the options I provide to help you continue working towards amazing
posture.

However, posture assessment is not enough. To truly make a difference, a structured corrective
exercise plan is needed. I want to also provide the opportunity to give you a training session
with me to help jump start your posture correction needs. As a result, I am offering you the
following starter posture correction package:

1) 60-minute in-depth posture assessment

2) 60-minute corrective exercise training session focused on improving your posture
3) A detailed write up of your postural issues and suggestions on how to improve them

This package has a real world value of (multiply your normal training session hourly rate by 2.5)
but if you purchase today, you can take advantage of a 25% discount! This is an incredible
opportunity, especially considering the full value of improving your posture.

This offer is unfortunately only available for the next 24 hours. My posture services are in high-
demand and my schedule fills up pretty quickly with this opportunity, so be sure to schedule
with me. (END OF CALL SCRIPT)

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If you implement everything you learned in this book, you should at a minimum see an
increase in client satisfaction. However, don’t be surprised if you also see an increase in your
bank account. As one thing is certain, if you offer posture, they will come (cheesy I know, but
true).

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 Author:

Dimitri Onyskow is the Academic Director of National Posture Institute. He

has a Bachelor’s degree in Health and Fitness through Purdue University and
is a Certified Posture Specialist and Resistance Training Professional. He has
been in the field of online education for over 10 years, overseeing a variety
of posture, fitness and nutrition related programs. In addition, Dimitri has a
passion for helping current health/fitness professionals obtain their career
goals by implementing posture analysis and correction programming.

National Posture Institute’s Executive Director:

Kenneth E. Baldwin is an Associate Professor/Coordinator for the

Undergraduate degree in Fitness and Wellness Leadership and is the
Executive Director for The National Posture Institute, an
educational/professional organization that educates allied health/fitness and
medical professionals to become designated NPI-Certified Posture
Specialists™. He is the Senior Editor/Lead Author for ACSM’s Resources for
the Personal Trainer (2nd Edition), former Chair of IDEA’s Personal Trainer
Committee, and recipient of IDEA’s Personal Trainer of the Year Award.

You can reach out to NPI via email and phone:

Email: info@npionline.org

Phone: 888-240-2914

National Posture Institute | 888-240-2914 | info@npionline.org | www.npionline.org

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All advice provided is just that, advice. If you have any health concerns or questions, consult your physician before implementing.