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Postural Analysis: A Professional Tool for Building Your Practice

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By: David Kent, LMT, NCTMB

When patients go to the dentist with a toothache, they expect the dentist to take x-rays, perform an exam, and explain the findings: the patient needs a filling, root canal, crown, or an extraction. Likewise, when patients go to the doctor or chiropractor complaining of headaches or back pain, they usually expect the doctor to run assessment tests and/or take x-rays or an MRI, both of which produce images that pinpoint the nature of the injury and the origin of pain. Doctors often use these images to educate their patients in an effort to instill confidence that the problem can be properly treated. This article will discuss how massage therapists can use postural analysis and photos to educate their clients, as well as deliver their objective findings in a professional manner, while subsequently building their practice.

Permission

First, your health history and intake forms should include wording that gives you permission to take postural analysis photos. Always treat these photos as confidential medical records and inform the client of this as well.

 

Efficiency

The x-ray tech at the dentist’s office can develop and deliver results in just a few minutes. In the same amount of time, you too should be able to conduct a postural analysis that includes photos, report your findings, and describe how your treatments can help. This process must be quick, easy and non-threatening to your client.

Attire

Clients must feel safe, comfortable and respected. For the initial set of postural analysis photos, ask your clients to remove their shoes and jacket, but let them leave on whatever other clothing they came in wearing. The photos will still show key distortions, such as a high shoulder or forward-head posture, and provide enough information to help them commit to a series of therapy treatments.

 

Charts

The human body is designed with a great deal of symmetry, or balance. The body has the same bones and muscles on each side. Muscles in the front and the back of the body balance each other, and muscles also determine where the bones are moved or held in space. Muscular and skeletal charts are useful for showing the symmetry that exists in the body.

Postural analysis grid charts make it easy for anyone to see asymmetries in the body. Charts are available in different sizes and hang easily. Large charts can be hung on a wall; however, when wall space is limited, a space saver version of the chart fits on the back of a door.

A postural analysis chart is most effective when used in conjunction with a plumb line, which is a straight line that suspends a weight or “Bob” on its end. This system has been used since the time of the Egyptians to ensure that structures were being built perfectly upright. When the weight is made of lead (plumbum in Latin), it is referred to as a lead weight or Plumb Bob. A plumb line is used for many reasons during a postural analysis, as it will:

  • ensure the posture chart is hanging straight;
  • guarantee the client is viewed from a 90-degree angle;
  • determine placement of the client’s feet prior to taking postural analysis photos; and
  • supply a visual reference of the midsagittal and coronal planes in the posture photos. This shows clients where their body is being held in space by the muscles, why the muscles hurt, and how you can help.

Hang the plumb line from the ceiling, approximately 3 feet in front of your posture analysis chart. This distance will allow clients of all sizes to stand between the posture chart and the plumb line without touching either one. The Plumb Bob should be suspended from the ceiling and hang approximately ¼-inch from the floor. To get the plumb line out of the way and conserve space when the posture chart is not in use, simply hook it over one of the pins holding the chart on the wall. If you are using the door version of the chart, hook the plumb line behind the hinges.

The use of a construction-grade plumb line to suspend the Plumb Bob will prevent a lot of problems—just make sure the line is securely attached to the ceiling. A professional Plumb Bob kit comes with ceiling anchors and a construction-grade line attached to a professional Plumb Bob.

Positioning

Have the client stand between the postural analysis chart and the plumb line. Be sure his/her body is not touching the plumb line or the posture chart. It is important for the client’s feet to be placed in the identical position from one photo to another to guarantee consistency. Use tape, a template or a piece of Plexiglas on the floor to mark the client’s position.

Anterior and Posterior Views

There are a few things to remember when taking anterior and posterior posture analysis photos. First, place the medial (inside) aspects of the client’s heels shoulder width apart and equally spaced from the plumb line (Photo 2). This position allows the plumb line to indicate the midsagittal plane of the body in your photos. Then you can also use postural analysis photos to show the client that his/her body is to the right or left of the midsagittal plane (Photo 1). Second, position the back or posterior aspect of the client’s heels the same distance away from the posture chart to avoid creating the illusion of a twist, torque or rotation in the body.

By positioning the feet using the medial and posterior aspects of the heels, the client is free to laterally rotate the lower extremities, thereby revealing more postural distortions.

 

Lateral Views

For lateral views, position the client so that the plumb line is immediately anterior to the lateral malleolus. (Photo 5) This position allows the plumb line to represent the coronal plane of the body. Ask the client to place his/her hair behind the ears to expose the external auditory meatus: an anatomical landmark used as a reference point to determine the position of the head on the coronal plane.

 

Camera and Photos

The camera you use does not have to be elaborate. Most massage therapists can simply use a cell phone camera. If using a cell phone camera, however, make sure to implement the necessary safeguards to protect your client’s privacy, such as setting security codes or downloading the photos to a secure computer for storage and retrieval.

