Getting patients to understand the importance of good posture is by no means an easy task. They either believe that they have good posture, or they have heard it so many times to "stand up straight" or "sit up straight" that they become desensitized to the importance of good posture for overall health.

As DCs, we understand the importance of correct posture and the effects of poor posture on our patients' spinal health. Many of the patients we see will complain of neck stiffness, headaches, back pain, and numbness or tingling in their extremities. All these symptoms can be directly related to poor posture.

Evaluating Posture

We can evaluate a patient's posture in several ways. One that costs you nothing is a visual inspection of the patient. Most of us perform this activity on every person we see, whether he is a patient or not.

This visual inspection allows us to determine forward head posture, rounding and unevenness of the shoulders in the AP view, head tilt, and other variables. No special equipment is needed to show the patient his poor posture, other than a mirror and body drawing to mark the imbalance that you see.

A computerized program is another way to evaluate posture. The program allows you to take digital pictures of the patient and place marks on specific anatomical reference points. It also allows you to obtain a detailed analysis of forward head posture and degrees of deviation from normal. Whichever one you choose to use, postural evaluation is a powerful tool to help the patient understand the importance of correct posture on spinal health.

Seated Posture

Many of our patients work in jobs that require them to be seated at a computer for extended periods of time. Heavy phone work may also be a part of their job, as well as the normal daily stresses that we endure. While sitting at the computer, the patient should sit erect with his head upright, looking straight ahead and not down toward the desk or notes. Shoulders, back, and hips should be aligned to keep the back straight. Hips should be slightly higher than the knees, and the angle should not exceed 90°. The feet should be flat on the floor to help distribute weight.

Ergonomic evaluation of a patient's workstation may help to make changes in his work environment to improve his posture and decrease the likelihood of forward head posture and increased stress on the muscles of the neck and back.

Standing Posture

We relate good posture to how a patient looks when he is standing. When we view a patient in the AP, we look for his head to be in the midline without deviation, shoulders to be level without rounding, hips to be even, and feet to be shoulder-width apart or at least even and toes pointing forward. In the lateral view, we look for alignment with the ear, shoulder, hips, and knees. You can say we are looking for perfect anatomic position.

Pictured is an AP and lateral analysis using the Posture Pro software system.

Computerized Evaluation

In my office I use Posture Pro by Ventura Designs. I find the software easy to use and very reproducible. It allows me to take two digital photos of my patients' AP and lateral and import them into the software. I can then plot points on their photo and derive their posture. It allows me to show them essentially how they look to the public. This is powerful because they see everything we see as DCs. One of the most important numbers the program offers is the amount of forward head posture, both in degrees and distance of forward travel. The patients are shown their head in lateral view with relation to their shoulder and to the rest of the body.

Forward head posture can cause an increase in muscle pain and stress of the cervical paraspinal and upper trapezius muscle, to name a few. According to Dr Ventura, forward head posture causes shifting of the center of gravity, causing the upper body to move backward and the lower body and hips to slip forward, which can lead to not just neck pain but back pain as well.

Forward Head Posture

Educating patients on forward head posture is rather easy. Take a 10-pound medicine ball and have the patient hold it with his elbows locked in a flexed position. Ask him if this is strenuous to his arm. He will almost always say no. I then have the patient start moving the ball away from his chest as if he was performing a bicep curl and lowering the weight. I ask him to hold the ball in this position for a few minutes, and he begins to feel the strain on the bicep muscle.

For more on patient education products, see our April 2007 article "Roundtable: Practice with Class."

This activity allows me to then explain that his head weighs about 10 to 12 pounds and that the forward head posture is doing the same thing to his neck as the ball is to their arms. Simple, yes, but the patient understands completely the importance of keeping good head posture.

Exercise

Exercise recommendations are also important in correcting posture. We provide our patient with 12 exercises that help improve forward head posture, strengthen the abdominal muscles, and stretch the upper and lower body. These exercises are part of the Posture Pro Software package that we use.

Patient Media provides an excellent brochure on the importance of posture and the chiropractic approach to correction and detection of incorrect posture.

Robert D. Eisen, DC, practices in Paramus, NJ. Contact him at .