Postural dilemma - did Adam and Eve ever suffer from back pain?

I won't lie, I am a little annoyed at God for not giving us a bigger representation of the spine and core stabilising muscles on the homunculus when the hand is so huge!

Name me one fellow blogger that hasn't included postural education as part of their treatment plan for any one patient at any one time. Though I am on a musculo outpatient prac, this leading issue is widespread across all areas of Physiotherapy. We educate patients on this all the time, but how much sinks in or is forgotten is a mystery yet SO important they should probably design an outcome measure or test for it and standardise it across the nation!

Who's mum told them to "sit up straight" when they were younger? It might be because i'm from the country, but I seriously thought it was because slouching was rude, not to protect my back! (so naive) This begs the question;
Is there enough emphasis and resources allocated to the prevetnion of back pain and poor posture from an early age?
Due to prevalence of posture related chronic back pain, I would argue No!

You might wonder where I am going with this. In the last week I have dealt with at least 8 (thats 8/11!) patients suffereing from chronic LBP. Every single one of these have displayed poor-posture related changes resulting in abnormal stress on the spine leading to chronic LBP, often constant and very difficult (not to mention time consuming) to eradicate. My challenge is, as has been all the hype from previous bloggers, tailoring a similar message to different characters so that each individual fully understands how their body has changed through poor posture. As we didn't listen to our parents when they told us to simply "sit up straight", some patients bypass the importance of the postural education portion in a treatment session. In most part, this postural education is similar and the underlying concepts are the same. The challenge, however, is the delivery of the message... you really have to have a repertoire of several approaches for the variety of individuals that present.

We do gain some credibility in being (or nearly being) physiotherapists and CAN influence this, but problems can exist when you see a patient for the first time, and from your subjective and objective Ax you deduct it is a priority and perhaps the leading cause, and you don't know enough about them to establish the best approach. Dont forget the chronicity, potential yellow flags and the fact that it probably wont decrease their pain straight away so they may not see the relevance of postural activities. These are examples of just some of the battles we face in our choice to include postural education in treatment.

My first attempt was to just hammer home good posture, give a few home execises to help strengthen the core stabilisers and postural muscles, and pelvic dissociation activites to practice getting into and out-of a good pelvic postion in sitting and (if able) standing. The pt then returns the following week with no improvement in LBP, and on objective Re Ax when you ask them to perform their HEP, you note that the haven't been doing it correctly despite the emphasis you put on it in the first session. pt = unhappy, probably less confident in your ability and your back to square one! What I didnt do enough of was show them whats happening to their spine because of their posture and spend enough time just on education alone, giving them time to ask question about how it relates to their pain and more feedback on how postural correction will, in time, start to resolve if they maintain it. Also, it helps to give a time-frame. even if you dont know, tell them that due to the chronic nature, they are not likely to feel cured straight away. Then explain how the exercises relate, perhaps not giving them all at once so that they have to take the education away with them as that was he focus. I have found better compliance, and understanding of exercises (especially pf/Tr A activation ex's) since taking this approach.

Anyone else with any suggestions.. send your thoughts through!
and so i conclude;
Posture - If YOU have any comments then good,
If YOU know any helpful hints then great!
If YOU have the solution, then i will invite you over for dinner!!!!!

Until next time...