Over the last decade or so, assessing static and dynamic posture has become increasingly common during health and fitness assessments performed by certified fitness professionals with clients, athletes, and patients. This has been a great addition to certified fitness professionals’ toolboxes to assist in determining possible postural deviations and movement compensations that may be caused by muscular imbalances. These muscular imbalances may then be corrected through exercise performed with a certified fitness professional before they lead to either acute and/or chronic musculoskeletal conditions and pain. ACSM has recently introduced a static posture assessment via a plumb line in ACSM's Resources for the Exercise Physiologist: A Practical Guide for the Health Fitness Professional (3rd ed.).

For the scope of this article series, we will simply be discussing how to perform a static postural assessment. However, there are some great resources available that can assist the certified fitness professional in assessing the movement of clients, athletes, and patients via dynamic assessments such as the overhead squat; single-leg squat; split-squat; gait analysis; jumping and landing; and upper-body pushing, pulling, and pressing. All of these are great follow-ups to confirm possible findings from the static postural assessment and lead to further single-joint mobility assessments to confirm any possible joint mobility issues.

When assessing static posture, the certified fitness professional will assess the client from both the anterior (Figure 1) and lateral (i.e., sagittal) view (Figure 2). Assessing the client from the posterior view (Figure 3) may be beneficial to confirm possible findings from the anterior view (specifically at the foot/ankle region) but will not be discussed in this article. Please note that this article will be assessing specific areas of the body from each view in an attempt to witness the three most common postural distortion syndromes: (a) pes planus/pronation distortion syndrome, (b) lower crossed syndrome, and (c) upper crossed syndrome.

When assessing static posture, certified fitness professionals may use a plumb line to assist in witnessing possible postural deviations and/or asymmetries. However, a plumb line is not required. To learn how to hang a plumb line appropriately, please see the section of this webpage titled “Assessment.” Certified fitness professionals may also use posture assessment grids or simply line the client up to a vertical line of a wall as a reference point.

Prior to assessing your client’s posture, please be sure that your client is wearing either shorts or yoga pants, a T-shirt or tank top, and has removed their footwear. Form-fitting clothing is preferred and will allow the certified fitness professional to more easily identify postural deviations. If a plumb line is used, the certified fitness professional should line the client up properly in both the anterior and lateral views, as well as the posterior view, if used. When assessing clients’ static posture, clients may become very self-conscious of their posture, which will affect the validity and reliability of the assessment. Therefore, the certified fitness professional should ask their client to stand naturally as if they were doing something like waiting for an elevator. The certified fitness professional may also ask the client to “shake everything out” prior to the assessment or even perform a few mini squats to allow the client to assume as natural a static posture as possible.

From the anterior view, the client should stand facing the plumb line (if used), with the plumb line or line in the wall halfway between the client’s feet. The plumb line should be aligned with the client’s pubis. From the anterior view, the certified fitness professional is specifically assessing the posture of the feet, ankles, knees, and hips. When viewing the client from the lateral view, the plumb bob at the bottom of the plumb line (if used), should line up just anteriorly to the client’s lateral malleolus. From the lateral view, the certified fitness professional is specifically assessing the posture of the hips, pelvis, lumbar spine, thoracic spine, shoulder complex (i.e., scapula and shoulder joint), neck, and head. Please note, further body areas may be assessed. However, for the scope of this article, only the body areas mentioned above will be assessed.

In the first part of this article series, we discussed the importance of certified fitness professionals performing static postural assessments with their clients, athletes, and patients. Within the second part of this article series, we will be describing the process of performing a static postural assessment, what an “ideal” static posture should look like, and common deviations from ideal posture that may indicate postural distortion syndromes such as pes planus/pronation distortion syndrome, lower crossed syndrome, and upper crossed syndrome.

