Posts Tagged ‘Posture Pro’

Every Case a Case Study

Thursday, March 14th, 2013

Some time ago I set myself a goal to write up case studies based on the positive results that have I seen in my practice. Like every Chiropractor I get excited when I hear of life changing turnarounds in a wide range of health complaints. And not always because that person first consulted me with “Condition X” – they may come to me with the garden variety neck and back ailments. But then weeks later the person shares their story of healing and improved quality of life since starting to see me.

Well you might say I have opened a can of worms because the reality of “writing up” has been daunting: A clear history, examination findings and having some sort of outcome measure in place so that after those weeks of adjustments you can say for real that signs and symptoms have diminished – the objective before and after as opposed to the testimonial. And then there is the challenge of writing up an introduction and discussion of the condition in question – requires literature research and time.

So retrospectively I began to dig out files of my fondest case memories and quickly discovered that I did not have much more to go on than a testimonial. Child was a bed wetter – now they aren’t, teenager had reduced asthma medications and number and severity of attacks but no actual numbers to go along with those subjective observations, person who attended for low back pain and was then able to become pregnant after being adjusted (why didn’t they tell me they were infertile when they presented?), a parent stating that their child’s ADHD had significantly improved but now I have the challenge of finding out of their academic and social performance has improved – where to start?

I had been haunted by the words of an “old-timer” chiropractor at a Dynamic Growth Congress years before. He asserted that you “never ask your patients how they are – you tell them!” How do you do that? Now I know that we get to know our practice member’s bodies and that we can to a degree sense where they are at – but that intuition wasn’t quite enough for me – I wanted tools to measure where someone was in their functional journey. I’ve never been a dedicated user of Xrays and biomechanical lines and would always prefer non-invasive technologies so I began searching. The first purchase I made somewhere in the mid-nineties was software to analyse posture (www.torquerelease.com.au/Posture-Pro-Software.htm) and to come up with some objective calculations – cool tool and patients love the before and after pictures – a win-win. Back then this type of software cost thousands. This was in the days when computers were like old-age pensioners – took half the morning to warm up, and then didn’t do much after lunch. And we had to buy excessively expensive cameras that had a removable floppy disc – remember what those were? I envy today’s chiropractors who can pick up the latest version of this software for less than a grand, and download and install it on their high-speed notebook, and already have the camera that connects wirelessly.

Next I took out a five-year lease to get my hands on an Insight Subluxation Station (www.subluxation.net.au) and discovered that surface EMG, thermography and inclinometry were awesome tools for me to see if I was making the physiological changes that I hoped my adjustments produced. Boy was this confronting as I was forced along a pathway of finding better ways to deliver better adjustments and advice. I think we Chiropractors have had it too easy for too long because the only quality assurance that we have had to answer to is customer satisfaction. I remember one of my associate Chiropractors who was notorious for bypassing initial and progress exams, who when confronted stated that he didn’t see the point in using the measurements when they didn’t change! I guess my conclusion had been different as my revelation was that maybe I had to find the best ways for making positive changes – After all if a spine isn’t better aligned, more flexible and surrounded by less muscle tension after a series of adjustments, then what has been the actual benefit of those adjustments?

My next revelation was that I needed better outcome measures in my practice for a range of health concerns: If someone consults me and they suffer with migraines then I need to be able to demonstrate that the improvements in the sEMG, posture, thermography and range of motion are matched by measurable improvements in the regularity and severity of the signs and symptoms of migraine – sounds simple – just visit outcomemeasures.? to download the free tools I hoped? Not! My fantasy was a file of severity questionnaires that could be accessed depending on the name of the presenting dis-ease. So I contacted the academics and was told that such standardized and validated tools did exist. Next step was to find them… Still looking! Here’s the problem – they all have different completion and rating systems, most aren’t free or at least accessible, and regardless of whether they are scientifically validated few have been designed by chiropractors, for chiropractic – what is the point of a headache questionnaire that lacks a question about neck pain or dysfunction, or a low back questionnaire that fails to note any associated gastrointestinal or genitourinary signs? Since this time I have been gradually authoring my own range of health questionnaires – as I encountered a different health syndrome in practice, I would spend hours researching and then listing the “top twenty” associated signs and symptoms which would then be pasted into my template – each having exactly the same rating and format (www.torquerelease.com.au/Health-Questionnaires.htm) . Now these aren’t validated research tools but I love them for the power that they offer in terms of being able to take a subjective snapshot in time.

