170- The Link Between Posture and Respiratory Function

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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langme. Today we are talking about forward head posture, thoracic shape and respiratory function. This is a good one and it probably affects 90 plus percent of the people who walk through your front door. So we're gonna break it down, talk about how you can make this information actionable and have some fun in the process. Before we get started, I'll say a few words about Rock Tape. Rocktape has revolutionized the soc tissue world again with Rock Blades Mohawk. You know about them, they're 175 bucks. If you haven't checked them out, visit rocktape.com mohawk you can check out the tools and you can also see all of the educational courses there. Additionally, super early bird tickets for Adjust your marketing are nearly out which is crazy. So those who have already committed to coming thank you a ton. If you are on the fence, I would encourage you to make a decision soon. The evidencebasedchiropractor.com events. That is where you can pick up a ticket and if you do not know about Adjust yout Marketing, it is my first live intensive immersion event. It's happening here in Tampa June 7th through June 9th. It is gonna be cool. We're doing food, we're doing some drinks, we're having a lot of fun and we are actually going to be producing content. So we're gonna be working on strategy together. This is actionable. This is a weekend of action. Right? So it is about coming down, working one on one, things you can actually take home to implement immediately. We're going to shoot video together. It's going to be awesome. So please, if you are interested in doing more on social media, doing More online in 2019, pick up a ticket to adjust your marketing. While there are some left at the evidence basedchiropractor.com events. So with all that out of the way and you could always ask me any questions jeff@the evidencebasedchiropractor.com but for today we are talking research and as I said at the top we are looking actually at a super new paper. This is from 2019. It is hot, hot, hot off the press and it is titled Effect of Forward head posture on Thoracic Shape and Respiratory Function. This came out just this year, as I said in the Journal of Physical Therapy Science. So posture is something I think that almost all chiropractors can agree on. One of those very few things that it plays big role. It's structure meets function, right? And posture plays a role in the structure, which then plays a direct causation or correlation to what goes on functionally. So these researchers took a look at it from the standpoint of, okay, let's look at neutral head posture, which almost nobody has, and let's look at forward head posture and see what happens with thoracic shape and see what happens with respiratory function. They also looked at this through the lens of, hey, this could be people with neck pain or without neck pain, which is interesting, right? It's not all about pain. It's also about function. So they cite a few very, very important things and they kind of address it right at the top, literally the first line of the research paper. Because the rising popularity of media devices such as smartphones and computers, frequent users often exhibit incorrect posture. Forward head posture is a poor habitual neck posture that is defined by hyperextension of the upper cervical vertebra and forward translation of the cervical vertebra. So that kind of says it all right there. Talking about popularity of media devices such as computers and smartphones, sounds like the person who wrote this was 80 years old. I'm sure that's not the case, but anyway, we'll move on from that. They touch on the fact that forward had posture places, as we know, significant compressive loading on the cervical spine. So that old. I don't know if that old adage is correct. For every inch, it's X amount of pounds. I'm sure there's some sort of formula there. But the bottom line is the facet joints, the ligaments and the disc undergo increased stress and strain with forward head posture. There's no question about it from the facet, there's no question about any of it. But the facets particularly can undergo significant stress and strain because as you poke that chin forward, it literally just like almost closes down the facet. If you want to think about it that way, that's a really important thing. Now, additionally, another interesting piece of this puzzle is the respiratory function. So we see compensation, right? As the head goes forward, it's chicken and egg. But as the head goes forward, we see compensatory action in the thorac. Thoracic spine. And what happens there? Well, that's what these researchers took a look at. So I'll read a few key quotes that they Came up with, and then we'll break things down. So the researchers found forward head posture increases compressive loading on the tissues of the cervical spine, particularly facet joints and ligaments. In addition, forward head posture greatly influences respiratory function by weakening the regulatory muscles. So that's important. Weakening of the muscles due to a forward head posture, that's pretty significant muscle effect. Again, structure meets function. Researchers also found a critical finding in the present study was that the shape of the thorax was significantly changed by forward head posture. Forward head posture induced expansion of the upper thorax and contraction of the lower thorax. So again, deep breathing, where does that come from? Lower thorax, Right. Where does that superficial, as we'd call it, breathing come from? The upper thorax. So it's almost encouraging superficial breathing rather than deep breathing. And that is a big factor in overall respiratory function. Finally, the researchers found our results revealed that the shape of the thorax changed and that respiratory