Common Postural Impairments

Lordosis | Posterior Pelvic Tilt | Kyphosis | Forward Head Posture | Winged Scapula | Protracted Shoulder Girdle | Scoliosis

Standing Postural Muscles

Click for a larger view of postural muscles

The diagram to the right illustrates how the body is held erect. The thick black lines represent the principal muscles involved in standing. The vertical dotted line indicates the center of gravity. Note this line falls behind the axis of rotation of the hip and in front of the knee. This renders the ligaments of the joints tense, which are represented by dotted lines passing in front of the hip (ilio-femoral) and behind the knee (posterior ligament).

Posterior Pelvic Tilt

Sometimes referred to as flat back, posterior pelvic tilt involves the reduction of the natural lumbar curvature. This posture is characterized by the shortening of the hip extensors (Hamstrings & Gluteus Maximus inflexibility), tight abdominals, and lax hip flexors. Sitting on the back of the hips may indicate a posterior pelvic tilt. It is rarely brought about by lack of muscular strength. The posterior pelvic tilt is less common as the anterior tilt as seen with lordosis.


Pelvis is positioned forward and downward. Hips are slightly flexed and lumbar spine is excessively hyperextended. Hip flexors, erector spinae are short. Abdominal, hamstrings, gluteus maximus muscles may be weak. Increased risk of lower back injury during standing or lying hip extension, flexion, or stabilization activities, and weighted overhead activities. See abdominal weakness and hip flexor inflexibility.

Good and Bad Posture


Exaggerated anterior-posterior curvature of the vertebral column, most often involves an excessive forward bending in the thoracic area. Kyphosis occurs in older adults, particularly women with osteoporosis and osteoarthritis. Kyphosis is sometimes accompanied by other posterior problems such as posterior or anterior pelvic tilt (compensates for altered line of gravity) and protracted shoulder girdle (unrelated). Kyphosis makes it difficult to include overhead exercises, particularly when combined with a winged scapula condition or shoulder external rotation inflexibility.

Forward Head Posture

Forward Head Posture

An anterior positioning of the cervical spine is characteristic of forward head posture, or protracted neck. Forward head posture may make it more difficult to perform exercises with the bar in front of the head or neck. Evaluate neck position at night since elevating head too high with additional pillows may act as a continuous neck stretch throughout the evening exacerbating the forward head posture.

Winged Scapula

Winged Scapula

Medial border or inferior angle of scapula protrudes slightly from body. A winged scapula condition may be accompanied by a protracted shoulder girdle. Risk of shoulder injury is compounded with a supraspinatus weakness or an external shoulder rotation inflexibility. Because of the forward tilt of the scapula, complete flexion or external rotation of the shoulder may be seemingly restricted. A winged scapula condition indicates a serratus anterior weakness. The rhomboids may be weak and the pectoralis minor may be short. A winged scapula is considered normal posture in young children, but not older children and adults.

Protracted Shoulder Girdle

The shoulders are pulled forward. Medial border of the scapula may also protrude slightly from body. Scapula protraction can decrease width of subacromical space (Solem-Bertift E 1993) preventing the greater tuberosity of the humerus to pass freely under the acromion during humeral elevation (Browne AO 1990), possibly increasing risk of subacromical impingement. Scapula protraction can also increased risk of shoulder injury during shoulder transverse flexion and transverse adduction activities, specifically when elbow travels behind shoulder. Risk of shoulder injury is compounded with a infraspinatus weakness. Possible limited range of motion during retraction of the shoulder girdle. A protracted shoulder girdle may be accompanied by a winged scapula condition or transverse adduction/flexion inflexibility. The subscapularis and Pectoralis minor and clavicular & sternal heads of the Pectoralis Major muscles may be short. The Trapezius (middle fibers) and particularly the rhomboids may be weak if the medial borders of the scapula also protrude slightly from body. Limiting transverse extension (eg: limited Bench Press Range of Motion ) or possibly shoulder extension (eg: limited Shoulder Flexion during Pulldowns) may contribute to this posture. Not performing adequate rowing exercises (emphasizing shoulder retraction) may also contribute to protracted shoulder posture.

Protracted Shoulder Girdle

If lying on one's side, position upper arm under head (with or without pillow in between) since lying on one's side with one's arm down or in front (protracting shoulder girdle) may act as a continuous stretch throughout the night exacerbating this condition.

Likewise, those with a protracted shoulder girdle should avoid stretches that protract the shoulder such as Rear Delt Stretches or holding a protracted position during rowing resistive exercises.

Normalizing this postural deficiency can improve mechanics of the shoulder and provide a fuller appearance throughout the chest.

Browne AO, Hoffmeyer PJ, Tanaka S, An KN, Morrey BF (1990). Glenohumeral elevation studied in three dimensions. J Bone Joint Surg Br; 72: 843-845

Solem-Bertoft E, Thomas KA, Westerberg CE (1993). The influence of scapular retraction and protraction on the width of the subacromial space: an MRI study. Clin Orthop; 296: 99-103.


Scoliosis is the abnormal lateral curvature of the spine. Screening may include the following assessments:

  • Shoulder height (top of Scapula) asymmetry
  • Hip height (Illiac crest) asymmetry
  • Adam's forward bend test
    • Thoracic spine in the horizontal plane
    • Lumbar spine in the horizontal plane

In the Adam's forward bend test, subject bends forward by flexing spine with feet together, knees extended, and arms hanging, in above two positions. The examiner looks from behind, along the horizontal plane of the column vertebrae in each position and looks for abnormalities such as spinal asymmetry, unlevel shoulders, scapula asymmetry, unlevel hips, head not inline with pelvis or rib hump. An increase or decrease of lordosis/kyphosis can also be a sign for scoliosis. The rotation deformity or rib hump can be measured with a scoliometer.

Physiopedia contributors (2018). Adam's Forward Bend Test. Accessed 20 May 2018.

Animian A (2012). Scoliosis Screening. YouTube. Accessed 20 May 2018.

AAFP (2018). USPSTF: Evidence Lacking on Scoliosis Screening in Kids, Teens. Accessed 20 May 2018.

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