An exercise in seeing…

One thing that has always surprised me is how different a patient’s posture can be from the way patients see themselves. I ask people if the are sitting up straight and they reply yes yet they have their neck leaning forward at a 20 degree angle. I ask people to stand on one leg and tell me if they are standing up straight and again the answer is always a resounding ‘yes’. It seems that we believe what we think until we are forced to do a reality check which is something that rarely happens before coming to me.

So I thought maybe if I gave you a couple of things to try out on your own you might start to get a better idea of what reality is like for you, before you necessarily have any complaints. Ready to have a go?

First, you will need at least one if not both of the following tools. I like a mirror because it is in effect dynamic and will show you exactly what you are doing. Preferably a full length mirror because it leaves you with no where to hide and exposes any faults that might be present. Alternatively, you could use a camera (still or video) which also will tell you similar information. Unfortunately with cameras it is harder to get immediate feedback unless you have it connected to a large screen monitor or TV (which is not always convenient). (note – if you have any health problems that restrict your ability to exercise then please check with your health care provider before attempting to try out these exercises)

Ok now once you have your tool(s) it’s time for a couple simple tests.. Try standing in front of the mirror: hips straight and pelvis not rotated, feet pointing straight forward and placed under your shoulders, knees slightly flexed over the middle of your feet with the weight distributed equally. Try to set yourself up without looking in the mirror and then look up and see if everything is where you think it would be. Common faults are having one foot turned out, one arch flattened/raised, more weight on one leg, the trunk leaning off to one side, one knee pointing either towards the middle or away from mid-line.. the list goes on!! At first it might not be obvious to you what you are doing and a photo or video recording may allow you to relax and review what your posture is like after. It is good to look for natural vertical lines (or you can hang a string behind you to act as a plumb line) so you can compare where you are positioned to what I have asked for.

Happy with where you are? Okay then lets progress to the next step. If not, then see if you can work on getting your body to take on this basic posture.

Now that you think can find a balanced position it’s time to add a bit of chaos :’ ).

Stand on one leg with the knee slightly bent and see if you can once again line yourself up with everything straight as in the first test. Can you do it? No? Well, many people can’t and this time faults are even more obvious. You may find that on one side it is easy to do but on the other your knee twists in quite a bit, the foot twists out, the pelvis rotates, you lean over quite a bit to one side… again the list can be extensive!! You may need some help from a friend who can look at what you are doing and give you honest feedback to help you correct your positioning. A healthy adult should potentially be able to stand up straight without leaning/twisting for up to 2 minutes without huge difficulties. Most people won’t be able to do this but that does not mean that they are not capable. ┬áIf you can get into this posture then see if you can relax and breath comfortably and hold the position with the least amount of effort. You should not have to strain yourself when you doing these exercises.

Sometimes I will do things to see if I can identify what the potential cause of the leaning/twisting is. For example, if I think that the person has weakness in their hip muscles then I give them a weight (a couple of kilos/up to 5 pounds) to hold onto on the same side they lean to. If this makes the list go away then the weight is doing what the hip muscles are supposed to be doing and I tell them that they should be doing something to strengthen the hip to see if that makes controlling the movement easier. I also like to see if the list happens before they actually try to shift their weight which might be more a habit than something their bodies are forcing them to do.

There are more things that can be tested/evaluated but you can at least start to see ,from what I describe, the process that needs to be carried out to improve your performance of these tests.

These sort of postures are similar to what people may do in some yoga, qigong and tai chi classes. I am not pretending to be teaching these arts but what I think is that someone in the past decided to provide simple preventative posture exercises that would be useful in keeping up one’s strength and coordination. I personally feel they are a useful tool and still have a use for most of the population these days.

The victim and the criminal

Often patients ask why they have a problem in a certain place when there has been no obvious injury or reason for a complaint that has snuck into their lives.  There might not be any obvious incident and they can't think of anything they have done to cause their discomfort.

One way of looking at how the body behaves is to think that it will take care of you as long as it can. But that is as long as your wants match what is natural.  You have reflexes that try to keep your head vertical. Your nervous system is programmed to be sure that certain basic requirements happen.

In the case of a sore knee there are many factors that might be at fault.  If you have a problem your body will shift the pressure to another area to keep that part from becoming symptomatic and interfering with its tasks. This will continue to happen so as the next area becomes overloaded the pressure will shift again.  When there is no where left for the pressure to go the weakest part will become irritated.  If you get a stiff hip you may change the way you walk. This may affect your back or your ankle. As those areas start to stiffen up to try to avoid becoming irritated the knee will take more pressure.  Eventually you will find you knee complaining.  Too often treatment can be applied to the sore knee alone which is which is the victim in this conspiracy.  You have to  look hard to see the stiffness (which does not hurt, only limit you) or weakness(which you will compensate for) and the real criminal area that has made your knee hurt you. 

Whatever type of treatment you engage in the important thing in the long run is to be sure that the cause and not just the effects are dealt with.  Treating the pain alone will give relief temporarily but the underlying problems will eventually come back to haunt you.

Hope this has provoked some thoughts. Sorry I took so long to get something new on here. I will try harder next time. 

Best wishes and hope you are having a great summer!!

Ross