This is an excerpt from Postural Correction by Jane Johnson.
Identification and Avoidance of Causal Habits
This is included as a technique because it is so important to the correction of posture. The physiological benefits of postural correction may be short lived if your client returns to those behaviours that were significant in bringing about such posture. Is your client performing some activity in her occupation, sport or recreational activity that contributes to the perpetuation of this posture? In some cases a client may know what these behaviours are. For example, she may have realized that wearing high heels shortens calf muscles because when she wears flat-heeled shoes, she has pain or a stretching sensation in those muscles. In many cases a client may be unaware that a behaviour is aggravating a particular posture. For example, regularly using the same hand to carry a heavy bag or always slinging a rucksack over the same shoulder results in more frequent contraction of levator scapulae muscles on that shoulder than of the other shoulder.
In a random selection of 100 participants, Guimond and Massrieh (2012) found a correlation between a person's demeanour and posture (see table 2.3), supporting the notion that the body shapes itself into various postures depending on the underlying mental and emotional state. Grouping particpants according to the four postures described by Kendall and McCreary (1983), they used a Myers-Briggs Type Indicator to determine characteristics of personality and discovered a relationship between posture type and two aspects of personality: extroversion and introversion. For example, they found that 96% of participants with 'perfect posture' were extrovert and only 4% were introvert, whereas the converse was true for participants with a kyphosis - lordosis posture, where only 17% were extrovert and 83% were introvert. This makes for slightly uncomfortable reading. If postural deviations are purely anatomical, manual correction of a joint or joints by either the client or a therapist is a good starting point in minimizing, eradicating or preventing an undesirable posture. There are enough variables to make this challenging. To add the variable of whether your client's personality might be correlated with posture raises many questions. For example, when attempting to correct the kyphosis - lordosis posture of your client, which Guimond and Massrieh found to correlate with the introverted personality type, would you be more successful if your client agreed to behave in a manner normally associated with extroversion? Can personality types be changed from introvert to extrovert, and would this affect posture?
There may, however, be a link between posture and emotion. Consider what happens to your own posture when you feel embarrassed, shy, ashamed, uncertain or withdrawn. Do you flex your spine, lower your head, flex your elbows, bring your hand to your mouth or jaw or hug yourself, making yourself physically smaller? Compare this to how your posture changes when you feel confident, certain and elated. Does your spine straighten, do you raise your head and do you pull back your shoulders? Changing how you feel affects muscle tone and overall posture, so the significance of the part played by your client in helping to correct his own posture - whether via physiological or emotional means - cannot be overemphasized.
Helping Your Client Identify, Eliminate or Reduce Causal Habits
- Use of pertinent questions during the subject stage of your assessment will help you identify factors that contribute to the posture that needs correction. A change in posture may be acute (e.g., an altered upper-limb posture after elbow fracture or altered neck or back posture associated with sudden spasm of a muscle), or it may be insidious (e.g., with progressive arthritis in the knee). Ask your client whether she regularly sustains a particular posture or regularly performs a repetitive action. These are likely to be contributing factors to imbalance in the body.
- Encourage your client to take an active part in the correction of posture.
- Encourage honest feedback. For example, did he do all of the exercises and stretches?
- Avoid overloading a client with too many stretches or exercises; instead, help him to focus on performing one or two correctly.
- Explain that, in some cases, correction can take weeks or months, depending on how long the body part has been out of alignment. In some cases correction may be readily attained, but what is important is sustained correction. Expecting gradual progress is probably a more realistic expectation than wanting immediate results.
- If you believe that some aspect of your client's work environment may be contributing to his posture, you may wish to refer him to the occupational health department of his organization, if there is one, or to an ergonomist. Factors affecting work-related musculoskeletal conditions are complex, and interventions require a tailored approach (Panel on Musculoskeletal Disorders and the Workplace Commission on Behavioral and Social Sciences and Education National Research Council and Institute of Medicine 2001). It seems reasonable that postural problems believed to have a work-related component are also likely to be complex and require an individualized approach.
- If your client has a job in which he remains seated at a computer, an ideal situation is for you to visit him and to assess how he is using the computer. Provide advice on basic computer setup and, if possible, follow the guidelines set forth in the appendix: Correct setup for display screen equipment to minimize postural stress in sitting. Give this advice to your client verbally and in printed form. Many sources of information are available for your client to refer to should he fall back into bad habits. Examples are Working With Display Screen Equipment (Health & Safety Executive 2013), How to Sit at a Computer (American Academy of Orthopaedic Surgeons 2007), Perfect Posture (Chartered Society of Physiotherapists 2013) and Ergonomics Program: The Computer Workstation (National Institutes of Health 2014).
- Discourage reliance on your intervention in the long term. Hopefully, you will work with your client to help him correct a certain posture, and in doing so he will become aware of poor postural habits. Many professional sources are available for tips on postural correction, such as the American Chiropractic Association (2014). Your client may turn to these for gentle reminders on sitting, standing and sleeping postures in general.
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