For stroke survivors, regaining functional mobility and independence often hinges on retraining balance, gait, and posture. Hemiplegia from stroke commonly manifests in pronounced postural asymmetries, shortened limbs, and torso lateralization towards the non-paretic side.

This shifts the body’s center of mass, increasing fall risks, curtailing mobility, and hampering activities of daily living. For experts in stroke rehabilitation, effectively addressing these postural deviations and gait abnormalities is essential for patients’ recovery. Integrating posture assessments into initial and ongoing evaluations illuminates specific postural limitations to target with therapies.

The Value of Serial Posture Analyses

Studies show that up to 83% of acute stroke patients present with postural instability, greatly increasing fall risks in the 6 months post-stroke. At chronic stages, quality of life is closely tied to lingering postural imbalances. Postural rehabilitation is thus critical for regaining independence in activities of daily living after a stroke.

During evaluations, a posture grid analysis captures anterior, posterior, and lateral views of patients in a natural standing position. Comparing photos over the course of rehabilitation illuminates postural asymmetries and weight distribution issues resulting from hemiparesis.

Consistent posture analyses quantify gait improvements and reveal needs for continued or adaptive therapies.

Monitoring Home Exercise Progress

Posture focused exercise programs like StrongPosture provide guided sessions to stretch, strengthen, and mobilize the body through full ranges targeting postural symmetry. Serial posture analyses during these programs quantifies progress and reveals specific muscle groups needing more focused work.

Patients appreciate the visible improvements, which motivates continuing exercises independently between therapy visits. Follow-up posture checks confirm proper technique and alignment being practiced at home. This continuity between supervised rehab and self-guided practice leads to better stroke rehab outcomes.

Optimizing Rehabilitation at Each Stage

For acute ischemic strokes, monitoring early postural changes helps determine the pace and intensity of mobilization to prevent deconditioning versus falls. It also informs prognosis for recovery. In hemorrhagic strokes, posture asymmetry and head positioning guides rehab pacing and medication use.

With TIAs, recurrent events frequently reflect vascular instability. But postural declines may indicate emerging neurological damage requiring imaging and medications. For chronic stroke complications like shoulder subluxation, posture analysis identifies needs for bracing, Botox, or surgery.

Patients appreciate visible posture progress, which boosts engagement in therapeutic exercises and mobility work. For families, objective data builds appropriate expectations for realistic recoveries. Documented posture photos also facilitate insurance approvals for ongoing therapies.

While adding minimal time to evaluations, posture analysis provides vascular neurologists and stroke rehab specialists with objective measures for quantifying progress, guiding interventions, and educating patients. Given the data showing lasting postural instability even years post-stroke, making posture assessments a clinical cornerstone ensures the best outcomes.

Efficiency of physical therapy on postural imbalance after stroke: study protocol for a systematic review and meta-analysis. BMJ Open. 2017, A Hugues, J Di Marco, P Janiaud, Y Xue, J Pires, H Khademi, M Cucherat, I Bonan, F Gueyffier, and G Rode

Postural instability years after stroke. J Stroke Cerebrovasc Dis 2020 Sep;29(9):105038. Epub 2020 Jun 23, Zsófia Halmi, Trevor W Stone, Elek Dinya, Judit Málly

For more about StrongPosture® and to incorporate it in your practice get the Posture Rehab Exercise Program and take the latest training via online continuing education course.

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At a minimum, aim to perform a quick posture check at the initial and final visits with each patient. Additionally, a postural photogrammetric assessment each quarter allows you to track progress over time. There are several key reasons this practice is worth the small time investment:

• Gain insight into underlying muscle imbalances, restrictions, and weaknesses impacting posture
• Educate patients on postural habits that may be contributing to their health complaints
• Monitor improvements or declines in posture over the course of care
• Demonstrate tangible changes that motivate patients to continue treatment
• Identify needs for corrective exercises or additional therapies
• Quantify progress and outcomes to showcase the value you provide

Posture assessments can be done using an inexpensive tool like a wall-mounted posture grid. Have patients stand in front of the grid in their natural posture, then capture photos from the front, side, and back. Look for symmetry, alignment, and weight distribution issues. Compare photos over time to illustrate progress.

Be sure to explain the purpose of posture checks to patients. Show them the photos and point out areas in need of improvement. Provide positive feedback on progress made between visits. Patients appreciate visual evidence and your expert guidance.

Incorporating more holistic posture assessments takes little time but offers immense rewards. Not only will you gather valuable clinical information, you’ll also demonstrate expanded value to patients and empower them in their health journey. With simple consistency, it’s a best practice that breeds results and referrals.

