Solutions to assess and correct postural dysfunctions to support long-term wellness
Solutions to assess and correct postural dysfunctions to support long-term wellnessPosture checks, posture screenings and patient posture
As DCs, we tend to have redundant conversations with our patients about the need for good posture. However, aside from the chiropractic lens of posture, we should be reminded of the research trends on the systemic effects of poor posture. With this research behind us, we should be on a mission for perfect posture during waking and sleeping hours for every patient we see.
Posture is foundational in maintaining overall health, influencing musculoskeletal alignment, neurological signaling and organ function. In recent years, posture has re-emerged as a critical focus in both preventative and rehabilitative care. Current research links poor posture to a wide array of health concerns, including chronic pain, respiratory dysfunction,3 reduced cognitive performance2 and cardiovascular strain.
Posture is defined as the alignment and positioning of the body in relation to gravity while standing, sitting or lying down. While often associated with musculoskeletal function, posture has broader implications across multiple physiological systems. As sedentary behaviors, digital device use and poor ergonomics become more prevalent, posture-related dysfunction has grown increasingly common. This article examines current evidence linking posture to health outcomes and underscores chiropractic care’s essential role in postural evaluation and intervention via posture checks and screenings.
What the research says about posture and health
Musculoskeletal health: Recent studies confirm that postural misalignments, primarily forward head posture and thoracic hyperkyphosis, are associated with neck pain, back pain and musculoskeletal dysfunction.1 A 2023 study found a significant correlation between thoracic kyphosis and chronic neck and shoulder pain in young adults.5
Respiratory function: Poor posture, particularly thoracic slouching, limits chest wall expansion and impairs pulmonary function. Research demonstrates forward head posture can reduce lung capacity and diaphragm mobility, contributing to fatigue and poor oxygenation.3
Cognitive and mental health: Emerging evidence suggests posture affects neurological processing and emotional state. A study found slouched posture led to decreased energy, increased stress perception and a lower ability to perform mental tasks, particularly among students.2
Cardiovascular effects: Abnormal posture may also increase cardiovascular strain. Sedentary posture with excessive kyphosis is linked to elevated blood pressure and sympathetic nervous system overactivity.6
Chiropractic assessment of posture
DCs use a combination of visual posture checks and assessments, plumb line analysis, palpation and digital tools, such as full-body posture scanning or surface electromyography, (EMG) to evaluate their patients. These newer systems allow for three-dimensional mapping of spinal alignment, offering objective data to guide care plans.
Key assessment markers for posture checks include:
- Head position relative to shoulders
- Shoulder height discrepancies
- Pelvic tilt or rotation
- Spinal curvature analysis (cervical lordosis,
thoracic kyphosis, lumbar lordosis) - Foot/ankle posture
- Plantar vault status
- Sleeping position
Interventions to improve posture checks
Spinal adjustments: Chiropractic adjustments correct subluxations and restore joint motion, directly influencing postural alignment and reducing biomechanical stress. As we realign the joints, we directly and indirectly affect many body systems that promote health. The foundations of chiropractic are emerging as research-driven facts in medicine today.
Neuromuscular reeducation: Corrective exercises focusing on deep postural stabilizers, such as the transverse abdominis and multifidus, help retrain muscle activation patterns. A 2021 study demonstrated improved head posture and pain reduction following a six-week program of chiropractic and corrective exercises.
Ergonomic and lifestyle counseling: DCs educate their patients on workstation ergonomics, proper lifting techniques and sleep posture.
Take the time to educate patients on posture care that extends beyond waking hours, while also emphasizing the importance of a good sleeping position for recovery and reduced nocturnal ergonomic load on the spine. These behavioral modifications can reinforce the benefits of in-office care.
Custom flexible orthotics: Foot dysfunction can impact posture throughout the entire kinetic chain. Custom flexible orthotics have been shown to improve pelvic and spinal alignment and support postural stability. Resetting the kinetic chain from the ground up is the first step in postural alignment with movement.
Call to action
Scan each patient for postural discrepancies
Set patients up for success with correction of the foundation of posture with custom flexible orthotics when indicated
Evaluate the sleeping position and surface of each patient. A custom, ergonomically crafted pillow can be a game changer for many health concerns.
Final thoughts
Current research clearly demonstrates that posture affects far more than spinal alignment; it impacts respiratory efficiency, cognitive function, cardiovascular strain and emotional well-being. As posture becomes increasingly compromised by modern lifestyles, your role in evaluating and correcting postural dysfunction is more vital than ever.
Posture is not just a manifestation of standing but a 24-hour-a-day concept. Daily posture and sleep ergonomic corrections are a powerful combination that can help alleviate many health concerns.
By integrating spinal adjustments, neuromuscular reeducation, ergonomic training, custom flexible orthotics and sleep support with the proper custom ergonomically correct sleep surface and pillow, you can play a central role in restoring posture and improving patient health.
Christine Foss, DC, is the director and lead instructor of the Certified Chiropractic Sports Physician program for Northeast College of Health Sciences and director of education for the International Federation of Sports Chiropractic. She was named the 2020 American Chiropractic Association Sports Council Chiropractor of the Year and the 2023 International Federation of Sports Chiropractic Educator of the Year. Foss is also director of education and research for Foot Levelers. She can be contacted at drcfoss@gmail.com or @drchristinefoss on Instagram.
References
1. Kang JH, et al. The relationship between posture and musculoskeletal symptoms in smartphone users. Applied Ergonomics. 2021;95:103450. PubMed Central.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4395668/. Accessed April 15, 2025.
2. Peper E, Lin IM. Increase strength and mood with posture. Biofeedback. 2016;12(2):14-17. Research Gate. https://www.researchgate.net/publication/303540780_Increase_Strength_and_Mood_with_Posture. Accessed April 15, 2025.
3. Yamaguchi T, et al. Effect of forward head posture on thoracic shape and respiratory function. J Phys Ther Sci. 2019;31(1):63-68. PubMed Central. https://pmc.ncbi.nlm.nih.gov/articles/PMC6348172/. Accessed April 15, 2025.
4. Normand MC, et al. Three-dimensional evaluation of posture in standing with the Posture Print: An intra- and inter-examiner reliability study. Chiropractic and
Osteopathy. 2007;15(15). BioMed Central. https://www.researchgate.net/publication/5951247_Three_dimensional_evaluation_of_posture_in_standing_with_the_PosturePrint_An_intra-_and_inter-examiner_reliability_study. Accessed April 14, 2025.
5. Pacheco MP, et al. Prevalence of postural changes and musculoskeletal disorders in young adults. Int J Environ Res Public Health. 2023;20(24):7191. MDPI. https://www.mdpi.com/1660-4601/20/24/7191. Accessed April 14, 2025.
6. Wang H, et al. Effects of trunk posture on cardiovascular and autonomic nervous systems: A pilot study. Front Physiol. 2022;13. Front Physiol. https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2022.1009806/full. Accessed April 14, 2025.
7. Abdollahzade Z, et al. Research paper: Effects of four week postural corrective exercise on correcting forward head posture. J Mod Rehabil. 2017;11(2):85-92. https://jmr.tums.ac.ir/index.php/jmr/article/view/81. Accessed April 16, 2025.
8. Nigg BM, Nurse MA. Foot orthotics affect lower extremity kinematics and kinetics during running. Clinical Biomechanics. 2023;18(3):254-262. Research Gate. https://www.researchgate.net/publication/10658777_Foot_orthotics_affect_lower_extremity_kinematics_and_kinetics_during_running. Accessed April 14, 2025.