Nowadays I am in a newer practice and while designing my new systems I spent numerous hours (internet) searching for the best outcome tools out there: They had to be affordable, simple to use, and easy for the practice member to comprehend. After much shopping I combined Posture Pro, with digital photographic range of motion analysis software, Heart Rate Variability (www.torquerelease.com.au/emWave.htm) , along with the Torque Release Technique Indicators of Subluxation Scoring System that I had developed, and my Health Outcomes Questionnaires. Now I present my practice members with what I call their Spinal Functional Age (SFA) and Self-Perceived Health Age (SPHA).

The next barrier was in getting humans to follow the plan. I realised that my chances of producing legitimate case studies retrospectively were small. I needed to have a prospective plan: When Master Bedwetter, or Miss Asthma, or Mr Parkinsons or Mrs Multiple Sclerosis arrives at my rooms then I need the procedures in place so that I have sufficient pre-examination findings. Next challenge is to achieve sufficient compliance with care that will result in the types of positive changes we aspire to. And step three is to conduct a progress examination that supplies the “evidence” that I crave which is going to look good in ink.

What I am trying to say here is that my initial urge to write up a simple case study that is of some value to the evidence-base has actually sent me on a path of research and development that I like to think is making me a better Chiropractor.

Have you ever watched an episode of Geoffrey Robertson’s Hypothetical? This famous legal shark draws together a diverse cross section of “experts” and then forces them through a hypothetical case scenario that pushes the ethical, moral and human boundaries. Entertaining and usually enlightening viewing. To a point I believe it is valuable to apply this principle in our practice development pathway.

So, how does MY hypothetical influence YOUR life in practice? Ask yourself these questions:

1) Is your initial intake process thorough and objective enough that you could present clear evidence of what it is you are setting out to change for that person?

2) Do you have objective measurement tools to demonstrate how much this person’s functional status needs to change and whether you will have been able to initiate a change in their health concern?

3) Do you conduct a progress or review exam to measure whether you are achieving your shared goals?

4) Have you had the guts to put your technique to the objective litmus test across your entire practice population and not just your favourite miracle cases?

5) Do you have enough evidence to contribute a Case Study for the advancement of the Chiropractic Evidence Base?

When I present the stats from my own practice I show the average functional changes that occur and share the journey I have had to follow to ensure that I consistently generate significant objective improvements. At one seminar a Chiropractor pulled me aside during a refreshment break, and with a concerned look on his face stated that the changes I had documented were not very BIG. “Oh really” I said “how big are the changes that you are seeing?” “Well I don’t know” he said “but I know that they would be better than yours”. I almost envy his delusions of grandeur, but the reality is if you don’t know for sure, then you don’t know! My own research based on the functional tools that I currently prefer, suggest that one adjustment reduces someone’s functional age by one year. I personally think that is very significant – name any other healing method that can make someone one year younger in one visit?

To find out more about the next Torque Release Technique Seminar visit: www.torquerelease.com.au/Torque-Release-Discount.htm

THE MOST UP TO DATE POSTURE RESEARCH

Thursday, January 31st, 2013

 

It’s been a while since I have done a review of research relevant to good and bad posture. And in that time some things have changed – the most noticeable is that if you look closely in the following papers you should notice that digital photography and the objective measurements possible as a result are a key feature. Now I don’t hate to tell you that “I told you so” – but I have been pushing the use of digital postural analysis since about 1996!

The other clear point from the following abbreviated abstracts is just how powerful postural analysis is as an outcome tool, and a predictor of morbidity. If you are not incorporating objective postural analysis and including corrective strategies that work in your practice – then WHY NOT?

Check out the world’s best postural analysis software at this link: www.torquerelease.com.au/Posture-Pro-Software.htm

 

1) Sensitivity of clinical assessments of sagittal head posture.

J Eval Clin Pract. 2010 Feb;16(1):141-4. Gadotti IC, Biasotto-Gonzalez DA.

Historically, clinicians visually evaluate posture using anatomical landmarks. Advances in technology made digital photographs now feasible to use in clinical practice. Photogrammetry may increase the reliability of the assessment of postural changes. However, differences between visually estimated and photogrammetric recorded changes in posture need to be tested. The objective of this study was to evaluate the sensitivity of visual assessments of changes in head posture in the sagittal plane in relation to photogrammetric recorded data… Visual assessments of sagittal head posture were sensitive to detect differences between no FHP and FHP groups, but were not sensitive to detect differences between no FHP and slight FHP groups. Head posture photogrammetry is recommended to quantitatively detect less evident differences in head posture.

