Postural Stress: Research, Theory, and Practical Tips for Chiropractors | Podcast Ep. 231

Foreign. Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. On this week's episode, we are talking all about posture and the science of body positioning. This was our monthly campaign within the Smart Chiropractor. And I wanted to bring in some of this research to the podcast, break down some of what's important with posture, maybe some of what's not so important, and some things to look out for in your practice. So, as you probably know, posture, and more specifically the idea of quote, unquote, perfect posture has been hotly debated in the research world for decades. And while the answers continue to remain somewhat elusive, we do know that prolonged postural stress can lead to a variety of health challenges. Could be pain, it could be dysfunction, could be premature degenerative changes. There's even an association with depressive type stuff symptoms. But all of this has to be viewed within the context of each individual patient. I know, I have seen within the multidisciplinary groups I worked at, you know, MRIs with people with, you know, curves that I could not literally believe existed. And at the apex of that curve where the foraminal canal looked like it was crunched, they had absolutely no symptomatology. And other people seem to have mild postural distortions and significant symptomatology. So you have to keep that in mind as you go through this. And I think that's where we're gonna frame this as well. Posture is not a static idea, but it's really about the dynamic nature of the body. And why does this matter? Well, it matters to a lot of people out there. Typing posture into Google will result. It results in over like 150 million responses. So a lot of people are searching out information relative to posture. The question is, is your practice putting out the answers? And the answers might still lead to more questions, but I think it's a place where us as chiropractors, we want to have at least some inkling. We want to have some representation of what we believe. And depending upon who you are listening to this, that might vary a little bit in terms of how you view posture. But it's important to have a voice in your community. And with that sort of volume, 150 million responses when you type in posture, there's no question it's a highly searched topic in your community because if you just break down those numbers, people are searching for it. And over the course of May, we've really been focusing on this within the smart chiropractor. And what are some papers that we looked at, we looked at papers from the Cleveland Clinic, from Columbia Spine, from the Journal of Behavioral Therapy and Experimental Psychiatry, We've looked at occupational and environmental medicine. We've looked at all of these things and tried to distill down what matters with posture and what might be less relevant. And there's a few key facts that I think are really, really important to keep in mind. And some of this quote, forward head posture affects millions and results in neck pain for up to 75% of individuals. So I know historically chiropractors really, you know, you think about chiropractors 10 or 15 years ago, you know, maybe sitting at an airport together, watching people walk by and talking about the postural distortions or abnormalities or imbalances that they see. And, and I think that that's fallen out of favor a lot with what we do in the context of modern chiropractic. And some of that's a good thing that has fallen out of favor because it's not just about the static symmetry or asymmetry, it's about the dynamics of it. But it's important to keep in mind that with forward head posture, there are a lot of potential, potential, keep in mind downstream effects from that. So neck pain, tension, stiffness and tenderness all are all signs of chronic forward head posture. And this is important as we talk about tech neck and really how many hours per day. I know my phone reminds me all the time and I'm like, oh my gosh, you know, two hours, three hours a day on my phone. And there's a lot of people out there living with those same numbers and, or more. And if you're not really careful about how you set up your workstation or how you're viewing your phone day in and day out again, I always say, you know, those, you know, those hours become days, become months, become, you know, become weeks, become months, become years. And before you know it, you know, you could have tens of thousands of hours in sort of these compromised positions. And then it's not just the compromised position often, but. And then you add to it. Inflammation from a diet, you add to it. Stress, you add to it a lack of exercise, you add to it all of these things and you end up people with chronic pain syndrome. So trapezius strengthening has been shown to provide clinically significant relief for those struggling with neck pain as a result of forward head posture. Important to keep in mind, right, if you have engaged, whether you're using web exercises, which is built into the smart chiropractor as your tool to Guide people at home. Whether you're doing active care and rehab in your practice. Trapezius strengthening is something you want to take a look at, right? Trap strengthening. It provides clinically significant relief for those struggling with neck pain as a result of forward head posture. Important to keep in mind. So what are some of the other things the research says? Let's break down a few and then we'll go back to them. So good posture means keeping your spinal curves aligned and weight evenly distributed. That's not from a chiropractic journal, ironically, but it speaks to what we do. Good posture can cut down on the wear and tear of your joints. Again, imbalance over a course of time can lead to biomechanical. I guess, what would I say, inefficiencies that have a propensity for potential injury. A lot of P's there in a slight alliteration, but I think you get the point. A balanced posture can help prevent back pain. Tech neck is a term used to describe the flexed head and neck position that occurs when looking down at your smartphone. We all know that and this is an interesting