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HEALTH CONCERN? BioHealth Health Concerns

Posture - The CHEK Approach

Contributing Author: Chek, Paul H.H.P.

Paul ChekPaul Chek is a world-renowned expert in the fields of corrective and high-performance exercise kinesiology. For over twenty years, Paul’s unique, holistic approach to treatment and education has changed the lives of many of his clients, his students and their clients. By treating the body as a whole system and finding the root cause of a problem, Paul has been successful where traditional approaches have consistently failed. Paul is the founder of the C.H.E.K (Corrective Holistic Exercise Kinesiology) Institute, based in California, USA.
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Posture is an important topic, yet far more complex than commonly appreciated! Most academic institutions teaching postural assessment and correction approach the topic mechanically, much the same way a builder views a sagging roof, or a bicycle mechanic fixes a bent wheel. While this can be a good starting point, this is just scratching the surface of the issue.

In this article, I will take you through the CHEK approach to posture. I will begin by defining posture and show you how to identify good posture as well as poor posture. To continue, I will discuss the seen forces of posturalization; these include factors such as developmental forces, ergonomic forces and so on. In part three, I will introduce the concept of unseen forces of posturalization. These involve the emotional, mental and spiritual forces acting on a person.

Due to wide range of professions and experience of the readership, I have chosen to introduce posture from the simplest-to-understand concepts and progress to the more challenging ideas. Level 1 and 2 C.H.E.K Practitioners may find the third section to be much different than what they have been taught to this point. This is not meant to confuse or contradict, but rather to show that there are many different tools and levels of awareness that the professional can use when working with clients. As I frequently say, everyone has to learn in layers, so bear this in mind when reading the article. Adopt those concepts that you find useful to you at this point in your personal or professional development and don’t worry about the rest. Reread the article in six months or a year, and it may well seem as if portions of the article have been re-written! This is simply because your knowledge base has expanded and you are now able to take on board the next layer of information.

As this article ended up rather longer than anticipated, the third section can be found on-line. Details of how to access this portion of the article are found at the end of the first two sections.


Posture: The position from which movement begins and ends.

Ideal Posture

(Figure 1 Ideal Posture)That state of muscular and skeletal balance, which protects the supporting structures of the body against injury or progressive deformity, irrespective of the attitude in which these structures are working or resting. It is during a state of ideal posture that the muscles will function most efficiently

In ideal posture, a line extending down the side of the body should run through the ear lobe, transect the shoulder, hip and knee joints and fall just anterior to (in front of) the ankle bone (Figure 1). If a small plumb line is suspended from the apex of the cheekbone, it should bisect the clavicle (collar bone). When evaluating posture, a client should also be viewed from the front and back. A simple grid can be set up to help the Practitioner assess posture and identify faults, such as deviations from the midline, differences in height between right and left ear, shoulder or hip, increased or decreased lumbar curvatures. For a comprehensive postural evaluation, actual measurements should be taken with inclinometers and goniometers. Then changes in posture due to treatment or exercise can be empirically measured over time. This type of evaluation is introduced in Level 1 and advanced upon in Level 2 of the C.H.E.K Certification Program.

Poor posture not only takes away from esthetics, it compromises how we were designed to function, eventually leading to pain and/or injury. The next time you are in a public place, take a few minutes to study the posture of the people around you. Unfortunately, you will most likely find that the majority exhibits poor posture. This is the result of a number of different factors, such as working in environments that are ergonomically incorrect, performing repetitive tasks with poor form or developmental dysfunctions during childhood.

The following are common postural dysfunctions. It is important for the fitness or rehab. professional to be able to identify and correct these dysfunctions.

Figure 2 shows the effects of imbalance between the trunk flexors and trunk extensors. As the abdominal musculature become progressively stronger than their antagonists, the following postural aberrations may be seen:

A. Short and tight upper abdominal musculature

B. Depressed sternum

C. Forward head

D. Increased thoracic kyphosis, often with its apex at approximately T7.

This type of posture is frequently associated with a decreased lumbar curvature – a flat back. Often due to excessive time spent in a seated environment, this can progress to a C-shaped spine, and severely altered spinal mechanics. The C-curve posture encourages degenerative changes in the spinal column, not to mention that it increases your chances of cervical or lumbar disc protrusion, and PAIN!

