The average human head weighs 10-12 pounds when it’s in the neutral position, which occurs when your ears are in line with your shoulder in the sagittal (side) view of your spine. Unfortunately, the excessive use of smartphones (averaging 2-4 hours/day) has caused many to develop what is known as “anterior head carriage” or “forward head posture”. For every inch that your head is going forward from the neutral position, you are adding 10 pounds of pressure to your neck. Dr. Kenneth Hansraj, chief of spine surgery at New York Spine Surgery and Rehabilitation Medicine states that “The weight seen by the spine dramatically increases when flexing the head forward at varying degrees. Loss of the natural curve of the cervical spine leads to incrementally increased stresses about the cervical spine. These stresses may lead to early wear, tear, degeneration and possibly surgeries.” Forward head posture compresses the facet joints and adds excess stress to the neck muscles, ligaments and tendons.
At a 30 degree forward head tilt from neutral, you are adding 40 pounds of pressure to your neck, at 60 degrees you are adding 60 pounds at 90 degrees the amount of pressure you are adding to your neck is not measurable. Bad posture has been linked to a host of medical problems, including headaches and other neurological problems, depression, constipation, and heart disease. At a minimum, constant slouching is likely to cause a lot of chronic pain. Engaging in proper form while texting is important for everyone, but it is especially important for scoliosis patients. In order to restore the thoracic and lumbar curves, the cervical lordosis must first be addressed.
Here are some tips to combat giving in to your body’s natural affinity to slouch as well as the proper posture to text:
- Head in neutral
- Phone at eye level or abobe
- Engaging your abdominal muscles at 20%
- Flip shoulders out (make your arms look like they are carrying a pizza, also known as external rotation) from here you can bend your elbows to hold your phone at eye level
This position creates mechanically stable shoulders, unloads the cervical spine and engages your pectoralis muscles. While it may appear odd or unusual to be holding your phone in this fashion, the benefits of healthy posture far outweigh the stares you may receive.
Scoliosis affects roughly 4.5 percent of the population, however, many cases go undiagnosed and the real number is thought to be closer to 15-20% of the population. The best way to treat scoliosis is early detection and intervention. Here are some ways to help in identifying a curvature of the spine:
- Adam’s forward bending test where the child bends forward at the waist in an attempt to touch their toes. The examiner will then look for asymmetry of the spine and hips. This test will only be positive if a curvature is already present.
- Difficulty with proprioception and balance. Proprioception is the sense of the relative position of body segments in relation to other body segments. For example, being able to close your eyes and touch your nose with your pinkie finger. Some scoliosis patients are unable to complete this because the communication between the brain and the body is compromised. Tests that can be done to check your balance and proprioception are:
- Marching test: patients will close their eyes and march in place with their arms straight out in front of them for 30-60 seconds. Individuals with impaired proprioception will unconsciously rotate from their starting position.
- One-legged stork test: patients stand on one leg with their arms folded in front of their chest for 30 seconds. First with eyes open and second with eyes closed. Scoliosis patients tend to be able to complete the test with their eyes open but when performing the test with their eyes closed they are unable to complete the test.
- Standing on an unstable surface such as a foam pad first with eyes open then repeated with eyes closed. If unable to do with eyes closed it is indicative of a proprioceptive imbalance.
If any of these tests are positive, it is important to have an x-ray taken immediately as it is the only definitive way to diagnose a scoliosis.
Adult patients with Idiopathic Scoliosis (ADIS) are generally told that their scoliosis will have stopped progressing when they stopped growing. However there is increasingly more scientific data that contradicts this premise. It has been shown that contrary to what doctors were taught in medical schools in the past 100 years; adult IS (Idiopathic scoliosis) does progress on average between .5-1 degrees per year. (Negrini et al. Scoliosis (2015) 10:20).
Once there exists an ‘asymmetrical’ load, or shift of the spinal vertebrae, then there is a high degree of potential (at least 60%) of continued worsening of the scoliosis. Especially as age brings on further degenerative changes in the spine, such as osteoarthritis, osteoporosis, osteopenia,etc. Surgery previously thought of as the only solution, is now being re-evaluated. Various forms of therapeutic exercises and non-surgical conservative therapies are being successfully implemented in adults, as well as children. Among them are CLEAR Scoliosis Institute Protocols (www.clear-institute.org), SEAS (scientific exercise approach to scoliosis), Schroth Exercise, SSE (scoliosis specific exercises). See below an example of an adult scoliosis that has not been treated as it worsens both posture wise and on x ray.
Sleeping is essential to our wellbeing. As human beings we spend about 1/3 of our lives sleeping so we might as well be doing it correctly. Our sleep posture can determine our spinal wellness. It may affect whether we are experiencing back pain currently or deteriorating our spinal curvatures over time causing countless future spinal issues.
Stomach sleeping promotes terrible posture. It flattens and compresses your low back. Stomach sleeping also puts a lot of added stress on your upper back and neck causing the cervical spine (neck) to be strained and twisted in unhealthy spinal positions, which dehydrate the disc and forces a kyphotic (reversed) neck curve.
Side sleeping is better but still not ideal as it can torque your pelvis and put added stress on your body’s lateral curvatures. Side sleeping also puts pressure on your stomach and lungs and may cause you to sleep on one of your arms, which impedes blood and nerve flow.
The best sleeping position regardless of spinal curvature is face up in the supine position. Sleeping on your back allows for your mattress to maintain your spine’s overall neutral position with out adding any extra curves or stress to your spine, discs or joints. Most patients with scoliosis have a decreased or reversed curve in their neck so it is important to have proper support while sleeping. A single cervical pillow while sleeping will help to maintain and improve the cervical curve.
It is evident that the best position regardless of spinal curvature is on your back. This will allow your body to maintain it’s natural blood and nerve flow with out adding extra curves to your spine. If you are used to sleeping on your side or stomach it may take some getting used to and re-training to change your sleep habits. A trick that can help is to tape an uncooked pea to your shirt in various spots so that if you do roll over the discomfort from the pea will either wake you up or cause you to roll onto your back. You can also sleep with barriers (pillows) on either side of you to prevent you from rolling onto your side or stomach.
According to the journal ‘”Spine” one of the pre-eminent medical journals, there is no evidence that concretely supports conservative care for adult scoliosis. Nonsurgical treatment options are commonly advocated, but no evidence to discriminate between these methods is presented. Therefore, a formal systematic review of the literature for conservative treatment of adult deformity was selected as it provides a current assessment of literature concerning this area of treatment. Patients seek treatment for adult degenerative scoliosis. The primary reasons are pain of course which is always the first reason to seek help, physical appearance, (cosmetic reasons), nerve compression and its associated symptoms of numbness, tingling in extremities, and muscle weakness.
While the research is limited, and generally skeptical and inconclusive, there are several successful clinical results we see on a regular basis in our clinics. For example, Whole Body Vibration at a specific frequency and hertz is scientifically proven to increase bone mass. Therefore it amongst other conservative options is available and should be utilized under proper supervision (don’t go out and buy a generic WBV machine or use at the gym without first checking with your chiropractor or therapist first).
This is just one viable conservative treatment option that has been shown to be effective. There are more and we will explore them in future blogs.