one. I'd really love to see more research on this one. But even there's a study that says even 15 degrees of forward bending or flexion can, can increase the stress of your head onto your neck by over three times. Now that starts to get really interesting because 15 degrees is not very much at all. And we're Talking about a three time, you know, a 3x amplitude in terms of the amount of weight and stress that that places upon the cervical spine. And again in a moment in time. That's no big deal. Our bodies are built to adapt. They're built to be dynamic. But, but when you look at that over the course of weeks and months and years, I can't help but think that that causes challenges that it causes, as we said a few minutes ago, whether it be biomechanical and movement based inefficiencies, whether it causes just additional unbalanced stress upon the spine, maybe there's osteophyte formation. A lot of these things depend upon the individual and are very, very difficult, near impossible in some cases to predict in terms of the symptomatology. So I don't want you to jump off the end of the dock here and think that just because there's a slight postural imbalance or just because there's a slight change on a film that it's gonna result in this catastrophic event 10 to 15 years down the road. Our bodies are just so dynamic. Our Lives are so dynamic and in our spine and neuromusculoskeletal system, it's so resilient that it's difficult to predict. But I think there is something to be said as far as taking proactive steps today and encouraging your patients, most importantly, to take proactive steps today to minimize any potential challenges in the future. And a lot of that, here's the beauty of it, a lot of that can be accomplished through active care. As we talked about, your trapezius strengthening that provides clinically significant relief. Now, again, if you check range, if they have pain, you check range of motion, there's facets that have, and they're just not moving well segmentally. Get in there and do a manipulation or an adjustment unless you see something that tells you otherwise. But make sure that the patient is doing active care at home. And this is the crux of what I believe is the important piece of posture is that again, talked about this, but just think about, I want you to really think about your patients. A lot of these individuals are in compromised ergonomic positions for hours and hours per day. They're in their car for multiple hours. Maybe not right now, but you know, they might traditionally be in their car commuting to the office. You know, they probably have poor ergonomics in their office. They're working from home right now. I can nearly guarantee you they have terrible ergonomics. And those hours add up. And doing just little things to counteract that amount of time, I can't help but think is a step in the positive direction. Getting up and taking a break every 15 minutes, resetting the position and height of the monitor, identifying challenges that they're with their chair and the height of their desk. Are they using a sit to stand desk or not? These are all really, really important things that as a chiropractor you can ask questions about and that you can kind of coach them, you can help guide them. And ultimately, whether it's a telehealth visit or an in office visit, you can be compensated for that time. That expertise is very, very valuable. And I think a lot of times as docs, we deal with this where patients come in to see us and we're seeing the, you know, we always say results follow actions in terms of marketing, right? You take an action and then you see a result. And obviously we're deeming this to the positive implications of marketing. But the same holds true to how people interact day in and day out and what they do day in and day out. Their actions will yield results and if you are in an unbalanced posture, if you're just sort of in a biomechanically compromised situation and you have repetitive stress, AKA typing on an assembly line, you name it, that repetitive stress type syndrome, over time those actions may yield, may yield unsatisfactory results. So helping guide even just 15, 20 minutes where you can showcase to a patient how they can at least attempt to counterbalance those hours and hours per day in a stressed position can be very, very beneficial long term. So ultimately, posture was really where we dove into heavy in the smart chiropractor. And this past May, I just touched on it right there. This was. We devoted an entire month, right? Our monthly campaign was literally devoted to posture. But there's just so much to this. It's continually evolving. And I think it's time for us to think beyond just what we're seeing statically, right? All of us would agree that our bodies, no matter what sort of technique you do as a chiropractor, no matter how you look at the body, we all know that it's a dynamic for force, right? And dynamic forces are what guide us. Gravity, standing upright, being biped, what we do and how we use our bodies day in and day out is so dynamic that an X Ray, an MRI. I looked at 30 MRIs a day for years in one of the surgery centers and they were a supremely important tool at understanding the structure of what's going on. But it did not tell me the function of what's going on. So all of us should keep in mind as we analyze posture, as we look at posture, as we look at this and guide our patients towards hopefully success and ultimately what are their health goals and what are you guiding them towards? Those two things should be completely aligned. You should think about this in terms of dynamics, you should think about this in a lot in terms of active care. And you should also think about this in terms of balance and movement dynamic instead of static positioning. So keep all that in mind. If you have any questions, hit me up. Jeff the evidencebasedchiropractor.com Also, I love feedback on this podcast. So if you're listening to this on your iPhone, scroll on down, give us some feedback on itunes. That is how more and more docs find out about this podcast. Have a great week at practice and I'll talk to you soon.

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