Resources:

• Posture assessment using grids are an easy addition to any practice. Capture standing posture using any digital camera or mobile device (phone, tablet, ipad).
• Wall mount, as well as door mount and free-standing posture charts are available from BodyZone and PostureZone. These companies work with doctors, therapists, trainers and hospitals worldwide providing posture related supplies.

In a word, WOW!

WHO experts from multiple professions did an exhaustive, 244-page guideline on 37 chronic low back pain therapies, and their conclusions are a strong validation of the work we’ve taught for the past 20 years! 

I’m really excited because our StrongPosture® method integrates 3 of the five classes of therapies recommended for routine chronic low back pain care by WHO.

The WHO Recommendations on 5 Classes of cLBP Interventions

Class A:  Education         

Structured and standardized education and/or advice

         StrongPosture® interactive demos and our 5 Posture Principles were designed to standardize self-care communications in my NMS practice.   Instead of focusing people cognitively about pain science, we connect people to somatically feel and understand their body’s biomechanics.

Class B:  Physical interventions

  i. Structured exercise therapies or programs

         StrongPosture® BAM (Balance-Alignment-Motion) exercises direct biomechanic understanding to successful actions people can feel.

ii Spinal manipulation

iii Massage

iv Needling

iv Mobility assistive products.

     StrongPosture® protocols were initially designed to optimize the benefits of spinal manipulation and massage.

Class C: Psychological interventions

i. Operant therapy

ii. Cognitive behavioral therapy

         StrongPosture® protocols focus mental attention on subtleties of body motion with MUST vs TRY cueing.  So, while not mentioned by name, focusing attention on more accurate control has been described as SOMATIC behavioral therapy. Clearly defined and structured external feedback that’s individualized to each person’s functional ability to understand and execute is why clinicians globally use our integration of education, exercise and protocoled engagement.

While valuable in some cases, I agree with WHO that Class D & E should be last on the list for routine care.

Class D: Medicines  

                    Recommended for routine care: NSAIDs & topicals. 

                    Not recommended: Opioids to muscle relaxers, oral and injectables, and some herbals

Class E: Multicomponent Biopsychosocial Care

Generally delivered by multiple professionals in a hospital or group interdisciplinary practice.

         We integrate the essentials targeted by WHO – Educational concepts blended into individualized exercise, standardized, and structured into a step-by-step framework.  The StrongPosture® work I’ve taught around the world and on CEsoup.com online, for home care with 7 Steps to StrongPosture® on StrongPosture.com, the CPEP® certification program, as well as the public health program and May’s campaign from PostureMonth.org.

Integrate StrongPosture® as an Intervention in Your Practice

i Begin with Posture and Balance Assessment, Rehabilitation, and Motor Control Exercise presented on CEsoup.com. A comprehensive 15-hour CE approved online program.

ii Read: Stand Taller Live Longer: Posture & Anti-Aging Strategy, including the 5 Posture Principles

RESOURCES

For more on the WHO report on Chronic Low Back Pain see: Summary: WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings

World Health Organization Chronic Low Back Pain overview, see the Executive Summary.

If you want to dive deep, see: https://www.who.int/publications/i/item/9789240081789

To see WHAT 37 interventions were looked at, read:  https://iris.who.int/bitstream/handle/10665/374422/9789240085718-eng.pdf

For HOW it was looked at, see: https://iris.who.int/bitstream/handle/10665/374420/9789240085701-eng.pdf\

Which is why there’s a growing relevance for Neuromusculoskeletal (NMS) professionals. Despite billions spent annually marketing drugs and non-nutritional food, and the institutionalization of society (blame corporations or government…your choice), NMS pros have unrealized potential for greater relevance as healers in our tech society: The powers of touch in body, and mind.

Leveraging Symbols, Stories & Actions

Recent studies show a consumer’s decision to buy is driven by symbolic motives in addition to practical considerations. Researcher and Wharton Marketing professor Stefano Puntoni define symbolic consumption as when individuals gladly pay a premium for how others will perceive the brand they choose. Designer clothing by Gucci, shoes by Air Jordan or a Porsche that can go 180 miles are all examples of the desire to express one’s identity, values, interests, status, or style.

However, studies show consumers frequently exhibit a strong preference for services that involve a living person, rather than those performed by robots or AI. For instance, people overwhelming choose to be tattooed by human (however, there’s no such preference for having a tattoo removed). Similarly, while a massage chair provides comfort, people overwhelming prefer experiencing the touch of skilled hands.