 

2) Differences in Standing and Sitting Postures of Youth with Idiopathic Scoliosis from Quantitative Analysis of Digital Photographs.

Phys Occup Ther Pediatr. 2013 Jan 8. Fortin C, Ehrmann Feldman D, Cheriet F, Labelle H.

The objective of this study was to explore whether differences in standing and sitting postures of youth with idiopathic scoliosis could be detected from quantitative analysis of digital photographs. Standing and sitting postures of 50 participants aged 10-20-years-old with idiopathic scoliosis (Cobb angle: 15° to 60°) were assessed from digital photographs using a posture evaluation software program… Significant differences between standing and sitting positions (p < 0.05) were found for head protraction, shoulder elevation, scapula asymmetry, trunk list, scoliosis angle, waist angles, and frontal and sagittal plane pelvic tilt. Quantitative analysis of digital photographs is a clinically feasible method to measure standing and sitting postures among youth with scoliosis and to assist in decisions on therapeutic interventions.

 

3) Trunk deformity is associated with a reduction in outdoor activities of daily living and life satisfaction in community-dwelling older people.

Osteoporos Int. 2005 Mar;16(3):273-9. Takahashi T, Ishida K, Hirose D, Nagano Y, Okumiya K, Nishinaga M, Matsubayashi K, Doi Y, Tani T, Yamamoto H.

We have evaluated the association between trunk deformities of the sagittal plane and functional impairment of daily living in community-dwelling elderly subjects. The analysis involved a detailed assessment of indoor and outdoor activities of daily living, satisfaction with life, and mental status. The participants in this study were 236 community-dwelling older adults, aged 65 years and older, living in Kahoku district of Kochi in Japan. The participants were classified based on their posture, which was assessed using photographs of the subjects, and interviewed to assess their basic activities of daily living (BADL), instrumental ADL (IADL), and cognitive well-being in the cross-sectional study… The lumbar kyphosis group received significantly lower BADL and IADL scores than the normal group. The trunk deformity group which were defined as kyphosis, flat back, and lumbar lordosis groups exhibited decreases in activities that included going out, shopping, depositing and withdrawing money, and visiting friends in the hospital. These activities require going outdoors; thus, this study showed that the trunk deformity group had limitations in outdoor activities… The abnormal trunk deformity groups tended to score lower than the normal group with regard to subjective healthiness and life satisfaction measures, including subjective health condition, everyday feeling, satisfaction with human relationships, satisfaction with economic condition, and satisfaction with present life.

 

4) Video analysis of sagittal spinal posture in healthy and young adults

Journal of Manipulative and Physiological Therapeutics. Volume 32, Number 3, 2009;32:210-215. Yi-Liang Kuo, Elizabeth A. Tully, PhD, and Mary P. Galea, PhD

Changes in posture are of concern because of their association with pain or impaired physical function… Compared to young adults, healthy older adults demonstrated a forward head posture, with increased lower cervical spine flexion and increased upper cervical extension in both positions. Older adults also sat with significantly increased thoracic kyphosis and decreased lumbar spine flexion… The angular relationship between adjacent spinal regions in the sagittal plane can be objectively quantified using image-based analysis. The concept that the anteroposterior tilt of the pelvis in standing dictates the lumbar and thoracic curves was supported by the correlations between these adjacent regions in both age groups. The model of skin marker placement used in this study can have a broader application as a clinical tool for image-based postural assessment.

 

5) Reliability of a quantitative clinical posture assessment tool among persons with idiopathic scoliosis.

Physiotherapy. 2012 Mar;98(1):64-75. Fortin C, Feldman DE, Cheriet F, Gravel D, Gauthier F, Labelle H.

Seventy participants aged between 10 and 20 years with different types of idiopathic scoliosis (Cobb angle 15 to 60°) were recruited from the scoliosis clinic… Based on the XY co-ordinates of natural reference points (e.g., eyes) as well as markers placed on several anatomical landmarks, 32 angular and linear posture indices taken from digital photographs in the standing position were calculated from a specially developed software program… Posture can be assessed in a global fashion from photographs in persons with idiopathic scoliosis. Despite the good reliability of marker placement, other studies are needed to minimise measurement errors in order to provide a suitable tool for monitoring change in posture over time.

