Category Archives: Posture

Scoliosis Treatment Options – Chiropractic Care & Medical Model

scoliosis treatmentScoliosis is a condition in which there is an abnormal lateral deviation of the spine. In layman’s translation: if you look at a person from the back side, the spine has a C-shape or S-shape curve instead of the normal, vertically upright orientation.

There are two categories of scoliosis: postural scoliosis and structural scoliosis. The purpose of this article is to differentiate these two types of scoliosis, to describe the chiropractic approach to scoliosis care and lastly, to differentiate this from the medical approach. This is so that you may better understand some of the various available options for scoliosis care.

Functional / Postural Scoliosis:

overpronation causing posture changeA postural scoliosis is essentially an postural adaptation to an imbalance in your base of support. For example, a leg length inequality or a low arch on one side compared to the other. This will cause the pelvis to dip down on one side. Then your spine will curve as an adaptive response because all of the joints are functionally connected. This type of scoliosis is generally flexible and can be diagnosed from physical examination findings (evidence of short leg and a flexible spinal curve that unwinds with side bending of the torso). This type of scoliosis is also usually fairly straightforward to correct. Custom foot orthotics are used to correct the alignment of the feet or a heel rise is used if there is a structurally short leg. Chiropractic care may also be recommended to the postural scoliosis patient to address any muscle or joint findings and any resulting pain from years of abnormal force distribution.

Structural Scoliosis:

A structural scoliosis is a bit more complicated to deal with. There are many types of structural scoliosis. One such type is adolescent idiopathic scoliosis. This is a rigid, inflexible spinal curve and for unknown reasons, the spine just grows that way. While the spine continues to grow, there is a risk that it will continue to get worse. Chiropractic management includes manual adjustments and/or mobilizations to the spine to improve flexibility, function, alignment and mechanical balance. Chiropractic care is also helpful for naturally managing pain. Exercises are also prescribed.

Proprioceptive exercises are particularly beneficial for scoliosis patients (of either type). Proprioceptive exercises are exercises that improve body position awareness. Examples include exercises on an exercise ball, rocker board, wobble board or vibration platform. Yoga and Tai Chi are also great balancing exercises. Chiropractic care combined with proprioceptive exercises help to retrain the central nervous system. Beyond this, specific corrective exercises may be prescribed which are designed to stretch the relatively tighter muscles and strengthen the relatively weaker ones. Preferably, these should be done daily. Deep breathing exercises and sleep posture awareness are also beneficial.

Risks of Scoliosis:

Just because you have scoliosis does not guarantee that you will have problems later in life. Many people carry on with their lives with no idea and a scoliosis is incidentally found later. That being said, there are some risks with scoliosis. Statistically, with greater curves there tends to be more pain and also earlier onset of arthritis due to uneven wear and tear to the joints. There is also a risk that the scoliosis may continue to progress (especially during adolescence, when the spine is still growing). With structural scoliosis, there is concern about compression of the internal organs when curves progress beyond a certain point.

Scoliosis Diagnosis:

Scoliosis is diagnosed through physical examination and/or x-ray imaging. The physical examination entails an assessment of posture, flexibility of spinal ranges of motion and orthopedic testing. Chiropractors have trained eyes for detecting posture abnormalities such as unleveling of the shoulders, pelvis, hips, knees and feet which may indicate an underlying scoliosis. If a scoliosis is detected, the second step is to determine if it is postural or structural. A postural scoliosis will unwind upon side bending of the torso. A structural scoliosis will not unwind fully upon side bending and will have a positive Adam’s test (forward flexing the spine will have evidence of rib protrusion on one side). An x-ray may be ordered to evaluate the severity and objectively measure the curve. Other potential causes for scoliosis also need to be ruled out.

