Tuesday, May 7, 2013

The Barrier to Good Posture


"STAND UP STRAIGHT"! 

If I had a dollar every time I heard that phase in a Rehab facility, I would be very wealthy. 

Don't you think our patients would like to have good posture if they could?

So why don't they?  

We are a manifestation of our compensations, meaning that when our body is not in alignment it will compensate to achieve function. 

I also believe that people become "Disabled" when their bodies run out of compensations. 

There are 2 main reflexes that dictate postural alignment in the human body. The body will contort itself by any means possible to achieve the following. 

1. Keeping the eyes on the horizon to facilitate the righting reflex and optimize vestibular function. A prime example of this is compensations due to a scoloitic curve. 

2. Weight bearing of the body over the hallux and medial foot. Examples of compensations include: rotation of the femur or tibia, medial shift of the talus, flat feet, genu recurvatum, genu valgum, anterior innominate rotation, and knee bending in standing. 

Diane Lee uses the term driver to describe the reason that there is a postural abnormality, the driving force behind the postural abnormality.

I feel the best way to determine is to place the bony structure in neutral and do the following: 

1. Observe compensations that occur as a result of this change. 
2. Ask our patients where they feel a resistance to allowing for movement to occur within the system. 
3. Feel through our tactile sense where there is a restriction to movement. 

I term this type of evaluation Diagnostic Static Evaluation. 

The ultimate way to achieve carryover and maximum functioning in your patient is to give your patient the best possible alignment in their system. 

The key to achieving this is to unlock the driver and treat the compensations. 

If you don't the patient will never physically be able to "STAND UP STRAIGHT"!