(Figure 4 Sway Back)

The Lower Cross Syndrome is shown in Figure 3. In this case there is shortening of the lumbar erectors, iliopsoas, rectus femoris and tensor fascia latae with lengthening of the lower abdominal musculature, hamstrings, thoracic extensors and superficial cervical flexors. Increased lumbar curvature is associated with this posture, which is frequently seen in exercisers who spend a lot of time in the gym following poorly designed programs.

The Sway Back Posture is shown in Figure 4. Here the hamstrings and lower abdominals are short and tight, while the lumbar erectors, rectus femoris and iliopsoas are long and may be weak. Note that the hips sway forwards of the line of good posture – hence the name.

As part of the correction of these cases of faulty alignment, the long weak muscles must be shortened and strengthened, while the short tight muscles must be stretched. The stretching should take place first. It is very important to stretch tight muscles prior to exercising. It has been shown by Janda (The Neurobiologic Mechanisms in Manipulative Therapy) that tonic muscles have a propensity for shortening and tightening, often becoming facilitated (have a lowered threshold of stimulation). Phasic muscles, on the other hand, have a propensity for lengthening and weakening. If a muscle group becomes facilitated, it will try to take over the function of synergistic and antagonistic muscles, resulting in perpetuation of muscle imbalance and often overuse injury to the facilitated muscles.


Ergonomic Forces Of Posturalization

Whenever we sit or stand with poor posture due to ergonomic constraints, or simply the lack of skill and understanding of how to create an optimal ergonomic environment, we induce ligamentous fatigue and muscle imbalance syndromes. Extended sitting is one of the primary causes of poor posture. Clinically, I have witnessed a shift in the types of postural problems I have seen in my clients over the past 20 years.

Up until the mid-1990s, the most commonly seen posture problem was a lower cross syndrome with excessive lumbar curvature. In the mid 1990s, this changed as more and more clients presented with reduced lumbar curvatures, C-curve spines, increased kyphosis and forward head posture. I attribute this to the huge increase in the amount of time people spend sitting down. Not only do people sit most of the time they are at home, eating or watching TV, the seated workplace is the most common in the world today. Some people sit almost every minute of their waking day, aside from walking to the toilet! Clearly, the modern environment is not favorable to good posture.

Correct ergonomics in the workplace are essential and could easily take up a whole article in itself. The C.H.E.K Institute’s booklet 10 Tips For Healthy Ergonomics outlines the principles of basic ergonomics and is designed to aid you in client instruction. The guidelines in the booklet, as well as the more advanced training in the C.H.E.K Certification Program are but another essential elements in your coaching and treatment program if posture is to be corrected for the long run!

Environmental Forces Of Posturalization

While I could easily write a book on this topic alone, I will hit a few key highlights to make the point regarding environment and postural influence. As I often say, we are still cavemen, just wearing suits and driving cars! When you consider that experts in genetics tell us that it takes 100,000 years to change the human genome one 10th of one percent, and that we are ~2.8% different than our nearest relative, the chimpanzee, it’s safe to say that in the past 100 years, we’ve rapidly removed ourselves from our natural developmental environment.

And as you know, it hasn’t come without a cost to our health. For example, experts in ophthalmology have described how living in the city can encourage visual dysfunction. Reduced color variety, changes in depth of field (mostly loss of distance vision), and the increased exposure to close-up working conditions such as computer screens have all contributed poor posture secondary to visual inadequacy, while at the same time creating a booming business in glasses, contact lenses and corrective eye surgery.

Our environment has resulted in more and more individuals living predominantly sedentary lives. The average hunter-gather is said to have spent about 3 hours a day hunting or doing chores to sustain a normal life, which means that they were getting about 21+ hours of exercise per week! When I did the research to write my chapter “Posture and Craniofacial Pain,” one of the favorable influences on posture that repeatedly came up was participation in sports, which is at an all time low today. In fact, many elementary and high schools have dropped physical education and installed Coke machines, stating that they needed to cut the budget and bring in more money to cover the cost of computers for the children!