Conventional Medical Management of Structural Scoliosis:

The conventional medical management of structural scoliosis involves monitoring, bracing, medication and/or surgery. Medication is suggested only as a means for symptomatic relief and does nothing to solve the underlying cause (which is unknown). If the patient is still growing, progression is monitored by first a baseline x-ray and then follow-up x-rays every few months. If the curve progresses, a spinal brace is typically recommended. A brace is intended to prevent further progression but patient compliance is a challenge because spinal braces tend to be uncomfortable and awkward (especially for the self-conscious adolescent). If the scoliosis progresses beyond a certain point, the patient may be recommended spinal surgery in which a metal rod is surgically fused to the spine to straighten it out. This procedure is invasive and has many inherent risks.

Why Chiropractic Makes Sense:

In light of the other available options, chiropractic care is a logical approach for scoliosis management. Chiropractic care is hands on, non-invasive and drug-free. It attempts to correct the underlying mechanical problems in scoliosis, relieve pain naturally and empower the patient to continue appropriate home care corrective and postural awareness exercises. While there is no guarantee that chiropractic will correct a structural scoliosis, there is evidence in the literature that it can slow the progression and improve the curve in some cases. For these reasons, chiropractic care makes sense. If unsuccessful, the conventional medical management is still an option. While chiropractic care is a logical approach, it is not a quick fix. Typically a lengthy course of care is recommended, with regular progress examinations to objectively evaluate changes.

  1. Chen, Kao-Chang & Chiu, Elley. (2008). Adolescent Idiopathic Scoliosis Treated by Spinal Manipulation: A Case Study. The Journal of Alternative and Complementary Medicine: 14(6); 749-751.

  2. Sanna, Mark. (2009). A New Look at Adolescent Idiopathic Scoliosis. The American Chiropractor: April 2009; 18-19.

  3. Woggon, Dennis. (2005). Scoliosis Correction – CEAR Solutions; Chiropractic Leadership, Educational Advancement & Research. The American Chiropractor. February 2005; 54-56.

  4. Hyland, John. (2008). Functional Scoliosis. The American Chiropractor. April 2008; 30-31

  5. Payne, Mark. (2008). Scoliosis: A Postural Approach. The American Chiropractor. April 2008; 26-28.

  6. Yochum, Terry & Maola, Chad. (2008). Scoliosis. The American Chiropractor. April 2008; 14-16.

  7. Lamantia, Marc. (2009). Review of the Literature: Non-operative Scoliosis Treatment. The American Chiropractor. April 2009; 20-23.

  8. Woggon, Dennis. (2006). Can Chiropractic Care Help Scoliosis? The American Chiropractor: May 2006; 24-25.

  9. Morningstar, Mark, Woggan, Dennis & Lawrence, Gary. (2004). Scoliosis treatment using a combination of manipulative and rehabilitative therapy: a retrospective case series. BMC Musculoskeletal Disorders.

Dr. Elisabeth Miron

The Forward Head Posture Epidemic

poor posture - forward head posture epidemicMost of us appreciate that posture is important. Ideal posture means there is a ideal distribution of forces across different joints in the body and balanced muscle tone. Optimal posture will help you to not only feel great but also look great and exude confidence!

Today, I’m going to talk about a common postural phenomenon – forward head posture. I’m calling this an epidemic because Webster’s dictionary defines epidemic as “affecting or tending to affect a disproportionately large number of individuals within a population, community, or region.” When I meet people in my community, I see this everywhere!

What is Forward Head Posture?

Forward head posture is when the head translates forward relative to the torso. It is also commonly associated with straight neck syndrome (when there is loss of the normal curvature of the neck). Ideally, when looking at a person from the side, the ear should line up with the shoulder. Forward head posture is common especially in students and office workers who sit at a desk for hours on end.

Causes of Forward Head Posture:

Common causes of forward head posture are…

  1. Carrying too heavy of a backpack or carrying it too low – the head often moves forward to counterbalance the weight of your bag.

