Categorizing Posture to Customize Routines - An excerpt from chapter 5

Categorizing Posture

“The numerous major muscles that connect with the pelvis mean the hips play a central role in our mobility. Hip misalignment has dramatic consequences from head to toe…” - Pete Egoscue

A posture therapist must complete a final, yet relatively simple step before creating a customized routine based on the posture analysis and functional testing performed so far. Posture categorization further helps to guide both the choice of exercises and the amount of focus that will be placed on various phases of the therapy process.

Technically, a posture therapist will place a tentative category on a person’s posture immediately after analysis and before functional testing, then use testing to confirm that category. In the interest of simplifying the discussion, I decided this order makes the information a little easier to digest. Additionally, a rookie posture analyst is more likely to miscategorize if relying on pictures alone. Pictures guide analysis and functional testing confirms or denies hypotheses that arise from the analysis.

As the opening quote indicates, the hips and pelvis play a central role in the overall function of the human body. There are many reasons for this, which we aren’t going to explore too deeply. Suffice it to say that while we have almost no conscious control over our primary hip flexors, they are the only muscle that directly connects the upper body to the lower body, bypassing the pelvis. This bypassing of the pelvis aspect of the hip flexors’ construction gives them immense mechanical leverage, which can wreak havoc across your body when the subconscious processes controlling them get disrupted.

The position of the pelvis relative to the rest of the body allows us to draw a number of conclusions about overall function immediately.

We'll work with four categories of posture:

• Pure Anterior Pelvic Tilt

• Posterior Pelvic Tilt

• Swayback Pelvic Tilt

• Radically Asymmetrical Posture

You may have noticed that the last entry doesn’t fit the pattern. This category is a little bit special. More on that in just a bit.

Let’s discuss each briefly before diving into the finer details of each category, with a whole section devoted to each throughout this chapter.

Radically Asymmetrical Posture

Sometimes, your body might take a detour sideways, leaning to one side. One hip may be higher than the other, and your shoulders may not align. And these asymmetries are pronounced enough to largely define your overall posture. Asymmetrical posture can stem from various sources. Previous injury, certain jobs or hobbies, as well as the ergonomics of home or office might result in these deviations. Don't worry, though. With proper guidance, you can make great strides toward regaining balance.

As mentioned above, this category is a little bit special. That’s because a person can fall into it as well as any one of the other three. No other categories have this transitive property. So, for example, a person can have a Posterior Pelvic Tilt and be Radically Asymmetrical, but you can’t have the physical appearance of both a Posterior and Pure Anterior Pelvic Tilt at the same time.

Pure Anterior Pelvic Tilt

In this category, your body overcompensates for tight, short hip flexors. You might notice an excessive arch in your lower back and that you’re constantly fighting a forward center of gravity. While it can convey a confident air and most professional athletes have a forms of this posture, it might come with its share of discomfort and pain. Fortunately, targeted exercises can help bring equilibrium back into your life.

Posterior Pelvic Tilt

Imagine your body taking on a subtle, protective stance—rounded shoulders, tucked pelvis, and a slight forward lean. This posture often arises from a sedentary lifestyle or prolonged desk work. The good news? With the right exercises and adjustments, you can reverse the effects and regain balance.

Swayback Pelvic Tilt

This is an interesting posture because it involves components of the previous two categories simultaneously, even though it is technically a subcategory of anterior pelvic tilt by appearance. It’s also becoming the most common posture in the younger generations.

Let's be Crystal Clear

These categories are not medical diagnoses implying that something is inherently "wrong" with you. Instead, they reflect the incredible adaptability of the human body—a remarkable survival mechanism that has allowed us to endure for hundreds of thousands of years. Over time, your body has adapted to the unique demands and stimuli it encountered over the course of your life. While these adaptations have enabled you to keep moving, they may not necessarily align with your goals, whether they involve overall fitness, pain management, endurance, or aesthetics.

It's crucial to emphasize that these categories are not meant to pathologize your posture. We must avoid falling into this trap.11 What exactly does it mean to pathologize a diagnosis? It is essentially when a person uses a diagnosis to justify becoming paralyzed by a defeatist attitude and avoids taking corrective action. This may happen consciously or subconsciously. It may be accompanied by attaching the diagnosis to the ego, making it harder to address the situation constructively.

Consider the example of someone who, feeling down, receives a depression diagnosis and then stumbles upon statistics suggesting the challenges of recovering from clinically diagnosed depression. This individual might inadvertently reduce their efforts to overcome their condition, attributing their situation to external factors. They may cultivate feelings of hopelessness, convinced that they're destined for a prolonged state of depression. Such patterns, rooted in the logical fallacies of catastrophizing and fortune-telling, underscore the human tendency to pathologize a diagnosis. I implore you not to succumb to this trap when it comes to posture.

It is my opinion that social media has incentivized people to pathologize symptoms. People become so proud of how many likes they get posting about battling chronic mental or physical illness that they may not realize how much of their self-esteem and sense of identity relies on the existence of their chronic illness. 

As you continue with this chapter, keep this idea of avoiding pathologizing your posture condition in mind. The upcoming sections define the general categories that posture therapists use to help guide the course of treatment.

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