7.3 Observation

Observation of a client during a fitness assessment performed by a personal trainer refers to carefully examining the client’s static posture and active movement patterns. This process helps trainers identify any imbalances, asymmetries, or limitations that may impact the client’s performance and safety during exercise (Clark et al., 2014). One approach to observing a client involves a three-part assessment, which includes a postural assessment, a movement analysis, and a flexibility assessment.

Postural assessment: This involves evaluating the client’s static posture while standing, sitting, or lying down. The trainer looks for any deviations or misalignments in the body’s natural alignment, which could indicate muscle imbalances, joint restrictions, or other issues that may need to be addressed in their exercise program (Kritz & Cronin, 2008).

In Chapter 4, Section 3, we have discussed the topic of posture, examined Common Postural Deviations, and analyzed the impact of sitting and phone usage on posture. In this section, we will guide you on conducting a postural assessment effectively.

Movement analysis: This component of the observation process examines the client’s active movement patterns during various exercises or functional movements. The trainer assesses these movements’ quality, control, and efficiency, identifying any compensations, weaknesses, or imbalances that may contribute to injury or limit performance (Cook et al., 2006).

Flexibility assessment: Lastly, the trainer evaluates the client’s flexibility and range of motion in specific joints and muscle groups. This assessment can help identify areas of tightness or restriction, which may impact the client’s overall movement and function (Norkin & White, 2016).

A comprehensive fitness assessment can also include balance and core assessments. Incorporating balance and core assessments into a fitness assessment allows for a more comprehensive understanding of the client’s overall functional capabilities and potential areas for improvement.

A personal trainer can gather crucial information through these observation techniques to design an effective and safe exercise program tailored to the client’s unique needs and goals. Addressing identified issues through targeted exercises, stretches, and modifications can help improve overall function and reduce the risk of injury.

Postural assessment

Postural assessment involves observing and analyzing a person’s posture to identify potential issues or imbalances affecting their health, mobility, and overall posture. Personal trainers and health professionals commonly use this practice to assess and diagnose musculoskeletal imbalances, prevent injury, and develop effective exercise programs.

Posture refers to the relative arrangement of the body at any given moment, which is a composite of the positions of the body’s various joints. The position of each joint influences the position of the other joints.

Posture can generally be classified into two types: static and dynamic. It can also be further divided into correct (or neutral) and faulty (or poor) (Physio-Pedia, 2023).

Static posture represents the alignment of the body’s segments or how a person holds themselves “statically” or “isometrically” in space.

Postural assessment involves observing and analyzing a person’s posture to identify potential issues or imbalances affecting their health, mobility, and overall posture. Personal trainers and health professionals commonly use this practice to assess and diagnose musculoskeletal imbalances, prevent injury, and develop effective exercise programs.

Maintaining proper postural positions involves multiple postural muscles, generally, deeper muscles with higher concentrations of type I muscle fibers that hold static positions or low-grade isometric contractions for extended periods. Good posture or structural integrity is the state of musculoskeletal alignment and balance that allows muscles, joints, and nerves to function efficiently.

The correct posture entails horizontal alignment of the pelvis, providing a balanced foundation for the lumbar vertebrae. The concave curve of the lumbar spine and the convex curve of the thoracic regions of the spine are sinusoidal and well-balanced, such that the cervical spine has a small concave curve. The head position is aligned with the pelvis, falling within the center of gravity.

Characteristics of correct alignment include:

  • Body parts balanced and symmetrical around the center of gravity 
  • Balanced front-to-back and right-to-left distribution, allowing the spine to maintain its normal curvature (slight inward curve at the lower back and neck, and slight outward curve in the upper back) 
  • Even and parallel joints to the floor (shoulders, hips, knees, and ankles) 
  • When standing, the line of gravity should be just in front of the ankles, through the center of the knee, hip, and shoulder joints, and the external auditory canal of the ear 
  • Equal distribution of body weight on both legs 
  • Proper sitting posture is similar to standing, except thighs are parallel to the floor and knees are bent at a 90° angle. The centerline of gravity passes through the same positions of the spine from the hip to the ear as in standing.