 

6) Postural compensations and subjective complaints due to backpack loads and wear time in schoolchildren.

Pediatr Phys Ther. 2013 Spring;25(1):15-24. Kistner F, Fiebert I, Roach K, Moore J.

This study investigated the effects of carrying weighted backpacks of up to 20% of body weight on the posture and pain complaints of elementary-school children. Craniovertebral, forward trunk lean and pelvic tilt angles were measured from sagittal photographs of 62 children (8-11 years old) before and after walking while carrying backpacks containing 10%, 15%, or 20% of body weight. Pain severity after a 6-minute walk with the loaded backpack was recorded. Subjective complaints of pain were assessed using a visual analog scale after walking. Repeated-measures ANOVA revealed statistically significant differences in postural angles and increased complaints of pain after walking with increased backpack loads. These results indicate that typical backpack loads create worsening postural changes due to backpack loads and time spent carrying those loads, putting children at increased risk for injury and pain, the latter of which is a strong predictor for back pain in adulthood.

 

7) Effect of backpack load carriage on cervical posture in primary schoolchildren.

Work. 2012;41(1):99-108. Kistner F, Fiebert I, Roach K.

This study examined the effects of various backpack loads on elementary schoolchildren’s posture and postural compensations as demonstrated by a change in forward head position. Sagittal digital photographs were taken of each subject standing without a backpack, and then with the loaded backpack before and after walking 6 minutes (6MWT) at free walking speed. This was repeated over three consecutive weeks using backpacks containing randomly assigned weights of 10%, 15%, or 20% body weight of each respective subject. The craniovertebral angle (CVA) was measured using digitizing software, recorded and analyzed. Subjects demonstrated immediate and statistically significant changes in CVA, indicating increased forward head positions upon donning the backpacks containing 15% and 20% body weight. Following the 6MWT, the CVA demonstrated further statistically significant changes for all backpack loads indicating increased forward head postures. For the 15 & 20%BW conditions, more than 50% of the subjects reported discomfort after walking, with the neck as the primary location of reported pain.

 

8) Effect of backpack weight on postural angles in preadolescent children.

Indian Pediatr. 2010 Jul;47(7):575-80. Ramprasad M, Alias J, Raghuveer AK.

Carrying heavy backpacks could cause a wide spectrum of pain related musculoskeletal disorders and postural dysfunctions. To determine the changes in various postural angles with different backpack weights in preadolescent children… digitizing software was used for analyzing photographs to determine craniovertebral (CV), head on neck (HON), head and neck on trunk (HNOT), trunk and lower limb angles. Postural angles were compared with no backpack and with backpacks weighing 5% to 25% of the subject’s bodyweight. The CV angle changed significantly after 15% of backpack load (P <0.05). The HON and HNOT angles changed significantly after 10% of backpack load (P <0.05). The trunk and lower limb angle also changed significantly after 5% of backpack load (P <0.05). Carrying a backpack weighing 15% of body weight change all the postural angles in preadolescent children.

 

9) Spinal Posture in the Sagittal Plane Is Associated With Future Dependence in Activities of Daily Living: A Community-Based Cohort Study of Older Adults in Japan.

J Gerontol A Biol Sci Med Sci. 2013 Jan 28. Kamitani K, Michikawa T, Iwasawa S, Eto N, Tanaka T, Takebayashi T, Nishiwaki Y.

Accumulated evidence shows how important spinal posture is for aged populations in maintaining independence in everyday life. However, the cross-sectional designs of most previous studies prevent elucidation of the relationship between spinal posture and future dependence in activities of daily living (ADL). We tried to clarify the association by measuring spinal posture noninvasively in a community-based prospective cohort study of older adults, paying particular attention to thoracic curvature, lumbar curvature, sacral hip angle, and inclination to determine which parameter is most strongly associated with dependence in ADL… This study indicates that spinal inclination is associated with future dependence in ADL among older adults.

 

10) Association of spinal inclination with physical performance measures among community-dwelling Japanese women aged 40 years and older.

Geriatr Gerontol Int. 2012 Dec 26. Abe Y, Aoyagi K, Tsurumoto T, Chen CY, Kanagae M, Mizukami S, Ye Z, Kusano Y.

