So, having addressed the initial question of what effect traditional postural advice has on your patients and clients, I will now have a look at what I would do if conscious postural advice isn’t such a good idea.
The first thing I would say is that it is important to give any advice at the appropriate time and in reasonable amounts. It’s unlikely you would ever use a dozen manual therapy techniques in one session, so don’t give that many pieces of advice…it can be overwhelming for a patient.
Firstly, the timing is key. It’s a judgement call when you should start addressing these postural issues, but I rarely go for it on the first treatment, unless absolutely necassary. I prefer to start working on the root cause of their postural dysfunction with functional manual therapy and exercise. This is often all the patient can cope with to start with and I would much rather they focus on one or two things to keep the quality high, rather than 3-4 exercises and 4-5 postural advice cues! There is always time for the advice later on 🙂
So having chosen your timing, it’s now about the amount? Having spoken to people that have been on the end of a barrage of well intentioned postural advice, it tends to demotivate them, confuse them and focus them on their pain…everything you don’t want. So I would say treat the advice like a ‘dose’ and keep it within the tolerable limits of the patient…and as always individuals will vary in their tolerance, so keep this in mind.
Then the question is ‘what do you actually say?’. Personally I don’t tell them to ‘sit up straight’, ‘keep their shouldes back’, etc. I just don’t think it works like that as previously discussed. I prefer to bring their ‘postural dysfunctions to their attention (99 times out of 100, they already know about some of it). We discuss what the dysfucntion means for them and their pain. This usually gets a fairly good reponse because they then make the connection with what we have been doing in their previous sessions and with their home exercise programme. Then, rather then give them cues to change their posture, I make them aware of when their posture is getting them into trouble and to recognise this themselves…and when they recognise this pattern, it’s time to use their solutions.
I always find the simplest things work best, I use 3D sitting thoracic spine matrix, 3D shoulder matrix, standing thoracic matrix and any specific things to work on their individual problems. I usually only give them one solution to start with, it helps keep them focussed and keeps the quality high. All of these strategies and more can be found on the AFT Assess and Solve course.
Some of the big advantages of this approach is that the patient isn’t focussing on their pain, they are just looking at patterns. They aren’t consciously changing their sitting position so artificial muscle recruitment patterns are avoided, the posture is addressed by the exercise solutions that fire up the appropriate muscles with authentic drivers to assist their sitting position.
I have found this approach to extremely effective, it’s easier for me the therapist and I’m sure it makes the patients life easier. The only stumbling block is if they have been given lots of postural advice in the past, sometimes they find it hard to let go of the strategies they were told would work and sometimes they find it hard to stop consciously changing their postures…no surprise, that’s part of the reason it is not a good, sustainable strategy!
If you have any questions or comments please let me know.