Chiropractic and Sagittal Posture
Chiropractors are primary health care providers. This means that patients who seek chiropractic care do not need a referral from another health care provider. Patients may self-refer themselves for chiropractic assessment and treatment. If you’re looking for a chiropractic professional, look at this chiropractor in Medina, OH.
The large majority (93%) of patients who initially present themselves for chiropractic care do so for the complaints of spinal pain (1). A typical chiropractic assessment of these patients would often include:
History of the complaint; this would include information such as causative factors, duration, location, severity, factors that help or aggravate it, etc.
This type of information helps the chiropractic to determine if the condition is the type of problem that chiropractic typically helps.
Orthopedic and neurological tests; these tests are often specific for the complaint and history.
These tests help the chiropractor establish a working diagnosis as the clinical reasons for the complaints. The results can both rule-out or rule-in various pathophysiological processes.
Imaging studies, which is an optional clinical call by the chiropractor.
This would typically involve x-rays or perhaps advanced imaging such as a magnetic resonance imaging (MRI) or even computed tomography (CT).
A chiropractic examination.
Chiropractors primarily assess and treat patients mechanically. A spinal complaint and problem that a medical doctor might prescribe medication for would be managed quite differently by a chiropractor. The chiropractic examination is to determine if a mechanical problem might be the cause of the patient’s complaints. A common rhetorical scenario would be:
If your hand was caught is a closed door resulting in severe pain, how would you prefer to be treated?
Prescribed the best drug available to mask the pain?
OR
Ask a chiropractor to come by and open the door?
The chiropractic mechanical examination typically involves two approaches:
Segmental Spinal Examination
The spinal column is comprised of 24 individual bones (vertebra) plus the skull and the pelvis: 7 neck bones (cervical spine) 12 mid back bones (thoracic spine) 5 low back bones (lumbar spine)
Each vertebra has multiple joints, both above and below (and with the ribs in the thoracic spinal area). Each spinal joint has an optimal ability to move and an optimal position.
The chiropractic segmental spinal examination assesses the integrity of these vertebra and joints.
Postural Spinal Examination
The overall postural alignment of the spinal column and pelvis is an important component of the chiropractic mechanical examination. This typically involves observations of the alignment of ears, jaw, head, shoulders, ribs, and pelvis.
Spinal x-rays are often used and helpful at documenting and measuring both segmental and postural mechanical problems.
Posture is important to health and physiology. Postural distortions are three-dimensional. Clinicians often simplify postural distortions by categorizing them into the coronal plane (side-to-side) and the sagittal plane (front-to-back). Evidence is accumulating that forward postural distortion in the sagittal plane is particularly deleterious, increasing pain, reducing health, and enhancing disability. This evidence is reviewed below in this paper.
There are four primary reasons for forward postural distortion in the sagittal plane:
Forward head: This is often accompanied with increased cervical spine lordosis.
Cervical spine kyphosis (reversal of the normal cervical spine lordotic curve).
Hyperkyphosis of the thoracic spine.
Loss of lumbar lordosis.
Within the chiropractic profession there are a number of accepted and proven techniques to treat the segmental and postural mechanical problems that are found during the chiropractic mechanical examination. These techniques are taught at both the chiropractic university/college level as well as in post-graduate classes.
The best documented chiropractic postural technique is Chiropractic Biophysics (CBP). This CBP group has an impressive number of published works pertaining to ideal posture and methods for postural corrections. Currently the group has an excess of 200 studies in the peer-reviewed scientific literature (2).
Entire medical texts and chapters in medical texts are dedicated to posture and its influences (3, 4). An early description of the importance of good posture on physiology is described by James Oschman, PhD, in his 2000 book titled Energy Medicine, The Scientific Basis (5):
Joel E. Goldthwait and his colleagues at Harvard Medical School “developed a successful therapeutic approach to chronic disorders. The aim of his therapies was to get his patients to sit, stand, and move with their bodies in a more appropriate relationship with the vertical. After years of treating patients with chronic problems, he concluded that many of these problems arise because parts of the body become misaligned with respect to the vertical.”
“Goldthwait’s therapeutic approach corrected many difficult problems without the use of drugs. He viewed the human body from a mechanical engineering perspective, in which alignment of parts is essential to reduce wear and stress. He pleaded with physicians to recognize and correct misalignments to prevent long-term harmful effects.”
“Misalignment of any part will affect the whole system, and that restoration of verticality is a way to address a wide variety of clinical problems.”
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Upright posture is a first-class lever mechanical system (6, 7). An example would be a teeter-totter or seesaw. In the first-class lever mechanical system, the fulcrum is the pivot in the center. The fulcrum is where the mechanical loads are the greatest.
In upright human posture, the fulcrum is the spinal vertebra (vertebral body, intervertebral disc, facet joints). When a person has a forward postural distortion in the sagittal plane, they would literally fall onto their face if the muscles on the opposite side of the fulcrum did not contract, maintaining balance. This counterbalance contraction of the muscles is both fatiguing to the muscle and increases the compressive loads on the fulcrum tissues. The counterbalancing muscles are the posterior spinal muscles; they exist from the back of the skull and neck, all the way down the spinal column to the pelvis.