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THE IMPORTANCE OF POSTURAL ASSESSMENT AND CORRECTION...

 

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THE LINK BETWEEN POSTURE, HEALTH, AND DEATH...

Not convinced that you need to improve posture? Below is a sampling of scientific research papers demonstrating the importance of good posture.

Hyperkyphotic Posture Predicts Mortality in Older Community-Dwelling Men and Women: A Prospective Study.

Journal of the American Geriatrics Society, Volume 52, Issue 10, Page 1662, October 2004. Deborah M. Kado, MD, MS, Mei-Hua Huang, DrPH, Arun S. Karlamangla, MD, PhD, Elizabeth Barrett-Connor, MD and Gail A. Greendale, MD.

Objectives: To determine the association between hyperkyphotic (bent-forwards) posture and rate of mortality and cause-specific mortality in older persons.

Participants: Subjects were 1,353 participants from the Rancho Bernardo Study who had measurements of kyphotic posture made at an osteoporosis visit between 1988 and 1991.

Participants were followed for an average of 4.2 years, with mortality and cause of death confirmed using review of death certificates.

Hyperkyphotic posture, was more common in men than women (44% in men, 22% of women). In age- and sex-adjusted analyses, persons with hyperkyphotic posture had a 1.44 greater rate of mortality. In multiply adjusted models, the increased rate of death associated with hyperkyphotic posture remained significant (relative hazard=1.40). In cause-specific mortality analyses, hyperkyphotic posture was specifically associated with an increased rate of death due to atherosclerosis.

Conclusion: Older men and women with hyperkyphotic posture have higher mortality rates.

NICK’S FOOTNOTE: This is scary. This suggest that bad posture means you are probably going to die younger than you should. So, improve your posture now before it is too late.

Spinal Kyphosis Causes Demyelination and Neuronal Loss in the Spinal Cord: A New Model of Kyphotic Deformity Using Juvenile Japanese Small Game Fowls.

Spine, 30 (21): 2388-2392, November 1, 2005. Shimizu, Kentaro MD; Nakamura, Masaya MD; Nishikawa, Yuji MD; Hijikata, Sadahisa MD; Chiba, Kazuhiro MD; Toyama, Yoshiaki MD.

Study Design. Histologic changes in the spinal cord caused by progressive spinal kyphosis were assessed using a new animal model.

Objectives. To evaluate the effects of chronic compression associated with kyphotic deformity of the cervical spine on the spinal cord.

Summary of Background Data. The spinal cord has remarkable ability to resist chronic compression, however, delayed paralysis is sometimes seen following the development of spinal kyphosis.

Results. There was a significant correlation between the kyphotic angle and the degree of spinal cord flattening. The spinal cord was compressed most intensely at the apex of the kyphosis, where demyelination of the anterior funiculus as well as neuronal loss and atrophy of the anterior horn were observed. Demyelination progressed as the kyphotic deformity became more severe, initially affecting the anterior funiculus and later extending to the lateral and then the posterior funiculus. Angiography revealed a decrease of the vascular distribution at the ventral side of the compressed spinal cord.

Conclusions. Progressive kyphosis of the cervical spine resulted in demyelination of nerve fibers in the funiculi and neuronal loss in the anterior horn due to chronic compression of the spinal cord. These histologic changes seem to be associated with both continuous mechanical compression and vascular changes in the spinal cord.

NICK’S FOOTNOTE: Lots of big words. But this may explain the first study discussed: Bottom line, as the spine curves forward (as in bad posture) the nerve tissue in the spinal cord begins to decay. I’d rather have good posture and healthy nerves thanks.

The effects of upright and slumped postures on the recall of positive and negative thoughts.

Appl Psychophysiol Biofeedback, 2004 Sep;29(3):189-95. Wilson VE, Peper E, Department of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.

This study assessed whether it was easier to generate positive and negative thoughts in either an upright or slumped position. Twenty-four participants, who reported no clinical depression or anxiety, completed the Tellegen absorption questionnaire and a self-assessment of imagery ability. Surface electromyography (sEMG) of zygomaticus major, heart rate, and respiratory rate were assessed across four 1-min counterbalanced conditions of either upright or slumped posture and either positive or negative thought generation. Posttrial checks of compliance were completed. At the end of the study, participants rated which thought was easiest to generate in the two postures. Significantly more participants (22), or 92%, indicated it was easiest to generate positive thoughts in the upright position. ANOVA of sEMG activity significantly distinguished positive and negative thoughts in both positions. Significant correlation coefficients were observed between scores on the Tellegen scale of absorption and the ability to generate thoughts quickly and between self-perceptions of imagery ability with the maintenance of thoughts across time. This study supports the finding that positive thoughts are more easily recalled in the upright posture.

