Postural language

Build patient trust by interpreting nonverbal cues.

The success of a chiropractic practice often depends on your paying attention to minute details. Patients are quick to adapt to the routine of their regular weekly or monthly appointments, and at times they may wonder if their treatments are as necessary as when they were first in pain.

If they’re beginning to question the value of returning, then your visit protocol is lacking the sequential imperatives that make for a long and lasting patient experience. In an added-value visit, chiropractic care explores more than pain and ventures into the area of well-being—both physical and mental.

How often do you operate in automatic mode while analyzing and adjusting a regular patient? You know where you’re going because the patient’s postural pattern has become static and predictable to both you and the patient. It is natural to make logical assumptions and expectations of findings in patients you have come to know well, but is it healthy?

It can be deceptively easy to overlook what is right in front of you. What about looking deeper into what you can see on the surface of the patient? Learn to see and hear the story their posture is trying to tell you.

Outward appearances

Patients are multidimensional in how they think, feel, and express themselves and only a small part of that communication is verbal. You often care for patients who are, by nature, poor communicators but who have much to tell you if you tune into their preferred methods of connecting, which may include postures and other nonverbal cues. These indicators will speak to the listening chiropractor and reveal patients’ true feelings and the unconscious, posture-based pain they carry.

Posture is mechanical and prone to patterns both learned and reflexive. People tend to deal with their environment internally through structural, behavioral, and kinesthetic reactions in response to stress. This leads to structural adaptations, which are converted into an active and corresponding postural pattern that provides a temporary coping mechanism and reduces stress through chronic postural fixations.

These fixations are usually defensive. They clearly express a mood or disposition. Over time, postures have been recognized as biomarkers, or active indicators within an individual’s unconscious postural repertoire. They indicate the type of stress an individual is experiencing.

Patients may overtly display some postures as nonverbal indicators. How can you interpret them? Quite simply, patients cannot or will not always make a verbal request to their doctor, rather they may wish to be asked the question their posture is indicating, such as “Is everything OK with your shoulder?”

Some individuals require more time and effort on your part before they will share an emotional moment. You should instinctively recognize and identify such postures as invitations to inquire about a patient’s inner self and well-being.

Gaining trust

Understanding a patient’s nonverbal behavior, as demonstrated structurally and kinesthetically, is necessary for a making an overall assessment, especially when you infer the relevance of posture to a state of mind. This approach validates you as a confidant and allows a stressed patient to relay personal issues that may be associated with chronic pain. These problems tend to become more intense during home, work, and social interactions.

You may notice that some patients come in more during the holidays than any other time of year. Stress, both physical and mental, tends to express itself cyclically in chronic postures that produce pain from old injuries and traumas. This discomfort is commonly provoked by the learned and reflexive postures of unanchored stress and anxiety brought about by holidays, birthdays, weddings, deaths, and other life-altering events.

Drawing out the truth

Often a patient will return with the same unrelenting complaint. In these cases, you might simply ask, “Why do you think this is happening?” This is a good way to encourage a patient to express his or her feelings about a stubborn posture or pain. Your inquiry might reveal that the posture is related to a particular person or activity. With long-term patients, small variations in chronic postural patterns can be reliable indicators that a certain event is dominating their daily thoughts. If so, you should help them break the postural-pain cycle and resolve as much anxiety associated with that posture as possible.

This method of care does two things: It helps you teach patients about their structural, behavioral, and kinesthetic activity. In addition, you can uncover the reasons behind your patients’ postural appearance.

You likely appraise posture from the moment patients walk into the treatment room. You know whether they are OK in that moment. So engage patients based on your para-postural findings and let them understand that you correlate your care with their inner selves.

Stand out by listening

So much of good practice management is showing patients your insights into their problems. In the healthcare section of your local bookstore, you’ll likely find dozens of titles like My Doctor Doesn’t Hear Me, or How to Get Your Doctor to Listen. People want to be understood. Their friends and family are tired of hearing the same story about pain, stress, and anxiety.

Most of your chronic-pain patients have already been told by their allopathic physicians that pain is a part of life and they simply have to deal with it. But posture and its emotional components are real threats.

The chiropractor who decides to look at a posture and its minuscule variants during critical visits will not only provide invaluable insight to the patient at a time of need but may also create a permanent bond. All individuals want to be validated and they will remain as patients only where they believe they are valued.

Take it all in

There is no magic to understanding patients’ painful postures. But begin with an eye toward the emotion and demeanor shown during the initial phase of care. Evaluate moods, and how and when they appear.

Look at the ever changing micro-expressions of the face. Take in the unconscious cues that revolve around this postural moment. Listen to tone of voice and patients’ willful proximity to you. Then, assess the unconscious and nonverbal communications being presented, leading to the fundamental question: “So, how is everything?”

Posture rarely lies, as it is generally subconscious. Accept the invitation to inquire about it when it appears. And expand your practice value into an area less often explored, or even considered, by other doctors.

The mind of a patient is shown to you on a postural level first; you need only take the time to recognize and identify it in the person sitting across from you, or resting on your table. Analyzing and interpreting presented postures is both a science and an art.

All too often, doctors speed their way through a visit, taking pride in their own efficiency. But if you cannot see or hear patients’ immediate needs, they will find someone else who will.

Mark S. Chiacchi, DC, has retired from his chiropractic practice and has recently established his Center for the Study of the Expressive Posture on Boston’s North Shore. He can be contacted at exprpost@aol.com or through his blog at expressivepostures.blogspot.com.