Related content: 
Blog | A Fitness Professional’s Introductory Guide to Assessing Static Posture: Part II

Related CEC Courses:
Using Posture to Enhance Movement (1 CEC)
Anatomy of Movement (5 CECs)

Ryan R. Fairall, Ph.D., ACSM-EP, EIM, CSCS,is an assistant professor of exercise science at Catawba College in Salisbury, N.C. He has worked in the fields of health/fitness and sports since the year 2000, has been a certified personal trainer since 2003, and has been an instructor in higher education since 2015. In his free time, Ryan enjoys being physically active — lifting weights, playing sports, kayaking, fishing, going on walks with his female Shih Tzu, Bledsoe, and watching his hometown Philadelphia sports teams, which can be very frustrating at times.

The Good

Athletes today have a variety of cryotherapy options available to them. Cold water immersion (CWI) is the most studied cryotherapy application and the most commonly used modality for athletes at all competition levels in post-recovery regimens. CWI is thought to affect pain pathways through alpha and c-fibers, limit the inflammatory process and cell damage, expedite metabolite removal and improve energy metabolism. Utilizing CWI at 10°C (50°F) for 10 minutes demonstrated effective recovery at 72 hours. CWI has shown an ability to maintain aerobic metabolism by decreasing delayed onset muscle soreness (DOMS) and improving muscle oxygen saturation.

Prescription: Frequency, Duration and Intensity

CWI is beneficial for improving neuromuscular performance up to 24 hours, but does not extend past this period. CWI should include two exposures of 10°C (50°F) for five minutes each, and athletes should sit in ambient temperature for two minutes between exposures. Other studies have shown that the effectiveness of CWI is ideal when temperatures are between 11°C and 15°C (52-60°F) for 11 to 15 min to reduce DOMS and enhance recovery for athletes. The evidence for CWI appears to be strongest for whole-body endurance athletes, and the efficacy varies by sport. To mitigate the interference of CWI on specific strength and hypertrophy goals, many have shifted the use of CWI to four to six hours after exercise. There are only a few studies that have looked at the timing of CWI after exercise, and those found diminished but still beneficial outcomes with delayed CWI vs. immediate post-exercise CWI.

The Bad

Athletes and medical professionals should consider the following contraindications before utilizing CWI:

• Prior cold injury
• Claustrophobia
• Raynaud’s disease
• Hypothyroidism
• Cryoglobulinemia
• Cardiovascular disease (stage III or IV heart failure, CAD, unstable angina pectoris)
• Uncontrolled hypertension
• Sympathetic or sensory nervous system disorders

Injury risks for CWI include:

• Frostbite, cold water/exposure injury
• Asphyxiation
• Loss of consciousness

The Ugly

A 2015 study of 24 physically active men showed reduced strength and hypertrophy in the group that utilized CWI as an immediate post-exercise recovery tool. The group that performed low-impact active recovery had larger gains in strength and muscle hypertrophy at the end of 12 weeks. This has led many athletes, trainers and medical professionals to reconsider when and if they should use CWI.

In addition to this, others conclude that CWI will inhibit the natural healing process. CWI leads to vasoconstriction, which limits the body’s ability to mobilize a cellular response to micro injuries induced by exercise. Critics argue that using cryotherapy mutes this process and may lead to chronic injuries as the body is not allowed to progress through its desired healing progression. Proponents argue that pain and discomfort should instead be treated with alternate methods that do not impede this first stage of the healing process.

Summary

Overall, the body of research seems to support the use of CWI as a passive recovery tool. There are two options when enhancing recovery is the primary goal: two five-min periods at 10°C (50°F) with two minutes out of the bath at ambient temperature or single exposure for 11-15 minute duration between 11°C and 15°C (52-60°F). These two protocols have been studied to maximize recovery. Athletes and their medical team could utilize these protocols when facing back-to-back competitions during the season.

