May 2009

Reverse posture exercise a simple approach to rehab

by Dr. Mark Payne

The last decade has seen an increasing number of chiropractors incorporating some form of therapeutic exercise into their practices. Many first to jump on the bandwagon were successful practitioners who invested heavily in the latest high-tech equipment. Now these doctors find themselves saddled with huge overheads and facing tough competition from big budget fitness facilities. In their rush to have the latest and greatest equipment, they failed to effectively differentiate themselves in the marketplace from the local gym. Today's recessionary economy is now putting huge strains on many of these practitioners.

Many DCs who were on tighter budgets never implemented rehab because they were unable to afford the initial outlay for equipment. Others steered away from rehab simply because they lacked training and understanding of how it should be done. Unfortunately, by failing to include rehab, doctors often end up doing little more than occasionally prescribing a generic series of take-home exercises for their patients. If you find yourself in either of these last two categories, I would like to share a simple approach to active care that has worked well for thousands of doctors.

The first thing you should know is that inexpensive, low-tech rehab procedures work just as well or better than top-of-the-line, high-tech equipment. (See Evans, R., Bronfort, G., et al. "Two-Year follow-up of a Randomized Clinical Trial of Spinal Manipulation and Two Types of exercise for Patients with Chronic Neck Pain." Spine 27 (21): 2383-2389, 2002. Lippincott Williams & Wilkins.)

A tight budget doesn't mean you'll have to compromise your quality of care. And if you're new to rehab and looking for a simple and effective way to get started, and differentiate yourself from the "personal trainers" down at the local gym, I suggest you consider a postural approach to rehab.

It works quite simply. First, the patient's posture is analyzed in both the frontal and sagittal planes. Next, significant postural imbalances are noted. Then the patient is instructed to exercise into the "reverse" or "opposite" posture(s)

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Fig. 1: With eyes closed, the patient is asked to assume what feels to be a normal, resting posture. In this case, the patient carries herself with the thorax right translated, relative to the pelvis. (Posture is exaggerated here for illustration purposes.)

Fig. 2: The patient is instructed to exercise the thorax into the "reverse" or "opposite" posture. In this particular case, the patient is translating her thorax to her left against resistance provided by a simple tubing type exerciser.

Of course you need to know how to objectively analyze posture and a few basics about postural rehab, but we're here to help you with that if you're genuinely interested in learning. You really don't need a dozen seminars or a new guru to get started.

One of the great things about approaching spinal correction from a postural perspective is that almost all chiropractors can agree it's generally a good thing for spines to be straight in the frontal plane and to have healthy curves in the sagittal plane. A posture-based approach to therapeutic exercise integrates well with essentially all styles of practice. It's not the only way to approach rehab, but it's conceptually simple to learn, therapeutically effective, and easy to relate to your patients. Combine your reverse posture maneuvers with some general strengthening exercises for the spine and I think you'll be very pleased with your outcomes.

Maybe the best part is that posture-based rehab can be implemented in your office for just about a hundred dollars per station. All you need is a small, dedicated space to exercise in and a few simple pieces of equipment.

Ten years ago, I was struggling to find affordable ways to implement rehab, improve our treatment outcomes, and keep the practice profitable. The solutions we came up with are even more relevant in today's tough economy than they were then. If you're interested, call 334-448-1210 for my free, complete report entitled "Guerilla Rehab-Survival Strategies for the Chiropractic Jungle" to find out how to implement rehab without breaking your bank account. I'll show you how we were able to build out an effective rehab area in our clinic that actually paid for itself in one day.

We did it. You can too.

(A 1979 graduate of Life Chiropractic College, Dr. Mark Payne is the president of Matlin Mfg., a manufacturer and distributor of postural rehabilitation products since 1988. For more information regarding issues, products or methods discussed in this column, call 334-448-1210. Visit www.matlinmfg.com  for a free product catalog.)