  2. Slouching or leaning forward for prolonged periods at one’s workstation

  3. General lack of postural awareness

Symptoms Associated with Forward Head Posture:

Common symptoms associated with forward head posture are…

  1. Neck pain

  2. Tense and sore muscles in the back of the neck and shoulders

  3. Joint irritation

  4. Headaches

  5. Back pain (yes, even back pain!)

What causes these symptoms? Basically, there is suboptimal loading of the muscles and joints. The head is akin to a bowling ball – roughly 10 pounds – that sits atop your neck and shoulders. When it moves forward, the posterior neck muscles must work more to counterbalance your head. Hence, tense and sore muscles. When the muscles tense up, this also increased pressure between the joints. This, combined with shearing forces from suboptimal position, results in joint irritation. Joint irritation and excessive muscle tension in the neck often causes headaches due to pain referral. Irritated nerve endings in the neck refer pain to the head causing or contributing to tension headaches.

Now what about back pain, you ask? Yes, forward head posture can even cause back pain! All the joints and muscles in your body are functionally connected. Think back to high school physics class when you learned about levers. When an object moves further from the fulcrum, the turning force (or moment) becomes greater. You can apply this concept for lifting a large object by using a long lever. The only problem in your low back is that the lever is short and can’t be changed. So, when your head moves forward relative to your centre of gravity, your low back muscles must fire like crazy to counterbalance your head – otherwise you’ll fall over.forward head posture puts more load on the back

How to Fix Forward Head Posture:

Chiropractic care can help you correct forward head posture. Your chiropractor will quickly and easily identify postural defects and will let you know if you have any. Specific exercises can be prescribed for stretching relatively short and tense muscles and for strengthening relatively weaker, lengthened muscles. A chiropractor will help you become more aware of your posture. Individualized treatments including chiropractic adjustments will help to release pressure in tight, restricted and irritated joints balancing spinal mechanics and relieving pain.

So, go see your chiropractor! Or, if you’re from Aurora or York Region, come see me!

A healthy spine = A healthy body!

Dr. Elisabeth Miron

Common Muscle Imbalances: Upper Crossed Syndrome & Lower Crossed Syndrome

Maintaining poor posture for a prolonged period can lead to common muscle imbalances known as upper crossed syndrome and lower crossed syndrome, described first by Dr. Vladimir Janda. In these syndromes, there is a pattern of muscles that become relatively tight/short versus muscles that become weak/long. Unfortunately, with ageing, posture tends to decline. That being said, much improvement can be gained from posture retraining and rehabilitation exercises of the involved muscles.

Predisposing Activities Leading to Muscle Imbalance:

It appears that we are living in a flexion-addicted society. What this means, is that people tend to frequently stoop forward. This is seen in office workers and students who tend to sit at a desk for prolonged periods, slouching forward to see the computer screen. Students carrying heavy backpacks also tend to lean forward – the shoulders curve inwards and the head juts forward to counterbalance the load. Reclining on the sofa and driving in one’s car, people are frequently in a forward flexed position.

In the above examples, the muscle imbalances are seen between the front and back of the body. It is also possible to see muscle imbalance between left and right sides. Handedness contributes to this phenomenon because the dominant side is used more and becomes stronger. One-sided rotational sports (such as tennis, golf, hockey, baseball…) can also predispose an individual to this type of muscle imbalance.

Consequences of Poor Posture:

Most people don’t think about the impact that posture plays on overall health. Many people also don’t put two and two together and recognize that posture can be responsible for pain – yet they wonder why they have frequent headaches, neck pain, back pain and fatigue. Suboptimal posture inevitably leads to suboptimal loading of the spinal joints and stress and strain on muscles and ligaments which can contribute to pain and even arthritis over time. Below is a list of common negative consequences of poor posture.