Spinal inclination assesses spinal posture as a whole. However, the association between spinal inclination and physical performance has not yet been fully elucidated. Therefore, this study aimed to explore the association of spinal inclination with physical performance measures. The participants were 107 Japanese women aged 40-84 years. Spinal posture was assessed as inclination to a perpendicular line by using a computer-assisted device. Increased inclination value means forward inclination of the spine. Physical performance was measured by using the following methods: 6-m walking time, chair stand time, functional reach, Timed Up & Go Test, and grip strength. Information on participants’ comorbidities, osteoporosis, knee joint pain, back pain, falls in the previous year, regular exercise and usage of non-steroidal anti-inflammatory drugs (NSAIDs), was also collected. Pearson’s correlation analysis showed significant associations between spinal inclination and all of the physical performance measures. Pearson’s partial correlation analysis adjusted for age showed significant associations of increased inclination with poor physical functioning in 6-m walking time, chair stand time, functional reach, and Timed Up & Go Test, but not in grip strength. Linear regression analysis adjusted for age, grip strength, number of comorbidities, osteoporosis, knee joint pain, back pain, falls in previous year, regular activity and taking NSAIDs showed that spinal inclination was associated with poor function in 6-m walking time, chair stand time, functional reach and Timed Up & Go Test. Forward spinal inclination was associated with impairment in various physical performance measures. Proper prevention and treatment of underlying disorders should be prompted.

 

11) Importance of posture assessment in ankylosing spondylitis. Preliminary study.

Rev Med Chir Soc Med Nat Iasi. 2012 Jul-Sep;116(3):780-4. Roşu MO, Ancuţa C, Iordache C, Chirieac R.

The aim of this study is to perform a screening of patients diagnosed with ankylosing spondylitis (AS) in order to evaluate the static spinal disorders and correlate the results with the main clinical and functional parameters that characterize this disease… The assessment of lumbosacral pain in the morning and daytime lumbosacral pain showed a higher scores in patients suffering from kyphoscoliosis than in those with scoliosis, or kyphosis. Ott and modified Schöber index, and chest expansion, had higher mean values in patients with scoliosis compared with the other postural disorders. Statistically higher mean BASFI values were recorded in patients with kyphoscoliosis, while the mean BASMI values were lower in scoliosis patients. As to the quality of life of AS patients, HAQ-DI index recorded significantly lower mean values for kyphoscoliosis compared with other postural disorders. Our study suggests that posture assessment and implicitly the correction of possible misalignments should be part of the kinetic physical therapy program. Rigorous observing of postural recommendations can prevent the respiratory system complications.

 

12) Effects of thoracic kyphosis and forward head posture on cervical range of motion in older adults.

Man Ther. 2013 Feb;18(1):65-71. Quek J, Pua YH, Clark RA, Bryant AL.

It is unclear how age-related postural changes such as thoracic spine kyphosis influence cervical range-of-motion (ROM) in patients with cervical spine dysfunction. The purpose of this study was to explore the mediating effects of forward head posture (FHP) on the relationship between thoracic kyphosis and cervical mobility in older adults with cervical spine dysfunction. Fifty-one older adults… with cervical spine dysfunction – that is, cervical pain with or without referred pain, numbness or paraesthesia – participated. Pain-related disability was measured using the neck disability index (NDI). Thoracic kyphosis was measured using a flexicurve. FHP was assessed via the craniovertebral angle (CVA) measured from a digitized, lateral-view photograph of each subject. Cervical ROM - namely, upper and general cervical rotation and cervical flexion – was measured by the Cervical Range-of-Motion (CROM) device. Greater thoracic kyphosis was significantly associated with lesser CVA whereas greater CVA was significantly associated with greater cervical flexion and general rotation ROM, but not with upper cervical rotation ROM… Our results show that FHP mediated the relationship between thoracic kyphosis and cervical ROM, specifically general cervical rotation and flexion. These results not only support the justifiable attention given to addressing FHP to improve cervical impairments, but they also suggest that addressing thoracic kyphosis impairments may constitute an “upstream” approach.

 

13) Increased forward head posture and restricted cervical range of motion in patients with carpal tunnel syndrome.

J Orthop Sports Phys Ther. 2009 Sep;39(9):658-64. De-la-Llave-Rincón AI, Fernández-de-las-Peñas C, Palacios-Ceña D, Cleland JA.