NMS pros can leverage the power of human touch to establish profound connections with individuals by actionably connecting them with subtleties of their unique body, especially in the realms of functionally strengthening posture and motion.

The experience of performing a seemingly simple exercise can become a fusion of language and touch, motion and even emotion. Especially when performed with conscious somatic awareness (aka interoceptive awareness, or internal awareness of your body), focused motor control exercises (MCE, such as Tai Chi, Yoga and StrongPosture®) can communicate symbolic ideas related to a person’s uniqueness as an individual. Plus, when progressively sequenced to their functional ability, MCEs strengthen the sense of personal agency.

Role of NMS Pros: Relief & Reassurance to Empowerment

For people in pain, temporary relief is a good respite. Reassurance from a professional can offer short-term comfort to mind and body. However, true healers understand it’s ultimately futile to rely on quick relief. NMS professionals bear the obligation to not only to provide temporary relief and reassurance, but also to engage patients in strategies for self-care, prevention, and long-term resilience.

Shifting rehab practices towards fostering subtle awareness and more accurate-to-reality somatic control cultivates a heightened sense of interoceptive motion control. Connecting language with awareness of subtle motions also heightens interoceptive body awareness. This kind of approach is increasingly seen to transcend temporary pain relief.

Somatic Care for Humans in a Tech Society

Going forward, NMS professionals can and should empower patients to be more mindful of their everyday actions and movements. Strategies that progressively and noticeably help patients improve control and symmetry in how they stand, sit and move can shift biomechanics and even mindsets in meaningful and sustainable ways.

Aspirations can become rungs of ladder to recognize a person’s unique experiences and challenges. Effective communication plays a pivotal role in connecting with patients, empowering them to take action and explore what their body can actually do, and do well.

By bridging the gap between words and actionable deeds, NMS pros can better tailor their approaches to suit each individual’s unique capacities, needs and aspirations. Systematically expanding awareness and control of subtle motions creates a positive spiral of success and personal agency, fueling compliance and motivation for behavioral changes.

As AI and robots continue their rapid integration into life, economists predict an increased recognition of “the special value of human labor”. In a world where artificial intelligence and automation pose challenges for everyone, the human touch will remain highly valued by patients and consumers, especially in contexts that embrace symbolism of our own uniqueness.

The Pivot Point

Researchers anticipate that as machines become more accepted by consumers, the unique actions of another human will contribute significantly to their own feelings of uniqueness. It is not solely the tangible output that people appreciate, but also the emotional connection and personalization when they are the focus of another person’s efforts.

NMS Role for Humans in a Tech Society  

Neuromusculoskeletal professionals have an exceptional opportunity to emphasize their role as healers. By aligning conceptual symbols with proprioceptive perceptions, we can tell the story of standing taller and stronger to move better, for longer. To fill this role, NMS pros must strive to be true healers, people who connect with each individual with actionable plans for short and long-term behaviors tailored to that individual’s unique physicality, environments and lifehabits.

Through the power of touch, we can leverage symbols, stories, and actions to establish profound connections and empower individuals to optimize health. By beginning with how they stand and move, and delivering the experience of improved awareness and control of subtle body functions we can empower each individual to stand taller and move stronger…in every move they make.

Are You Ready to integrate these concepts with patients?

• Subscribe to 7SSP – the at-home patient exercise rehab program. Practitioners have unlimited access for their clientele. (Find out more)

References:

As AI Expands, Consumers Will Still Prefer Some Products Made With a Human Touch Wall Street Journal 6/19/23 

Consumers and Artificial Intelligence: An Experiential Perspective
Journal of Marketing, Puntoni et al 2021, Vol. 85(1) 131-151 a American Marketing Association

Identity-based consumer behavior; Reed et al, International Journal of Research in MarketingVolume 29, Issue 4, December 2012, Pages 310-321
Stand Taller-Live Longer: A Posture & Anti-Aging Strategy, S Weiniger, BodyZone Press, 2008 

The Body-Mind of Interoception, Pain and Posture

Pain is when your body tells your mind “We have a problem!” Pain is a valuable physiologic response of the body to stress or damage… but it’s important to understand that the experience of pain is always, all in your mind.

Stubbing your big toe hurts. Bad enough to make you yell! The physiologic reality of what caused the pain signal could just be  sudden pressure on soft tissue and cognitive surprise, or soft tissue tearing and more significant damage. Whether the pain fades in few minutes, or continues for a few weeks, the biology of the initial pain is pretty much the same-Incoming nerve signals (the afferents) going to the spinal cord, and then the brain.