  • pain in the neck, mid-back or low back

  • muscle spasm/tightness

  • decreased range of motion

  • fatigue

  • arthritis, due to uneven joint wear over time

  • increased risk for disc herniation (especially when poor posture is combined with exertion or repetitive flexion)

  • headaches (including migraines, tension headaches and cervicogenic headaches)

  • suboccipital pain

  • teeth clenching & TMJ problems

  • rib dysfunction

  • pinched nerves

  • reduced lung capacity

  • loss of overall height

  • poor appearance

  • reduced balance

  • reduced performance

  • poor digestion (due to compression of internal organs)

  • less energy, poor mood

As seen above, poor posture can impact one’s whole body and overall health. How do we correct this? The first step is awareness.

optimal postureOptimal Posture:

Optimal posture is the posture that minimizes joint compression and shearing forces and minimizes muscle contraction necessary to stand upright. The body can carry the weight of gravity comfortably and efficiently. In general, there are two gentle backward curves in the spine (the cervical lordosis and lumbar lordosis) and a gentle forward curve in the mid-back (thoracic kyphosis). Having these gentle curves aids in shock absorption between joint surfaces as you ambulate. Deviations from normal (either excessive curvature or reduced curvature) can lead to problems. When visualizing the body in the side view, ideally the following structures should line up: the ear, the shoulder, the hip, the knee and the front of the ankle.

Upper Crossed Syndrome:

Upper crossed syndrome is characterized by the following muscle pattern.

Tightness: upper trapezius, levator scapulae, sternocleidomastoid and pectoralis muscles

Weakness: deep neck flexors, serratus anterior, middle trapezius and lower trapezius muscles

upper crossed symdrome postureLower Crossed Syndrome:

Lower crossed syndrome is characterized by the following muscle pattern.

Tightness: erector spinae (thoraco-lumbar), rectus femoris and iliopsoas muscles

Weakness: abdominals and gluteal muscles

lower crossed syndromeCorrecting Upper and Lower Crossed Syndromes:

Correcting upper and lower crossed syndromes can be challenging especially if they’ve existed for a long time. Patience and dedication are required to ultimately correct posture. In some people, posture can’t be fully corrected but with the following tips, improvements can be made and further declines can be prevented.

**Note: Poor posture, especially when accompanied with pain can sometimes be a sign of a deeper underlying condition (such as osteoporosis or rheumatological conditions). The following is for information purposes only and does not apply to everyone. Consult with a health professional before beginning any exercise program.

  1. Posture Education: You must understand the importance of good posture and be conscious of your posture as you carry about daily activities. Actively correct yourself.

  2. Avoid Prolonged Postures: If your work requires prolonged sitting, remember to get up frequently and walk around. In other words, take posture breaks at regular intervals. Sit up tall and do the Brugger’s stretch.

  3. Stay Physically Active: Overall fitness and endurance helps improve posture and prevent declines. It is also good for overall health.

  4. Corrective Exercises: Specific exercises to target the involved muscles are important. In general, tight/short muscles must be stretched and weak/long muscles must be strengthened. Endurance is just as important as strength.

corrective stretches
CORRECTIVE STRETCHES A) Brugger’s stretch: Sitting tall with chin tucked back, lift chest and externally rotate arms back. B) Chin tuck: Tuck chin straight back and hold for several seconds. C) Forward lunge: With hands on hips and torso tall, lean forward to feel a stretch in the psoas. D) Pectoralis stretch: Staying tall, rotate shoulders and extend arms back. E) Quadriceps stretch: Pull heel to buttocks.
corrective strengthening
CORRECTIVE STRENGTHENING A) Deep neck flexor exercise: Tuck your chin straight back and lift head 1 inch off floor. B) Bridge: Squeeze gluteal muscles then lift pelvis of floor to make a straight line. C) Plank: Resting on elbows, lift body off floor in straight line to strengthen abdominals. D) Scap T: Lying prone with pillow under forehead, lift arms up in ‘T’ position with thumbs pointed to ceiling to strengthen middle traps. E) Reverse fly: This is an alternative to D. Keep spine neutral, only bending at hips and knees. Holding light weights, bring arms back in ‘T’ position.