To compare the amount of forward head posture (FHP) and cervical range of motion between patients with moderate carpal tunnel syndrome (CTS) and healthy controls. We also sought to assess the relationships among FHP, cervical range of motion, and clinical variables related to the intensity and temporal profile of pain due to CTS… FHP and cervical range of motion were assessed in 25 women with CTS and 25 matched healthy women. Side-view pictures were taken in both relaxed-sitting and standing positions to measure the craniovertebral angle. A CROM device was used to assess cervical range of motion. Posture and mobility measurements were performed by an experienced therapist blinded to the subjects’ condition… Patients with mild/moderate CTS exhibited a greater FHP and less cervical range of motion, as compared to healthy controls. Additionally, a greater FHP was associated with a reduction in cervical range of motion…

 

14) The role of forward head correction in management of adolescent idiopathic scoliotic patients: a randomized controlled trial.

Clin Rehabil. 2012 Dec;26(12):1123-32. Diab AA.

To investigate the effectiveness of forward head correction on three-dimensional posture parameters and functional level in adolescent idiopathic scoliotic patients… All the patients (n = 76) received traditional treatment in the form of stretching and strengthening exercises. In addition, patients in the study group (n = 38) received a forward head posture corrective exercise programme… Craniovertebral angle, Functional Rating Index and posture parameters, including: lumbar lordosis, thoracic kyphosis, trunk inclination, trunk imbalance, lateral deviation, surface rotation and pelvis torsion were measured before treatment, after 10 weeks, and at three-month follow-up… A forward head corrective exercise programme combined with conventional rehabilitation improved three-dimensional scoliotic posture and functional status in patients with adolescent idiopathic scoliosis.

 

15) The efficacy of forward head correction on nerve root function and pain in cervical spondylotic radiculopathy: a randomized trial.

Clin Rehabil. 2012 Apr;26(4):351-61. Diab AA, Moustafa IM.

To investigate the effect of forward head posture correction on pain and nerve root function in cases of cervical spondylotic radiculopathy… Ninety-six patients with unilateral lower cervical spondylotic radiculopathy (C5-C6 and C6-C7) and craniovertebral angle measured less than or equal to 50° were randomly assigned to an exercise or a control group… The control group (n = 48) received ultrasound and infrared radiation, whereas the exercise group (n = 48) received a posture corrective exercise programme in addition to ultrasound and infrared radiation… Forward head posture correction using a posture corrective exercise programme in addition to ultrasound and infrared radiation decreased pain and craniovertebral angle and increased the peak-to-peak amplitude of dermatomal somatosensory evoked potentials for C6 and C7 in cases of lower cervical spondylotic radiculopathy.

 

16) The effect of the forward head posture on postural balance in long time computer based worker.

Ann Rehabil Med. 2012 Feb;36(1):98-104. Kang JH, Park RY, Lee SJ, Kim JY, Yoon SR, Jung KI.

To estimate the effects of a relatively protruded head and neck posture on postural balance, in computer based worker… Thirty participants, who work with computers for over 6 hrs per day (Group I), and thirty participants, who rarely work with computers (Group II), were enrolled. The head and neck posture was measured by estimating angles A and B. A being the angle between the tragus of the ear, the lateral canthus of the eye, and horizontal line and B the angle between the C7 spinous process, the tragus of the ear, and the horizontal line. The severity of head protrusion with neck extension was assessed by the subtraction of angle A from angle B. We also measured the center of gravity (COG) and postural balance by using computerized dynamic posturography to determine the effect of computer-based work on postural balance… The results of this study suggest that forward head postures during computer-based work may contribute to some disturbance in the balance of healthy adults. These results could be applied to education programs regarding correct postures when working at a computer for extended periods of time.

 

17) Musculoskeletal dysfunction and pain in adults with asthma.

J Asthma. 2011 Feb;48(1):105-10. Lunardi AC, Marques da Silva CC, Rodrigues Mendes FA, Marques AP, Stelmach R, Fernandes Carvalho CR.

The mechanical alterations related to the overload of respiratory muscles observed in adults with persistent asthma might lead to the development of chronic alterations in posture, musculoskeletal dysfunction and pain; however, these changes remain poorly understood… This study aimed to assess postural alignment, muscle shortening and chronic pain in adults with persistent asthma… In comparison with non-asthmatic subjects, patients with mild or severe persistent asthma held their head and shoulders more forward and had lower chest wall expansion, decreased shoulder internal rotation, and decreased thoracic spine flexibility. Chronic lower thoracic, cervical, and shoulder pain was significantly increased in patients with mild or severe asthma compared with non-asthmatic subjects…

 

18) Head and shoulder alignment among patients with unilateral vestibular hypofunction.

