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Posture. It is one of the cornerstones of treatment of musculoskeletal disorders for as long as anyone can remember. It is a household name, one in which all patients have heard of to assist in self-treatment. It is on the same playing ground as ice for an acute injury. However, posture doesn’t have a strong backbone. Meaning, it hasn’t been directly linked to injury and other than our observations, no empirical evidence exists to conclusively rule it in as an effective intervention. I will say majority of my spinal disorder patients failed at sitting up tall or working on their posture, which eventually led to their symptoms continuing and cause to seek healthcare.

Just like most of our other interventions in physical therapy practice, posture has gone through some growing pains and changed in its use over the decades. We have moved away from static, postural grids to look at asymmetry and moving more into a dynamic, functional sense. The days of using plumb lines is numbered. However, if this is still your key approach but want to move into the modern age, search ‘posture’ in the App Store and you will certainly find that it is still a popular choice.

I haven’t given up on posture and neither should you. It is a no-brainer educational tool and similar to compression of tissues in a component model for manual therapy, as it is free. We see day to day that shoulder elevation improves after retracting the shoulders and cervical rotation improves after retracting the lower cervical spine, but is this posture? It is as an umbrella term but mostly an improvement in motor pattern from changing the arthrokinematics.

I normally take the posture key and use it to open up other doors. In the prior examples, you may want to consistently retract the scapulae and cervical spine throughout the day. The skill acquisition here is to provide optimal exercise frequency/duration and promoting good form. I have also used a treatment approach on a complicated case whereas good posture was the enemy, you can read it here

As mentioned earlier, posture (as the same of orthopedic manual assessment), is retiring from static positions to dynamic patterns. This is not updated news for most of you, but a good refresher. The extent of examples here would take all day so not going down that road, but going to provide below some statements that I make to patients in daily practice. I have collected these over the years from myself and reading/hearing others and do not know all the origins, my apologies and please comment if you know the source.

-Your posture is your shadow. It follows you everywhere you go. It can trail some individuals like a fall sunset or not less noticeable on high noon during a summer day. Meaning, it can affect some individuals much more than others.

-The best posture is the next posture.

-We should not view posture as a static entity.

-Posture education and intervention is free, take advantage of it.

-Posture is the king of bad habits. It can be almost impossible to break it.

What are some of your favorite statements about posture? I know all of you have analogies! Oh and thanks to Physio Picsfor the picture of slouched posture, the toothpick in the guy’s mouth makes it even better.

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3 comments

  1. Research or not, clinically it works.
    I’ve noticed it the most dealing with a forward head/rounded shoulders posture. I’ve used a modified version of a Rocobado Postural series to great effect. Activating deep neck flexors reduces a large amount of stress on the cervical facets. Scapular retraction and decreased use of the upper trapezius greatly reduces pressure on the subacromial space and reduces the likelihood of acromial issues.
    I liked your phrasing as the “posture key and use it to open up other doors.”

    Thanks for the post!

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