How Chiropractic Helps with Posture Syndromes:

Chiropractic care plays an important role in diagnosing and correcting postural problems. Chiropractic care helps relieve pain, improve flexibility, improve joint function and improve muscle balance. Chronic poor posture can lead to pain and arthritis. Muscle imbalance can lead to joint dysfunction and poor spinal alignment. Chiropractic care involves manual therapies to help put the body into better balance both mechanically and neurologically. Chiropractors can also prescribe exercises to balance the muscles and facilitate recovery and provide other holistic advice. Postural problems and related joint dysfunction do not appear overnight and will not disappear overnight. These issues require a program of care and dedication on the patient’s part too. Combining passive chiropractic treatment with home exercises leads to the best results.

Preventing Spinal Injuries:

Having good posture as you carry about your daily activities plays a critical role in prevention of spinal injuries. Having a strong core is also important.

Dr. Elisabeth Miron

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For more healthful tips, visit your local chiropractor! Or, if you’re in Aurora or York Region, come see me!

Poor Desk Posture

Why Prolonged Sitting Sucks – How to Save Your Spine

Poor Desk PostureA common misconception is that you won’t be injured from sitting. The fact of the matter is that you don’t need a forceful physical trauma to sustain an injury. Injuries can indeed occur form mere sitting! These are commonly understood as postural strain type disorders in which there is repetitive and cumulative microtrauma to the tissues of the body. The sad truth is that the majority of people sit for most of the day. An average day consists of sitting at a desk for hours staring at a computer screen, sitting when driving to and from work, sitting during meals and more sitting in front of the TV. That’s quite a lot of sitting! Some of the worst culprits are students, office workers and people who drive for a living.

So what is wrong with prolonged sitting? With prolonged sitting, there is a tendency to slouch forward (or you may have poor posture to begin with). Ultimately with sustained postures, you end up consistently loading the same tissues in the same way (ie: your muscles, ligaments and joints). Over time, this leads to a phenomenon known as creep. This is similar to the mechanism by which dentists use braces to repair crooked teeth. The braces impart a constant force to the teeth such that over time, the tissues surrounding the teeth deform to allow the teeth to move into better alignment. Similarly, in your back and neck, prolonged postures can result in structural changes (affecting joint position and alignment), postural strain to the muscles and sprain to the ligaments. Common complaints include neck and shoulder pain, upper back pain, low back pain and headaches. These problems can become chronic if nothing is done. Soft tissue creep from prolonged slouching also impairs the reflex contraction of back muscles which normally act to protect the underlying spine from injury1. Thus, a person is more likely to sustain an injury immediately following prolonged sitting.


1) Move around!

Don’t sit for more than 40 minutes straight. Get up, go for a walk, move around or stretch. Range of motion exercises and spinal extension exercises are good. Make sure to change your position frequently (ie: take micro-breaks!) as this will help redistribute the forces acting on your body. Did you know that fidgeting is actually good for you? Besides burning extra calories, it helps to redistribute the forces acting on your body. Another good tip is to drink plenty of water. Besides hydrating the body and flushing out toxins, drinking plenty of water forces you to get up frequently to go to the bathroom!

2) Don’t slouch!

The unfortunate tendency for desk workers is to slouch. The head juts forward, the shoulders and upper back curl forward and the normal backward curve of the low back is reduced. Over time, this leads to a postural problem known as “upper crossed syndrome.” Upper crossed syndrome describes a pattern of muscles which are either chronically tight/shortened or weak/lengthened that develops over time2. Instead, sit erect maintaining the natural curves of your back. You may consider purchasing a lumbar support.

3) Stretch those muscles!

The muscles that are most important to stretch are those which are being chronically activated or shortened. These most typically include the pectoralis muscles, SCM, upper trapezium and levator scapula.

4) Focus on ergonomics!

