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After giving a countless number of massages, it is easy to fall into the habit of performing the same routine on each client. When a client does not have a particular complaint, most therapists have a tendency to rely on a familiar work rhythm. Although many people seek massage therapy solely for relaxation, conducting a professional assessment, including postural evaluation, extends the benefits of your work beyond relaxation to target their specific needs.

A tool designed to identify structural imbalance, postural evaluation is a reliable method of customizing a treatment plan to facilitate a deeper level of healing. Since structural imbalances often underlie chronic pain and dysfunction, correcting the imbalance can be a long-term solution for chronic musculoskeletal imbalance.

Evaluating a client’s posture includes knowing what to look for and then deciphering the meaning of what you see.

What to Look For

Here are 20 questions to consider when evaluating a client’s physical characteristics.

When looking at the feet, ask:

  1. Are the toes clenched?
  2. Is the weight on the outside/inside of the feet or balanced over the ankles?
  3. Are the feet pointed in or out?
  4. Are one or both ankles falling in?

When looking at the knees, ask:

  1. Do the knees point forward, together?
  2. Are the knees directly under the hips or closer together than the hips?
  3. When the client is standing with their feet hip-width apart and asked to bring the knees forward as if they were going to sit, do the knees remain in the same plane or do they move outward or inward?
  4. Are the knees locked, straight or slightly bent?

When looking at the torso, ask:

  1. Is one iliac crest higher, farther forward or backward than the other?
  2. Is the waistline straight or is one side higher than the other?
  3. Are the hips forward over the feet or behind the feet?
  4. Does the low back sway forward or is it straight as a board?

When looking at the upper body, ask:

  1. Is the upper back rounded forward or are the shoulder blades pulled back?
  2. Is one shoulder higher or more forward than the other?
  3. Do the arms hang evenly?
  4. Do the scapulas stick out or are they close to the back?

When looking at the neck and head, ask:

  1. Does the head tilt to one side or the other?
  2. Does the neck go one way and the head the other way?
  3. Can you draw a straight line from the top of the head through the nose, chin, and navel to the mid-point between the feet?
  4. Is the head forward, backward or right over the shoulders?


Characterized primarily by symmetry, ideal alignment is when the feet are directly under the hips and knees, while the torso, shoulders and neck are balanced over the hips with minimal muscular activity to hold this upright position. The knees and feet should point straight ahead, and the client’s weight should be symmetrically balanced over the feet. From the side you should be able to draw a line perpendicular to the floor straight through the ear, shoulder, hip and ankle. Indicative of misalignment, any deviance from symmetry represents either a current or eventual problem.

The Next Step

Once a postural deviation from normal is identified, the next step is to identify the muscles involved. A working knowledge of anatomy will make this an easy task. Keep in mind that misalignment leads to more stress in certain areas of the body, just as when a car’s tires are in need of balancing. Certain areas will incur greater stress and wear out faster, especially under stress or trauma. After identifying the misalignment, the massage therapist must determine which muscles are abnormally stretched and which are shortened before choosing the most effective techniques to correct the imbalance. Neuromuscular therapy is one such massage technique traditionally used to restore balance to the musculoskeletal system.

Identifying the Cause of a Postural Imbalance

When applied correctly, massage techniques can restore a client’s ideal alignment. While this is good news for bodyworkers, there is one more step that must be taken – figuring out how the problem started. Detective work is often needed to determine where the poor posture originated from. Since the way we carry ourselves is a culmination of our experiences, emotions, traumas, strengths and weaknesses, a practitioner must typically recruit the client’s help to identify the cause of a postural imbalance.

A typical cause of bad posture is tense muscles, which will pull the body out of alignment. In general, being conscious of maintaining proper posture, as well as finding a way to release stress will help many people maintain their realignment. However, a lifestyle or ergonomic adjustment such as changing from a purse to a backpack, or sitting in a chair of proper height, may be necessary.

Postural evaluation is an extremely valuable skill for any massage therapist to have. For bodyworkers striving to break beyond the limits of “relaxation only” to provide therapeutic and individualized massage sessions, learning to perform and utilize postural evaluation will help bring their practice to the next level.

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Recommended Study:

Neuromuscular Therapy