Understanding the Miracle
In the last blog (Link To Previous Blog), you met Andreana, the bright 29-year old woman who sought postural correction treatment for persistent neck pain. The relief of neck pain was not the miracle; the correction of her chronic urinary incontinence was. Andreana had suffered for as long as she could remember from urinary incontinence. Like many other people in Andreana’s situation she identified herself with her symptoms. Although incontinence was the underlying problem, the resultant low level of self-esteem, constant state of high anxiety, and less attractive timid posture was what was really affecting her quality of life.
“Luckily” for Andreana she had job-related neck pain that stimulated her take action to correct her posture. Although she did expect her neck pain to go away, what she didn’t expect was a miracle. To her, the correction of her urinary incontinence was a miracle that she didn’t believe was possible.
What Posture Experts Need to Know:
From a clinical perspective, was this a miracle or an expected outcome of postural correction? Understanding the clinical “miracle” can be easily achieved by understanding the structure and function of the Posture System. For this case presentation, focus on posture quadrant 3, which extends from the diaphragm anteriorly and the first lumbar vertebra posteriorly to the base of the hip joints bilaterally.
Andreana’s distorted postural presentation was affecting the physiologic function of posture quadrant 3, the core lumbopelvic anatomic region. Posture quadrant 3 includes the core musculature, the lumbar spine, and the pelvic girdle. The core musculature is made up of the diaphragm, the transverse abdominus, the external obliques, and the pelvic floor muscles.
Pathologic Consequence of Postural Distortion Patterns:
Pelvic floor muscle control is directly related to postural symmetry and core activation. In fact, research demonstrates that electromyographic activity of the pelvic floor musculature increases significantly when patients go from a slumped posture to an upright posture. The activity increases even further as patients extend their posture to tall, erect sitting positions (Sapsford et al., 2007). Therefore, proper posture stimulates activation of the pelvic floor to prevent urinary leakage.
Efficient muscle activation of the pelvic floor restores proper load transfer through the lumbopelvic region, while strengthening the transverse abdominis (Critchley, 2006). The transverse abdominis, a deep core muscle plays a crucial role in supporting proper postural alignment of the lumbar spine. The majority of patients who present with dysfunction of posture quadrant 3 demonstrate weakness of the transverse abdominis.
Posture Experts should also consider the relationship between the alignment of the pelvis and sacrum, and how it affects urinary incontinence. Weakness of pelvic floor musculature can generate a backward rotation of the sacrum, as seen in both males and females. In females, there has also been noted stiffening of the sacroiliac joints with pelvic floor alteration (Pool-Goudzwaard, et al., 2004).
The lumbar curvature should also be considered. Asymptomatic women tend to have a greater depth of lumbar lordotic curvature (in particular while seated) than women with urinary incontinence. Women who present with urinary incontinence tend to demonstrate anterior pelvic translation while seated with related slumped spinal posture.
According to Norton and Baker (1994), “Postural changes are an effective means of reducing urine leakage in women with stress urinary incontinence and should be an integral part of the management of this condition.”
In the next blog you will discover the clinical analysis and clinical correction methods that can be applied to other patients just like Andreana. Continue reading about Andreana’s case to make the connection between the structure and function of the Posture System and the clinical application techniques necessary to make impactful changes in the lives of your patients.
Dr. Krista Burns DC, DRHA, CPEP, CPE
Doctor of Chiropractic
Doctor of Health Administration
Certified Postural Expert
Co-Founder American Posture Institute