Evaluating patient posture has been an essential tool in chiropractic care for decades, and it provides us with necessary information about how well the body is adapting to trauma, stress and the influence of gravity.
Evaluating patient posture has been an essential tool in chiropractic care for decades, and it provides us with necessary information about how well the body is adapting to trauma, stress and the influence of gravity.It’s important because it foreshadows how well the body will age and perform biomechanically and neurologically in the future. It’s also interesting to note posture analysis was used to promote the chiropractic profession.1
“In the 1950s and 1960s, U.S. doctors of chiropractic decided to use beauty contests to legitimize their profession. Through these pageants, they hoped to gain credibility with traditional doctors. Contest winners would win money or scholarships, thus increasing the profession’s popularity with the general public. ‘Miss Correct Posture’ was one of the few titles used in these chiropractic pageants.
“Winners were picked not only by their apparent beauty and their X-rays but also by their standing posture. Each girl stood on a pair of scales — one foot to each — and the winning trio each registered exactly half her weight on each scale, confirming the correct standing posture.”
Posture is important. We know the human body has a genetically preprogrammed ideal posture and gait movement pattern ensuring balance and movement efficiency. Not only does proper posture look good, but the ultimate purpose of correct posture is to allow the human body to seek food, shelter and community safely and efficiently with the least risk of injury. Ideal posture, when viewed from the front, includes a vertical gravity line in the midline of the spine, with the ears, shoulders and hips aligning on the horizontal plane. In the lateral plane, the center of gravity should fall from the external auditory meatus, crossing the AC joint of the shoulder, the greater trochanter of the hip, the lateral knee and the lateral malleolus of the ankle.
Is incorrect posture common?
In a research study, “Prevalence of Incorrect Posture among Children and Adolescents: Findings from a Large Population-Based Study in China,”2 evidence showed that bad posture in adulthood is often formed during childhood, and individuals with severe incorrect posture may be associated with the progress of scoliosis. The authors aimed to estimate the prevalence of incorrect posture in Chinese children and adolescents and to describe the epidemiological findings stratified by demographic characteristics. A total of 595,057 students were screened; the overall prevalence of incorrect posture in children and adolescents was 65.3%, and girls had a higher prevalence of incorrect posture than boys.
Incorrect posture is nearly the norm at this point, and it is influenced by many factors that need to be considered. If we are to combat forward head carriage successfully, we have to identify the contributing factors.
When feet hyperpronate, they can contribute to forward head carriage. The compensatory mechanisms involved in balancing the body result in an anterior translation of the pelvis, which requires the upper body to translate forward as well. Correcting forward head carriage without addressing the feet with custom orthotics can lead to limited improvement or a recurrence of forward head position correction over time.
The daily use of personal electronic devices, such as cell phones, tablets and computers3 tends to create the forward head position, which also brings the shoulders forward. The posture we practice the most is the posture we present. Students who study or use their electronics while sitting in a slouched sitting position feed the weak posture pattern. It is possible to improve the forward head position with chiropractic adjustments and corrective therapeutic exercises, but if those interventions are reduced in frequency, daily habits can override the previously gained improvements. Yearly posture evaluations are a good practice to ensure improvements are maintained or if additional interventions are needed to restore optimal postural function.
Jobs that require sitting for long periods or repetitive activities, such as assembly work, can also feed forward head posture. These postures become the default pattern because neural networks are developed due to the frequency and long duration of the activities.
Incorrect posture is an epidemic affecting a majority of the population and is present in nearly every chiropractic patient seeking relief from a myriad of conditions. Yet, according to a survey, less than half of the population is concerned about their posture; those who are concerned about it often complain about forward head posture and the possibility of developing a “hump” in the upper thoracic spine.
Quantifying forward head posture
DCs have practiced posture evaluation for many decades. Various tools have been used to document posture, including X-ray analysis, plumb line analysis, bilateral scales and photos of a patient standing in front of a grid.
Recent developments in technology allow us to quantify forward head posture both in the amount of anterior translation measured in inches and in the functional weight of the head compared to the actual weight of the head. This is important because it gives us a basis for determining progress in postural improvement and helps us communicate the seriousness of the distortion in contributing to further cervical disc compression and compensatory changes in the rest of the spine. In combatting forward head posture, we must consider the variety of presentations we see in practice. In the young patient population, we have the benefit of time. These patients generally haven’t developed degenerative changes in the spine, but they are creating habits that will contribute to degenerative changes due to habitual use of electronic devices. It’s a natural reaction to hold a phone or tablet well below the level of the eyes when reading or typing, and the phenomenon of neuroplasticity will create habitual reflexes that facilitate engagement of the flexors of the cervical spine over time. What fires together, wires together.
Two basic strategies can be employed at this stage in life: learn to hold the device correctly and do specific exercises to counteract the amount of time spent in the incorrect posture. I believe we are foolish to think that we will learn to use personal electronics less, so there is value in teaching these principles to our young patients.
Adult patients need the same strategies as young patients, but their challenge is more difficult because the lengthier duration of the incorrect posture they have developed has affected muscles, ligaments, tendons, spinal discs and myofascial systems more deeply. These patients can make improvements, but our intervention needs to be adequate enough in frequency, intensity and duration to maintain the changes and avoid the body’s natural tendency to return to its previous adaptations.
Final thoughts
Correction of forward head carriage can be accomplished with a combination of chiropractic adjusting techniques combined with corrective exercise protocols engaging and reactivating the postural muscles of the lower extremities, spine and upper extremities. Devices creating cervical spine extension and traction allow the patient to restore flexibility to the musculature of the cervical spine. Improvements in the cervical curve should be supported with an appropriate pillow and ongoing daily exercises.
For patients willing to engage in combatting forward carriage, it should be noted it’s an ongoing battle. Gravity, poor physical fitness, repetitive daily use of personal electronic devices and extended periods of sitting will always work against the patient in the quest to achieve correct posture. The victory will be won by those willing to incorporate strategies, such as the use of custom, flexible foot orthotics, chiropractic adjustments, specific posture-strengthening rehabilitative exercises and modifications to daily activities. It’s a victory worth fighting for.
BRIAN JENSEN, DC, is a graduate of Palmer College of Chiropractic and the owner of Cave Spring Chiropractic in Roanoke, Virginia. He has been in practice for more than 35 years. As a Foot Levelers Speakers Bureau member, he travels the country sharing his knowledge and insights. See continuing education seminars with Jensen and other Foot Levelers speakers at footlevelers.com/continuing-education-seminars.
References
- Miss Correct Posture: Pictures From a Chiropractor’s Beauty Contest Took Place in Chicago in 1956. Vintage Everyday. October 2, 2017. https://www.vintag.es/2017/10/miss-correct-posture-pictures-from.html. Accessed June 7, 2024.
- Yang L, et al. Prevalence of Incorrect Posture among Children and Adolescents: Finding from a Large Population-Based Study in China. iScience. 2020;23(5):101043. https://doi.org/10.1016/j.isci.2020.101043. Accessed June 7, 2024.
- Survey finds less than half of Americans concerned about poor posture. [Blog]. Orlando Health. October 9, 2019. Medical Xpress. https://medicalxpress.com/news/2019-10-survey-americans-poor-posture.html. Accessed June 7, 2024.