During off-season training when regimens look to achieve greater muscle strength and hypertrophy, athletes are suggested to delay the cold water exposure for four to six hours after exercise. This should minimize the potential negative consequences of CWI and still offer the benefits of decreased pain, soreness and recovery time. CWI exposure early in the morning, prior to exercise, would be ideal to trigger the release of dopamine, norepinephrine and epinephrine, enhancing overall health and well-being while minimizing the impact to desired strength training later in the day. Utilizing CWI later in the day could affect sleep cycles with the release of these potent neurotransmitters.

While there is evidence suggesting CWI’s potential to reduce inflammation, reduce cellular damage, improve recovery, and provide psychological benefits, it’s essential to approach this passive modality with caution and awareness. Individualization is key — what might work for one athlete may not work for another. As with any treatment strategy, consulting a health care professional or a sports medicine specialist is advisable, especially if you have pre-existing medical conditions or concerns. So, if you’re ready to take the icy plunge, do so mindfully, and tailor its use to your specific goals. 

Related CEC Courses: 
Exercise and Metabolic Modulation (1 CEC)
To Endure is Everything: New Discoveries in the Science of Endurance Exercise (1 CEC)

LTC Michael-Flynn L. Cullen, MD, is a board-certified physiatrist and sports medicine physician currently serving as the primary care physician for Headquarters Battalion I Corps at Joint Base Lewis-McChord in Tacoma, WA. He completed his residency at Walter Reed National Military Medical Center and his fellowship at the University of California, Davis.

Brian A. Davis, MD, FACSM, is a board-certified physiatrist and sports medicine physician currently serving with the Intermountain Healthcare system in Las Vegas, NV. He is a clinical professor with the Department of PM&R with UC Davis and the Department of Family and Community Medicine in the UNLV School of Medicine. 

ACSM Foundation grant applications open after Labor Day. We polled the Research Review Committee for their top tips for a high scoring grant application. Here’s what we learned:

Writing – Make it easy for reviewers to read

The number one piece of advice from experienced grant reviewers is to use clear, concise writing. You aren’t evaluated by the elegance of your writing, but by how logically the proposal is developed. Key tips include:

• Use a logical sequence – don’t make the reviewer scroll back and forth for pertinent information that is relevant to the current application section.
• Don’t be afraid to use bullet points to make the proposal easy to read. The less text you can use to make a point, the better.
• Avoid excess jargon and acronyms, explain key design choices, and if there are highly novel procedures, explain how they help answer your study question.
• Write so that an educated scientist can follow the logic of your study even if they don’t have expertise in your specific area. It’s even better to write so that a lay person can understand what your grant will accomplish and why it’s important.

Proposal – Clear, specific aims are vital

Clear, specific aims are the top concern for grant reviewers. However, don’t sleep on the importance and rational for the study. Detail the gap the research will fill and make a strong case for why the research question is interesting. Additional tips for a strong proposal:  

• Do not make small figures with tiny fonts. Keep figures simple, with crisp lines and easy to read text. 
• Demonstrate that you have the ability to execute the research (background, facilities, mentors, collaborators, etc.).  
• Indicate how this project fits into your overall research or education plan and the value of having this funding. 

General – Grantsmanship starts when applications open

ACSM Foundation grants, like all grants, are competitive, and grantsmanship is important to be successful. Reviewers encourage you to start early and give your mentors/collaborators plenty of time to read the grant and give feedback. Grantsmanship can include:

• Specifically aligning your proposal to the funding opportunity and following all of the grant instructions.  
• Demonstrating professionalism by submitting complete, final versions of applications. Believe it or not, the ACSM Foundation has received draft proposals with tracked changes still included. Reviewers do not want to see your drafts.  
• Matching the scale of the project to the maximal amount of the grant. Make sure the project can stand on its own merits. 

Final note: all of the research grant reviewers are volunteers. They have full-time jobs, families and lives outside of ACSM, and yet they each willingly review more than a half dozen grant applications every winter. Writing a strong application honors their time and dedication to making this a fair, yet rigorous process.

Learn about grants available to ACSM members