function decreased with forward head posture relative to neutral head posture in the same person, even amongst participants without neck pain. So that kind of puts it all together. We have seen an increase, in my opinion, in forward head posture probably over the last 25, 30 years as computers have become super, super prevalent. People are spending a lot of time and there is a significant portion of the workforce that spends all day looking at a screen. And quite frankly, probably a vast, overwhelming majority of their desks are not ergonomically correct and they probably are enhancing poor habits more than promoting good habits, to say the least. So that forward head pocket posture becomes very prevalent. And obviously over the last few years with smartphones, tablets, et cetera, that's kind of propelled that forward. So we know it can contribute to neck pain, we know it can contribute to compensatory patterns in the full spine. But now looking at it through the lens of thoracic shape and respiratory function is a different way to look at it. And that's important, as we'll talk about in a minute, specifically relative to rehab, but overall performance as well. And the factors that these researchers looked at. So how do you come up with respiratory function? Right. There was a couple factors that they looked at. One was expiratory reserve volume, forced expiratory reserve volume at 1 second, forced vital capacity, inspiratory reserve volume and peak flow rate. I can tell you every single aspect of what they looked at was decreased. So the reserve volume was decreased. Expiratory and inspiratory. With forward head posture, the forced volume at one second, the forced vital capacity, the peak flow rate Literally every single one of these things was decreased with forward head posture when compared to neutral head posture. So that's pretty staggering when you think about it as well. A lot of times in research there are multiple factors that are looked at and some kind of break even and some divert, right? But in this case, literally every single factor that they examined showcased the fact that forward head posture negatively impacts respiratory function. Now here's where things get super, super interesting from a chiropractic perspective. The researchers found, quote, the second finding presented here was that mobility in the lower thoracic spine was decreased with forward head posture during respiration. In particular, lower thorax mobility along the Y axis anterior posterior direction was significantly red. I don't know about you, but I happen to have at least one tool in my toolkit, so to speak, that might be able to increase that mobility, right? A chiropractic adjustment or spinal manipulation. So when you look at forward head posture and we see that there's decreased mobility in the lower thoracic spine, I also think this needs to be taken from a clinical sense, meaning when you have patients that have neck pain and forward head posture, the don't hesitate to look at the thoracic spine. Always look to that next, that next body joint or region, so to speak. That's very, very important. Doing a thorough examine, you might think yourself, gosh, but you know, billing or treating somewhere, not exactly where the pain is. We are a dynamic being. So if you're having trouble putting that together, I'd encourage you really to focus on your examination. That doesn't mean you go from the highest hair on the person's head all the way down to their toes. For every single complaint that might be within your technique set, that's okay. But for those of you who are getting maybe a little bit too myopic in terms of your treatment, it hurts right here. I'm just gonna treat right there and I don't wanna do anything else. Don't hesitate to look one joint or one body region or spinal region away. You'll notice that there's a lot of compensation there. And with a thorough examination, you should clearly be able to document that. In this case, the researchers do not go this far. So this is me kinda riffing on it, but increasing thoracic mobility, I'm interested to see where the research goes to see if there's showcased better respiratory function with that. I think that's been toyed with in the literature, but this paper really sets that up and that'll be something that'll be Very, very interesting. Cause when we look at performance, when we look at rehab, when we look at just daily activities of living, respiratory function is a key, key component to that. If you don't have respiratory function, you're not doing too much, right? So even just slight gains in respiratory function is better oxygenated blood, I mean in everything that case cascade from that. So this was a really, really cool paper. We're actually featuring it as a part of our research brief for members of the Evidence Based Chiropractor. So if you're a doc out there who's been looking to bridge the gap and build relationships with other healthcare providers in your community, check us out@the evidencebasedchiropractor.com and as I said at the top, if you want to do a deep dive, I'm basically putting together every single thing that I've learned working within orthopedic groups, multidisciplinary groups, having influence on multimillion dollar marketing budgets and quite frankly spending quite a bit of money myself. I'm putting it in a way that can be actionable for you, that can be actionable for your practice and really take the best practices of what's working currently in the marketing and outreach landscape in its content production. Right. That's where we're going to go through at Adjust Adjust your marketing here in Tampa. If you want to pick up one of the last Super Early Bird tickets, which is a discount, yes, a discount ticket. You can do so@the evidencebasedchiropractor.com events. I hope you have a great week in practice and I will talk to you soon.

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Sam.