Once you have taken the photos, keep it simple. The easiest way to review your findings with the client is on the screen of the camera. If you wish, you can download and print the photos later for the client’s file.

Anterior and posterior view photos can reveal a number of issues, including a high shoulder (Photo 3) or high hip, the space between the torso and the upper limb, the positions of the hands, an externally rotated lower limb, a fallen arch, or if the head and/or torso are held to the right or left of centerline, to name just a few. (Photo 1)

Lateral view photos make it easy to point out a forward head (Photo 6), rounded shoulders, and a slumped abdominal posture, as well as the angle of the innominate bones and the position of the knees; they are also helpful in identifying a twist or rotational pattern. (Photo 4)

Value

Just like chiropractors advertise free “spinal exams” to attract new patients, you could provide free “postural analysis” to attract new clients. Include the postural analysis as an added value during the initial visit; then include a second complimentary postural analysis once the client completes a series of treatments. This is not only a great way to sell packages, but it also demonstrates the client’s postural progress and shows the effectiveness of your treatments.

Additional Benefits

Everyone likes to be remembered. In addition to helping you ascertain the client’s structural issues, postural analysis photos can help you remember what your clients look like, so that you can greet them by first name. Clients often return months or years after receiving therapy; your photos can help you notice a new hairstyle or the weight the client lost, which makes them feel important and special.

Professional Image

You know what they say: A picture is worth a thousand words. Integrating postural analysis into your practice helps you stand out from other therapists in your area. The public will perceive your unique practice as a cut about the rest. Postural analysis raises your level of professionalism and credibility in the mind of your clients, while providing client education and building your practice at the same time. Postural analysis photos only take a moment to snap, but they are an invaluable resource to you and your clients.

 

SIDEBARS

 

Ten Advantages of Taking Postural Analysis Photos

1.     Educates clients about postural distortions

2.     Shows which muscles are stressed and over-lengthened

3.     Explains visually and logically the muscular causes of pain

4.     Helps clients decide to purchase a series treatments

5.     Documents posture before, during and after a series of treatments

6.     Shows clients, physicians and insurance companies treatment progress

7.     Presents clients with customized treatment plans

8.     Records and documents client’s postural changes

9.     Reflects the professionalism of your practice

10.  Helps build your practice

Postural Analysis Checklist

o      Obtain written permission to take photos.

o      Hang plumb line 3 feet in front of posture chart.

o      Hang Plumb Bob approximately ¼-inch off the floor.

o      Instruct client to remove shoes and jacket, and place hair behind the ears.

o      Have client stand between the postural chart and the plumb line.

o      Anterior view: Place heels an equal distance from the plumb line and posture chart.

o      Lateral view: Position client so that plumb line is immediately anterior to lateral malleolus.

o      Handle photos as confidential medical records.

David Kent, LMT, NCTMB, is an international presenter, product innovator and writer. His clinic Muscular Pain Relief Center is in Deltona, Florida, where he receives referrals from various healthcare providers. David teaches Human Dissection, Deep Tissue Medical Massage and Practice Building seminars, and has developed a line of products, including the Postural Analysis Grid Chart™, Trigger Point Charts, Personalized Essential Office Forms™, Muscle Movement Chart, and DVD programs. Visit www.KentHealtht.com or call (888) 574-5600.

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Getting Comfortable with Postural Analysis Practice Building Tips

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By: David Kent, LMT, NCTMB

We all recognize the importance of getting our cars serviced regularly so that they run at their optimal level. Not surprisingly, the same is true of the human body. In fact, there is a very useful car-related analogy we can use when it comes to describing postural analysis: a front-end alignment and wheel balance.

The word “posture” is derived from the Latin verb “ponere,” meaning “to put or place.” The word “analysis” comes from the Greek word “analyein,” meaning “to break up.” Therefore, postural analysis is simply the process of “breaking up” the body to determine where it should be “put or placed.” This article will review the body positioning for the purpose of taking a standing (static) postural analysis so that you can custom design your clients’ therapy sessions.

When a vehicle’s alignment is off, it manifests as uneven tread wear and loss of tire life. Likewise, when a car’s tires are not properly balanced, ride quality is diminished, tire life is shortened, and bearings and shock-absorber performance suffers. When one’s posture is off, the human body also experiences a range of problems: restricted range of motion; pain; organ dysfunction; and joint, tendon, ligament and muscle stress, to name a few.

The body, like tires, has an ideal position. It, too, must be balanced to run smoothly and last a long time. For a mechanic to assess and adjust the front end of a vehicle, he must first check wheel positioning for deviations from the norm. To do this, he sets the wheels in a standard position and conducts an evaluation. In massage terms, this is the equivalent of taking a postural analysis. A mechanic’s objective findings are also reported in terms we can relate to the body. For example, the mechanical term “toe-in or toe-out” is what we would call “internal or external rotation.” And what a mechanic calls “camber,” we call “tilt.”

