You may find it harder to sit up straight at the table. You may notice a certain crookedness when glancing in a mirror or store window. The lower back pain or forward lean seems to have gotten worse over the past year. Or your back just seems constantly tired. These symptoms all point to posture problems, which are common with both aging and SCI. Getting older with SCI? Pay attention ...
Many posture problems are associated with SCI, ranging from chronic pain and fatigue to scoliosis and kyphosis, as well as skin and respiratory problems. Just like the problems, the causes are numerous:
- Lack of trunk muscles puts the body in a constant slump
- Muscle imbalance, gravity or spasticity pulls us to one side or the other
- Inactivity or lack of exercising drastically decreases physical fitness, leaving us fatigued or in chronic pain
- Habitual functional activities done the same way every day, such as hooking the same arm on the chair back for support, can cause contractures and severe muscle imbalances
- Poorly fitted equipment -- wheelchair, cushion or back -- places the body in a poor position
When left unaddressed, the problems magnify, possibly causing worse problems. Sitting crooked means uneven weight distribution and possible skin sores. Slumping or slouching makes the lungs work harder, compromising respiratory function. Poor posture while sitting or wheeling puts extra strain on the neck and spine, causing pain and discomfort. The more slumping or leaning or slouching in response to pain, the more pain or fatigue that is produced.
Determining whether you've got a problem may be as easy as asking, and honestly answering, a few questions.
- Do you have chronic pain in the neck, lower back or trunk?
- Is your fatigue more in the trunk and back, rather than in your arms or shoulders?
- Do you sit crooked? Are you leaning to one side or the other? Is one hip higher than the other? Is one hip or knee more forward than the other?
- Are you always leaning a bit forward, or is balance a problem?
- Do you have breathing problems or trouble getting full breaths?
Thinking about these questions is a good first step. Answering yes to any means you may need to go further.
Looking at how you're sitting is a good second step.. Get someone to help. When facing a mirror, is more of the chair back visible on one side or the other? When viewing a profile, do your ear lobe, shoulder joint and hip joint form a straight vertical line above the chair axle?
Remember: living in our bodies day to day makes it difficult to always recognize small changes which can result in big problems. You may need to make a conscious effort to observe and evaluate how you sit.
The third step is seeking the opinion and evaluation of a physical or occupational therapist or physician trained in spinal cord injury.
Changes in the body often require new or different equipment. "Gravity is not your friend," says Craig Hospital physical therapist Cindy Smith. Lack of trunk muscles, or just minor trunk muscle imbalances can, over the course of years, cause major problems with posture. Smith compares the spine to building blocks. Stack them slightly off kilter and they'll probably be okay. Put some weight on them and problems develop over time.
Eventually, gravity takes its toll and the price is poor posture, chronic pain, decreased energy and skin problems. We can address the problems in a number of ways -- what we sit in, what we sit on, and possibly even the types of weight shifts we do.
Starting at the bottom and working up, many solutions exist to address posture problems. New or modified cushions can ensure proper weight distribution and begin to solve hip uneveness. Solid chair backs can provide the support necessary to compensate for weakness in the trunk. Lateral supports, or "wings," will serve to support the trunk and keep it straight.
Chest belts can ensure stability and help with balance. Corsets can counter act muscle imbalances, straighten out the trunk, reduce fatigue, and assist with balance. One, several, or all of these solutions can be used to deal with poor posture.
There are rewards for making these changes: reduced fatigue and thus more energy, decreased pain, fewer skin problems, reduction of spinal curvature or slanting hips and, in general, an overall better and more "normal" appearance.
Wearing a corset may provide the trunk stability necessary to make sports or other activities fun rather than work. Lateral supports and a chest belt may reduce pain and fatigue enough to make sitting at a desk for hours feasible and thus make employment possible. Proper posture leads to even weight distribution, fewer potential skin problems, and safer driving. Proper posture affects our body physics and places us in a more efficient wheeling position.
And not all the effects are physical. Posture is often a reflection of how we feel about ourselves. Sitting up straight speaks forcefully to others about our confidence, competence and self-image in general. Height, whether sitting or standing, is related to self-esteem.
Everyone ages, and as they do their bodies change. Responding to these changes with appropriate equipment can allow us to avoid future problems and enjoy ourselves as we age.
This is one of more than 20 educational brochures developed by Craig Hospital while it was a federally-funded Rehabilitation Research & Training Center on Aging with Spinal Cord Injury. The opinions expressed here are not necessarily those of the funding agency, the National Institute on Disability and Rehabilitation Research of the US Department of Education.
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