By Steven Weiniger, DC
POSTURE FASCINATES ME — it’s the connection between structure and function. I love observing how the subtle asymmetries of carriage and gait cascade from functionally compensatory motions to structural adaptations of muscle, ligament, nerve and even bone.
As a doctor of chiropractic, I’ve helped thousands of patients with an adjustment, a passive intervention (from the patient’s perspective) intended to unlock deep restrictions to free and symmetric motion, and to normalize neurologic feedback loops. However, early in practice, my frustration was having patients return with similar symptoms and patterns of asymmetry.
Rehab exercise was the beginning of working to help people help themselves. While it helps, often a lot, especially when our efforts focused on the injured part, the standard rehab protocols used in many DC, as well as PT practices, often seemed to reinforce previously learned patterns of unconscious asymmetric motion.
Motion Control Exercise
My personal yoga practice provided a 3,000-year-old insight: The key to changing patterns of motion is to focus conscious attention on the control of that motion. Clinically, I found the therapeutic application of this concept was even more powerful once restrictions to both active and passive movement are removed with appropriate adjustment of the spine, extremities and soft tissue release.
In the realm of scientific research, exercise using attentional focus of this sort falls under the umbrella of motion control exercise (MCE). Examples of MCEs include yoga as well as Pilates, tai chi and the Strong-Posture® exercise protocols. All share the goal of improving and strengthening posture and balance, and all do so by focusing attention to train fine control of previously neglected arcs of motion.
The challenge: You can focus on only one thing at a time. The ongoing lifestyle commitment to yoga or tai chi practice means you can focus on something different this week than last week, but this kind of random choice of focus can be challenging to apply in a clinical framework.
To the world at large, chiropractic is about low-back pain, the elephant in the neuromusculoskeletal (NMS) room. And clinically addressing the rehab of lowback and other biomechanical issues from a postural perspective means having a framework.
I teach posture rehab with a systematic focus on one link in the kinetic chain at a time. The goal is to retrain fine motor control and align subjective perception of body position with objective reality. In other words, reducing errors between perception and motion, or correcting sensorimotor errors. Of interest to DCs is how this approach synergizes elegantly with efforts to restore full range motion toward symmetry (e.g., spinal manipulation) and communicate with a sensible framework of posture.
I’m excited to share some of the recent findings supporting these ideas in the Blue Ocean Practice column:
All exercise is not created equal. MCE reduces pain and disability in chronic and recurrent low-back pain.
A recent meta-analysis looked at 16 studies of MCE and found, “In patients with chronic and recurrent low-back pain, MCE seem to be superior to several other treatments,”1 including general exercise and spinal manipulation.
Bottom line is that manipulation is good, exercise is good, but when there is chronic low-back pain, consciously exercising in a specific controlled pattern of motion can make a dramatic difference in pain as well as disability.
MCE protocols focus attention, and systematically correcting perception of balance, alignment and motion (BAM) on a granular level is a hallmark of the StrongPosture® exercise2 protocols that doctors report make a huge difference for many low-back and NMS patients.
Strengthening posture awareness begins with setting someone’s attention on standing taller, which synergizes with spinal manipulation.
Stand taller, feel better, move better.
According to a new Archives of Physical Medicine and Rehabilitation study that tracked height changes in men with degenerative joint disease, it’s true: Spinal manipulation can make you taller.3
Researchers looked at 40 middle-aged men with degenerative disc disease. Half received a placebo rubdown, while the other half received a high velocity, low amplitude spinal manipulation (HVLA SM). Height was measured precisely, mobility observed and pain documented with visual analog scale and neural mechanosensitivity.
The researchers’ conclusion: “An HVLA SM in the lumbosacral joint performed on male subjects with degenerative disc disease immediately improves self-perceived pain, spinal mobility in flexion, hip flexion during the passive SLR and subject’s full height.”
My contention: In addition to restoring motion, presumably via increased disc hydration, focusing attention to explore and retrain symmetry of motion on the newly unlocked segment can maintain and improve the beneficial effects of the adjustment.
That is why DCs treating NMS conditions should recommend BAM MCE in addition to SMT (HV or otherwise, with apologies for succumbing to alphabet soup).
1) Byström MG, Rasmussen-Barr E, Grooten WJ. Motor control exercises reduce pain and disability in chronic and recurrent low back pain: a meta-analysis. Spine (Phila Pa 1976). 2013 Mar 15;38(6):E350-8.
2) Weiniger S. Stand Taller~Live Longer: An Anti-Aging Strategy, BodyZonePress. 2008.
3) Vieira-Pellenz F, Oliva-Pascual-Vaca A, Rodriguez-Blanco C, Heredia-Rizo AM, Ricard F, Almazán-Campos G. Short-Term Effect of Spinal Manipulation on Pain Perception, Spinal Mobility, and Full Height Recovery in Male Subjects with Degenerative Disc Disease: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2014 Sep;95(9):1613-9. doi: 10.1016/j.apmr.2014.05.002. Epub 2014 May 24.
A Blue Ocean Practice, a concept Dr. Steven Weiniger has shared with thousands of DCs, earns respect, credibility and social relevance with evidence-supported chiropractic in new niches. He teaches the advanced posture specialist certification, Certified Posture Exercise Professional (CPEP®), which sets a clinical standard for posture improvement and rehabilitative protocols with DCs worldwide. Dr. Weiniger authored “Stand Taller, Live Longer,” and to promote posture awareness, he developed PostureZone, a free assessment app. His expertise is featured extensively in media, including ABC, CBS, NBC and Fox News. Contact him via PosturePractice.com, (866) 443-8966 or firstname.lastname@example.org.