How Poor Posture Increases Your Risk of Rotator Cuff Tears by 2,000% | Podcast Ep. 168

Foreign hello and welcome to the Evidence Based Chiropractor. I am your host Dr. Jeff Langmaid and today we are looking at a shocking paper that came out from the Journal of Shoulder and Elbow Surgery and it is titled the impact of Faulty posture on Rotator Cuff Tears with and Without Symptoms. This is a study you are going to want to pay attention to and again the results are pretty shocking. So stick with me for this episode and a huge shout out to Dr. Anthony Hussain for bringing this paper to my attention. Additionally, tickets are selling for Adjust yout Marketing My live intensive workshop that's happening here in Tampa June 78 and 9. It is all about getting you prepared to build and grow your practice online in 2019 and beyond. It's something I've worked hard on for a long time. I want to be your guide and your resource to take you where you want to go with your practice. And this is a weekend that is really going to kick that off in earnest. We are talking about website looks, we're talking about writing email copy, getting social media, filming some videos together. This is a hands on workshop. I am pumped. Tickets are selling right now. So if it is something that you want to get more serious about in 2019, visit the evidence based chiropractor.com events again, that's the evidence basedchiropractor.com events and pick up your ticket because there are just a couple super early bird tickets remaining. And on that note, I also had the luxury of traveling this past week to Parker Seminars out in Las Vegas. Then I hopped on a quick flight from Vegas to San Diego for Traffic and Conversion which is one of the largest marketing conferences in the world. So I got a bunch of great insight on what's working by people that are spending 100,000, 500,000 $1 million per month on their marketing budgets. And I'm excited because I look at that and I say what can I take from that and distill down that doesn't require the cost? What are the tactics and strategies that the big guys and gals are using right now to build and grow their businesses. And there I tell you what, there is so much correlation between what we can be doing as chiropractors in terms of building trust, following up. There's a lot that I want to get into. I'm dumping a lot of that information into the Adjust your marketing event. So I'm pumped for it. Huge shout out to Dr. Bill Morgan in the entire team at Parker for having me out there. Great job, awesome conference and I got to meet A bunch of super cool docs. And if you were one of them, I appreciate it because I had a lot of people coming up saying they listened to the podcast and then Traffic and Conversion out in San Diego is my second year there. It's awesome that I'll save my big takeaways for another day because I want to make sure I get to the research on this episode. So, as I said at the top, we're talking about a paper called the Impact of Faulty Posture on Rotator Cuff Tears with and Without Symptoms. So posture and rotator cuff, that's an interesting play, right? When I first heard about this paper, I was like, oh, that's interesting. That seems a little bit outside of the norm. Well, let me bring you right to the point, and then we'll start breaking things down. These researchers found postural abnormality represented an independent predictor of both symptomatic and asymptomatic rotator cuff tears. So this starts to get really, really interesting because when we talk about posture, we know faulty posture has been associated with musculoskeletal challenges. It's been associated with lumbar pain, the forward head posture, tech neck, all of these things can play a huge role in cervical challenges, in shoulder challenges. But really looking at thoracic posture and scapular and shoulder function hasn't really been evaluated until this study. We also know historically, rotator cuff tear is one of the most common disorders affecting the shoulder. The frequency of approximately 20% in the general population. 20% of people will deal with a rotator cuff tear at some point in their life. I did not know that. So that already was something that kind of shocked me. Well, when they looked at posture and they defined posture, the researchers, they looked at it really in four criteria. These are gonna really hit home for you listening right now because they're what we talk about all day, every day. Posture number one was they said, hey, there are people that we have in this study that have ideal alignment, characterized by normal curves of the spine with neutral position of the head, pelvis, and hip joints. We don't see that too often, but they certainly notated it secondarily. They looked at kyphotic lordotic posture. So what was this? Well, it was hyper kyphosis in the thoracic spine and hyperloridosis in the lumbar spine with hyperextension of the cervical spine, forward shift of the head, anterior tilt of the pelvis, and flexion of the hip joints. This is probably what we see most common, right? People spending long hours at a Desk. We see this kyphotic lordotic posture where there's a hyperextension, hyper kyphotic thoracic spine and a hyperloridotic lumbar spine. So that's something we see commonly. The two others, flat back syndrome, which is flattening of the lower thoracic spine and lumbar spine with forward shift of the head, posterior tilt of the pelvis, and extension of the hip joints, and then good old swayback posture. Swayback posture sounds like very 1940s to me. But swayback posture apparently is still a thing. And it's characterized by posterior displacement of the upper trunk and anterior displacement of the pelvis, compensating for flattening of the lumbar spine with forward shift of the head, posterior tilt of the pelvis, and