JiscMail Logo
Email discussion lists for the UK Education and Research communities

Help for PHYSIO Archives


PHYSIO Archives

PHYSIO Archives


PHYSIO@JISCMAIL.AC.UK


View:

Message:

[

First

|

Previous

|

Next

|

Last

]

By Topic:

[

First

|

Previous

|

Next

|

Last

]

By Author:

[

First

|

Previous

|

Next

|

Last

]

Font:

Proportional Font

LISTSERV Archives

LISTSERV Archives

PHYSIO Home

PHYSIO Home

PHYSIO  August 2002

PHYSIO August 2002

Options

Subscribe or Unsubscribe

Subscribe or Unsubscribe

Log In

Log In

Get Password

Get Password

Subject:

A question of posture

From:

Barrett Dorko <[log in to unmask]>

Reply-To:

- for physiotherapists in education and practice <[log in to unmask]>

Date:

Mon, 5 Aug 2002 22:32:50 -0400

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (86 lines)

In the latest issue of The Journal of Orthopedic and Sports Physical 
Therapy Shirley Sahrmann PT, PhD, FAPTA  (Professor of physical therapy, 
cell biology and physiology, associate professor of neurology; director of 
program in movement science, Washington University, St Louis MO) 
contributed a provocative guest editorial entitled “Does Postural 
Assessment Contribute to Patient Care?”

Dr. Sahrmann advocates postural assessment as a prerequisite for care and 
makes a case for this despite an absence of evidence. I think this is an 
important issue and have included a number of quotes from the editorial 
along with my own thoughts. I’m hoping it will generate some comments from 
our community.

Sahrmann begins: “Is the examination of posture just a tradition of 
physical therapy practice or is the information gathered from this 
assessment useful for diagnosis and treatment?

Dorko- I think it’s an example of the power of tradition and that this is 
the primary reason for its persistence.

Sahrmann: “What is the evidence that postural impairments contribute to 
pain problems and need to be included in therapists’ examinations? The 
simple answer to that question is that there is very little research to 
support a relationship between musculoskeletal pain and “posture”. Many 
respected texts and articles by physicians, physical therapists, and 
physical educators have cited the importance of good postural alignment to 
health, but clinical studies have not supported these beliefs. Though I am 
fully aware of the lack of evidence, I cannot imagine treating any patient 
without assessing posture or, more precisely, alignment…Studies of posture 
have focused on a narrow definition. Posture or carriage of the body should 
be considered differently than the alignment of one segment in relation to 
an immediately adjacent segment.”

Dorko- I treat patients without doing a postural assessment all the time so 
imagining it is not necessary for me. Without any evidence for a connection 
between postural alignment and health I can’t see any reason to “believe” 
in it. Shifting the focus from an overall or regional impression of posture 
to a description of segmental alignment seems to be Dr. Sahrmann’s response 
to an absence of evidence for the traditional view.

As Dr. Sahrmann continues: “Probably more important than overall posture in 
the sagittal plane is the relative alignment of one or two segments in 
multiple planes. For example the degree of lumbar curvature can vary a 
great deal, but one vertebra cannot change its sagittal position with 
another vertebra by more than a couple of millimeters before contributing 
to pain from spondylolisthesis.”

Dorko- I’m not aware that the system this sensitive. I don’t think it is.

Sahrmann goes on: “Studies have not addressed whether some postures are 
more likely to result in intersegmental changes such as spondylolisthesis 
than other postures…Defining subgroups of extreme postures is a necessary 
step in the consideration of alignment as a contributor to mechanical pain 
problems…Alignment is only one of multiple factors contributing to the 
development of mechanical pain…The individual who is overweight with a 
ponderous abdomen who stands all day may be at greater risk of developing 
back pain than an individual who is slender with the same alignment who 
also stands for prolonged periods. I believe most clinicians who use 
postural alignment as a guide to their diagnosis and treatment have 
consciously or subconsciously defined for themselves the degree of 
deviation, the context, and the modifiers that when combined reach a level 
of perceived clinical significance.” And “Studies suggesting that posture 
was not correlated to muscle strength also raised doubts about the value of 
alignment impairments because of the lack of valid information about muscle 
function.”