Brain activity is how the mind knows there’s a problem, and we say “It hurts!”

To put it simply the perception of pain is a chemical and physiologic process of the brain and body, as interpreted by the mind. It could be a runner’s torn ligament (the distress of damage) or a weightlifter’s last repetition (the eustress of micro-tears required for muscle to strengthen). The information coming into the central nervous system could indicate joint over-stress, ligament tears, or even a bone fracture. But the pain exists only in the mind.

We experience pain is as a result of how the brains integrates and interprets many signals from the body. Signals from the skin and outside world (aka exteroception), as well as conscious and subconscious inputs such as thoughts, fears and memories.

In addition, there’s also many layers of internal signals-our interoception. When someone feels hunger, thirst, sexual desire or proprioceptive awareness, that feeling is our body talking to us via our interoceptive nervous system. Interoception is part of the governing mechanisms of our biology, our homeostasis (as well as our allostasis, which is how homeostasis shifts over time…but that’s a conversation for another day).

Brains take in far more information than we’re aware of, or ever use.

Human awareness is based on sensory input from outside the body (i.e. vision or hearing), as well as from inside the body (i.e. hunger and thirst). The first is exteroceptive, the second, Interoceptive. The brain integrates both into what the mind perceives. “Exteroceptive and interoceptive information can powerfully influence cognitive and emotional processes, and, importantly, vice versa” ^⁠1

Interoception also governs the biology of how humans experience emotions, as well as physical and mental pain.

Brains take in far more information than we’re aware of, and most of our interoceptive senses are unconscious. However, humans are unique in that we can choose to focus and become more aware of aspects of our interoception, subtleties of how we function.

In a 2023 systematic review of studies, What is the role of interoception in the symptom experience of people with a chronic condition?^⁠2, Locatelli et al looked at chronic pain in physical neuromuscular (NMS) conditions like back pain, as well as chronic emotional conditions including anxiety, stress, depression and other psychologic conditions.

In multiple studies across domains exploring both mind and body, people were asked to focus on interoceptive sensations, input from inside the body like breathing and heartbeat. Subjects who were less accurate in their awareness of their body’s interoception couldn’t react accurately to their body’s inner signals. Locatelli’s conclusions: “Interoceptive abilities are lower in patients with chronic conditions” and that “higher interoceptive sensibility is associated with lower symptom severity and frequency”.

In other words, people who are more connected to their body’s inner feelings have less pain, less often.

Integrating Thought, Motion and Balance with Posture

Proprioception, balance and posture are all interoceptive, which is why a focus on strengthening posture awareness and control is a powerful tool for NMS pros to improve interoceptive awareness.

According to Locatelli, “The brain uses interoceptive signals to control bodily processes and eventually maintain a physiological homeostasis. When the organism fails to efficiently process and respond to bottle signals including symptoms diseases make progress. Indeed, accumulating research on…actively detecting and responding to internal battery signals is important for physical and mental well-being” ^⁠3

The chiropractors, therapists and trainers who actually touch people where they hurt, at the site of perceived pain, are uniquely positioned to experientially teach interoceptive awareness and strengthen the accuracy of how people listen to their body. For people in with biomechanic issues, congruently communicating basic concepts of how they move with interoceptive awareness and subtle, focused motion rehab empowers patients and clients towards greater interoceptive awareness and somatic control.

Especially for those suffering chronic pain, as well as to mitigate the risk of chronic pain developing in acute cases, people remember the experience connecting with subtleties of their body. From the first visit on, NMS pros can easily integrate rehab to more accurate connect someone with their body’s perceptions of their pain, the functional limits of when it hurts, and how to explore their movement and ability to move well-with less or no even no pain!

For non-pathologic biomechanic issues, by perceiving the limits of their pain more accurately, inside and out, people learn to fear the pain less and discover what they can do, and how well they can do it.

The sense of control by systematically focusing on the subtleties of their movements StrongPosture® training encourages people to move better, heal stronger, and build a deeper relationships with their NMS pro.

Looking for ways to integrate these concepts with patients?

• Get the free Upper body Posture Awareness Questionnaire (uPAQ). This is a tool for NMS pros to build interoceptive posture awareness (Click here to download)
• Subscribe to 7SSP – the at-home patient exercise rehab program. Practitioners have unlimited access for their clientele. (Find out more)

¹ [1] Manos Tsakiris and Helena De Preester (Oxford: Oxford University Press), 368 pages, ISBN: 9780198811930. (2018). The Interoceptive Mind: From Homeostasis to Awareness

² Locatelli, G., Matus, A., James, R., Salmoirago-Blotcher, E., Ausili, D., Vellone, E. et al. (2023). What is the role of interoception in the symptom experience of people with a chronic condition? A systematic review. Neuroscience & Biobehavioral Reviews, 105142.