However, if a participant exhibits deviations from the good posture in their static position, this may indicate muscle-endurance issues in postural muscles and/or potential joint imbalances. The movement begins from a static postural position, so poor posture often signifies dysfunctional movement. Although movement screens provide valuable information about neuromuscular efficiency, a static postural assessment is a starting point for trainers to identify muscle imbalances and potential movement compensations associated with poor posture (Kendall, 2005).

A static posture assessment can offer valuable insights into the following:

  • Muscle imbalances at a joint and the working relationships of muscles around a joint 
  • Muscle imbalances often contribute to dysfunctional movement 
  • Altered neural actions of the muscles moving and controlling the joint

For example, tight or shortened muscles are often overactive and dominate movement at the joint, potentially disrupting healthy joint mechanics.

The procedure of an assessment

Static posture should be observed from the anterior, posterior and lateral aspects and the observations compared to give a holistic impression of the client (Pimenta et al., 2016).

The client should remove any sweatshirts or jackets to expose as much of the body as is appropriate so the trainer can get a good visual of the body’s alignment. The client should breathe naturally while standing in a normal and relaxed position. Sometimes closing their eyes for a moment, then opening them, can help clients get into a more relaxed and normal posture.

You should start with the postural assessment, working from head to foot. Next, make a profile of the front of the client’s body, back, and both sides, looking for gross deviations and taking notes on what they see.

  • Head – Notice if the client’s head is rotated or tilted, forward or neutral.
  • Upper back – Is it kyphotic, flat or neutral?
  • Shoulders – Are they dropped or elevated, forward or internally rotated? Look at all the profiles. Does the client have a “winged” scapula?
  • Pelvis – Trainers will need to touch the client, so they ask for permission first and let the client know what they are looking for. Trainers should check if the hips are level by having the client stand with hips and shoulders touching a wall. Does the client have an anterior (lordotic) tilt or a posterior (under tuck) tilt?
  • Q-Angle – When standing with feet together, are the client’s hips significantly wider than his or her knees?
  • Knees – Are they the same height? Do they have a gross medial or lateral rotation?
  • Feet – The trainer should look at the client’s bare feet. Do they have an excessive arch? Are they flatfooted? When a client walks, look if the feet internally or externally rotate. Does the client pronate or supinate when walking, or is the client’s weight evenly distributed on his or her feet?
  • As clients walk, look at them from the feet up and the head down to see anything you overlooked while they were standing still. What is going on with the client’s feet? Does the client rotate through the torso while walking? Is the client’s arm swing consistent from side to side?

A photographic record may be made – with the client’s express consent, or a posture observation form completed, noting observations like “a forward head position”, etc.

Please refer to Chapter 4, Section 3, for Common Postural Deviations

Side effect of poor posture

Poor posture, such as lordosis (excessive inward curvature of the lower back), kyphosis (excessive outward curvature of the upper back), flat back (reduced lumbar curve), hyperlordotic posture (exaggerated lumbar curve), and swayback (forward-leaning posture with an accentuated curve in the lower back), can lead to a variety of side effects. These may include:

  1. Muscle strain and imbalance: Poor posture can cause some muscles to become tight, overworked, or weak, leading to muscle imbalances and strain.
  2. Joint stress and degeneration: Abnormal spinal curvatures can increase stress on the joints, potentially leading to premature wear and tear, arthritis, and other degenerative conditions.
  3. Pain and discomfort: Discomfort and pain can result from muscle strain, joint stress, or nerve compression. Typical areas of pain include the neck, shoulders, and lower back.
  4. Nerve compression: Poor posture can cause spinal misalignment, which may compress nerves and result in conditions like sciatica, radiculopathy, or other nerve-related issues.
  5. Reduced lung capacity: Kyphosis, in particular, can cause a decrease in lung capacity due to the compression of the ribcage, leading to shortness of breath or difficulty breathing.
  6. Digestive issues: Poor posture can compress abdominal organs, potentially resulting in digestive problems like acid reflux, constipation, or bloating.
  7. Poor circulation: Improper spinal alignment can impede blood flow, which may contribute to swelling or numbness in the extremities.
  8. Fatigue: Muscle strain and the energy required to maintain poor posture can lead to fatigue and reduced physical performance.
  9. Headaches: Muscle tension and nerve compression resulting from poor posture can contribute to tension headaches.
  10. Aesthetic concerns: Poor posture can lead to an unbalanced appearance and negatively impact self-esteem and body image.
  11. In women, it can lead to an imbalance in the core muscle leading to incontinence and/or pelvic organ prolapse.