Recently, on Don Bodenbach’s “Nature Of Health” radio show, Michael Mogodam, M.D. reported that only 3% of American women and 8% of American men do any regularly scheduled exercise! People are so sedentary they are even shopping for food on the Internet now! A big part of improving ones posture is to become active. Not everyone needs to go to the gym necessarily, but people do need to incorporate movement into their daily lives. Practicing Yoga or Tai Chi is beneficial as movement is taught holding a properly aligned spine! Good posture is actually needed to meditate properly, more on this in Part 3.

Our environment is more electrically and chemically polluted than ever in history. All these environmental factors, including such issues as our now universally toxic water supply, damaged and dirty air and chemically toxic soils secondary to commercial farming practices, and out-gassing from industrial, automotive and home building materials overload our detoxification, hormonal and immune systems. As the health and vitality of the body deteriorate, so to does ones posture. In the excellent book “The Body Electric” by Robert O. Becker, M.D., it becomes evident that chronic exposure to electromagnetic pollution can disrupt cell communication and lead to a plethora of health problems. When so many systems are disrupted, the Practitioner is unlikely to get good results from exercise or therapy alone. The load on the body must be reduced in order for healing and positive changes to be allowed to happen.

The next time you start working with a client who has poor posture, you may want to include an assessment of their home and work environment, including the environments where they take part in their hobbies. Model builders are often chronically exposed to glues, shooters are chronically exposed to munitions exhaust, auto buffs to numerous solvents, painters to thinners that enter the body as fast as you can blink an eye and are very toxic to the nervous system. I’ve even had female clients who were allergic to their make-up! 

Injury Response As A Force Of Posturalization

Whenever we get injured, we experience pain. Pain, according to Dr. Vladimir Janda, “reprograms the nervous system faster and more effectively than any therapeutic modality we have!” As a means of survival, the body always seeks to avoid pain, and move toward, or gain pleasure.

There are clinical pearls in the words above, particularly when it comes to assessing and correcting posture. First of all, if an injury results in pain generation, for which the position of alleviation is one of pronation (flexion-adduction-internal rotation), the body will seek avoidance of pain in a position that you or I would appreciate as poor posture. If we try to correct this seemingly poor posture without identification of the painful structure and resolving the issue at the etiology, any attempts to correct posture will counter a higher principle, namely avoidance of pain, an immediate threat to the system.

As Janda taught me, it is critical to keep people (particularly athletes), out of movement patterns of importance if performance of that given pattern(s) causes pain. If you do not, the nervous system will rewrite the software very quickly and very effectively, all in the name of compensation! Janda described, and I have seen over and over clinically, that there is a very finite point at which, if crossed, the individual’s muscle imbalances and motor sequencing disorders can no longer be restored by therapeutic intervention. The compensation becomes self-perpetuating.

On my recent trip to Sweden, I worked with an Olympic Decathlete whose career was interrupted by an Achilles tendon rupture. Now years later, after having completed his rehabilitation and returned to competitive athletics, I could easily see which leg the injury had occurred on…he was still limping! I showed him how his entire kinetic chain was in pronation and couldn’t stabilize effectively when upright against gravity. His core stability was also compromised. When his core was stimulated and activated, the degree or magnitude of lower extremity instability was noticeably reduced. These things are what we call dynamic posture.

This athlete is not a unique example. There are many people who have entrained their motor systems to move incorrectly, using a compensatory pattern that was generated by a faulty stabilizer mechanism, and possibly over-training, but is of no use once the injury has healed. The problem, typical of most rehabilitation today, is that the average therapist thinks that the absence of pain = recovery…it DOES NOT! This athlete, at all costs, should have not been allowed to perform any pattern of importance to his athletic performance in the healing phase, unless it could be performed pain-free and with no observable or measurable motor deficits. An example of how to handle this would be to take a running athlete into the pool, allowing them to exercise the gait pattern in a supportive environment that doesn’t erode his/her motor skills.

Another example of injury that erodes posture is any injury that adheres the central or peripheral nervous system. Once any nerve tissue is adhered anywhere in the system, the body will avoid any static or dynamic movements (postures) that stretch it, causing pain. By careful review of injury history and medical history (many nerve adherences are iatrogenic!), we can generally identify when nerve root adherence testing is necessary as a component of our postural correction program.