³ Locatelli, from Farb, Interoception, contemplative practice

Teaching people to listen to their body should be an integral part of all neuromusculoskeletal (NMS) care. In other words, NMS pros should educate people to strengthen their interoceptive senses.

In 2021 the National Institutes of Health (NIH) released a consensus paper defining interoception as “the representation of the internal states of an organism, and includes the processes by which it senses, interprets, integrates, and regulates signals from within itself”^⁠1.  To put that another way, interoception is the neurologic perception of an organism’s internal function. It’s the meeting place of our autonomic, somatic and visceral nervous systems.

Interoceptive awareness is being able to sense what’s biologically happening inside your body. From having an intuitive gut feeling to how we get teary eyed at a movie, research shows interoception is a major factor contributing to the uniqueness of human thought and cognition.

A recent meta-study on chronic pain^⁠2 found that weak interoceptive accuracy reflects an impairment in accurately detecting, and accurately reacting to, the body’s inner signals. For NMS as well as psychologic conditions, higher interoceptive sensibility was associated with less severe symptoms, less frequently.

Specifically, people who are more connected to their body’s inner feelings have less pain, less often.

Helping Patients Improve Interoceptive Awareness

As NMS professionals, we are in a unique position to help our patients improve their interoceptive awareness. After all, we are the professionals who actually touch people where they feel the pain. By helping people connect with their body’s perceptions of pain, we can set the stage for authoritative credibility.

One way to improve interoceptive awareness is by focusing on posture. Humans are obligate bipeds, the only mammals designed to balance on two feet as their primary mode of locomotion.

However, we’re rarely aware of the patterns of muscles we use to accomplish that feat. Is my body twisting, leaning or otherwise distorting? Am I listing to the left and straining my knee with every step? Over time, subtle errors of awareness and biomechanic control contribute to asymmetric joint stress, uneven muscle strain, and often pain.

Your body thinks in whole motions, not individual muscles.

People don’t think about their head tilt, or it alignment, much less consider orientation in space of their torso. Awareness of subtle shifts are unconscious…until attention is focused.

When someone is asked to physically mark their perception of subtleties of their body, attention is turned inward, focusing on interoceptive sensory input.

The Upper Body Posture Awareness Questionnaire

The Upper body Posture Awareness Questionnaire (uPAQ) is a tool for NMS pros to build interoceptive posture awareness (Click here to download). Created by posture expert Dr. Steven Weiniger for Posture Month 2023, the uPAQ is designed to educate people about their interoception, and create a remembered experience by focusing their attention on subtleties of their physical posture.

A PosturePractice is about building an in-office experience on each visit.  Which is why on it’s own or with a posture picture, at the beginning of care or periodically for wellness care, the uPAQ a foundation for NMS visits that people remember.

Click here to download the uPAQ and find out more about strengthening somatic interoception with posture.

¹ Chen, W. G., Schloesser, D., Arensdorf, A. M., Simmons, J. M., Cui, C., Valentino, R. et al. (2021). The Emerging Science of Interoception: Sensing, Integrating, Interpreting, and Regulating Signals within the Self. Trends Neurosci, 44(1), 3-16.

² Locatelli et. al. (2023). What is the role of interoception in the symptom experience of people with a chronic condition? A systematic review. Neuroscience & Biobehavioral Reviews, 105142.

The potential value of low tech neuromusculoskeletal (NMS) care is similarly undervalued… for similar reasons, both biologic and behavioral. In Interoception: A Multi-Sensory Foundation of Participation in Daily Life, Schmidt and Shoen describe interception as a “multidimensional, complex system representing the integration of multiple senses” with moment by moment homeostatic roles that “manage physiological stressors reflective of allostatic processes”^⁠2. 

A Physical Complement to Cognitive Behavioral Therapy

Pain and biomechanic compromises are potent physiologic stressors. Especially when they endure, their cumulative effects create negative cycles of function and structure, cognition and behavior, that together spiral downward.

