2005-11-11 / Columnists

Eye On Physical Therapy

By Dr. Tim Rohrs, DPT


As you may or may not know, October is National Physical Therapy month. Events are scheduled all throughout the month by the American Physical Therapy Association, local physical therapy clinics and private practices. The goal is to educate the heath care consumer as to who physical therapists are and what they do. In honor of National Physical Therapy month, I contemplated what message I could convey to let people know about physical therapy. I decided that the topic should be of great importance, one that all PT’s talk about it each and every day to their patients. That topic is posture.

A large percentage of the time when a person comes into the office in pain, there is no clear-cut mechanism of injury. There was no fall or trauma, just a gradual onset of pain that increases over time. This pain, more often than not, is worse with prolonged static positioning, such as watching TV or reading a book quietly. This pain is relieved with movement. That is the opposite of pain brought on by traumatic onset. That pain is usually worse with movement and better with sitting still and not moving. The postural pain is usually a deep gnawing ache, possibly with throbbing. The pain that was initiated by trauma is usually sharp and knife-like in nature. So, what is this postural pain?

Good posture could be defined by the perfect anatomical balance of head, neck, spine, trunk and legs. When this balance is achieved, muscle activity is at its least. Because of this anatomical balance, the muscles get to be in a relatively relaxed state of being. Either due to poor habits, or prior injury or work related activities, that balance can be thrown off. Those that sit and type most of the day usually have their mid-backs flexed forward, their head forward, and shoulders forward to type or work or drive. One study used an EMG machine to measure the electrical activity of muscles in different positions. When the subject was standing up straight in perfect posture, and their head balanced perfectly over their spine, there was minimum muscle electrical activity recorded. When the head of the person was displaced just three centimeters forward, the electrical activity increased threefold. This means that the neck muscles were working three times as hard to keep the head upright. This increased muscle tone might contribute chronic neck muscle spasms, decreased blood flow to those muscles due to the spasm, and make those muscles sore and tender. The longer they stay in spasm and in that position, the more it hurts. When the neck moves and the muscles contract, the exercise increases blood flow, flushes out local inflammation, and the neck feels better.

Joints can also be affected. Many times the joints of the neck are at their end range because of faulty posture. That means instead of the weight of the head being spread out over the three weight bearing surfaces of the vertebrae, one joint is in a chronically compressed position and will wear away quicker and show up as degenerative joint disease on x-ray.

This brief explanation of the effects of posture on cervical pain can be carried over to the mid and low back, as well as the joints of the hips, knees and ankles. Faulty positioning stresses ligaments, increases tone of muscles, which try to help by increasing support, and in the end, is the most difficult condition to treat. Why? It is the most difficult to treat because it fully depends upon the person changing bad habits and constant vigilance to maintain good posture. That is something I can teach but cannot enforce. Keep safe!

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