Using Posture for Automatic Patient Reactivation What do you have to see before you know what to do?

Successful doctors treat the cause of the problem, not the symptoms. They are able to quickly and accurately determine the source of the patient’s stress, devise a plan of treatment, and confidently convey their findings to the patient. They specialize in helping problem cases—the ones no one else can help. They solve these cases by identifying the specific cause(s) of the patients’ symptoms that have not been identified elsewhere.

What tests can you perform in your office that other practitioners do not? While addressing a chiropractic audience recently, I was surprised to find that few chiropractors perform a periodic postural analysis on their patients. A visual inspection only takes about one minute and is one of the most effective means of patient education available to you. No expensive equipment is needed, except perhaps a full length mirror. Once postural deviations are identified and related to their symptoms, the patient can recognize when they need to return to your office–before their symptoms return.

If you haven’t thought about postural analysis lately, let’s review posture and what it can tell you quickly and inexpensively. We will quickly scan for head tilt, shoulder level, hip level, knee flexion, and ankle pronation. That should take about 30 seconds, but will yield a great deal of information.

Head Tilt

This usually involves misalignment of the occipito-atlantal condyles and cervical flexion-extension problems. When palpation reveals painful muscles on the high side, the patient is usually experiencing stretch-related symptoms, such as muscle tension headaches. Painful muscle contractions of the low side are usually related to compression-type symptoms, such as vertigo and migraine headaches.

Low Shoulder

The low shoulder is usually the side of dysfunction and symptoms. But, remember that non-traumatic shoulder complaints can originate anywhere in the body. For example, many visceral dysfunctions such as bowel irregularity or lymphatic and respiratory congestion are often involved.

Loss of rib excursion on breathing will produce shoulder symptoms. Palpate the angle of the ribs adjacent to the medial border of the scapula and relate them to painful stress points within the infraspinatus fossa. These will be related not only to respiratory problems, but thyroid dysfunction and upper extremity complaints as well.

Another frequent source of shoulder symptoms is digestive inadequacy and the appearance of a Pottenger’s Saucer. Believe it or not, when I ask how many routinely check for loss of normal thoracic kyphosis, very few respond positively. This is responsible for many muscle-tension headaches and can be caused by any of the digestive complaints so common in today’s patients.

Iliac Crest

Place your hands on top of the iliac crests and compare their height. A low ilium can result from many causes, but leg deficiency is probably the most common and can be caused by a dropped arch in the foot or a fracture in the lower extremity. But, be aware that the short leg usually causes posterior rotation of the ilium, which elevates the crest, and it may appear level with the opposite side.

Lateral Pelvis

A lateral shifting of the pelvis is a frequent sign of sacroiliac involvement, but the key to resolving this problem is often seen at the level of the 5th cervical. The works of both Gravel and Reaver are convincing in this regard.

Flexed Knee

Unfortunately, this phenomenon is frequently overlooked. Knee flexion is usually a compensation and appears on the side opposite a leg deficiency. When this is the case, the knee can easily be straightened. This, of course, causes immediate and revealing changes in the pelvis. Instruct the patient that this produces a shearing type wear-and-tear in the hip joint above it while walking and may eventually lead to hip replacement.

But, the flexed knee may also be associated with cartilage damage and prevent complete knee extension. Condyle damage often occurs on the convex side of a scoliosis.

Ankle Pronation

Ankle pronation results in a “toeing out” of the foot when walking. This phenomenon and its resulting consequences are well documented. Asymmetrical pronation is a devastating stress to body mechanics, resulting in medial knee stress, anterior movement of the pelvis, increased thoracic kyphosis, and loss of cervical stability with the head carried in a forward position.


Without a doubt, the most overlooked postural deviation is one iliac crest being lower than the other when the patient is sitting. Studies indicate that 20 to 30 percent of the population could use an ischial lift to level the pelvis when sitting. The implications to lumbosacral stability, lumbar scoliosis, and pelvic organ dysfunctions are evident.


What do you have to see before you know what to do? Remember, the secret of your success is determined by how quickly and accurately you can determine the source of your patient’s stress, devise a plan of treatment, and confidently convey your findings to the patient.


Dr. Loomis can be reached by mail at 6421 Enterprise Lane, Madison, WI 53719 or by phone at 1-800-662-2630.Visit his website at

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