Supported by rapidly accumulating evidence based guidelines for pain, Cognitive Behavior Therapy attempts to reverse this spiral by focusing on the mental side of the equation, our human cognition. I believe this is a good thing, but in large part CBT neglects the effect of cognition and attention on the subtle physical functions facilitating this downward spiral. Which is why especially in our modern stressed tech-flexed life, qualitatively strengthening a person’s internal posture and body awareness and their externally expressed postural control is a valuable missing link for NMS care. 

Addressing the body-mind pain spiral is why we began working with doctors and therapists to develop a tool to benchmark and track interoceptive posture awareness. This was a step towards a more granular posture consciousness. Last month, we introduced uPAQ, the Upper body Posture Awareness Questionnaire as a free download for neuromusculoskeletal pros striving to improve pain-free, functional movement.

uPAQ is an easy to integrate, three-question form designed to build interoceptive somatic awareness. It was created for clinicians and health practitioners to help those they care for build greater interoceptive awareness. Laypeople are also finding the uPAQ an engaging way to improve posture.

The Problem with Quick Fixes for Bad Posture

The long-standing challenge with posture assessment has been the complexity of bipedal posture. Plus, when clinical issues develop that are posture related, or even attributed to posture, the problem usually is established from how the individual moves in everything they do.

Clinically relevant posture observations are exceedingly difficult to discern because posture is as unique as a fingerprint. Countless possible patterns exist for humans to balance the mass of their body by moving different combinations of individual joints, each with a wide range of possible arcs of motion.

The nearly infinite combination of subtle interactions between each person’s mind and body complicates the wide range of their unique genetic body. Plus, common structural variances can be insignificant, but ethically challenged practices can exaggerate the issue with fear based communications.

Clinicians and healers of many professions find that the uPAQ (Upper body Posture Awareness Questionnaire) addresses this challenge by simply having individuals focus on their subjective feeling of a somatic subtlety and document that feeling. It’s about empowering people by encouraging them to listen to their bodies.

When coupled with a simple posture picture, the uPAQ sets a proprioceptive and interoceptive baseline. It’s snapshot of how someone internally feels, linked to how they externally appear. We call this linkage of perception to reality P2R, and it’s a foundation for clinical frameworks seeking to create, enhance and document an individual’s internal awareness and control of their body’s unique external physicality. In other words, how they stand, sit and move in everything they do.

All Motion begins with Posture, All Motion Ends with Posture^⁠

The uPAQ makes posture real and personal. Using the PostureZone® framework to standardize observation and communication, interoceptive perception improves when someone focuses on, and then personally documents the subjective feeling of a subtlety. For example, focusing attention on relative head tilt in a perceived neutral position reliably improves the perceived value of the benefits of efforts to address that observation. 

It’s the application of MindBody to BodyMind, and it’s arguably why compliance for other advice for beneficial lifestyle behaviors improves as well. Which is why for sustainably changes to behavior, we urge clinical communications that blend in office therapies with at home short duration exercise and self care.

Battle the Pain Cycle: Get Posture Conscious

NMS health pros as well as other healers have discovered StrongPosture® exercise is uniquely designed to elegantly integrate neuromuscular attentional focus and motor control exercise towards greater interoceptive posture awareness. Even though the functional consequences of structural subtleties are be hard or impossible to tease out, by providing a foundation of awareness, communication and action we can help people strengthen posture awareness to be more accurate-to-reality, and train subtleties of motor control towards that objective reality as well.^⁠3 

We’re extending the free uPAQ download, so print it out and see for yourself how people react when they’re focused on their body’s posture. Whatever your choice of in-office therapeutic intervention, systematically correlating simple but subtle observations with interoceptive awareness of subtle somatic patterns can strengthen that awareness towards accuracy, within their unique sets of pain-free functional ranges of motor control.

¹ Sherrington, C. S. (1906). The Integrative Action of the Nervous System. Yale University Press.

² Schmitt, C. M., & Schoen, S. (2022). Interoception: A Multi-Sensory Foundation of Participation in Daily Life. Frontiers in Neuroscience, 16.

³ Weiniger, S; Stand Taller Live Longer: A Posture and Anti-Aging Strategy, 2008

Looking for ways to integrate these concepts with patients?

• Get the free Upper body Posture Awareness Questionnaire (uPAQ). This is a tool for NMS pros to build interoceptive posture awareness (Click here to download)
• Subscribe to 7SSP – the at-home patient exercise rehab program. Practitioners have unlimited access for their clientele. (Find out more)

It’s a question often asked by doctors and therapists who incorporate StrongPosture® as a foundational base for more traditional rehab. If you teach a hands-on BAM* framework integrated with other rehab, or you’re using the 7 Steps to StrongPosture® HEP (Home Exercise Program including motor control exercise) along with, or supported by in-office care, my answer is the same.

