No matter how well we've mastered our skills as chiropractors and no matter what techniques we use in our practice, our patients' patterned postural habits between office visits can dictate the level of success of our treatment plans.
One of my main motivations to become a chiropractor was my experience as an often-injured athlete. Innately, I was never satisfied with the symptom-oriented treatment the traditional medical model offered. I felt that given the right guidance, I could be doing things outside of the treatment and training room that would help my body heal faster and perhaps more effectively prevent future injury.
Score another win for innate intelligence! Over my many years in practice, and with the help and feedback from many incredible mentors, I've developed a "24/7 bubble" of healthy choices that I provide for my patients.
We become over time what we think, eat and do. As I observed patient after patient leave the office with reduced symptoms and increased function, I couldn't help but realize that many didn't even make it to their cars before reinforcement of pathological posture and faulty movement patterns began to undo the benefits of my care.
By the time I would see them a few days later, even if symptoms had subsided, it was apparent that their muscular imbalances, which more often than not were the actual cause of their condition, were recalcitrant to my attempts to correct them, even when the patient insisted they were doing their stretches and exercises.
When I got the chance, I would try to spy on them as they drove away, and to my dismay, car seat after car seat would defeat their posterior chain and allow the classic deformation pattern of the sitting man: lumbar lordosis replaced by increased thoracic kyphosis. The hip flexors and hamstrings would shorten, and the abdominals would go on vacation. I would often use the classic line, "What are you doing to undo what I did, to undo what you're doing?" and remind them of the negative effects of sitting; "and when I say 'sitting,' that includes when you drive!"
I also knew that once they got out of the car, it wouldn't be too long before they found another place to sit and continued their daily process of rewiring the muscles in the front of the body to become overused, shortened and over time, affect movement and joint health, and cause their S-shaped spines to mold into the sad "C." A very real sign of the de-evolution of modern man.
Sitting Bull
Did you know that in the U.S., we sit 9.3 hours a day on average? Heck, we only sleep an average of 7.3 hours a night! Recent studies show the physiological effects of sitting are devastating to our overall health. When we sit for long periods, our mortality rate increases exponentially. And let's not forget that the no-so-attractive C-spine posture pattern also restricts respiration and compresses organs that were designed over millennia to function best while we are upright and in motion. Each time we sit, we reinforce "death by chair." Show me the people who live long, healthy lives, and I'll show you people who don't spend their days sitting.
"Posture Follows Movement Like a Shadow" – Sherrington, 1906.
But it's not just sitting. Our bodies are highly plastic and we mold to the posture and activities we do the most often. So, if our patients reach forward hundreds of times a day (at the computer, in the car or to pick up their kids), and never reach back in the opposite direction to exercise the muscles that hold them up, the countless repetitions in one direction create and feed imbalance and faulty posture. Imagine doing biceps curls all day and never activating the triceps or stretching the biceps. Where would your arm eventually end up? With your fist resting on your shoulder!
Poor posture when sitting also stimulates a sympathetic, fight-or-flight state that, among many other stresses, creates a measurable increase in deadly C-reactive proteins, significantly slows our metabolism, and negatively impacts cardiovascular health, immunity and digestion – and this is just the beginning of the list of poor posture's negative effects on overall health and wellness.
If your patients are looking for some perspective on observing posture and movement the way we (chiropractors) do in our "modern world," just have them watch how a 4-year-old moves and they will understand. Children move without restriction. Observe how a child squats and you will see a perfect hip hinge while they maintain their natural spinal alignment and curvature. They are using efficient, quality movement, the way we were designed to move. Just watch a young child get out of a chair and walk away, and then compare it to someone age 30 or older. If we sit an average of 9.3 hours a day, that means by the time we are 30, we have spent 84,862 hours sitting. It's a wonder we can still move at all.
In almost every case I've seen over the past 25-plus years, there are predictable muscular imbalances (think Vladimir Janda's upper-crossed syndrome) that have most likely been there for years, and have been reinforced by repetition of poor movement habits and postures that over time, limit function in mobility, stability and strength in the muscles that support and protect the health and function of the human spine.
That being said, what happens after your patient leaves the office is one of the greatest challenges to the success of your treatment outcomes. In my experience, along with the treatment we provide in the office, we must build our patients a 24/7 bubble of health, function and good choices for them to heal and flourish within, which also means the patient must be committed to taking an active role in improving and controlling their health, environment and decision-making process.
What You Can Do
What They Can Do
Maintaining optimal posture and balancing one's health is a journey, not a destination. Stress progress, not perfection! No matter the treatment method or modality you provide during an office visit, if you don't address functional balance by improving posture and quality of movement, and provide better choices for the environment the patient is living in outside your office, you'd better put on your running shoes. Why? Because then we become just one more symptom chaser in today's health care system and end up constantly repairing the effects of the posture and movement challenges patients face in the other 23 hours left in their day.
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