Having an ergonomic office setup is important. For example, your computer screen is ideally placed straight in front and should be at a level that is directly in line with your eyes when you look forward. Make sure you have a comfortable chair that is adjustable. Make sure your keyboard and other equipment are placed close enough to avoid excessive/prolonged reaching and slouching.

5) Workout!

It is good to have an exercise routing during the workday. Exercise is good for the cardiovascular system and overall health. Doing core strengthening exercises is also good because the muscles of the core help protect the spine from injury.

6) Visit your chiropractor!

Your chiropractor will assist you in determining the best course of action for your problem and the best exercises for your case. Chiropractors use spinal adjustments to help restore proper alignment and mobility and keep you functioning optimally.

Remember: Have some faith and patience! Postural problems don’t develop over night and rarely go away over night. You need to change your bad habits into good habits and over time, your back (and overall health) will thank you.

  1. Sanchez-Zuriaga, D, Adams, MA & Dolan, P. (2010). Is activation of the back muscles impaired by creep or muscle fatigue? Spine. 35(5):517-25.

  2. Page, P. (2005). Muscle imbalances in older adults: improving posture and decreasing pain. The Journal on Active Aging. March April 2005; 30-39.

Dr. Elisabeth Miron

Looking for a chiropractor in Aurora or York Region? Visit my chiropractic website!

Why Posture Matters

It always amazes me how many people have postural imbalances and don’t even realize it! Many of them wonder why they have neck pain, back pain, headaches or general soreness without having any form of injury or trauma. A lot of the time, these problems are a direct result of irritation to muscles, joints or nerves from chronic, uncorrected imbalances in the body. Allow me to explain…

Some of the most common postural imbalances that I see are forward head carriage, excessive spinal curves, uneven shoulders or pelvis and scoliosis. These imbalances can arise from many different things such as daily activities, slips/falls, inactivity, daily stress, one-sided activities (such as golf or tennis) or poor posture habits (such as slouching). Posture imbalances can also sometimes originate at the feet which serve as one’s base of support. For example, if one or both arches collapse, it sets up an imbalance that will affect the alignment of related joints (like the knees, hips and pelvis). Everything is connected! In any event, body asymmetry over time can lead to uneven wear and tear to the body which can contribute to arthritis, muscle tension and tightness/restriction in spinal joints.posture types

It simply makes sense that a body in balance will feel better, heal better and function better!

A Healthy Spine = A Healthy Body.

Standing posture, sitting posture and dynamic postures are all important. Inappropriate body posture/position while lifting, for example, can result in injuries.

Posture is a like a window to the spine. If your posture is off, so too is your spinal alignment.

Regardless of pain or symptoms it is important to have your posture imbalances and alignment corrected as a form of spinal health maintenance and overall wellness. You don’t have to have pain to have a problem and a lot of the time these asymmetries can be corrected before chronic uneven wear and tear results in pain. You only have one spine! So take care of the one you have! Regular chiropractic checkups can prevent problems before they start just like how regular dental cleanings can prevent cavities.

The great news is that many posture problems can be corrected or drastically improved with chiropractic care. Chiropractors use hands-on adjustments to correct the alignment and mobility of the spine, pelvis and related joints such that your body regains its mechanical and neurological balance. Soft tissue therapies and home exercises may also be incorporated into your care plan depending on individual needs.

Achieving mechanical balance is only half of the chiropractic story. Chiropractic care also helps to balance nervous system function. Spinal health is so important because it protects the nervous system which controls and co-ordinates every system and process in the body. For optimal health, we need optimal communication in the nervous system. This can be achieved by optimizing alignment of the spine.

Regardless of pain or symptoms, everyone should have their spine checked. Chiropractic works.

The doctor of the future will give no medicine but will interest his patients int he care of the human frame, in diet, and in the cause and prevention of disease.” ~ Thomas Edison

Health is a lifestyle choice. Choose it. Make Chiropractic care a part of your healthy lifestyle.

Dr. Elisabeth Miron