I found an interesting article written by Dr. Craig Liebenson, one of foremost Chiropractic authorities on rehabilitation of the spine. This article touched on poor posture as it relates to the Thoracic and Cervical spine and how it can generate from the Thoracic spine due to excessive sitting and slouching.
The first part of the article discusses the biomechanics of the Thoracic spine and sitting. It gets a little wordy but the point can be understood by anyone who sits a lot or has poor posture.
Biomechanical Underpinnings and Kinesiopathology
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| Figure 1: Forward head posture - upper-crossed syndrome. |
“The thoracic spine represents a critical, yet underappreciated spinal region.10 Of all structures, the thoracic spine is one of the most vulnerable in modern lifestyles. In the fetal posture, the entire spine is kyphotic. We are hard-wired to achieve a stable, upright posture by 4 years of age,3 yet due to television, soft couches, chairs, desks, computers, etc., the thoracic spine slips back into greater kyphosis. The result: straightening of the lower cervical lordosis with compensatory C0-C1 hyperextension, as the eyes must peer horizontally. In the lumbar spine, we find poor control of the natural lordosis with resultant disc vulnerability during activities of daily living, such as sitting, bending, twist, lifting, etc.
Having a stiff upper-thoracic spine also decreases our ability to activate the deep neck flexors and even the abdominals. With freely moveable vertebrae in this junctional area, we are able to achieve balance between the extensors and deep neck flexors, which ironically, originate in the mid- to upper-thoracic region.3“
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| Figure 2: Internally rotated arms. |
“We know that with cervical rotation, we should appreciate motion all the way down to T4. Typically, patients with this restriction do not lose much active range of motion. It has been demonstrated that a significant association exists between decreased mobility of the thoracic spine and the presence of patient-reported complaints associated with neck pain.78-9 In a controlled study, this treatment was determined effective by itself.4“ Cleland showed that in select patients, thoracic spine manipulation provided a successful treatment for patients with neck pain. Thoracic spine mobilization or manipulation acted as a component of a multi-modal intervention demonstrated to be effective for the treatment of patients with shoulder impingement syndromes.
After addressing the biomechanics Dr. Liebenson gives some great rationale for Chiropractic treatment and corrective exercises. In our office the combination is vital to ridding the patient of the symptoms and correcting the dysfunction. Here is a brief description of the Assessment Protocols the he recommends.
Assessment Protocols
“The masters of manual therapy are able to marry what they find with their hands through palpation with what they see with their eyes through movement analysis or functional screening. With finely tuned dynamic palpation skills, the physician is able to palpate joint restriction, joint hypermobility and soft-tissue pathology. As Karel Lewit once said, "The human hand is the greatest therapeutic tool that has [been] or ever will be invented." The purpose of functional assessment is to identify a patient's functional or performance deficits and capabilities. Structural problems, such as disc herniations or arthritis are noted but not over-emphasized to the patient.”