There is also the issue of motor memory. People literally develop a memory of an injury or the pain associated with it, and keeps it active, as though they were still injured. This locks them into the very posture that afforded them avoidance at that time. I have had a number of clients over the years that required the intervention of a psychologist as an integral part of their rehabilitation program. If I didn’t address the mental, or memory aspects of their injury, my rehabilitation efforts would have been futile! We are physical-emotional-mental-spiritual beings; all four areas are intertwined and cannot be considered separately.

We will expand on this in Part 3. As you learn to understand the emotional-mental-spiritual implications and offerings afforded by injury, you will be able to assist your clients in finding the true purpose for injury. You will also become more skilled at recognizing energy blockage in their body and subtle energy systems, which are responsible for holding a pattern.

Mechanical Forces Of Posturalization

Many people are born with structural asymmetries that alter posture and may produce pain syndromes as a result. There are numerous genetic traits that can be passed from parent to child that can affect posture; for example lumbarization (6th lumbar vertebra) and sacralization (fusion of L-5 to sacrum). Examples of structural asymmetries that all C.H.E.K Practitioners should seek to recognize are:

  • Leg length discrepancies
  • Hemipelvis asymmetries; I had a patient a few years back who had a right hemipelvis that was 16 mm larger than his left, which required quite a butt lift under his left ischium to balance his pelvis. Many physiotherapists, chiropractors and medical doctors, whom he had seen for chronic low back pain, had missed this. There was a significant functional scoliosis resulting from this structural abnormality, placing significant torque through his axial skeleton with resulting craniocervical pain.
  • Incompletely developed vertebra, such as lumbarization can cause what looks like the pelvic shift of a disc patient.
  • Subluxation of spinal joints can result in postural syndromes, particularly those vertebra at transitional zones. Special attention should be paid to the coccyx, lumbosacral and cervicothoracic spinal segments. The thorcolumbar segment is less frequently injured, but should not be overlooked.

The cranium can also be the source of profound mechanical disorders, resulting in postural dysfunction. Such problems, as the following, should be addressed with the tools you have, or referral if necessary!

  • Craniofacial growth and development disorders. The normal craniofacial development is such that the length of one’s face should be proportionate in three sectors created by the tip of the chin to just under the nose, nose tip to bridge of nose between eyes and the top third is created by the bridge of the nose to the top of the forehead, which is usually the hair line. You can adduct your thumb, laying it along side your index finger and tuck your thumb under your chin, and if you are anthropometrically normal, your index finger will just fit under your nose. Perform the same test with thumb tucked under nose and index finger should make it right to the bridge between your eyes, and finally use the same method to assess the length of the forehead.

If you look at children today, you will see that very few have normal craniofacial growth and development. The most common fault is a narrow middle third, which crowds the nasal airways, crowds the maxillary teeth, producing malocclusion in most such people and results in an endless string of abnormal respiratory and masticatory patterns that are all tied to suboptimal posture! It should interest you to know that both Weston A. Price and Francis Marion Pottenger demonstrated such craniofacial growth and development disorders in the 1940’s in their studies on animals and observations of primitive peoples who had been exposed to white man’s food! (Nutrition and Physical Degeneration by Weston A. Price and Pottenger’s Cats by Francis Marion Pottenger.) Both available at This information and what to do about it is covered in detail in Level 3 of the C.H.E.K Certification Program.

  • Flat Feet are also commonly related to nutritional deficiency in the parents, again clearly demonstrated by the authors cited above. On many occasions, I have had clients with one foot exhibiting greater pronation than the other. This puts an axial torque on the spine and can facilitate a number of challenging orthopedic and postural problems. To assess, simply put the patient in sub-talar neutral, leaving them standing that way and reassess iliac crest height, shoulder height and rotation of the extremities and cranium. You may find that there are torque syndromes that must be corrected via an orthotic device.

Developmental Forces Of Posturalization

In 1999 I went to the St. Charles Hospital in the Czech Republic to study with Vladimir Janda, M.D. He discussed the issue of developmental disorders and how they were linked to poor posture and muscle imbalance syndromes in adults. People presenting with these types of syndromes often seek treatment and relief from chronic pain. The term he had coined for this problem in the 70’s was “Minimal Brain Disorder,” and at that time, he stated that he found it to be a problem in approximately 20% of adult chronic pain patients.