NICK’S FOOTNOTE: PowerPosture program claims that it will make you look and feel more confident, and improve concentration and thinking ability. This paper provides evidence as to how this is possible. Try it yourself.

The representation of self reported affect in body posture and body posture simulation.

Coll Antropol. 2004; 28 Suppl 2: 159-73. Grammer K, Fink B, Oberzaucher E, Atzmuller M, Blantar I, Mitteroecker P. Ludwig Boltzmann Institute for Urban Ethology, Vienna, Austria.

It is taken for granted that the non-verbal information we acquire from a person's body posture and position affects our perception of others. However, to date human postures have never been described on an empirical level. This study is the first approach to tackle the unexplored topic of human postures. We combined two approaches: traditional behavior observation and modern anthropometric analysis. Photographs of 100 participants were taken, their body postures were transferred to a three dimensional virtual environment and the occurring body angles were measured. The participants were asked to fill in a questionnaire about their current affective state. A principal component analysis with the items of the affect questionnaire (Positive Negative Affect Scales, PANAS) revealed five main factors: aversion, openness, irritation, happiness, and self-confidence. The body angles were then regressed on these factors and the respective postures were reconstructed within a virtual environment. 50 different subjects rated the reconstructed postures from the positive and negative end of the regression. We found the ratings to be valid and accurate in respect to the five factors.

NICK’S FOOTNOTE: They say the eyes are the window to the soul. I say that your posture is the window to your mind. Good posture reflects and encourages good mind stuff, while bad posture exposes and predisposes to bad mind stuff.

Clinical characteristics of flexed posture in elderly women.

J Am Geriatr Soc. 2003 Oct; 51 (10): 1419-26. Balzini L, Vannucchi L, Benvenuti F, Benucci M, Monni M, Cappozzo A, Stanhope SJ. Laboratorio di Fisiopatologia e Riabilitazione del Movimento, Istituto Nazionale di Riposo e Cura Anziani, Dipartimento di Geriatria I Fraticini, Florence, Italy.

OBJECTIVES: To investigate the relationships between the severity of flexed posture (FP), skeletal fragility, and functional status level in elderly women.

PARTICIPANTS: Sixty elderly women (aged 70-93) with FP referred to a geriatric rehabilitation department for chronic back pain without apparent comorbid conditions.

MEASUREMENTS: Multidimensional clinical assessment included the severity of FP (standing occiput-to-wall distance) demographic (age) and anthropometric (height, weight) data, clinical profile (number of falls, pain assessment, Mini-Mental State Examination, Comorbidity Severity Index, Geriatric Depression Scale, Multidimensional Fatigue Inventory), measures of skeletal fragility (number of vertebral fractures by spine radiograph, bone mineral density (BMD), and T-score of lumbar spine and proximal femur), muscular impairment assessment (muscle strength and length), motor performance (Short Physical Performance Battery, Performance Oriented Mobility Assessment, instrumented gait analysis), and evaluation of disability (Barthel Index, Nottingham Extended Activities of Daily Living Index).

RESULTS: The severity of FP was classified as mild in 11, moderate in 28, and severe in 21 patients. Although there were no differences between FP groups on the skeletal fragility measurements, the moderate and severe FP groups were significantly different from the mild FP group for greater pain at the level of the cervical and lumbar spine. The severe FP group was also significantly different from the mild but not the moderate FP group in the following categories: clinical profile (greater depression, reduced motivation), muscle impairment (weaker spine extensor, ankle plantarflexor, and dorsiflexor muscles; shorter pectoralis and hip flexor muscles), the motor function performance-based tests (lower scores in the balance and gait subsets of the Performance Oriented Mobility Assessment), the instrumented gait analysis (slower and wider base of support), and disability (lower score on the Nottingham Extended Activities of Daily Living Index). The total number of vertebral fractures was not associated with differences in severity of FP, demographic and anthropometric characteristics, clinical profile, muscular function, performance-based and instrumental measures of motor function, and disability, but it was associated with reduced proximal femur and lumbar spine BMD.

CONCLUSION: The severity of FP in elderly female patients (without apparent comorbid conditions) is related to the severity of vertebral pain, emotional status, muscular impairments, and motor function but not to osteoporosis, and FP has a measurable effect on disability. In contrast, the presence of vertebral fractures in patients with FP is associated with lower BMD but not patients' clinical and functional status. Therefore, FP, back pain, and mobility problems can occur without osteoporosis. Older women with FP and vertebral pain may be candidates for rehabilitation interventions that address muscular impairments, posture, and behavior modification. Randomized controlled trials are needed to support these conclusions

NICK’S FOOTNOTE: This study should be as convincing as the first. Learn, develop and maintain good posture and you are setting yourself up for greater quality of life in the years to come. Ignore and neglect your bad posture at your own peril.

