Treating Posture Dysfunction of the Upper Extremities
By Tim Agnew

The woman on the phone didn’t waste any time.
“I have an issue with my fifteen-year-old daughter that I thought you might help me with,” she said directly.
“Okay,” I said.
“She is fifteen and a beautiful young lady."
“I’m sure she is,” I said.
“I don’t know if this is in your line of work."
“Tell me what it is and I’ll let you know,” I said. I waited.
“Okay, she left the room. She has horrible posture. She slouches all of the time."
“I see.”
“We have a cue, a phrase that we use and then she’ll straighten up.” She sighed. “But it doesn’t last. Can you help?"
When I said I could, she quickly asked, “It’s not too late?"

Calls from concerned parents about children’s posture issues have not been a rare item in my years of private kinesiology practice. If anything, it is something that I have seen more of the longer I practice. Heavier book bags, sports involvement, and poor posture habits all contribute to present posture dysfunction in children. Poor posture that starts early will stay later. As the child approaches adulthood, the posture that was adopted as a juvenile will remain “accepted” in older years. The body learns to accept poor posture because it begins to feel comfortable in the dysfunctional position. As proof, ask any child with rounded shoulders to “sit up” and watch what happens. It is often uncomfortable for the child to hold the shoulders back with the chest out. When the parent turns her head the child has resumed the poor posture.

It is important to recognize poor posture in children and correct it early, and it is never too late to help that poor posture. While you can treat an adult with dysfunctional posture, the ideal goal is to catch it early and prevent adult on-set problems such as wedged thoracic vertebra and scoliosis.

How should a therapist approach poor posture? Can massage therapists learn to correct dysfunctional posture? The answer is yes. While I practice traditional kinesiology (the science of muscle movement), I teach a modality known as Clinical Flexibility and Therapeutic Exercise (CFTE) to healthcare providers. This modality is derived from kinesiology, manual therapy, and biomechanics, and is easily adapted into massage therapy. One of the wonderful things about CFTE is that it is a modality that gives patients something they can do themselves. Its philosophy is powerful: treat and educate patients to involve them in the healing process. Very few modalities offer this in healthcare, yet it is the future of patient-therapy based medical care. When the patient understands what she must do to help correct the problem, an amazing thing happens: healing.

When patients become involved in their own therapy, the cycle of treatment after treatment is broken. This is one of the goals of CFTE; it becomes a self-contained method that allows patients to literally maintain their own problems. While it is not a miracle modality that will “cure” all ailments, it is an empowering modality that helps many common types of dysfunction such as arthritis, tendonitis, sciatica, carpal tunnel, posture dysfunction, and endless others.

When the mother I spoke to on the phone finally brought her daughter in, I observed “Nicole’s” posture as she walked through my door. She is a tall, thin teenager with a lanky torso. Her shoulders were indeed rounded, and although she was consciously trying to hold them back for my benefit, I saw it was a challenge for her. She has a long, graceful neck but she struggled to keep her chin retracted. As we talked her chin kept sliding forward into a “turkey neck” position as her chest caved in.

Nicole is a piano student hoping to get a scholarship to a music school. She sits for long periods practicing, and her neck bothers her on a daily basis. The pain is located at the base of the occipital, and to the right of her skull where the upper trapezius fibers attach. When I palpate her posterior neck and shoulders, I find tender areas at tips of both medial borders of the scapula. When I press into the belly of the rhomboids she jumps.

“The pain goes right up into my head,” she told me.

Part of the protocol for CFTE is to assess and treat limited range of motion (ROM) through Active Isolated Stretching (AIS), an active and specific method of stretching soft tissue. When I look at her pectoralis major and minor, I find these limited. It is not surprising in cases of rounded shoulders to find these muscles tight, and one of the first things that must be accomplished is to “open” her anterior thoracic spine.

Nicole’s antigravity muscles-rhomboids, trapezius, levator scapula, teres major, infraspinatus, and latissimus-must then be strengthened. In short, our goal is to:

Nicole was shown specific stretching exercises that she needed to perform on a daily basis through a book that detailed, step by step, the exercises she needed to do. The book came with the treatment, and was hers to take home. As long as she followed the pictures in the book, she could do the exercises herself. She was then shown, in one other visit, resistance exercises for her neck and antigravity muscles.
While all of this might sound complicated, it is not. Nicole was only shown a few exercises, and was made to understand that she must do them. I only saw her two times.

I ask all of my patients to give me a follow up call in two to three weeks to let me know how they are doing. In this case, it was her mother who called me.

“Nicole says her neck pain is gone. She’s doing the exercises and her shoulders look much straighter.”
Space will not allow me to go into every aspect of this work; I could spend an eternity discussing its benefits. That said, the CFTE work allows massage therapists to become proactive in their treatments, and it empowers their patients to improve their lives. It helps the individual massage therapist establish a “specialized” form of therapy because it offers a specific, dynamic approach with a proven success rate.
CFTE is a modality that must be mastered with practice and clinical experience. While a student can learn several techniques to add to their own practice, CFTE is a “life-art,” one that demands focus and intensive study. Yet its results are amazing.

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