Dorko- No doubt. There is no evidence that correcting postural deviation 
leads to pain relief in the research literature or that these deviations 
lead to pain in the first place. Still, Dr Sahrmann concludes, “In my 
judgment, the current preponderance of negative studies about the 
relationship between posture and pain are more reflective of the types of 
questions that have been asked and the analysis that has been used than of 
the lack of a relationship. Assessment of alignment impairments has to be 
an important step in designing an appropriate treatment program for 
correcting mechanical impairment. We need to pursue the studies that will 
enable us to define the relationships among specific alignment impairments, 
altered movement patterns, contributing muscle adaptations, patient 
modifiers and mechanical pain problems.”

Dorko- It seems to me that this effort to come up with research to justify 
traditional practices is uncalled for, not that anybody has asked my opinion.

I’m wondering what the list thinks.

Barrett L. Dorko, P.T.
<http://barrettdorko.com> 

Top of Message | Previous Page | Permalink

JiscMail Tools


RSS Feeds and Sharing


Advanced Options


Archives

December 2017
November 2017
October 2017
September 2017
August 2017
July 2017
June 2017
May 2017
April 2017
March 2017
February 2017
January 2017
December 2016
November 2016
October 2016
September 2016
August 2016
July 2016
June 2016
May 2016
April 2016
March 2016
February 2016
January 2016
December 2015
November 2015
October 2015
September 2015
August 2015
July 2015
June 2015
May 2015
April 2015
March 2015
February 2015
January 2015
December 2014
November 2014
October 2014
September 2014
August 2014
July 2014
June 2014
May 2014
April 2014
March 2014
February 2014
January 2014
December 2013
November 2013
October 2013
September 2013
August 2013
July 2013
June 2013
May 2013
April 2013
March 2013
February 2013
January 2013
December 2012
November 2012
October 2012
September 2012
August 2012
July 2012
June 2012
May 2012
April 2012
March 2012
February 2012
January 2012
December 2011
November 2011
October 2011
September 2011
August 2011
May 2011
April 2011
March 2011
February 2011
January 2011
December 2010
October 2010
September 2010
August 2010
July 2010
May 2010
April 2010
March 2010
February 2010
January 2010
December 2009
November 2009
October 2009
September 2009
July 2009
June 2009
May 2009
April 2009
March 2009
February 2009
December 2008
November 2008
October 2008
September 2008
August 2008
July 2008
June 2008
May 2008
April 2008
March 2008
February 2008
January 2008
December 2007
November 2007
October 2007
September 2007
August 2007
July 2007
June 2007
May 2007
April 2007
March 2007
February 2007
January 2007
December 2006
November 2006
October 2006
September 2006
August 2006
July 2006
June 2006
May 2006
April 2006
March 2006
February 2006
January 2006
December 2005
November 2005
October 2005
September 2005
August 2005
July 2005
June 2005
May 2005
April 2005
March 2005
February 2005
January 2005
December 2004
November 2004
October 2004
September 2004
August 2004
July 2004
June 2004
May 2004
April 2004
March 2004
February 2004
January 2004
December 2003
November 2003
October 2003
September 2003
August 2003
July 2003
June 2003
May 2003
April 2003
March 2003
February 2003
January 2003
December 2002
November 2002
October 2002
September 2002
August 2002
July 2002
June 2002
May 2002
April 2002
March 2002
February 2002
January 2002
December 2001
November 2001
October 2001
September 2001
August 2001
July 2001
June 2001
May 2001
April 2001
March 2001
February 2001
January 2001
December 2000
November 2000
October 2000
September 2000
August 2000
July 2000
June 2000
May 2000
April 2000
March 2000
February 2000
January 2000
December 1999
November 1999
October 1999
September 1999
August 1999
July 1999
June 1999
May 1999
April 1999
March 1999
February 1999
January 1999
December 1998
November 1998
October 1998
September 1998
August 1998
July 1998
June 1998
May 1998
April 1998
March 1998


WWW.JISCMAIL.AC.UK

Secured by F-Secure Anti-Virus CataList Email List Search Powered by the LISTSERV Email List Manager