Movement analysis

When observing active movement, we assess dynamic posture- the body or its segments are moving—walking, running, jumping, throwing, and lifting. Observing active movement is an effective method to determine muscle imbalances and poor posture contribute to neural control. It also helps identify movement compensations (Whiting & Rugg, 2012).

When compensations occur during movement, it usually indicates some form of altered neural action, commonly called “faulty neural control,” which normally manifests due to muscle tightness or an imbalance between muscles acting at the joint.

Movement can essentially be broken down and described by five primary movements that people perform during many daily activities (Cook et al., 2006):

  • Bending/raising and lifting/lowering movements (e.g., squatting)
  • Single-leg movements
  • Pushing movements (in vertical/horizontal planes) and resultant movement
  • Pulling movements (in vertical/horizontal planes) and resultant movement
  • Rotational movements

Movement screens help a trainer observe the ability and efficiency with which a participant performs many activities of daily living.

The procedure of an assessment

After observing a demonstration from the trainer, the client should perform the movements you have shown them. During each movement, take note of the client’s ability to maintain proper joint alignment and form without pain. Ask the client how their body feels while performing each movement and make notes on their feedback (Bushman, 2017).

  • Squats – The client should stand with feet hip to shoulder-width apart, chest lifted, abs engaged, and arms reaching forward. They should slowly lower into a squat position and repeat 5 to 10 times. Observe internal rotation of the hip (knees knocking), external rotation of the hip (knees bowing), leaning to one side or the other, and heels lifting up (Rippetoe & Kilgore, 2007).
  • Lunges – The client should stand with feet hip to shoulder-width apart, right foot forward and left foot back with the heel lifted. Weight should be in the heel of the front foot and on the ball of the back foot. The client should slowly lower the back knee toward the floor and return to standing. Repeat about five times on each leg. Look for hip, knee, and ankle alignment, internal/external rotation of the hip, the front knee sliding forward beyond the toes, the front heel lifting up, and/or balance issues. Notice if there is a difference on each side (Clark et al., 2014).
  • Pull – Have clients perform a row, seated if necessary. The client should stand with feet hip to shoulder-width apart, chest lifted, abs engaged, and knees slightly bent. Using a tube or cable machine, the client should perform a row by pulling elbows toward the ribs, then return to the starting position. Have clients repeat 5 to 10 times. Observe whether clients can keep their shoulders down and retract their shoulder blades. Watch for activation of muscles (lats/rhomboids/mid traps), control through concentric and eccentric phases of contraction, and symmetry on both sides of the body (Schoenfeld & Contreras, 2016).
  • Push – The client should perform a knee-based push-up with hands wider than shoulder-width apart. They should lower the push-up to 90 degrees at the elbow and press back up to the starting position, repeating 5 to 10 times. Look for back swaying, scapular stability/scapular winging, and symmetry during both the eccentric and concentric phases (Zatsiorsky & Kraemer, 2006).
  • Core – The client should lie on their back with their knees bent and feet on the floor with the trainer’s hand under their low back. Instruct them to maintain pressure on the trainer’s hand. As the client maintains abdominal contraction, have them bring one leg up to 90 degrees at the knee and hip, then lower without arching through the spine. Repeat with the opposite leg. If the client does not have a problem with that, have them lift one leg to 90 degrees and hold, then bring the opposite leg to 90 degrees without arching through the spine. If the client has no problem with that, place the trainer’s hand under the client’s lumbar spine, and have the client lower both heels to the floor while maintaining a 90-degree angle at the knees. Ideally, the client should maintain the same pressure on the trainer’s hands until their feet touch the floor (Akuthota & Nadler, 2004).

Flexibility assessment

Assessing participants’ range of motion (ROM) using flexibility tests is an effective way to identify areas of the body that may require focused stretching. Stiff, inflexible muscles and joints can increase the risk of injury and negatively impact the performance of even the simplest tasks.

During initial assessments of posture and movement, a trainer may choose to assess the flexibility of specific muscle groups suspected to have tightness or limited movement.

