Posture and Pain in Children

:dropcap_open:I:dropcap_close:t’s probably fair to say that most chiropractors treat children in their practices to one degree or another. A 2012 survey of European chiropractors reported that children under age 18 comprised slightly over 8% of the patient mix among more than 900 practices surveyed.1  That’s a significant number of kids and I suspect the numbers aren’t much different here in the US. But that’s not really the study I wanted to discuss this month. I mentioned that paper so I could tell you about another paper that I personally think is important.
childslouchingThis paper, a 2012 study from Spine, examined the relationship between posture and spinal pain in young people. The authors looked at 1,196 Flemish adolescents. The average age of the 639 male participants was 12.6 years; it was 10.6 years for the 557 females. The authors acknowledge that data relating posture to pain, particularly in young people, are “sparse.” As a profession, chiropractors historically have placed a great deal of emphasis on the relationship between spinal structure and spinal pain, although that emphasis has waned in recent decades. In spite of our profession’s history, a number of previous studies, several of which looked at the status of the spinal curves, have failed to show any clear correlation between posture and spinal pain. Other studies that focused more on regional or segmental misalignment have also failed to show a correlation between spinal structure and pain.  
This study was done a bit differently. The authors assessed the habitual standing posture of the children using digital “head to toe” photographs. The photos were then measured to assess the global alignment of the large body segments (head, trunk, and pelvis) relative to a vertical gravity line extending upward from the lateral malleolus. What they found should be of interest to our profession. It appears, at least in the study, that posture does indeed matter.
:dropcap_open:How we hold our bodies is intimately related to how our bodies move and function.:quoteleft_close: 
Global misalignment of the large body segments appeared to be associated with spinal pain. The authors suggest that “orientation of various body segments with respect to the gravity plumb line (i.e., anteroposterior translations of the head, trunk, and pelvis) may be paramount compared with the local spinopelvic characteristics with respect to the development of symptomatic IASP [idiopathic adolescent spinal pain].” There were some observed differences between sexes (results appear to be more applicable for boys than girls) and final conclusions are probably further down the road. As always, more research is needed.
However, this approach of looking at global postural alignment may have exciting possibilities for the chiropractic profession. Although early chiropractors embraced an admittedly flawed model (single segmental misalignment) to explain how and why our adjusting methods seemed to work, chiropractic in recent decades has poured much effort into embracing a more dynamic/functional approach to manipulative therapies. In doing so, we may have inadvertently developed a case of professional tunnel vision and failed to note the obvious—how we hold our bodies is intimately related to how our bodies move and function. 
Take Home:
Young people make up a significant percentage of patients treated by chiropractors and idiopathic adolescent spinal pain is a significant problem. Poor postural alignment of the large body segments, an easily observable phenomenon, appears to be associated with spinal pain in adolescents. The authors point out that by age 18 the prevalence of back pain in adolescents is approaching that of the general population. The authors also point out that spinal pain during adolescence may represent a risk factor for spinal pain/problems in adulthood as well. This article provides a useful reference for those practitioners already interested in a structural/postural approach to chiropractic care and perhaps food for thought for the rest of us.
Special thanks to Chiropractic Sciences Contributor Roger Coleman, DC of Othello, Washington for his recent review at
  1. .Marchand AM. Chiropractic care of children from birth to adolescence and classification of reported conditions: an internet cross-sectional survey of 956 European chiropractors. J Manipulative Physiol Ther. 2012 Jun;35(5):372-80.
  2. Dolphens M, Cagnie B, Coorevits P, Vanderstraeten G, Cardon G, D’hooge R, Daneels L. Sagittal standing posture and its association with spinal pain: a school-based epidemiological study of 1196 Flemish adolescents before age at peak height velocity. Spine. 2012;37:1657-66.
Link to Abstract:
Dr. Mark R Payne, Phenix City, AL is Editor of, a scientific literature review for busy chiropractors. He is also President of Matlin Mfg Inc. a manufacturer of postural rehabilitation products since 1988. Subscription to is FREE to doctors of chiropractic and chiropractic students. Reviews of relevant scientific articles are emailed weekly to subscribers.

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