CPT7 Static Dynamic Posture Assessment Template

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Static and Dynamic Postural Assessment

Name ________________________________________ Date __________


Static Postural Assessment
Notes
View Observation
(circle Yes or No)
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)


Notes
Kinetic Chain
View Observation (circle Yes or No)
Checkpoint
Left Right

Foot / Ankle Feet turn out? Yes or No Yes or No


Anterior
Knee Knees moves in? Yes or No Yes or No

Excessive forward lean? Yes or No


Lumbo-pelvic-hip
Complex
Lateral Low back arches? Yes or No

Shoulder Arms fall forward? Yes or No

Single-Leg Squat Assessment


Notes
Kinetic Chain
View Observation (circle Yes or No)
Checkpoint
Left Right
Anterior Knee Knees moves in? Yes or No Yes or No

Pushing / Pulling Assessments


Notes
Kinetic Chain
View Observation (circle Yes or No)
Checkpoint
Pushing Pulling
Lumbo-pelvic-hip
Low back arches? Yes or No Yes or No
Complex
Lateral 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 Anterior tibialis Hip flexors Gluteus maximus Upper trapezius Deep cervical flexors
Soleus Posterior tibialis Lumbar extensors Gluteus medius Levator scapulae Rhomboids
Adductors Gluteus maximus Hamstrings Sternocleidomastoid Middle trapezius
Hip flexors Gluteus medius Pectoralis major Lower trapezius
Abdominals
Pectoralis minor

DYNAMIC POSTURAL ASSESSMENTS


Kinetic Chain
View Movement Impairment Overactive Muscles Underactive Muscles
Checkpoint
Soleus Anterior tibialis
Foot and Gastrocnemius Posterior tibialis
Turn out
Ankle Hamstrings complex Gluteus maximus
Gluteus medius
Anterior
Tensor fascia latae (TFL) Gluteus maximus
Adductor Complex Gluteus medius
Knee Valgus
Anterior tibialis
Posterior tibialis
Soleus Hamstrings complex
Gastrocnemius Gluteus maximus
Excessive forward trunk lean Hip flexors Lumbar extensors
Rectus abdominis
LPHC
External obliques
Hip flexors Gluteus maximus
Low back arches Lumbar extensors Hamstrings complex
Lateral Latissimus dorsi (OHSA only) Abdominals
Latissimus dorsi Middle trapezius
Teres major Lower trapezius
Arms fall forward Pectoralis major Rhomboids
Shoulders Pectoralis minor Posterior deltoids
Rotator cuff
Levator scapulae Lower trapezius
Scapular elevation (push/pull only)
Upper trapezius
Head and Levator scapulae Deep cervical flexors
Head juts forward (push/pull only)
Neck Sternocleidomastoid

Overactive Muscles: _____________________________________________________________

Underactive Muscles: ____________________________________________________________

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