hyperextension of the hip joints. So flat back and sway back do have some commonalities there in terms of their posture and positioning. No pun intended. So what did these researchers found? Well, they found some pretty staggering results when they analyzed hundreds of people across those four postures. Listen to this. They found prevalences of rotator cuff tears in this study were 2.9% in ideal alignment, 65.8% in kyphotic lordotic posture, 54.3% in flat back, and 48.9 in sway back. Those were the prevalences of rotator cuff tears. So the prevalence, if you had an ideal alignment, you had a less than 3% prevalence of having a rotator cuff tear that was either symptomatic or asymptomatic. Less than 3%. If you went to a kyphotic lordotic spine, again, hyper kyphosis in the thoracic spine, hyperlordotic curve in the lumbar spine. We see it all day, every day. Right. It jumped from under 3% to over 65% of those individuals. That is absolutely staggering. That is absolutely staggering. We're looking at. I'm not the best mathematician on planet Earth, but 65 minus 3, 66 minus 3, 63% more likely. That's hundreds, if not thousands of percent more likely. @ any rate, this is something to keep in mind, and I think about it from a clinical perspective for me and you and your practice. Right. We probably see people all day, every day, that are hyperkyphotic. I know I have in the past. I know. Just walking around. I see them walking around all over the place. You probably see a lot of people in your practice with a hyperkyphotic thoracic spine. Keep an eye on those shoulders. Make sure that their scapula are moving appropriately, check their shoulder range of motion. That's where I start to go with this, with my mindset. When we start to see prevalences in an ideal posture at under 3% jump 60 practically to 66% for rotator cuff issues. This paper doesn't use the term causation, but that is a very high correlation in the bare minimum. So keep an eye on that scapular motion, Keep an eye on their shoulder range of motion. If you're working that mid thoracic spine again, sometimes I think insurance criteria and how we go about our day to day, we start to really focus in and really narrow in. I'm just gonna adjust. It's where there's pain, it's where there's dysfunction. Don't hesitate. Always be looking that one joint or that one body region away because you're going to see compensatory action. And that is what this paper reminds me of personally. It says to me and speaks to me saying when you see a thoracic spine that isn't moving appropriately, take a look at the adjacent regions. In this case, take a look at those shoulders, make sure that they are mobilized. Not only is that what's in the best interest of your patient, which is job one patient centric approach, but it's something that, hey, if you get a shoulder adjustment out of it and you can do that ethically and with a patient centered approach, well, you can bill for that as well. So the compounding positive interest for your practice when you start looking at things more dynamically and more holistically. Additionally, I look at the other side of the coin. You and I both know that there are hundreds, if not probably hundreds of thousands of individuals right now in physical therapy for rotator cuff tears. And I can nearly guarantee you that a vast majority of those individuals are not having their thoracic spine mobilized or their posture addressed. They're strictly going through shoulder exercises to kind of strengthen, reduce inflammation, et cetera, around the torn rotator cuff. So keep an eye on that. If you see a patient that's coming in. If you have physical therapy in your practice or active care, if you see shoulder issues, the same thing applies the other direction. Check out the thoracic spine. Don't stop just on that shoulder. And as you have conversations maybe with physical therapists in your community, as you have conversations with medical doctors in your community, this isn't a paper that it's aha, look at how much better we can do. But it's a paper that showcases your expertise. It's a paper that showcases you're on the cutting edge of what's going on. This paper just came out in the last couple years and I can guarantee you there are a vast majority of physical therapists, a vast majority of medical doctors, and quite frankly right now, a vast majority of chiropractors that didn't know the prevalence rates, that didn't understand actually. Oh my gosh. This jumps from an ideal posture at 3% rotator cuff issue to 66%. It's staggering. It's something to keep in mind and it's something where you can do the best work for your patients. You could might be able to bill for a couple additional treatments, which is fantastic. When you're doing the right thing and ethically the patient's gonna be happier and you're addressing and setting things up for long term success when you're also addressing the compensations that go on, not just myopically focusing on that injured area. I think that's what we all want. I know that's what I want as a practitioner, as a healthcare professional, I can pretty sure if you're listening to this podcast, it's what you want as well. So if you want to check out this paper, I will leave a link in the show notes. And if you want to dive deeper to bridge that gap and build relationships with other healthcare providers, join us as a member of the Evidence Based Chiropractor. We'll give you all the tools, all the resources, step by step to bridge the gap, build relationships and get more referrals into your practice. But you got to be consistent and you have to have a plan. That's where we come in. So check us out at the Evidence Based Chiropractor. I hope you have a great week in practice and I will talk to you soon.

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