Rev Bras Fisioter. 2010 Jul-Aug;14(4):330-6. Coelho Júnior AN, Gazzola JM, Gabilan YP, Mazzetti KR, Perracini MR, Ganança FF.

To investigate head and shoulder alignment among patients with unilateral vestibular hypofunction (UVH), using computerized biophotogrammetry (CB) and to correlate these measurements with gender, age, duration of clinical evolution, self-perception of intensity of dizziness and occurrences of falls… The patients with UVH had greater forward and lateral head deviation angles than did the normal individuals, with a statistically significant difference… Forward head was associated with the duration of clinical symptoms of the vestibular disease, age, intensity of dizziness and occurrence of falls.

 

19) Influence of forward head posture on scapular upward rotators during isometric shoulder flexion.

J Bodyw Mov Ther. 2010 Oct;14(4):367-74. Weon JH, Oh JS, Cynn HS, Kim YW, Kwon OY, Yi CH.

We assessed the effects of forward head posture in the sitting position on the activity of the scapular upward rotators during loaded isometric shoulder flexion in the sagittal plane. Healthy volunteers (n = 21; 11 men, 10 women) with no history of pathology participated in the study. Subjects were instructed to perform isometric shoulder flexion with the right upper extremity in both the forward head posture (FHP) and neutral head posture (NHP) while sitting. Surface electromyography (EMG) was recorded from the upper trapezius, lower trapezius, and serratus anterior muscles… Significantly increased EMG activity in the upper trapezius and lower trapezius and significantly decreased EMG activity in the serratus anterior were found during loaded isometric shoulder flexion with FHP. Thus, FHP may contribute to work-related neck and shoulder pain during loaded shoulder flexion while sitting. These results suggest that maintaining NHP is advantageous in reducing sustained upper and lower trapezius activity and enhancing serratus anterior activity as compared with FHP during loaded shoulder flexion.

 

20) Head and shoulder posture affect scapular mechanics and muscle activity in overhead tasks.

J Electromyogr Kinesiol. 2010 Aug;20(4):701-9. Thigpen CA, Padua DA, Michener LA, Guskiewicz K, Giuliani C, Keener JD, Stergiou N.

Forward head and rounded shoulder posture (FHRSP) is theorized to contribute to alterations in scapular kinematics and muscle activity leading to the development of shoulder pain. However, reported differences in scapular kinematics and muscle activity in those with forward head and rounded shoulder posture are confounded by the presence of shoulder pain. Therefore, the purpose of this study was to compare scapular kinematics and muscle activity in individuals free from shoulder pain, with and without FHRSP. Eighty volunteers were classified as having FHRSP or ideal posture. Scapular kinematics were collected concurrently with muscle activity from the upper and lower trapezius as well as the serratus anterior muscles during a loaded flexion and overhead reaching task using an electromagnetic tracking system and surface electromyography. Separate mixed model analyses of variance were used to compare three-dimensional scapular kinematics and muscle activity during the ascending phases of both tasks. Individuals with FHRSP displayed significantly greater scapular internal rotation with less serratus anterior activity, during both tasks as well as greater scapular upward rotation, anterior tilting during the flexion task when compared with the ideal posture group. These results provide support for the clinical hypothesis that FHRSP impacts shoulder mechanics independent of shoulder pain.

 

21) The influence of cranio-cervical posture on maximal mouth opening and pressure pain threshold in patients with myofascial temporomandibular pain disorders.

Clin J Pain. 2011 Jan;27(1):48-55. La Touche R, París-Alemany A, von Piekartz H, Mannheimer JS, Fernández-Carnero J, Rocabado M.

The aim of this study was to assess the influence of cranio-cervical posture on the maximal mouth opening (MMO) and pressure pain threshold (PPT) in patients with myofascial temporomandibular pain disorders… The results of this study shows that the experimental induction of different cranio-cervical postures influences the MMO and PPT values of the temporomandibular joint and muscles of mastication that receive motor and sensory innervation by the trigeminal nerve. Our results provide data that supports the biomechanical relationship between the cranio-cervical region and the dynamics of the temporomandibular joint, as well as trigeminal nociceptive processing in different cranio-cervical postures.

