Posture
Posture
You may find it harder to sit up straight at the table. You may
notice a certain crookedness when glancing in a mirror or store
window. The lower back pain or forward lean seems to have gotten
worse over the past year. Or your back just seems constantly tired.
These symptoms all point to posture problems, which are common
with both aging and SCI. Getting older with SCI? Pay attention
...
The Problems:
Many posture problems are associated with SCI, ranging from chronic
pain and fatigue to scoliosis and kyphosis, as well as skin and
respiratory problems. Just like the problems, the causes are numerous:
- Lack of trunk muscles puts the body in a constant slump
- Muscle imbalance, gravity or spasticity pulls us to one side or
the other
- Inactivity or lack of exercising drastically decreases physical
fitness, leaving us fatigued or in chronic pain
- Habitual functional activities done the same way every day, such
as hooking the same arm on the chair back for support, can cause
contractures and severe muscle imbalances
- Poorly fitted equipment -- wheelchair, cushion or back -- places
the body in a poor position
When left unaddressed, the problems magnify, possibly causing
worse problems. Sitting crooked means uneven weight distribution
and possible skin sores. Slumping or slouching makes the lungs
work harder, compromising respiratory function. Poor posture while
sitting or wheeling puts extra strain on the neck and spine, causing
pain and discomfort. The more slumping or leaning or slouching
in response to pain, the more pain or fatigue that is produced.
Evaluation:
Determining whether you’ve got a problem may be as easy as asking,
and honestly answering, a few questions.
- Do you have chronic pain in the neck, lower back or trunk?
- Is your fatigue more in the trunk and back, rather than in your
arms or shoulders?
- Do you sit crooked? Are you leaning to one side or the other?
Is one hip higher than the other? Is one hip or knee more forward
than the other?
- Are you always leaning a bit forward, or is balance a problem?
- Do you have breathing problems or trouble getting full breaths?
Thinking about these questions is a good first step. Answering yes to any means you may need to go further.
Looking at how you’re sitting is a good second step. Get someone to help. When facing a mirror, is more of the chair
back visible on one side or the other? When viewing a profile,
do your ear lobe, shoulder joint and hip joint form a straight
vertical line above the chair axle?
Remember: living in our bodies day to day makes it difficult to
always recognize small changes which can result in big problems.
You may need to make a conscious effort to observe and evaluate
how you sit.
The third step is seeking the opinion and evaluation of a physical or occupational
therapist or physician trained in spinal cord injury.
Getting Straight:
Changes in the body often require new or different equipment.
“Gravity is not your friend,” says Craig Hospital physical therapist
Cindy Smith. Lack of trunk muscles, or just minor trunk muscle
imbalances can, over the course of years, cause major problems
with posture. Smith compares the spine to building blocks. Stack
them slightly off kilter and they’ll probably be okay. Put some
weight on them and problems develop over time.
Eventually, gravity takes its toll and the price is poor posture,
chronic pain, decreased energy and skin problems. We can address
the problems in a number of ways -- what we sit in, what we sit
on, and possibly even the types of weight shifts we do.
Starting at the bottom and working up, many solutions exist to
address posture problems. New or modified cushions can ensure
proper weight distribution and begin to solve hip uneveness. Solid
chair backs can provide the support necessary to compensate for
weakness in the trunk. Lateral supports, or "wings," will serve
to support the trunk and keep it straight.
Chest belts can ensure stability and help with balance. Corsets
can counter act muscle imbalances, straighten out the trunk, reduce
fatigue, and assist with balance. One, several, or all of these
solutions can be used to deal with poor posture.
The Payoffs:
There are rewards for making these changes: reduced fatigue and
thus more energy, decreased pain, fewer skin problems, reduction
of spinal curvature or slanting hips and, in general, an overall
better and more “normal” appearance.
Wearing a corset may provide the trunk stability necessary to
make sports or other activities fun rather than work. Lateral
supports and a chest belt may reduce pain and fatigue enough to
make sitting at a desk for hours feasible and thus make employment
possible. Proper posture leads to even weight distribution, fewer
potential skin problems, and safer driving. Proper posture affects
our body physics and places us in a more efficient wheeling position.
And not all the effects are physical. Posture is often a reflection
of how we feel about ourselves. Sitting up straight speaks forcefully
to others about our confidence, competence and self-image in general.
Height, whether sitting or standing, is related to self-esteem.
Everyone ages, and as they do their bodies change. Responding
to these changes with appropriate equipment can allow us to avoid
future problems and enjoy ourselves as we age.
This is one of more than 20 educational brochures developed by
Craig Hospital while it was a federally-funded Rehabilitation
Research & Training Center on Aging with Spinal Cord Injury. The
opinions expressed here are not necessarily those of the funding
agency, the National Institute on Disability and Rehabilitation
Research of the US Department of Education.
For a hard copy of a METS brochure, click on your selection above
and hit the "print" button on your browser. If you'd like to ask for one directly from Craig Hospital, you can contact us by telephone at 303-789-8202, or you can e-mail us at HealthResources@craighospital.org.
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