It depends…

As a doctor of chiropractic my preference is to start with pain relief focused passive care. The feedback I receive from other DCs tends towards spinal and extremity manipulation first, along with targeted muscle therapy as indicated. The rationale is that unlocking segmental motion allows a person to retrain and recruit different motion patterns when learning the new stabilization patterns of strengthening posture.

Diagnostic and Therapeutic

When fascial adhesions and/or other mechanical restrictions are lessened or removed, accessing subtleties of motion with StrongPosture® protocols becomes more possible. The value of MUST vs TRY cueing is that when precisely taught, it is both diagnostic to observe previously neglected motions, as well as actively therapeutic by recruiting neglected muscle fibers and the controlling neurologic pathways.

Especially when there’s a spinal issue, properly applied segmental manipulation can stimulate facet capsule and fascial proprioception, and recruit neglected muscle fibers controlling reflexive balance. Shifting the proprioception towards greater accuracy can propagate up and down the kinetic chain, which in turn and again, makes it easier to find previously forgotten subtleties of movement and posture.

An Opportunity to Individualize Your Care

For my colleagues in other professions using StrongPosture® BAM protocols, I find it’s more of a 50-50 proposition. Some physical therapists, massage therapists and trainers subscribe to the passive therapy first school of thought. Others use the BAM MUST vs TRY cueing to observe, assess and target areas to cue in other motor control exercises, or as a target for other passive therapies.

Bottom line. I’ve tried it both ways in many combinations. It comes down to the individual. At the end of the day it’s about helping the person by building personal agency through stronger posture consciousness.

PosturePractice Tip:

Create more engaging experiences by trying it both ways.

• Here’s what Visit #1 looks like:
  “Today, first we’re going to do (fill in your passive therapy of choice), then we’ll do your StrongPosture® work). Next time we’ll try it the other way. Pay attention so we can see what works best for your body”.
• Here’s what Visit #2 looks like:
  Reverse the order.
• Here’s what Visit #3 looks like:
  Assess progress yourself, and then ask the patient which seemed to work best for their unique body.

Try it over the next month and let me know what you find works best.

Exploring Posture Assessment through Photographs: The Power of the Posture Grid

In our pursuit of promoting optimal musculoskeletal health, the use of posture assessment pictures is a transformative practice. By incorporating a posture grid, a visual guide that delineates specific anatomical landmarks, we gain a nuanced understanding of our patients’ postural dynamics. This visual aid serves as a structured framework, allowing us to meticulously analyze any asymmetries, deviations, or imbalances present. What sets this approach apart is its ability to transcend traditional assessments, offering a dynamic snapshot of a person’s posture in various positions and activities. By capturing these images, we not only establish a baseline for evaluation but also empower people with a tangible representation of their postural habits. This visual feedback becomes a cornerstone for effective communication, fostering a collaborative journey towards improved musculoskeletal well-being.

The Role of Posture Assessment Images in Tailoring Interventions

Armed with a comprehensive understanding of our clients’ postural nuances, we embark on a journey of personalized intervention strategies. The visual cues obtained through posture assessment pictures guide the development of therapies, targeted exercises and other corrective measures. This tailored approach addresses specific areas of concern, facilitating a more efficient and impactful intervention. Moreover, the visual documentation of progress becomes a motivational tool for the people we work with, reinforcing the positive changes in their posture and encouraging continued commitment to corrective interventions.

Analyzing the Posture Findings:

Front and Back View Posture Pictures

When examining front and back view posture images, the vertical and horizontal lines play a crucial role in identifying asymmetry. Beginning from the bottom and moving upward in the PostureZone® method, practitioners can meticulously observe and numerically document various aspects using the grid:

• Assessing the lateral edges of the feet for discrepancies
• Comparing the lateral edges of the pelvis on the left and right sides
• Noting any shoulder height imbalances
• Counting the number of boxes visible between the arm and the body, especially when one upper extremity is held closer than the other
• Identifying any leftward deviation of the head in relation to the line extending from between the feet

Side View Posture Pictures

Shifting the focus to the top of the kinetic chain, clinicians examine the relationship between the head, torso, and feet—the pivotal point where the entire body finds balance. On lateral views, attention is directed to the alignment of the posterior margins of the feet, buttocks, shoulder blades, and head. For anterior/posterior views, the emphasis is on achieving symmetry between the left and right sides. Each PostureZone® on the grid approximates the center of masses that dictate balance in virtually any vertical posture.

