A posture support curriculum for older patients

Chiropractic as well as ancillary activities such as yoga, chair stretches and more provide efficient posture support for senior patients

Seniors are just like other chiropractic patients, all of whom have postural stresses and need adjusting. Seniors do have some special considerations, however, and need a little or a lot of TLC (Tender Loving Chiropractic).

Time is a consideration in providing that TLC. Schedule your senior patients during your slower times to give them extra attention. Since getting around for seniors can be challenging, many will show up early for appointments. This should help you provide extra time if needed.

Common sense dictates that you should be careful with your senior patients, especially if your technique is osseous, such as diversified. Another option would be to use a low-force technique such as Activator SOT, or NUCCA.

Another strategy: Recommend to your senior patient that he/she be accompanied by someone for the initial visits. This can reduce his/her stress and provide a second set of ears for the information you will be sharing.

Posture support

In terms of recommended treatment, a wall can be helpful as a posture corrector. Have your patient back against the wall with heels, shoulders and head touching. A forward head carriage makes this difficult for many seniors. Make sure your patient looks straight ahead, not up (some patients might cheat). To strengthen the posterior cervical muscles that allow for posterior head translation, have the patient do brief isometrics against a ball (something the size of a ball for dodgeball or kick ball) or supply them with a “neckserciser.”

The practice of T’ai Chi (preferably Yang style) offers great mind/body exercises as posture support. The gentle flowing movements are surprisingly effective for neuromuscular coordination, toning, conditioning, and mental focus. Hatha yoga is another great exercise for seniors. Both tai chi and yoga also emphasize meditation and conscious breathing, which are helpful for longevity.

Since seniors tend to spend more time in a chair than most, postural awareness and good ergonomics are important. The chair must have good back/neck support to keep seniors upright and avoid slouching. Seniors should also practice sound computer ergonomics — sit up straight; stretch or take a short walk every half hour to an hour.

Stretches to increase flexibility

Three great flexibility stretches seniors can employ include:

• While sitting in a chair, instruct your patient to clasp their hands under their chin and keep his/her shoulders relaxed. Instruct them to slowly turn their head to the end of ROM without forcing it and then rotate the body in the same direction. To create balance, come back and go to the other side, again doing one section of the spine at a time for posture support.
• From a seated position, laterally flex the head (ear to shoulder) and then the body follows in the same direction. Again, balance it by going in the opposite direction.
• Flexion/extension of the spine (sitting Yoga Cat/Cow). Patient sits in a slouched position with hands on knees. Inhaling deeply, the patient pushes up, arching his/her back and looking up at the ceiling. He/she then exhales and releases back to a slouch.

Start with five reps of each exercise and slowly have them work up to 10 reps. The key is to do these at least once per day. The best time is in the a.m. upon rising to work out the soreness (osteoarthritics especially) from sleep. It’s also helpful to stretch during the day after prolonged periods of sitting. It’s amazing how effective these simple full spine safe stretches are if done regularly.

Gravity is a constant stressor that can take a toll on seniors. If they can handle it without getting dizzy, why not have them try reverse gravity on an inversion table? It’s a great way to combat the effects of degenerative disc disease/osteoarthritis.  Also, you can have them use a soft cervical collar with a pump bulb to apply gentle traction with caution.

Additionally, three simple exercises for spinal core strengthening are:

• The plank (modified to suit the patient). Push up position or leaning on elbows or, if needed, on knees; then have the patient hold the position to tighten up the abdominals.
• The side plank to strengthen the oblique muscles. Have the patient on their side, pushing their pelvis off the floor balancing on their ankle (or knees) and elbows.
• Have your patient get on their hands and knees and instruct them to stretch out their opposite arm and leg. Then do the other arm/leg.

All of these exercises can be started at 15 seconds per position with a goal to work up to 30-45 seconds.

Dietary habits

Finally, proper nutrition can be a key contributor as posture support for seniors. A Medicare study completed some years ago concluded that the most cost-effective step that a senior could do for themselves would be to take a multi-vitamin/mineral supplement. Since quality can be an issue with absorbability, you might think about recommending a food-based supplement. 

Increasing water and fresh vegetables and fruit intake while decreasing empty carbs and meat intake and frying foods is good advice for everyone. The benefits are even more pronounced for seniors who sometimes have poor dietary habits. Having your senior patients fill out a one-week food journal can be quite beneficial in getting their eating habits back on track.

The bottom line: common sense posture care for seniors, coupled with TLC can have your patients living healthfully to 100, or maybe more.

Michael Gottfried, DC, is the past president of the Chiropractic Society of Rhode Island (CSRI), one of the oldest chiropractic associations in the United States. He’s a chiropractic physician at Aquidneck Chiropractic in Middletown, R.I. He has received Chiropractor of the Year honors from TOP Education (Ma) and CSRI and was named a Top Doctor by Rhode Island Monthly Magazine. For more information, visit www.drmgottfried.com.