For the past few weeks, I have been reading through the McKenzie text books in order to establish a stronger foundation on source material for repeated motions. Those of you familiar with repeated motions know that posture plays an essential role in treatment. In the lumbar spine books, it is recommended that we have our patients sit in a chair without a backrest, so that we can see their "natural" posture. I disagree with this for several reasons. One, I believe it is important that the patient be as comfortable as possible during the evaluation. The patient will immediately begin to have increased trust in you, the patient will be able to focus on a more accurate subjective examination, and it helps to avoid flare-ups during the evaluation. Second, most patients will regularly assume a more comfortable position (or what they view as being comfortable). It is best, in my opinion, to see how the patient regularly sits. For example, some patients with low back pain will exhibit a slouched posture with excessive lumbar flexion, while some others will sit on the edge of their chair using their hip flexors for stability in the upright position (remember the iliopsoas acts as a spinal compressor!). Regardless, simply addressing these issues may take care of the patient's pain while sitting.
There is a lot of debate out there on should we or should we not assess posture. Those that argue against it, say "look at all the people sitting poorly and have no pain." I will respond with the fact that pain with these prolonged positions can be corrected if the posture is corrected. Now, I wouldn't attribute the problem and fixes to mechanical factors in the tissues. I typically explain it as a hypersensitivity of the nervous system towards one prolonged position and that we need to balance it out and work to keep things more even across the equilibrium. Overall, I recommend trying to get a picture of how the patient acts in their natural habitat and addressing any contributing factors.
-Dr. Chris Fox, PT, DPT, OCS
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