When we report to a mechanic that the tire tread on our vehicle is wearing unevenly and the steering wheel vibrates, we have given our subjective complaints. The mechanic hears this complaint frequently and knows exactly what needs to be done. Before he can conduct his evaluation, however, he needs to use the proper equipment to access and design a repair plan, according to the car model’s specifications.

In the same way, clients often make subjective complaints to us about headaches and neck and back pain. These are common complaints we hear frequently. Just like a mechanic, we need to use the proper equipment to access and design a customized therapy session to meet each individual client’s needs, focusing on both short- and long-term goals.

The “manufacturer specifications” for the human body include the anatomical planes that show us the ideal positioning of joints and bones. While individuals are not expected to be perfectly positioned, we want to facilitate the best posture possible through massage therapy. According to Muscles: Testing and Function” “Ideal skeletal alignment…involves a minimal amount of stress and strain, and is conducive to maximal efficiency of the body.” Moreover, “the intersection of the sagittal and coronal midplanes of the body forms a line that is analogous to the gravity line. Around this line, the body is hypothetically in a position of equilibrium. Such a position implies a balanced distribution of weight, and a stable position of each joint. When viewing a posture in a standing [position], a plumb line is used to represent a line of reference…Since the only fixed point in the standing posture is at the base where the feet are in contact with the floor, the point of reference must be at the base,” or the foundation of the body.[1]

Whether you work in spa, clinic, medical office, fitness center, or some other venue, there are certain things you must do to conduct an effective postural analysis.

Postural Analysis Checklist

[Graphic designer: please insert check boxes next to each entry]

o      Hang a plumb bob approximately 3 feet in front of a postural analysis grid chart. The plumb bob should be approximately a ¼ inch off the floor.

o      The client should be:

o       in bare feet

o      wear clothing that allows for visual observation of body contours.

o      Standing between the postural chart and the plumb line, but his/her body should not be touching the plumb line or chart.

o      Client should place the hair behind the ears as the external auditory meatus is an anatomical landmark that is used as a reference point.

o      Position the feet in relation to the plumb line:

o      For anterior and posterior views, the heels are equally spaced from the plumb line and posture chart. See images #1 and 2

o      For a lateral view, the plumb line is immediately anterior to lateral maleous. See images # 4 and 5

Now, stand a few feet back from the plumb line. Using a digital camera, move from side to side (right to left) until the plumb line is lined up with the center line of the grid chart. Take a photo of the client and make any necessary notes for your objective your findings.

We all know the saying “A picture is worth a thousand words”. In images #1 and 3 it is easy to see how the right shoulder is higher then the left. We see the torso and head are to right of the midsaggital plane. In images 4 and 6 it is easy to see the forward head posture and the right shoulder being posterior to the coronal plane. These “deviations” have numerous origins. A muscle movement chart will help quickly determine which muscles are shortened and which ones are lengthened helping you design a customized treatment plan.

There are many advantages of taking postural photos, including

• Documenting posture before and after a series of treatments;

• Educating clients about their postural distortions and demonstrating causes of pain, muscle weakness, etc;

• Showing clients, physicians, and other relevant parties a client’s treatment progress;

• Presenting clients with clear treatment solutions;

• Recording and documenting the client’s postural changes;

• Customizing treatment plans; and

• Confirming your objective findings via trigger point charts. (See my article, “Charting Progress: Visuals for Success” in the February issue of Massage Today for more about this.)
When you take the time to administer a precise posture evaluation for your clients and devise a customized treatment plan, you will gain their respect and earn a reputation as a top massage therapist. Your clients will also appreciate how you utilized the information to educate them.

Don’t let the idea of conducting a postural analysis intimidate you. There are many things we do every day that we needed to learn to do for the first time. Once you get comfortable with posture, it will be easier to think about each client as an individual and know how to develop special treatment plans for each person. Over time, posture analysis becomes easy—second nature. You just need to start doing it.

For more information about posture analysis, as well as several tools to get started, visit KentHealth.com.

David Kent, LMT, NCTMB, is an international presenter, product innovator and writer. His clinic Muscular Pain Relief Center is in Deltona, Florida, where he receives referrals from various healthcare providers. David teaches Human Dissection, Deep Tissue Medical Massage and Practice Building seminars, and has developed a line of products, including the Postural Analysis Grid Chart™, Trigger Point Charts, Personalized Essential Office Forms™, and DVD programs. Visit www.KentHealtht.com or call (888) 574-5600.


[1] Kendall FP, McCreary EK, Provance PG. Muscles: Testing and Function, 4th ed. Williams & Wilkins, 1993: pg 71.

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