Checking your child’s posture is easy to do without the help of a doctor. By checking for correct posture, you can determine whether your child has significant deviations in the development of his/her back. For example, you will be able to find out if your child displays signs of scoliosis, or if he is developing kyphosis, or if he simply has good posture.
In order to determine whether or not the posture is correct, we must first ask the child to stand straight, and inspect his posture from the back and from the side.
Exam #1 – Inspection of the back
Upon inspection of the back, notice the shoulders. They should be symmetrical and equally distal to the spine and close to the body (Image 1.1). Symmetry should also be apparent in the skin folds around the waistline and neck. Pay close attention to the height of the shoulders. Does one shoulder appear higher than the other? (See figure 1.2)
Another indicator is the space created between the arms when hanging straight down along the sides of the body (See figure 1.3)
If the spaces between the two sides of the body are unequal, or the shoulders and skin folds in the waist and neck are asymmetrical, it indicates varying degrees of scoliosis. However, minimal asymmetry is present in most people – as ideally balanced people, do not exist.
Figure 1 – Inspection of the back
We will now inspect the child from the side (Figure #2)
In the normal development of a person, the chest should be slightly raised, the belly tucked in, legs should be straight, and the physiological curves of the spine should be mild and fluid.
When examining a child with poor posture, a thoracic arch can easily be seen. This is a form of kyphosis characterized by forward head and shoulder carriage. There are many factors in the development and exacerbation of kyphosis. Some might include, genetics, behavioral, psychological, Scheuermann’s disease etc. We will expand on this in a separate article entitled, “Possible Causes of Kyphosis”. But usually, kyphosis develops and worsens during the active growth of the skeleton, at around 11-17 years of age.
Additionally, you may find increased Lordosis of the lower back indicated by an excessive curvature of that region, with a protruding abdomen and an anterior pelvic tilt (butt sticking out). This is usually the result of weak muscles that tilt the pelvis back and short muscles that turn the pelvis inward. This condition is typically apparent in thin children with a protruding abdomen.
Figure 2 – Inspection from the side
Exam #2 – Inspection forward bending (Figure #3)
Upon inspection, we would ask the child to bend forward and try to touch the ground with his hands. Typically, a person should easily be able to touch the floor with his fingertips without bending his knees.
If, when bending forward the child (or adult) is able to touch the floor with the palms of his hands with ease, without bending his knees, this would indicate excessive flexibility of the joints and spine. This could mean that the person focuses too much on stretching exercises and that is not always a good thing.
On the other hand, if the child or adult can only reach 10-15 cm off the floor when bending forward (without bending the knees), it points to the opposite extreme – a poor physical condition associated with chronic muscle spasms of the legs and back, or maybe even Scheuermann’s disease (a lack of flexibility in combination with kyphosis).
When the distance between the fingers to the floor is greater than 30-40 cm for a person under the age of 45, special attention is required!
Once the distance is determined between the fingertips and the floor, continue examining the back as the child remains upright. Curvature of the spine can easily be spotted (if it exists at all) to the right or to the left. Additionally, you can easily determine whether one shoulder is bulging more than the other. All of these are signs of scoliosis.
Figure 3 – Inspection forward bending
There is another exam that can be performed when bending forward. While bending forward, we can see which parts of the spine are inactive. If the curve is smooth and consistent, then everything is fine. If there’s a part of the upper back that is not totally fluid (like in figure 2), this is a clear sign of kyphosis.
Exam #3 – Checking the posture against the wall (Fig. 4)
At this stage, we will ask the person being tested to stand against the wall, with his feet 10-15 cm away from the wall, arms hanging straight alongside the body, with the buttocks and back of the head pressing against the wall.
A person with a good posture will not have difficulties performing this test. But an individual with a curved back and slumped shoulders, especially if suffering from Scheuermann’s, would find it difficult to touch the wall with the back of his head, or not detach his heels or buttocks from the wall. It would be even more difficult if we were to ask him to press his shoulders on the wall. For a child or an adult with a bent back, this would be impossible. The fact that the person being tested cannot press his head or shoulders against the wall points to the presence of kyphosis. The question is if kyphosis functional or structural?
Upon completion of the test, while the person is still standing against the wall, we will take note of the distance between the lower back and the wall. In a normal situation, you’d only be able to put the palm of your hand through that gap. But if the space is too big, meaning, the hand passes through too easily, and a gap remains, it means that pronounced lordosis of the lower back is present which is indicated by an excessive curvature of that area, with a protruding abdomen and an anterior pelvic tilt.
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Figure 4 – Inspection agains ther wall
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