The patient must be suitably undressed for proper observation. The following traits must be observed in sitting and standing:

  • Body type
  • Gait – when patient is entering examination room and moving about
  • Attitude –  willingness to move, tense, worried
  • Total spinal posture – look for antalgic postures, markings and possible step deformities. Observe anteriorly, laterally and posteriorly.

When observing a patient, always work systematically: observe from head to toe and note any asymmetries even when you know the source of the problem. When observing gait, work from the ground up, beginning with the foot to the head.

Anterior: Watch levels of shoulders, ASISs should be aligned, patellae looking straight forward, medial and lateral malleoli should be leveled. Look for any protrusions, soft tissue contours, depressions that are not symmetrical.


Lateral: The ear lobe, acromion process and iliac crest should be in line, normal lordosis and kyphosis, shoulders drooping forward, pelvis neutral.


Posterior: Note levels of shoulders, space between arms and trunk, spine and inferior angles of the scapula and any possible deformities. A scoliosis will be visible posteriorly. Observe the levels of the PSIS, make a note if one is higher than the other and compare them with the ASIS to see if they are higher. The gluteal folds and knee joints should be level, and Achilles tendon straight.