Posture and Shame

I’ve always had an issue with posture (not mine).

When I begin an evaluation, I always start with a standing assessment. That is usually the time they “admit” to me that they have bad posture and they know they need to work in it.
There is very often a sense of shame attached to their admission. I
often will ask them what it is that they need to do to fix their poor
posture. Invariably they say something like “I need to strengthen” (you
know what is coming from me here) or that they need to be more mindful
of their posture. Many will report previous visits with physical
therapists where the PT used lack of strength as a reason for poor
posture.

Now before you quote me studies that show improvements in posture with exercise, save your fingers. I am sure someone has done a study that showed positive results, but what does
improving strength really do for posture?

Forward shoulders are a typical type of postural deficit in many people. The exercise model will see this as weakness in the musculature in the upper back and shoulders. Strengthen
the back and back of shoulders and the shoulders will be held in a more
normal positions. Does this sound familiar? And, does this make sense?

Unless we are talking about smooth involuntary musculature, and we are not, muscles only respond when they are actively contracting. When you relax or take your mind away from the
action, relaxation occurs and the shoulders will pop forward once
again. But if you would simply move around the front of your patient and
evaluate the tightness in the front of the shoulders and chest, you
will see what can create real change in posture.

Using the “lack of strength model” to address poor posture is setting your patient up for failure. Think length, not strength.

Walt Fritz, PT

www.MyofascialResource.com