After conducting the following flexibility assessments, note whether the ROM is “good” or “needs improvement” on the client’s chart. Instead of recording exact ROM measurements, address these areas by strengthening opposing muscle groups and lengthening tight muscles.

  • Piriformis/Medial glute – The client should sit upright on a bench, placing one ankle on the opposite knee. If the client’s shin is somewhat parallel to the floor, they have good ROM; if the knee points slightly upward at an angle, ROM is limited. Observe any differences between the right and left sides and note the symmetry of the client’s ROM.
  • Hamstring: passive straight leg raise – The client should lie supine on the floor (if the client experiences back pain when lying like this with both legs extended, have them bend one leg with their foot on the floor). The client should contract their abs, fully extend the leg, dorsiflex the foot, and lift the straight leg as high as possible. Observe how high the leg goes before it starts to bend at the knee or the spine begins pressing into the floor. Ideally, they should lift their legs close to 80 degrees. Again, note the symmetry of their ROM.
  • Hip flexor: Thomas test – While in a supine position, the client should bring one knee to the chest with the opposite leg extended. If the hip flexors are tight, the extended leg will bend at the knee and/or the client’s head will lift off the floor. Observe differences on the right and left sides of the body (Kendall et al., 2005).
  • Pectoralis/lats – The client should remain supine with tight abs, spine neutral, and arms down to the side. The client should extend both arms up over their head until they are resting on or towards the floor. Observe whether the client can touch their hands, wrists, and elbows to the floor without arching the spine. If the client cannot reach the floor, they may have tight pecs and/or lats. Note the symmetry of the ROM.
  • Subscapularis/Teres major: shoulder mobility – The client should remain supine on the floor with abs tight, spine neutral, and elbows directly lateral to the shoulder. Keeping elbows in position, the client should externally rotate their forearms towards the ground. Observe whether the client can touch their hands and wrists to the ground without arching their spine. If they cannot, they have tight and weak internal rotators. Note the symmetry of the ROM (Page et al., 2010).
  • Quadriceps – The client should lie prone on the floor with arms crossed and head resting on the arms and legs extended. The client should bring one foot to their glute. The client should be able to bend more than 90 degrees at the knee. Note the symmetry of the ROM. Remember that clients with a lot of body fat or muscle may be restricted by the mass of the back of their leg, not necessarily by the tightness of the quadriceps (Norkin & White, 2016).

Balance and Core

Given the importance of balance and the condition of the core musculature to fitness and overall quality of life, these baseline assessments should be collected to evaluate the need for comprehensive balance training and core conditioning during the early stages of a conditioning program. While dynamic balance correlates more closely with people’s daily activities, these tests are generally movement-specific and quite complex. Consequently, a trainer should aim to first evaluate the basic level of static balance that a participant exhibits by using the sharpened Romberg test or the stork-stand test.

Sharpened romberg Test

Sources: Black et al., 1982; Newton, 1989

Objective: To assess static balance by standing with a reduced base of support while removing visual sensory information

Equipment:

  • Flat, non-slip surface 
  • Stopwatch

Instructions:

1)Explain the purpose of the test.

2) Instruct the participant to remove his or her shoes and stand with one foot directly in front of the other (tandem or heel-to-toe position), with the eyes open.

3) Ask the participant to fold his or her arms across the chest, touching each hand to the opposite shoulder.

4) Allow sufficient practice trials. Once the participant feels stable, instruct him or her to close his or her eyes. Start the stopwatch to begin the test.

5) Always stand in close proximity as a precaution to prevent falling.

6) Continue the test for 60 seconds or until the participant exhibits any test-termination cue. Allow up to two trials per leg position and record the best performance on each side.

Observations:

Continue to time the participant’s performance until one of the following occurs:

  • The participant loses postural control and balance.
  • The participant’s feet move on the floor.
  • The participant’s eyes open.
  • The participant’s arms move from the folded position.
  • The participant exceeds 60 seconds with good postural control.

General interpretations:

  • The participant needs to maintain his or her balance with good postural control (without excessive swaying) and not exhibit any of the test-termination criteria for 30 or more seconds.
  • The inability to reach 30 seconds is indicative of inadequate static balance and postural control.