As a member of the American Chiropractic Association Media Team, I am privileged and honored to talk to various members of the press. A couple of days ago, I fielded a question from a freelance writer for the web version of Prevention Magazine (Prevention.com). Her question was interesting: “What can you tell about a person from observing posture?”
Posture tells us a lot about your state of health. It can tell us if you have a pain source and roughly where it is. It tells us if you have structural issues that make life more difficult when you try to move. It can even reflect depression, self-image problems, happiness, confidence, etc.
As I write this, I have just come from church. Sometimes I look out on the congregation and find some of our patients. I watch them squirm in their seats, leaning one way or the other, fidgeting, or making an excuse to stand and walk. I understand that they are hurting, and sometimes I even imagine their x-rays above their heads. They are not squirming out of boredom with the sermon (giving the pastor the benefit of the doubt). They are attempting to change their body position to one that hurts less. I will see one or two of these by Tuesday and I will already know why they are here to see me. They think that is spooky.
Going to chiropractic school will forever change how you watch people. Going to a mall or a theater is never the same again. Instead of enjoying “people watching,” I find myself observing scoliosis, limps, tilted pelvises, and problems with the feet. Somehow it is not as much fun as it was before chiropractic school.
Returning to her question, posture is very important in the initial contact I have with everyone, whether they are new or established patients. My observations begin with the feet and work their way north.
The part of your body that is most active in resisting gravity is your feet. Most people have some degree of pronation – meaning that we tend to walk on the blades of our feet. Try this for a minute: stand up and turn your feet so that you were standing on the blades of your feet for a minute. Notice that your knees have bowed. As you stand there for a minute or two, you may notice some burning on the insides of your knees. Imagine walking like this for an extended period, like years. The wear and tear on your feet and knees would be significant.
That wear and tear does not stop at the knees. This postural problem changes the way we walk and distribute weight. This will affect the hips, the sacroiliac joints, and the lumbar spine in time.
Your lumbar spine (low back) sits on top of your sacrum, that triangular bone on which you sit. If the sacrum is tilted to one side or the other, your lumbar spine will curve. Here’s how it works: if you are standing in a room that is tilted to your left, you would have to lean to your right to stand upright. That’s how your lumbar spine reacts as it sits on the tilted sacrum. If the sacrum tilts, your lumbar spine will curve toward the high side to keep your center of gravity in the middle. This lateral curvature is what we call scoliosis.
This does not stop in the lumbar spine. If there is a curvature in the lumbar spine, most often there is a compensatory curve in the opposite direction in the thoracic spine (upper back). This produces the characteristic “S curve” of scoliosis.
Frequently as we look at posture, we also find that one leg is shorter than the other. Sometimes we can adjust the pelvis, knees, and feet/ankles and make that better. Many times we will use a rubber cushion placed under the insole of the short leg to balance the pelvis or even have one shoe sole built up to compensate. This lessens the curve in the lumbar spine and may lessen discomfort associated with posture.
So you can see that we literally look at posture from the ground up. As that old song says, “Dem bones” are all connected. A problem with a foot or both feet will have impact all the way up the spine. When we find these problems, we often have the most impact we address where it all starts – the feet. We use an electronic scanner to assess the arches of the feet and often prescribed custom orthotics to address the issues there.
Sometimes posture is affected by our occupations. For example, truck drivers are seated for long periods of time and have issues in the low back and knees that are fairly predictable as a result. People who use computers (accountants, teachers, clerks, and almost everyone else) for several hours a day may develop exaggerated curves in the thoracic spine or abnormal curves in the cervical spine that may cause problems. Mechanics are well-known for being bent out of shape.
I shared with this freelance writer something else that may not be in the textbooks. Your posture broadcasts information about your self-image, your state of mind, or your mood/affect. A person who is depressed or worried is likely to be looking down as they walk, perhaps with rounded shoulders and a humped back. Someone who has excessive anxiety may walk in a defensive posture, constantly observing the horizon for potential threats, real or imagined. This is more evidence of how our physical bodies are affected by psychological, social, and spiritual issues.
The last point I made with this writer is that we need to consider the posture we assume during that ¼ to 1/3 of life that we spend asleep. I recommend that people sleep in a side lying position if possible with a body pillow that supports the upper arm and leg to keep the spine is straight as possible. Along with this we talk about pillows for the head, level to keep the head as straight as possible, and firm so that when you turn over it is the same height. This prevents wear and tear on the skeleton and joints that may occur when you have no idea what’s going on.
That is my straight talk on posture. Look for the article in www.prevention.com sometime in the future. That is a good website for general health information that is not encumbered with a lot of medical terminology or misleading information directing you toward a particular medical specialty.
Now that you have read this far – are you sitting up straight?