Postural Assessment and Functional Movement Observation

Why Postural Assessment Matters for PT Aides

A physical therapist (PT) designs every treatment plan around a thorough evaluation of how the patient stands, sits, and moves. As a PT aide, you will not interpret clinical findings or make diagnoses — that responsibility belongs solely to the supervising PT. However, you will be asked to set up equipment, assist with screening procedures, and document what you observe using precise language. Understanding postural assessment allows you to support the PT efficiently and communicate in the professional terms the team relies on.

The Plumb Line and Postural Grid

The standard tool for static postural observation is a plumb line — a weighted string hung vertically — or a posture grid, a wall-mounted or free-standing grid of horizontal and vertical lines. Both give you a true vertical reference against which you compare body segments.

Observation is performed in three views:

• Anterior view (patient facing you): check symmetry of the head, shoulders, rib cage, iliac crests, knees (genu valgum/varum), and feet (pronation/supination).
• Posterior view (patient facing away): assess the same landmarks from behind, plus the spine for lateral curvature (scoliosis screening) and scapular position.
• Lateral view (patient facing 90° to you): evaluate spinal curves (cervical lordosis, thoracic kyphosis, lumbar lordosis), head position relative to the shoulder, and pelvic tilt.

In ideal alignment, the plumb line from the lateral view passes through the earlobe, the middle of the shoulder, just posterior to the hip joint, just anterior to the knee joint, and just anterior to the lateral malleolus.

Key Deviation Patterns

Learning to recognize these patterns allows you to use the correct anatomical terms when completing screening forms.

Forward head posture: The head translates anteriorly so the ear sits in front of the shoulder plumb line. This commonly accompanies increased thoracic kyphosis and is frequently seen in patients who work at computers or use smartphones for extended periods.

Anterior pelvic tilt: The anterior superior iliac spine (ASIS) sits lower than the posterior superior iliac spine (PSIS), creating an increased lumbar lordosis and a protruding abdomen. The pelvis appears to "tip forward."

Posterior pelvic tilt: The opposite — the PSIS drops lower than the ASIS — producing a flattened lumbar curve. Sometimes called a "tucked" pelvis.

Elevated shoulder: One shoulder sits visibly higher than the other when viewed anteriorly or posteriorly. May suggest muscle imbalance or scoliosis involvement.

Genu valgum ("knock-knee"): The knees angle inward so that when the knees touch, the ankles are apart.

Genu varum ("bow-leg"): The knees angle outward; ankles may touch while knees are wide apart.

Foot pronation/supination: Excessive pronation causes the medial arch to collapse and the ankle to roll inward; supination produces a high arch with the ankle rolling outward.

Functional Movement Observation

Static posture tells only part of the story. The PT also needs to know how the patient moves. As an aide, you may assist by observing and noting five common functional tasks:

1. Sit to stand: Watch for symmetrical weight-bearing through both lower extremities, trunk lean, and use of arm support.

2. Squat: Note knee tracking (do the knees cave inward — valgus collapse?), heel lift, and trunk position.

3. Single-leg stance: Observe for lateral trunk lean (Trendelenburg sign) suggesting hip abductor weakness.

4. Overhead reach: Check for scapular winging, trunk side-bending compensation, or limited shoulder range of motion.

5. Walking (gait): Assess step symmetry, arm swing, foot clearance, and trunk rotation.

For each task, document which joints move, whether motion appears symmetric, and any compensations you observe. A compensation is a movement substitution — for example, hiking the hip to clear the foot during swing phase instead of achieving normal dorsiflexion.

Documentation: Writing a PT Aide Observation Note

AIDA communication guidelines emphasize that aides write objective observation notes, not clinical assessments. Use this structure:

• What you set up or assisted with: "Assisted PT in setting up plumb-line postural screen."
• What was observed (factual, anatomical): "Patient demonstrated forward head posture in lateral view; increased thoracic kyphosis; bilateral genu valgum in anterior view."
• Any safety concerns noted: Report immediately to the supervising PT.
• Never write a diagnosis or clinical conclusion: "Patient has poor posture" is vague and outside aide scope. "Head positioned approximately 3 cm anterior to plumb line" is objective and useful.

Use precise anatomical directional terms: anterior, posterior, medial, lateral, superior, inferior, bilateral, unilateral.

Safety and Scope-of-Practice Reminders

• Never instruct a patient to correct posture unless the supervising PT has specifically directed you to cue a particular correction.
• If a patient reports pain during any observation task, stop the task immediately and notify the PT.
• Ensure the patient has a stable surface or support nearby during single-leg stance tasks.
• Maintain patient dignity: expose only the body region necessary, use appropriate draping, and obtain patient permission before proceeding.
• All clinical findings and their interpretation are the PT's responsibility. Your role is accurate observation and documentation.