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cpt7-static-dynamic-posture-assessment-template

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Static and Dynamic Postural Assessment
Name ________________________________________
Date __________
Static Postural Assessment
View
Notes
(circle Yes or No)
Observation
Anterior
Pes Planus Syndrome
Yes or No
Lateral
Lower Crossed Syndrome
Yes or No
Lateral
Upper Crossed Syndrome
Yes or No
Overhead Squat Assessment (OHSA)
View
Kinetic Chain
Checkpoint
Observation
Notes
(circle Yes or No)
Left
Right
Foot / Ankle
Feet turn out?
Yes or No
Yes or No
Knee
Knees moves in?
Yes or No
Yes or No
Anterior
Lateral
Lumbo-pelvic-hip
Complex
Shoulder
Excessive forward lean?
Yes or No
Low back arches?
Yes or No
Arms fall forward?
Yes or No
Single-Leg Squat Assessment
View
Anterior
Kinetic Chain
Checkpoint
Knee
Observation
Knees moves in?
Notes
(circle Yes or No)
Left
Right
Yes or No
Yes or No
Pushing / Pulling Assessments
View
Lateral
Kinetic Chain
Checkpoint
Observation
Notes
(circle Yes or No)
Pushing
Pulling
Lumbo-pelvic-hip
Complex
Low back arches?
Yes or No
Yes or No
Shoulder
Shoulders elevate?
Yes or No
Yes or No
Head / Neck
Head juts forward?
Yes or No
Yes or No
Static and Dynamic Postural Assessment
STATIC POSTURAL ASSESSMENT
Pes Planus Distortion Syndrome
Lower Crossed Syndrome
Upper Crossed Syndrome
Overactive
Underactive
Overactive
Underactive
Overactive
Underactive
Gastrocnemius
Soleus
Adductors
Hip flexors
Anterior tibialis
Posterior tibialis
Gluteus maximus
Gluteus medius
Hip flexors
Lumbar extensors
Gluteus maximus
Gluteus medius
Hamstrings
Upper trapezius
Levator scapulae
Sternocleidomastoid
Pectoralis major
Pectoralis minor
Deep cervical flexors
Rhomboids
Middle trapezius
Lower trapezius
Abdominals
DYNAMIC POSTURAL ASSESSMENTS
View
Kinetic Chain
Checkpoint
Foot and
Ankle
Movement Impairment
Turn out
Anterior
Knee
Valgus
Overactive Muscles
Underactive Muscles
Soleus
Gastrocnemius
Anterior tibialis
Posterior tibialis
Hamstrings complex
Gluteus maximus
Gluteus medius
Tensor fascia latae (TFL)
Gluteus maximus
Adductor Complex
Gluteus medius
Anterior tibialis
Soleus
Gastrocnemius
Excessive forward trunk lean
LPHC
Low back arches
Lateral
Arms fall forward
Shoulders
Scapular elevation (push/pull only)
Head and
Neck
Head juts forward (push/pull only)
Hip flexors
Rectus abdominis
Posterior tibialis
Hamstrings complex
Gluteus maximus
Lumbar extensors
External obliques
Hip flexors
Lumbar extensors
Gluteus maximus
Hamstrings complex
Latissimus dorsi (OHSA only)
Latissimus dorsi
Teres major
Abdominals
Middle trapezius
Lower trapezius
Pectoralis major
Pectoralis minor
Rhomboids
Posterior deltoids
Levator scapulae
Upper trapezius
Levator scapulae
Rotator cuff
Lower trapezius
Deep cervical flexors
Sternocleidomastoid
Overactive Muscles: _____________________________________________________________
Underactive Muscles: ____________________________________________________________
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