Posture: More Than Just Sitting Up Straight

You have probably heard it over and over, or you may have even said it yourself: "You need to sit up straight." Everyone knows they should have good posture. Beauty pageant contestants practice with books on their heads to stand straight. People spend money on special chairs and sit on giant exercise balls to improve their sitting posture. But despite hours of practice or hundreds of dollars spent on the next great thing, when people are asked about their posture, they usually say, "it is hard to hold good posture."

If posture is just sitting up straight, why can it be so hard to maintain?

As an orthopedic physical therapist at Mary Lou Corcoran Physical and Aquatic Therapy, every assessment I perform starts with posture. Whether a patient comes in with a knee issue, a foot problem, back pain or even an elbow issue, I start with a postural assessment. Bad postural alignment influences every joint and every muscle in the body. If the postural alignment problem is severe enough, it can even effect internal organs.

When I assess posture, I am looking at more than just sitting or standing straight. That accounts for only one plane the body can move in, the sagittal plane (forward and backward). There are two other planes the body moves in, the frontal plane (side to side, or laterally) and the transverse plane (rotation). The frontal and transverse planes can be hard to see during static posture.

In assessing the human body, one plane of movement directly influences other planes of movement. For example, if a hip joint is posturally positioned into rotation, it limits movement of the hip into forward and backward movement. Also, if a hip is posturally positioned into rotation, it may prevent another area of the body (like the lumbar spine) from moving into forward and backward movement. In turn, if the lumbar spine cannot move forward and backward, it will influence the next area of the body, the ribs and thoracic spine. This process may continue to the top of the head and tips of the fingers. So asking your body to correct posture by moving one part of the body into one plane of movement without addressing the other areas and planes will actually inhibit your body 's ability to achieve "good" posture.

All of this can be complicated. That is where physical therapy becomes important. Throughout the course of a thorough examination, it is the role of the physical therapist to look at a patient's body to determine what might be too tight, too weak, too strong or too loose. Developing an understanding of each individual's posture guides the physical therapist to what needs to be corrected to take the negative influences off the posture of the body. For instance, neck pain may be relieved by stretching hip muscles to help correct the posture at the low back which directly places an undue stress on the neck.

Once neutral postural alignment is restored, it becomes easier to maintain a more upright posture. Unfortunately, the problem does not end there. Why do these postural imbalances occur? Everyone has habits and activities they do every day that create asymmetries, preventing them from maintaining good posture. Discovering what activities are having a negative impact and trying to find a good balance is necessary. One of the most important jobs of the physical therapist is to help the patient learn what can be done throughout their day to minimize the negative impact of their daily activities and work with the patient to develop a plan that helps patients attain (and keep) the balance their body needs to feel good.

With a keen eye and years of clinical experience, the physical therapists at Mary Lou Corcoran Physical and Aquatic Therapy can help you attain good postural alignment and balance across all planes and areas of the body, helping with problems that arise throughout the body and helping you "sit up straight".

Posted by Robert Wolfe, PT, CSCS

WIXT-9, The Real Deal On High Physical Therapy Copays

The following news segment recently aired on WIXT-9 and helps shed some light on the issue of high physical therapy copays in New York and the impact they are having on patient care.



Christine Casciano: In an effort to keep premiums down, many employers are choosing health insurance plans that have much higher copays.

Dan Cummings: It is a double edged sword for many people, especially those who need physical therapy, because in many cases, they are being forced to choose between what (they) can afford and what (their) doctor prescribes.

Christine Casciano: And Consumer Investigator Jennifer Lewke has the Real Deal now on how physical therapists say that it is only hurting everyone involved.

Jennifer Lewke: Sue Skabinski owns 3 physical therapy offices in Central New York. Over the past few years, copays for her patients have gotten out of control.

Sue Skibinski: Thirty, forty, fifty and in some cases sixty dollars [copays] depending on the plan.

Jennifer Lewke: And keep in mind, most people require two or three visits per week. Who can afford that?

Sue Skibinski: We have seen a significant number of patients who, before, would require a month's worth of PT. Now they are telling me, "Look, I can only afford to come in three times. Can you just do whatever you can do in 3 visits?"

Jennifer Lewke: Which Sue says may be pushing people into unnecessary medications and surgery. One of her patients, Theresa Piering, is beyond frustrated.

Theresa Piering: ...fifty dollar copay, so I had to pay the full shot. I had both knees (meniscus rips) repaired.

Jennifer Lewke: Eventually it just got too expensive.

Theresa Piering: I was coming in (at the beginning) three times, then it went down to two...

Jennifer Lewke: Part of the problem is that physical therapy is technically considered a specialty, so you've got to pay the more expensive "specialist" copay.

Sue Skibinksi: If you go to a cardiologist, and the office visit fee is $400...the insurance company is paying $360 of it, and you have to pay a $40 copay, you have spent 10%. You have paid 10% of the cost of service. I don't think that anybody thinks that is unreasonable.

Jennifer Lewke: But a PT visit is no where near that amount. Sue and some of her colleagues around Central New York have these cards for patients with high copays to fill out. They plan on bringing them to Albany in May. They want to be given a copay designation of their own or at least be moved to primary care. Most everyone here at Westside Physical Therapy agrees that a change is needed.

Theresa Pierling: It's become ridiculous, you know? It's like, "Why even have insurance?"

Jennifer Lewke: The word "co"-pay is a bit misleading too. In order to be in-network, physical therapists have to agree to accept a certain amount, per visit, from an insurer. Sue has an agreement with MVP, for example, that she'll accept $42 per visit. Most of her MVP patients are paying a $40 copay. So, the insurer is really only paying $2. Makes you wonder if it is even worth the stamp and paperwork to bill the insurance company. Of course, they have to but you get the ridiculousness of all of this. That is the real deal...

Dan Cummings: Now because of the how the copay rules are written, there is really nothing that can be done about this until there is a change in the law. That's why those providers are petitioning the local politicians.