From the Guidelines
Maintaining proper posture and joint alignment is crucial for preventing pain, reducing injury risk, and optimizing physical function, as emphasized in the 2013 EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis 1. To achieve this, focus on keeping your spine in a neutral position with ears aligned over shoulders, shoulders over hips, and hips over ankles when standing. When sitting, maintain a 90-degree angle at hips and knees, with feet flat on the floor and lower back supported. For optimal joint alignment, avoid hyperextending joints, distribute weight evenly across joint surfaces, and maintain muscle balance through regular stretching and strengthening exercises. Core-strengthening exercises like planks and bird-dogs can significantly improve postural stability, as supported by the 2020 American College of Rheumatology guideline for the management of osteoarthritis of the hand, hip, and knee 1. Incorporate movement breaks every 30 minutes when sitting for prolonged periods, and consider ergonomic adjustments to your workspace, including a chair with lumbar support and a monitor at eye level. Proper alignment reduces unnecessary stress on muscles and joints, prevents abnormal wear on cartilage, and allows for efficient movement patterns. Being mindful of your posture throughout daily activities gradually trains your body to maintain healthier alignment naturally. Additionally, consider the use of assistive devices, such as canes, for patients with knee and/or hip OA, as strongly recommended by the 2020 American College of Rheumatology guideline 1. It is also essential to address weight loss, as it can significantly improve OA symptom management, especially when combined with a concomitant exercise program, as highlighted in the 2020 guideline 1. Overall, a comprehensive approach to maintaining proper posture and joint alignment, combined with regular exercise, weight management, and the use of assistive devices when necessary, can significantly improve morbidity, mortality, and quality of life outcomes for individuals with osteoarthritis.
From the Research
Posture and Joint Alignment
- Posture is the position of the body in space, controlled by a set of anatomical structures, including muscle-skeletal, visual, vestibular, and skin systems 2
- The maintenance and control of posture involve interactions between these systems, and defects or obstructions in certain areas, such as temporomandibular disorders, can impact posture 2
- Research suggests that posture is less relevant than movement itself in managing pain, and that creating change in patients' behavior and beliefs requires understanding, physical examination, clear communication, and not necessarily focusing on posture as the primary issue 3
Exercise and Postural Alignment
- Exercises, such as strengthening and stretching, can be effective in improving postural dysfunctions, including forward head and shoulder dysfunction, hyperkyphosis, and scoliosis 4
- The type and amount of exercise, as well as the intensity, volume, and duration, need to be taken into consideration when designing exercise programs for postural improvement 4
- Yoga, in particular, has been shown to be an effective intervention for improving functional ability, pain, and psychosocial outcomes in musculoskeletal conditions, including low back pain, osteoarthritis, and fibromyalgia 5, 6
Importance of Individualized Approach
- Reconciling the evidence regarding posture with a patient's individual context is important to optimally manage presenting patients 3
- A patient-centered approach, taking into account the individual's specific needs and circumstances, is essential for effective management of postural and musculoskeletal conditions 3, 5, 6