As part of the training, we were introduced to the work of Dr. Voita, who studied infant and child development for over 50 years. We saw a Voita therapist treating a car accident victim who had suffered a brain injury. By pressing and holding specific reflex points on the ventral surface of the body, the therapist was able to reactivate the developmental motor software that exists in the brainstem of all neonates with an intact cerebrospinal axis. The patient would begin moving under the reflex activation of reptilian and paleomammalian software, being guided by the Voita-trained physiotherapist to ensure proper motor-sensory feedback. When questioned, the patient said “It is as if my body has a mind of it’s own. I’m not consciously doing anything. My body is just moving.”

Over their extensive careers, Dr. Janda, Dr. Voita, and Dr. Lewit had all observed numerous accounts of people with chronic pain syndromes who were not exposed to optimal developmental progression through the crawling phases as an infant. Through my own experience in clinical practice and by confirmation from Dr. Janda, I can state that poor posture is likely to be found in people who did not develop correctly in their crawling phase.

Why is crawling so important? During the development of the neonate from the fetus, through the crawling stages and finally into the neocortical phase (walking) there are numerous, highly integrated functional and physiological, phase-locked progressions between the musculoskeletal, limbic, hormonal and cellular systems. What this means is that when someone passes through their developmental phases incorrectly, they literally develop incorrectly, which may alter their psychoneuroimmunological profile for life! This is important today when so many infants are positioned upright in baby bouncers and encouraged to walk early, rather than allowing them to locomote around on their stomachs or on all fours, as they naturally would. This perception that Junior is more advanced because he walked at 9 months is a leading problem in the poor motor development of children today. We must allow infants to pass through all phases of growth and development at their natural rate. The last things we need are more dysfunctional children roaming the streets today!

Please keep in mind that poor posture for any reason disrupts internal physiological processes with an unspecified degree of magnitude! Therefore, it is safe to say that it is crucial for humans to learn to crawl correctly in order to allow development of their full physical and as we shall discuss in Part 3, spiritual potential.

Parental Forces Of Posturalization

The word parent could easily be interchanged with the word programmer. There are numerous examples of children being raised in a completely different country and culture to that in which they were born, and the children took aboard the language, movement characteristics and cultural ideology of their adopted parents. Orphaned infants will grow up to have a mindset, beliefs and biases (software) passed onto them by their foster parents while expressing the genetic characteristics of their natural parents in their physical structure (hardware), but even this can be altered by environmental factors as discussed above.

When considering posture, it is important to realize that the “software” can have an overriding influence on the “hardware.” Most people are visual learners and acquire their postural set by observing the parents. In my observation, a child generally adopts the postural characteristics of the parent they are closest to. With this in mind, if you really want to help a child improve their posture (which is very important in light of the fact that all the way back in 1988 Shirley Sahrmann found that 98% of high school children had poor posture, and I am sure the situation hasn’t improved since then!), you will have to educate the parents as well, including them as part of the program.

Idol and Icon Forces Of Posturalization

Much in line with the information on parents above, people often invest so much attention and energy into becoming like an icon or idol; they literally take on their persona. I used to see this happen frequently with the US Army Boxing team; whoever was the heavy weight champion that year would unknowingly have his gait pattern reproduced by thousands of wanna-be boxers around the world! The same thing happens in every sport, with actors and any other field that produces celebrities. Unfortunately, some people really shouldn’t be emulated!

Should you find a case such as I’ve described here, education in the direction of the value of maintaining one’s self-identity, be it for postural reasons or otherwise, will be the most important form of treatment. Just be careful not to be destructive of their icon/idol or you may lose the client!

So you don’t feel like I’m leaving you with a cliffhanger, I will tell you that my primary tools I use for the successful correction of chronic neuromusculoskeletal pain and postural syndromes are:


  • A Swiss ball
  • A dowel rod (wooden stick about 1 3/8 inches by 6 feet)
  • Horse Stance exercises

This is why I emphasis the important of correct exercise technique and posture in all my videos and why you should always train using the Form Principle rather than to failure – a set or exercise is stopped when you can no longer perform the exercise with perfect form. Dr. Janda, who I highly respect and who had seen most of my videos and correspondence courses, agreed that this approach would be effective!