Trigger points in the suboccipital muscles and forward head posture in tension-type headache.

Headache. 2006 Mar; 46 (3): 454-60. Fernandez-de-las-Penas C, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA. Department of Physical Therapy, University Rey Juan Carlos, Madrid, Spain.

OBJECTIVE: To assess the presence of trigger points (TrPs) in the suboccipital muscles and forward head posture (FHP) in subjects with chronic tension-type headache (CTTH) and in healthy subjects, and to evaluate the relationship of TrPs and FHP with headache intensity, duration, and frequency.

METHODS: Twenty CTTH subjects and 20 matched controls without headache participated. TrPs were identified by eliciting referred pain with palpation, and increased referred pain with muscle contraction. Side-view pictures of each subject were taken in sitting and standing positions, in order to assess FHP by measuring the craniovertebral angle. Both measures were taken by a blinded assessor. A headache diary was kept for 4 weeks in order to assess headache intensity, frequency, and duration.

RESULTS: Sixty-five percent (13/20) CTTH subjects showed active TrPs and 35% (7/20) had latent TrPs in the suboccipital muscles. Six (30%) controls also had latent TrPs. Differences in the presence of suboccipital muscle TrPs between both the groups were significant for active TrPs but not for latent TrPs. CTTH subjects with active TrPs reported a greater headache intensity and frequency than those with latent TrPs. The degree of FHP was greater in CTTH subjects than in controls in both sitting and standing positions. Within the CTTH group, there was a negative correlation between the craniovertebral angle and the frequency of headache, in sitting position, in standing position). CTTH subjects with active TrPs had a greater FHP than those with latent TrPs, though this difference was not significant.

CONCLUSIONS: Suboccipital active TrPs and FHP were associated with CTTH. CCTH subjects with active TrPs reported a greater headache intensity and frequency than those with latent TrPs. The degree of FHP correlated positively with headache duration, headache frequency, and the presence of suboccipital active TrPs.

NICK’S FOOTNOTE: I have to confess that occasionally I have had headache suffering clients who only get temporary relief, from their headaches. Not everyone gets the wonder cure that they (and I) were hoping for. But I have found that if these clients also complete the PowerPosture program that their results are massively improved as this study would support.

Relationship between peak expiratory flow rate and shoulders posture in healthy individuals and moderate to severe asthmatic patients.

J Asthma. 2005 Nov; 42 (9): 783-6. Robles-Ribeiro PG, Ribeiro M, Lianza S. Department of Rehabilitation Medicine, Santa Casa School of Medicine, Sao Paulo, Brazil.

INTRODUCTION: Asthma overloads respiratory muscles causing changes in posture.

OBJECTIVES: To evaluate shoulder position in asthmatics and its correlation to the peak expiratory flow rate (PEFR).

METHODS: A cross-sectional study involving 19 asthmatics (study group) and 20 healthy volunteers (control group). Assessment of PEFR was used to determine airway obstruction. Shoulder position was quantified as the ratio between the front and back measurements, in centimeters, of the distance between the two outermost points of each scapula. Shoulder position measurement (SPM) ratio data from both groups were compared and correlated to PEFR.

RESULTS: The asthmatics presented lower PEFR (279 +/- 64 L/min) and SPM (0.88: range 0.83-0.9) than did control subjects (555 +/- 100 L/min and 0.97: range 0.95-1, respectively). There was a correlation between PEFR and SPM (asthmatics r = 0.8; controls r = 0.5).

CONCLUSION: Determining SPM ratios allowed us to identify those postural alterations that correlated with pulmonary function in asthmatics and in healthy individuals. Further investigation is needed before SPM can be used as a tool for clinical evaluation of asthma patients.

NICK’S FOOTNOTE: Once again there is a clear correlation between bad posture and an reduction of an important internal function – lung capacity.

Sitting posture of subjects with postural backache.

J Manipulative Physiol Ther. 2006 Mar-Apr; 29 (3): 213-8. Womersley L, May S. Faculty Health and Wellbeing, Sheffield Hallam University, Sheffield, UK.

OBJECTIVE: To test the construct validity of postural backache. To identify if individuals with backache sit for longer periods of sustained sitting and have more flexed relaxed sitting posture than individuals in a no backache group.

