Using Postural Education to Build a Practice
Estimated Reading Time: 5 MinutesPostural Education
By Robert D. Eisen, D.C.
Getting patients to understand the importance of good posture is by no means an easy task. They either believe that they have good posture or they have heard "stand up straight or sit up straight” so many times they become desensitized.
As DC’s we understand the importance of correct posture and the effects of poor posture on our patients’ spinal health. Many recent studies support the relationship of posture to health and performance. Many patients we see complain of neck stiffness, headaches, back pain and numbness or tingling in their extremities, all these symptoms can be directly related to poor posture.
Evaluating Posture
There are several ways we can evaluate a patient’s posture. One that costs you just a little bit of time is a visual inspection of the patient. Many of us perform this activity on every person we see whether they are a patient of not. This visual inspection allows us to determine at a glance, forward head posture, rounding of the shoulders in the lateral view and unevenness of the shoulders, head tilt and other variables in the AP view. No special equipment is needed to show the patient their poor posture other than a mirror and body drawing to mark the imbalance that you see. Another way to evaluate posture is with a computerized program, which allows you to take digital pictures of the patient and place marks on specific anatomical reference points and obtain detailed analysis of forward head posture and degrees of deviation from normal, and other stress calculations. Whichever one you choose to use, postural evaluation is a powerful tool to help the patient understand the importance of correct posture on spinal health.
Seated Posture.
Many of our patients work in jobs that require them to be seated at a computer or on the phone for extended periods of time. While sitting at the computer it is important for the patient to sit erect with their head upright looking straight ahead and not down towards the desk or notes, shoulders, back and hips aligned to keep the back straight. Hips should be slightly higher than the knees and the angle should not exceed 90 degrees and the feet should be flat on the floor to help distribute weight.
Ergonomic evaluation of a patient’s workstation may help to make changes in their work environment as a way to improve their posture and decrease the likelihood of forward head posture and increased stress on the muscles of the neck and back. A recent study suggests a connection between neck stress and high blood pressure.
Standing Posture
We relate good posture to how a patient looks when they are standing. When we view a patient in the AP we look for their head to be in the midline without deviation, shoulders to be level without rounding, hip to be even and feet to be shoulder width apart or at least even and toes pointing forward. In the lateral view we look for alignment with the ear, shoulder hips and knees. You can say we are looking for perfect anatomic position, or a neutral posture.
Computerized Postural Evaluation
In my office I utilize Posture Pro by VenturaDesigns (www.posturepro.com), I find the software easy to use and very reproducible. It allows me to take 2 digital photos of my patients AP and Lateral and import them into the software. I can then plot points on their photo and derive their posture. It allows me to show them essentially how they look to the public. This is powerful because they see everything we see as DC’s. One of the most important numbers the program offers is the amount Forward Head Posture, both in degrees and distance of forward travel. The patients are shown their head in lateral view with relation to their shoulder and to the rest of the body. The software can also predict how the skeleton might be distorting, which is reflected in the outward posture appearance
Forward head posture can cause an increase in muscle pain and stress of the cervical paraspinal and upper trapezius muscle to name a few. According to Dr. Ventura forward head posture causes shifting of the center of gravity, causing the upper body to move backward and the lower body and hips to slip forward which can lead to not just neck pain but back pain as well.
Educating patients on forward head posture.
This is rather easy, take a 10-pound medicine ball and have the patient hold it with their elbows locked in a flexed position. Ask them if this is strenuous to their arm. They will almost always say no. I them have them start moving the ball away from their chest as if they were performing a bicep curl and lowering the weight. I ask them to hold the ball in this position for a few minutes and they then begin to feel the strain on the bicep muscle. This activity allows me to then explain that their head is about 10 – 12 pounds and that forward head posture is doing the same thing to their neck as the ball is to their arms. Simple yes, but they understand completely the importance of keeping good head posture.
Exercise.
Exercise recommendations are also important in correcting posture. We provide our patient with 6 exercises and 6 stretches that aid in the improvement of forward head posture, strengthening the abdominal muscles and stretching the upper and lower body. These exercise are part of the Posture Pro Software package that we use.
Patient media provides an excellent brochure on the importance of posture and the chiropractic approach to correction and detection of incorrect posture.