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june 2012

Poor Posture and the Tweet Generation
By: Joseph Ventura D.C.

Consider the conclusions from two recent studies:

“A significant linear trend for increasing sagittal plane postural translations of the head, thorax, pelvis, and knee was found in children age from 4 years to 12 years.”1

“Poor posture was diagnosed in 38.3% children, more frequently in boys. A significantly different occurrence of poor posture was found between 7-year-old and 11-year-old children (33.0% and 40.8%, respectively). The most frequently detected defects were as follows: protruding scapulae (50% of all children), increased lumbar lordosis (32%), and round back (31%). Children with poor posture reported headache and pain in the cervical and lumbar spine more frequently.”2

Study after study is validating what chiropractors have been seeing for the past decade or more: Children at a younger and younger age are seeking relief from adult type pain and discomfort. What could be the cause of this increased frequency of young patients seeking care? The author believes it is the result of sociological and technological pressures that have only developed within the past generation, the Tweet Generation.

It began in the early 90’s when schools eliminated lockers and required children to carry their lockers in backpacks. A couple of years later that child began playing hand held video games. Next came the cell phone for kids with affordable family plans. But the child didn’t use the phone to make and receive calls. They used them for texting. Massive amounts of texting. The author’s 11 year old daughter sent out 11,000 text messages in one month.

Next we go back to a change made at the school level. As the Internet expanded so did the reliance of schools on the Internet as a method of delivering content. So, as a result, time in front of a computer at school and at home was required.

The connection between all these activities is clear: Since the early 90’s children from the age of nine up through young adulthood, their musculoskeletal formative years, have engaged in activities that create a Forward Head Posture environment. These activities have literally molded their bodies into an abnormal posture profile. Re-read the conclusions of the studies cited at the beginning of this article. For those readers not yet alarmed at those conclusions, consider these other studies.

• “All measures of health status showed significantly poorer scores as C7 plumb line deviation increased.”3

• “Older men and women with hyperkyphotic posture have higher mortality rates.”4

• “Spinal pain, headache, mood, blood pressure, pulse, and lung capacity are among the functions most easily influenced by posture.”5

What is being done to raise adult awareness of this growing trend in children? Not much. Every State requires a school scoliosis exam. During a school scoliosis exam a child is also examined from the side, but only to observe evidence of gross kyphosis. And in most States that part of the exam is not mandatory. Studies have shown that 4.2% of the children screened for scoliosis trigger a referral for radiographs. And of those 4% only a small fraction will require advanced treatment. It appears that nobody is educating parents and schools about the

30% of the children in that same age group that are experiencing Forward Head Posture and it effects.


Good Posture Primer

For the purpose of this article, the focus will be on postural alignment from the side. Normal, neutral posture is present when a plumb line passes through five anatomical landmarks: Center of the ear, center of the shoulder, greater trochanter, center of the knee and just in front of the ankle. This is illustrated in the picture on the left. Notice how straight the black plumb line is.

The most common abnormal posture profile is illustrated on the right. The head sits forward of the shoulders, the upper back has drifted backward and the pelvis has tipped forward. This is commonly known as Forward Head Posture (FHP). Notice the straight plumb line we expect to see in good posture now has a substantial curve in FHP. It’s been estimated that 80% of the general population has varying degrees of FHP

The author placed a typical middle school youth in front of a posture grid and asked the youth to send out a text. Itwas discovered that the head was placed in a position4.5” in front of the shoulders and placed the shoulder joints in internal rotation. The typical youth can text up to 30 hours per month.

Combined with other technology and social stressors, today’s youth is at a greater risk for “molded” forward head posture than any past generation. Considering the important immediate and future health ramifications of poor posture, accurate posture exams and counseling with parents, children and schools should be a part of every wellness practice.

1. Postural development in school children: a cross-sectional study.

Chiropr Osteopat. 2007; 15:1 (ISSN: 1746-1340)

2. Prevalence and risk factors of poor posture in school children in the Czech Republic.

J Sch Health. 2007; 77(3):131-7 (ISSN: 0022-4391) 

3. SPINE, 2005 

4. Journal of the American Geriatrics Society, 2004 

5. American Journal of Pain Management, 1994 

6. Archives of Internal Medicine 2007

About the Author

Dr. Joseph Ventura, one of the National Posture Institute's Board of Advisors, began his practice of sports injuries in 1978. He has treated numerous high school, college and professional athletes, and was the team physician for a local community college and high school. He was also one of the treating physicians at the U.S. Open Tennis tournament in 1985.


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