METHODS: Following an initial questionnaire, student volunteers without a history of 'serious' back pain were classified as either postural backache group or no backache group. With the use of an activity diary that plotted activity every 5 minutes over a 3-day period, the average time spent in different postures was established. Relaxed sitting posture was evaluated using Dartfish software to analyze videotape after 10 minutes of sitting.

RESULTS: The most common daytime activity of both groups was sitting, with average sitting time not significantly different between groups. Periods of uninterrupted sustained sitting and uninterrupted sustained studying were significantly longer, and the degree of flexion in relaxed sitting was significantly greater in the postural backache group.

CONCLUSION: In a group of student volunteers, half reported postural backache. The group with backache sat for longer periods without interruption and had a more flexed relaxed sitting posture than the no backache group. These findings appear to validate McKenzie's concept of a postural syndrome.

NICK’S FOOTNOTE: I’ve often told people who suffer with backache after sitting, that how they sit is more important than what they sit on. Bad posture can turn the best and most expensive ergonomic chair into a painful experience. If your work involves extended periods of sitting then it is vital to complete the PowerPosture program.

Determining the Relationship Between Cervical Lordosis and Neck Complaints.

J Manipulative Physiol Ther 2005 (Mar); 8 (3): Jeb McAviney, MS(Chiro), Dan Schulz, BSc, Richard Bock, MS(Chiro), Deed E. Harrison, DC, Burt Holland, PhD.

Objective: To investigate the presence of a “functionally normal” cervical lordosis and identify if this and the amount of forward head posture are related to neck complaints.

Results: Patients with lordosis of 20° or less were more likely to have cervicogenic symptoms. The association between cervical pain and lordosis of 0° or less was significant. The odds that a patient with cervical pain had a lordosis of 0° or less was 18 times greater than for a patient with a non-cervical complaint. Patients with cervical pain had less lordosis and this was consistent over all age ranges. Males had larger median cervical lordosis than females (20° vs 14°). When partitioned by age grouping, this trend is significant only in the 40- to 49-year-old range.

Conclusion: We found a statistically significant association between cervical pain and lordosis <20° and a “clinically normal” range for cervical lordosis of 31° to 40°. Maintenance of a lordosis in the range of 31° to 40° could be a clinical goal for chiropractic treatment.

NICK’S FOOTNOTE: Pretty convincing evidence that achieving and maintaining good neck posture helps to minimise the risk of neck problems

Cervical Kyphosis is a Possible Link to Attention-deficit/hyperactivity Disorder.

J Manipulative Physiol Ther 2004 (Oct); 27 (8): Bastecki AV, Harrison DE, Haas JW.

OBJECTIVE: To discuss the case of a patient who was diagnosed with attention-deficit/hyperactivity disorder (ADHD) by a general practitioner and was treated with chiropractic care.

CLINICAL FEATURES: A 5-year-old patient was diagnosed with ADHD and treated by a pediatrician unsuccessfully with methylphenidate (Ritalin), Adderall, and Haldol for 3 years. The patient received 35 chiropractic treatments during the course of 8 weeks. A change from a 12 degrees C2-7 kyphosis to a 32 degrees C2-7 lordosis was observed after treatment. During chiropractic care, the child's facial tics resolved and his behaviour vastly improved. After 27 chiropractic visits, the child's pediatrician stated that the child no longer exhibited symptoms of ADHD. The changes in structure and function may be related to the correction of cervical kyphosis.

CONCLUSION: The patient experienced significant reduction in symptoms. Additionally, the medical doctor concluded that the reduction in symptoms was significant enough to discontinue the medication. There may be a possible connection that correction of cervical kyphosis in patients with ADHD may produce a desirable clinical outcome.

NICK’S FOOTNOTE: How can this be? ADHD is seen as a brain disorder, and yet this child’s ADHD was significantly improved by improvement in neck posture and alignment. Could be that a healthy brain requires a healthy neck.

Cervical Spine Geometry Correlated to Cervical Degenerative Disease in a Symptomatic Group.

J Manipulative Physiol Ther 2003 (Jul); 26 (6): 341–346. Wiegand R, Kettner NW, Brahee D, Marquina N.

OBJECTIVE: To investigate whether a statistical correlation exists between lateral cervical geometry and cervical pathology, as identified on neutral anteroposterior (AP) and lateral radiographs within a symptomatic group; describe the cervical pathology and determine its location and frequency; and identify the subject's age, sex, and chief complaint.

