You know addressing posture is important to effectively care for back and neck pain.
After all, the best adjustment is fighting an uphill battle against gravity if a patient slumps in front of a computer for 10 hours a day, shoulders hunched up to their ears.
A good chair, a standing desk, and good shoes can help. But when some- one’s unconscious default posture is “slumped over with head jutting forward and spine collapsed back- wards,” you need to engage them to change their postural habits.
Our medical colleagues agree, according to a recent study in the European Spine Journal, which found that nearly 90 percent of primary care physicians consider biomechanical risk factors like posture to be the single most important short-term trigger of sudden onset low-back pain.1
Postural help can be exactly what patients want, even though clinical experience tells us patient compliance toward building new habits can be a challenge. A patient’s needs, wants, and desires are not always in alignment.
Perceived value
A 2014 study in the Journal of Rehabilitative Medicine looked at how perceptions of the value of care varied among neck-pain patients treated with different protocols of exercise, spinal manipulation, posture education, and applied biomechanics for pain management.2
You might think the most important thing from the patients’ perspective would be their neck pain followed by addressing the condition causing the problem.
You’d be wrong.
Michele Maiers, DC, and her team at Northwestern University of Health Sciences looked at 241 chronic neck-pain cases, and asked the patients what made their care “worthwhile.” Below is a word cloud of what people valued with the size of each word representing how many people gave that answer.
Least important was their neck condition and physical health. The most common response was “self-efficacy,” which is the patient’s perceived ability to successfully make a change.
Perceived treatment effect and neck pain followed, then exercises, and interaction between strength and motion. Also valued was the information provided, and the congruence of that information with the explanation of their problem, their care, and common sense.
In other words, respondents were saying “How do I help myself, and how can you help me do it?”
Raising awareness
Holding a postural health campaign can create an opportunity to help people understand biomechanical problems through a postural lens, and help them stand taller and move better—as well as deepen their under- standing of the benefits of your care.
Spinal manipulation gets people feeling better and frees potential motion, setting the physical and neurologic stage to regain control of their movement. But unconscious postural habits often cause problems to return. It’s ironic that, despite helping patients, chiropractors often get a reputation for “keeping the patient coming back.” In reality, it can be the patient’s own habits (e.g., texting six hours a day) that necessitate ongoing care.
The ACE strategy is a public health campaign for everyone—patients, the general public, and healthcare providers.3 It offers you a way to engage patients and your community to pursue better postural habits and strengthen how individuals carry themselves.
The ACE acronym stands for becoming posture aware, taking control of how you move your body, and optimizing your posture environment to make it easy to sit and stand taller.
Awareness: The first step to better posture. Awareness of a problem is the first step to making any change, and the best way to have people become aware of their posture is with a picture. You can visit PostureMonth.org, which has posture-improvement resources and educational material, and allows you to register as posture professional.
Control: The key to stronger posture. The door is opening wider for collaborations between DCs and evidence-aligned medical physicians with the new back-pain guidelines from the American College of Physicians (ACP). Low-back pain treatment guidelines don’t usually make mainstream media headlines, but they did in April when the world’s largest medical-specialty society (148,000 members) advised members to avoid prescribing drugs for “non-radicular low-back pain,” because research shows that better first-line alternatives for managing back pain are chiropractic, massage, acupuncture, and motion-control exercise (MCE).
MCE is more than rehab; it focuses awareness and attention to systematically retrain fine control toward greater accuracy. Yoga and tai chi (also recommended by the ACP) train this kind of mindfulness and control.
This is a seismic change in back care recommendations.
Protocols you can teach patients and the public are MCE and proprioception—aligning subjective perception of body position with objective reality. People can learn to actively retrain control of the subtle segmental motions restored with an adjustment, reducing errors between perception and motion to address subtle sensorimotor errors.
DCs observe and care for motion dysfunction, and so should also be helping the patient to retrain that motion, understand common- sense postural biomechanics, and address their habits. In addition to engaging the patient, the ACE framework creates an opportunity for evidence-congruent collaboration with medical physicians seeking options for their back-pain patients.
Environment: Optimizing your posture.
There are plenty of products on the market to support a posture campaign: chairs and desks, mattresses and pillows, orthotics to support the feet and back, and bands to straighten the back. These kind of posture devices, tools, gadgets, and other products are hot. Some are valuable and good for nearly everyone, some are appropriate for a few, but some create more problems than they solve.
Understanding posture basics is the beginning to designing a smart posture environment, creating an opportunity to help people choose for themselves what’s right for their body and their lifestyle.
The DC as posture specialist
The goal of a postural ACE campaign is the promotion of posture as an important and actionable health indicator. Especially with texting, smartphones, and tablets, improving postural awareness and habits is a valuable public service you can offer. Educating society about posture is a way to contribute to your community while increasing the perceived value of the chiropractic healthcare services that you provide.
Successful community and intra-professional collaborations require authentic messaging in peoples’ best interest, and not be self-serving. Exploiting fear or anxiety to build a busier practice is both wrong in the short term, and ineffective in the long run.
Take the opportunity to make people aware of their posture, teach them how to better control their body, and adjust their environment.
Educating them on how to better help themselves in a postural framework fits with the biomechanical problems you already address.
Steven Weiniger , DC, is the author of Stand Taller Live Longer and teaches the advanced posture specialist certification, Certified Posture Exercise Professional (CPEP), setting the clinical standard for posture improvement and rehab protocols with clinicians worldwide. He is managing partner of posturepractice.com and bodyzone.com. He can be contacted at 866-443-8966 or drweiniger@bodyzone.com.
References
1 Steffens D, Maher CG, Ferreira ML. Clinicians’ views on factors that trigger a sudden onset of low back pain. Eur Spine J. 2014;23(3):512-519.2 Maiers M, Vihstadt C, Hanson L, Evans Perceived Value of Spinal Manipulative Therapy and Exercise Among Seniors with Chronic Neck Pain: A Mixed Methods Study. J Rehabil Med. 2014;46(10):1022-8.
3 Weiniger S. “PostureMonth.org.” http:// posturemonth.org. Updated June 2017. Accessed June 2017.