Patient Communications

It’s crucial to remember that practitioners observe finer details compared to patients or clients. To facilitate effective communication, therapists and doctors can highlight significant concepts instead of delving into intricate details. Utilizing the measurements on the grid as talking points, practitioners can provide easily understandable explanations.

For instance:

• Align the center line from your feet to the top of your head. Does it align? If not, what does this indicate?
• Observe the height difference between the fingertips of your right and left hands.
• Note the level of your hips—your right hip at 3′ 2″ and your left at 3′ 5″—and its implications for body movement over time.
• Highlight the difference in shoulder heights (4′ 6″ on the right and 4′ 8″ on the left).

While there’s a wealth of detail, simplifying concepts resonates with individuals during their assessments. These straightforward explanations, coupled with visual evidence and measurements, foster understanding, trust, and ultimately compliance. Clients eagerly anticipate follow-up appointments as they seek tangible proof of improvement in their numbers on subsequent posture pictures.

In research settings, the posture assessment grid backdrop not only enhances the visual presentation but also enables the capture and communication of additional numeric details beyond the report and analysis findings.

Resources:

• Posture grids shown are available from BodyZone and PostureZone. These companies work with therapists, doctors, trainers and hospitals worldwide providing posture related supplies.

• 90-minute how-to on taking, analyzing and communicating posture pictures. See “Posture Pictures: >>>

With tech neck and other maladies of modern life, global posture has become a significant and often overlooked cephalometric variable responsible for chronic craniocervical stress.  In this article we discuss the integral relationship between posture and dental practice, and addressing the relevance of global posture as a vital cephalometric variable.

The Impact of Chronic Craniocervical Stress:

Chronic craniocervical stress, resulting from prolonged periods of improper posture, exerts a profound influence on mandibular dynamics, TMJ function, and the prevalence of cephalgias. Repetitive microtrauma stemming from poor posture leads to a cascade of deleterious effects, including altered occlusal forces, muscular imbalances, and condylar displacement. Over time, this chronic stress may culminate in condylar degeneration, exacerbating TMJ disorders and cephalgias.

Condylar Degeneration: A Consequence of Neglected Posture:

Condylar degeneration, a hallmark of craniomandibular dysfunction, arises from sustained malalignment of the craniocervical complex. Harmonious interplay between the temporomandibular joint and the mandible is disrupted by subtle global postural stress, which in turn causes aberrant loading patterns on the condyle. As a result, degenerative changes accumulate within the condylar tissues, compromising joint integrity and function.

Standardized Posture Pictures: A Diagnostic Dental Advantage:

In light of the profound impact of posture on craniocervical and craniomandibular function, dental and orthodontic professionals are increasingly adding standardized posture pictures to their diagnostic repertoire. By including a posture picture during annual exams the dental professional provides an understandable and concrete link between dental health and whole body health. 

A visual record of the patient’s global posture is an underutilized tool to promote early intervention and mitigate the effects of chronic craniocervical stress. By comparing successive images captured against the background of a standardized grid, clinicians can discern subtle changes in posture and more effectively link mouth heath to respiratory health. 

Assessment of Craniocervical and Craniomandibular Function:

Standardized posture pictures serve as invaluable tools for evaluating both craniocervical and craniomandibular function. By superimposing cephalometric analyses onto posture images, the clinician can delineate the intricate relationships between craniofacial structures and global posture. This integrated approach facilitates a holistic understanding of the patient’s craniofacial biomechanics, informing targeted treatment strategies. In addition, the referral of patients with co-existing neuromusculoskeletal conditions (eg, bad and neck pain) to an appropriate chiropractor or physical therapist, the dental professional can improve results and patient satisfaction, as well as cultivate a relationship for future collaboration and referrals.

Bottom line: 

Global posture should play a greater role in dental practice. Chronic craniocervical stress emerges as a significant factor in mandibular dynamics, TMJ disorders, and cephalgias, underscoring the importance of early intervention. The adoption of standardized posture pictures with a grid on an annual basis is advocated to comprehensively assess craniocervical and craniomandibular function. By incorporating posture assessment into their practice, dentists can enhance diagnostic accuracy and provide more effective, patient-centric care.

Resources:

• Posture grids used in dental, orthodontic and surgical practices are available from BodyZone and PostureZone. These companies work with dentists, orthodontists, therapists, researchers, universities and hospitals worldwide providing posture related supplies.

• The Evaluation of Head and Craniocervical Posture among Patients with and without Temporomandibular Joint Disorders- A Comparative Study