RESULTS: Regression and discriminant analysis identified 5 geometric variables that correctly classified pathology subjects from non-pathology subjects 79% of the time. Those variables were: (1) forward flexion angle of the lower cervical curve; (2) gravitational loading on the C5 superior vertebral end plate; (3) horizontal angle of C2 measured from its inferior vertebral end plate; (4) disk angle of C3; and (5) posterior disk height of C5. Degenerative joint disease was the most common pathological finding identified within discrete age, sex, and symptom groups.

CONCLUSION: We identified 5 geometric variables from the lateral cervical spine that were predictive 79% of the time for cervical degenerative joint disease. There were discrete age, sex, and symptom groups, which demonstrated an increased incidence of degenerative joint disease.

NICK’S FOOTNOTE: Want an arthritic neck as you grow older? Then ignore your head and neck posture and continue to live a slouched lifestyle: Or, work toward great posture and take preventative steps to avoiding a rusty neck.

Effects of abnormal posture on capsular ligament elongations in a computational model subjected to whiplash loading.

Brian D. Stemper, Narayan Yoganandan and Frank A. Pintar; Department of Neurosurgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, VA Medical Center, Milwaukee, WI 53226, USA Accepted 19 June 2004.

Abnormal postures increased elongation magnitudes in these regions by up to 70%. Excessive ligament elongations induce laxity to the facet joint, particularly at the local regions of the anatomy in the abnormal kyphotic posture. Increased laxity may predispose the cervical spine to accelerated degenerative changes over time and lead to instability. Results from the present study, while providing quantified level- and region-specific kinematic data, concur with clinical findings that abnormal spinal curvatures enhance the likelihood of whiplash injury and may have long-term clinical and biomechanical implications.

NICK’S FOOTNOTE: Wait a minute... Most argue that whiplash leads to increased forward head posture? Now we see evidence suggesting that having forward head posture increases the chance of suffering from a whiplash injury. That is, if you have good posture, an accident is less likely to create an injury that's going to give you long term problems... Bring on good posture!

The Impact of Positive Sagittal Balance in Adult Spinal Deformity

Glassman, SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F. Spine Volume 30(18), September 15, 2005 pp. 2024-2029.

  • “All measures of health status showed significantly poorer scores as C7 plumb line deviation increased.

  • “There was a high degree of correlation between positive sagittal balance and adverse health status scores, for physical health composite score and pain domain.”

  • “There was clear evidence of increased pain and decreased function as the magnitude of positive sagittal balance increased.”

  • “This study shows that although even mildly positive sagittal balance is somewhat detrimental, severity of symptoms increases in a linear fashion with progressive sagittal imbalance”

NICK’S FOOTNOTE: The further your head deviates forwards the worse things get.

Postural and Respiratory Modulation of Autonomic Function, Pain, and Health.

Lennon J, Shealy C, Cady R, Matta W, Cox R, Simpson W. AJPM (American Journal of Pain Management) 1994; 4:36-39.

“Observations of the striking influence of postural mechanics on function and symptomatology have led to our hypothesis that posture affects and moderates every physiologic function from breathing to hormonal production.  Spinal pain, headache, mood, blood pressure, pulse, and lung capacity are among the functions most easily influenced by posture.”

NICK’S FOOTNOTE: Couldn't have summed it up better myself!

The Neurochemically Diverse Intermedius Nucleus of the Medulla as a Source of Excitatory and Inhibitory Synaptic Input to the Nucleus Tractus Solitarii

Ian J. Edwards, Mark L. Dallas, Sarah L. Poole, Carol J. Milligan, Yuchio Yanagawa, Gábor Szabó, Ferenc Erdélyi, Susan A. Deuchars, and Jim Deuchars. The Journal of Neuroscience, August 1, 2007, 27 (31): 8324-8333.

Sensory afferent signals from neck muscles have been postulated to influence central cardiorespiratory control as components of postural reflexes, but neuronal pathways for this action have not been identified... Projections from the InM to the nucleus tractus solitarius (NTS) were studied electrophysiologically in rat brainstem slices. Electrical stimulation of the NTS resulted in antidromically activated action potentials within InM neurons... Thus, the InM contains neurochemically diverse neurons and sends both excitatory and inhibitory projections to the NTS. These data provide a novel pathway that may underlie possible reflex changes in autonomic variables after neck muscle spindle afferent activation.

NICK’S FOOTNOTE: "IN OTHER WORDS" - When your posture is bad nerve endings in the muscles of your neck fire-up and can stimulate the part of your nervous system that controls even the heart and the lungs...

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© Dr Nick Hodgson 2008

2005 Victorian Chiropractor of The Year, Australasian TRT Training Provider, Fellow Holder Research Institute.

 Visit Nick's other web site at www.superhealthy.com.au