- The Washington Times - Monday, March 14, 2005

Arlington resident Michael Jackson avoided back surgery by changing his posture and standing up straighter.

The 41-year-old tried acupuncture, yoga and chiropractic for a herniated disk in his lower back. It was the treatment of chiropractor Kevin Maggs that ended three years of pain caused by poor posture, prolonged sitting and improper exercising, he says.

“I’m pretty much in a position where the pain is subsided, and I can deal with it as long as I continue to do my exercises,” Mr. Jackson says. “I know if I don’t do it, my back will start hurting again.”

Poor posture — such as slouching, rounding the shoulders or holding the head too far forward —can result from an acute injury such as whiplash, a sedentary lifestyle, occupational demands, aging, and unbalanced exercising that focuses too heavily on one part of the body, metro-area physical therapists, chiropractors and orthopedic surgeons say.

A person’s genetic makeup, bone growth pattern or having sclerosis or osteoporosis can give the appearance of poor posture but may not cause postural problems, they say.

The professionals give tips for improving posture while defining what makes for good and poor posture.

“You want to be aware of your posture. It’s a conscious habit like anything else,” says Bruce Nordstrom, chiropractor and owner of Downtown Chiropractic in Northwest.

About 85 percent of Americans develop back pain and seek a physician’s assistance during their lifetimes, says Dr. Wiemi Douoguih, coordinator of sports medicine services at the Department of Orthopedic Surgery at Washington Hospital Center in Northwest. He serves as a consultant for the University of Maryland athletic teams and the Baltimore Ravens football team.

“It’s difficult to link poor posture and back pain,” Dr. Douoguih says. “The biggest issue is if it is associated with pain and if it’s different from what your usual posture is.”

Posture comes, in part, from how the spine sits. The spine consists of a series of bones stacked on top of one another — seven cervical bones in the neck, 12 thoracic bones in the upper and midback and five lumbar bones in the low back. They are separated by flexible pads called disks and a pair of facet joints that help control movement.

“Muscles in the front and back balance each other out,” Mr. Nordstrom says.

Poor posture, or a musculoskeletal imbalance, is caused by some muscles being shortened, or overly strengthened, and those in the opposing muscle group elongated, or weakened, says Laverne Tuckson, professor and program coordinator for the Physical Therapist Assistant Program at Montgomery College in Takoma Park. The shortened muscles need to be stretched and the elongated ones strengthened to bring the muscles back into balance and provide stability to the joints, she says.

For example, a computer user with poor postural habits can develop a forward head carriage from looking at the monitor, causing the muscles in the front of the neck to shorten and the shoulders to become rounded. A bodybuilder who focuses too much attention on building up the pectoral muscles while ignoring the back muscles can weaken the back.

“Posture plays a role in every position of your body,” Ms. Tuckson says. “It’s like a car out of alignment that doesn’t drive straight down the road, the same for the body. … When you’re out of alignment, that causes pain, joint deformity and even tingling and weakness.”

Postural problems in the spine are most commonly associated with low back pain, says Dr. Christopher Silveri, spine surgeon for Fair Oaks Orthopedic Associates and chairman of the Department of Orthopedics at Inova Fairfax Hospital, both in Fairfax.

The spine in the low back, or the lumbar spine, curves inward and is balanced by the outward curve of the thoracic spine in the upper back, which together form a backward S-curve.

“That curvature is important,” Dr. Silveri says. “When you sit with poor posture, you flatten that curvature out and your spine sits flexed forward.”

The disks are compressed when the low back is against the back of the chair rather than curving forward, causing the opposite curve in the upper spine to adapt, says Gerome F. McAndrews, chiropractor and national spokesman for the American Chiropractic Association in Arlington.

“The normal backward curve in the upper back is reduced to accommodate the loss of normal forward curve in the lower back,” Mr. McAndrews says. “You’re contributing to disk and joint degeneration because of that improper pressure on those disks.”

Poor posture can cause knee or hip pain, pinched nerves, disk herniations and rotator cuff tears, and it can alter a person’s gait or balance, says Jennifer Gamboa, physical therapist and president of Body Dynamics Inc. in Arlington. She is a member of the American Physical Therapy Association in Alexandria.

Alternatively, good posture is “the dynamic balance of skeletal segments to promote effortless initiation and execution of movement, as well as efficient balance,” Ms. Gamboa says.

Proper posture consists of keeping the shoulders back, the stomach in and the chest out, Dr. Silveri says. Good posture while sitting involves keeping the feet supported on the floor and the hips and knees at 90-degree angles to one another, he says.

Posture can be checked with a plumb line, which is a weighted vertical line, viewed from the side and the anterior and posterior views. The line should extend straight down from the ears to the shoulders, hips, knees and outside of the ankle bones, says Mr. Maggs, chiropractor and co-owner of Arlington Neck & Back Center.

To achieve that line, Mr. Maggs recommends routinely changing positions while sitting or standing.

Aerobic conditioning, building muscle strength and maintaining proper body weight also help achieve good posture, Dr. Silveri says. One form of exercise, Pilates, can help stabilize and strengthen the core muscles in the stomach and back that help support the lumbar spine, he says.

Arlington resident Kristina Stansel combines Pilates and physical therapy to counter poor posture and whiplash injuries she received from a car accident in 2002.

“Pilates is probably one of the best things you can do to strengthen your abdomen and the muscles that impact your posture,” Mrs. Stansel says, adding that physical therapy has helped her gain awareness of her posture.

“Through the manipulations that a physical therapist does, it actually, for me, has realigned my posture after years of sitting in school and slouching and not focusing on how I’m standing,” she says.

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