Postural Correction in Children, Adolescents, and Young Adults
For children and adolescents, postural correction can be crucial, especially in cases of scoliosis. SOSORT provides clear guidelines on the treatment of scoliosis based on the degree of Cobb angle, one of the important criteria for determining the severity of spinal curvature and the best treatment approach.Scoliosis and Postural Correction
Scoliosis is a three-dimensional curvature of the spine that can affect not only posture but overall health and self-esteem. The Cobb angle assessment is performed through a long X-ray, essential for determining the appropriate treatment:- Cobb angle < 20 degrees: Mild scoliosis is usually monitored with periodic observations and postural exercises. Postural correction at this stage (and in all others as well) involves specific exercises that should be conducted by professionals with specific training in scoliosis, following SOSORT guidelines.
- Cobb angle between 20-40 degrees: Moderate scoliosis may require the use of orthopedic braces in addition to postural correction exercises. The combination of specific exercises and the use of a brace aims to prevent the curvature from progressing.
- Cobb angle > 40 degrees: Severe scoliosis may require surgical intervention. Before and after surgery, postural correction through specific exercises is essential for rehabilitation and maintaining spinal function.
For children and adolescents, postural correction can prevent the progression of scoliosis and avoid future complications. It is an important intervention to ensure healthy growth and spinal functionality. Scoliosis in children and adolescents is typically progressive. From the moment it is detected, immediate intervention is crucial to prevent the curvature angle from increasing and making the rehabilitation process more difficult. It is highly discouraged to "wait for it to get worse to treat" or to treat with something other than specific exercises, such as swimming. This doesn't mean swimming cannot be done; it just isn't considered treatment when viewed in isolation. The prognosis depends on age, bone maturity, treatment adherence, etc.
Postural Correction in Adults
For adults, postural correction plays a different role because, in adults, pain relief is not achieved through correcting asymmetries. This is a concept related to the popularity of "straightening to treat," which is now outdated. Moreover, our bodies are not symmetrical, so attempting to make symmetrical what is naturally not can be more harmful than beneficial. The works of Ronald Melzack, co-author of the Gate Control Theory of Pain, and the BMJ guidelines of 2017, along with the concepts of Peter Sullivan, emphasize a broader view of pain and posture. This view, despite being the one that gains the most consensus within the scientific community, clashes with the general population's beliefs and is unfortunately still little known. This is one of the reasons why chronic back pain numbers have not stopped increasing over the past decades. However, it is time for healthcare professionals to re-educate their patients, offering them therapeutic guidelines based on scientific evidence that works. This is the path we must follow to reverse the pain pandemic we find ourselves in.
Postural Correction and Pain in Adults
Poor posture is often cited as a cause of lower back and neck pain in adults. However, the relationship between posture and pain is more complex than previously thought. Studies indicate that posture alone is not, in most cases, the main cause of pain. Other factors, once seen (and often still today) as "minor," should be considered and be the central point of treatment: stress, anxiety, sleep quality, physical activity, muscle strength, and lifestyle habits play a very significant role in spinal health.
Chronic Pain and Posture
Melzack suggested that the perception of pain is modulated by several factors, not just physical stimuli. This implies that posture, although potentially important, is not the sole determinant of chronic pain. The BMJ 2017 guidelines recommend a multifactorial approach to the treatment of chronic lower back pain, including manual therapy mainly in acute and subacute phases (when the person has difficulty performing daily activities), exercises, cognitive-behavioral therapy, and lifestyle changes. Conversely, the same guideline discourages the use of medication for pain relief, especially when used in isolation and even more so in the form of self-medication. Thus, an approach focused solely on an "ideal model" of body segment alignment and symmetry seeking is, in most cases, insufficient to achieve the desired results. All bodies are different and have their own form and structure. Idealizing a body segment alignment scheme the same for everyone will end up serving no one and will be (yet another) frustrating attempt at pain relief.
Postural Correction in Practice - Yes or No?
- Postural Education: Teaching patients about proper body mechanics can help reduce pain and improve posture but should not be the only strategy.
- Pain Education: This is a modern concept that has had good results for pain relief. Educating the patient on how to behave if they spend hours in the same position at work, taking regular breaks, explaining the negative effects of constant self-massage (called hypervigilance), understanding the chronicity, intensity, and frequency of their pain, and developing a realistic plan are viable, scientifically validated alternatives that can be a breath of fresh air for those who have tried everything and are willing to commit to a new approach. It's a whole new world that has emerged in recent years and is extremely important for therapeutic success. Just as a diabetic must know they cannot walk into a candy store and eat everything in sight, the chronic pain sufferer must know exactly what types of conduct science shows may or may not be beneficial to them. Postural correction alone, and especially "forcing good posture," is not!
- Multimodal Therapies: Combining long-term exercises, manual therapy in acute and subacute cases of pain with significant impact on daily activities, and behavioral interventions when necessary is a triad that, well-balanced, can help eliminate or reduce chronic back pain and is more effective than postural correction alone and used in isolation.
Conclusion: Postural Correction, Health, and Well-being
Postural correction can be a useful tool, but it should be seen as part of a holistic approach to spinal health. For children and adolescents, especially those with scoliosis, postural correction through specific exercises can prevent complications (such as the need for surgery or the use of orthopedic braces) and improve quality of life. For adults, the emphasis should be on an active lifestyle, exercise, and multimodal approaches to pain, depending on the phase of pain the patient is in (acute, subacute, or chronic). One of our professionals will be able to identify your situation and the best path to follow.
Key Points:
Scoliosis in Children and Young Adults: Postural correction and specific treatments based on the Cobb angle degree are essential.Pain in Adults: A multifactorial approach that goes beyond posture is crucial for effective treatment.
Education and Exercise: Promoting education on ergonomics and the importance of an active lifestyle are fundamental strategies for spinal health.
Acute and Sub-acute Pain with Daily Life Limitation: Manual therapy, such as Osteopathy.
For the population concerned with posture and pain, the message is clear: postural correction can be part of the treatment, but it should not be seen as the only solution. Incorporating regular physical activity, manual therapy when pain is more present and limiting, and pain education can provide better short, medium, and long-term results.
If you live with back pain or posture concerns, consider consulting one of our pain specialists for a complete evaluation and a personalized treatment plan based on current scientific evidence that takes all aspects of your health into account. If it is a teenager and you notice asymmetries in their shoulders and/or hips, time can be a key factor for the success of their treatment, so do not delay in seeking one of our specialists.
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