 

22) Body posture evaluations in subjects with internal temporomandibular joint derangement.

Cranio. 2009 Oct;27(4):231-42. Munhoz WC, Marques AP.

The aim of this study was to verify possible relationships between global body posture and temporomandibular joint internal derangement (TMJ-id), by comparing 30 subjects presenting typical TMJ-id signs to 20 healthy subjects. Body posture was assessed using the analysis of muscle chains on several photographs… There was a trend noticed in the group with the most severe dysfunction, to present a forward head and shoulders posture…

 

23) Global body posture evaluation in patients with temporomandibular joint disorder.

Clinics (Sao Paulo). 2009;64(1):35-9. Saito ET, Akashi PM, Sacco Ide C.

To identify the relationship between anterior disc displacement and global posture (plantar arches, lower limbs, shoulder and pelvic girdle, vertebral spine, head and mandibles). Common signs and symptoms of anterior disc displacement were also identified… Global posture deviations cause body adaptation and realignment, which may interfere with the organization and function of the temporomandibular joint… Our results suggest a close relationship between body posture and temporomandibular disorder, though it is not possible to determine whether postural deviations are the cause or the result of the disorder. Hence, postural evaluation could be an important component in the overall approach to providing accurate prevention and treatment in the management of patients with temporomandibular disorder.

 

24) Respiratory dysfunction in chronic neck pain patients. A pilot study.

Cephalalgia. 2009 Jul;29(7):701-10. Kapreli E, Vourazanis E, Billis E, Oldham JA, Strimpakos N.

The aim of this pilot study was to add weight to a hypothesis according to which patients presenting with chronic neck pain could have a predisposition towards respiratory dysfunction. Twelve patients with chronic neck pain and 12 matched controls participated in this study. Spirometric values, maximal static pressures, forward head posture and functional tests were examined in all subjects. According to the results, chronic neck patients presented with a statistically significant decreased maximal voluntary ventilation and respiratory muscle strength. Furthermore, the current study demonstrated a strong association between an increased forward head posture and decreased respiratory muscle strength in neck patients. The connection of neck pain and respiratory function could be an important consideration in relation to patient assessment, rehabilitation and consumption of pharmacological agents.

 

25) Influence of forward head posture on condylar position.

J Oral Rehabil. 2008 Nov;35(11):795-800. Ohmure H, Miyawaki S, Nagata J, Ikeda K, Yamasaki K, Al-Kalaly A.

There are several reports suggesting that forward head posture is associated with temporomandibular disorders and restraint of mandibular growth, possibly due to mandibular displacement posteriorly. However, there have been few reports in which the condylar position was examined in forward head posture. The purpose of this study was to test the hypothesis that the condyle moves posteriorly in the forward head posture. The condylar position and electromyography from the masseter, temporal and digastric muscles were recorded on 15 healthy male adults at mandibular rest position in the natural head posture and deliberate forward head posture. The condylar position in the deliberate forward head posture was significantly more posterior than that in the natural head posture. The activity of the masseter and digastric muscles in the deliberate forward head posture was slightly increased. These results suggest that the condyle moves posteriorly in subjects with forward head posture.

 

Check out the world’s best postural analysis software at this link: www.torquerelease.com.au/Posture-Pro-Software.htm

 

Yours for better health and better chiropractic

Nick Hodgson

POSTURE - THE SIMPLEST AND MOST POWERFUL PRACTICE TOOL

Monday, October 29th, 2007

A Picture Paints A Thousand Words!

Many Chiropractors analyse their new patients’ posture, and then scribble lines on a stick figure chart that is supposed to represent the person’s postural distortions? Try showing the hand-drawn diagram to the person - IT WILL MEAN NOTHING TO THEM - And it’s not a very convincing communication medium. Try showing the diagram to another chiropractor - I bet they won’t even understand what the markings mean. Then try using this diagram at the re-exam - How could you objectively measure, let alone demonstrate to the client that any sort of change has occurred?

Some others have entered the twentieth century and have started to take digital photos of their practice members’ posture. I’ve seen some who print the photos and then draw lines all over the picture to highlight the problems. But the question remains - How can you objectively track and demonstrate the changes that are occurring in their posture? And, how could you store, file and retrieve all those images?

There is a twenty first century technology that is cheap and effective for storing, analysing, calculating, retrieving, and comparing digital postural analyses - And it takes about the same time as a traditional postural assessment…

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