John Lennon, BM, MM, C. Norman Sheeley, MD, Roger K. Cady, MD, William
Matta, Ph.D., Richard Cox, Ph.D. and William F. Simpson, Ph.D.

American Journal of Pain Management (AJPM 1994; 4:36-39)

Despite considerable evidence that posture affects physiology and function, the significant influence of posture on health is not addressed by most physicians. In fact, neither comprehensive postural nor structural evaluation is a routine part of training in physical diagnosis, and most osteopathic physicians do not describe postural/spinal mechanics in their usual patient evaluations.

Observations of the striking influence of postural mechanics on function and symptomatology have led to our hypothesis that posture affects and moderates every physiological function from breathing to normal hormonal production.

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

The most significant influences of posture are upon respiration, oxygenation, and sympathetic function. Ultimately, it appears that homeostasis and autonomic regulation are intimately connected with posture. The corollary these observations that many symptoms, including pain, may be moderated  or eliminated by improved posture.

Spinal Posture in the Sagittal Plane Is Associated With Future Dependence in Activities of Daily Living:
A Community-Based Cohort Study of Older Adults in Japan

goodPostureSmallerbadPostureSmallerJ Gerontol A Biol Sci Med Sci (2013) 68 (7): 869-875. doi: 10.1093/gerona/gls253

“Accumulated evidence shows how important spinal posture is for aged populations in maintaining independence in everyday life”, according to the author.

A team of researchers based in Japan discovered that the trunk angle of inclination — the angle between the true vertical and a straight line from the first thoracic vertebra to the first sacral vertebra (view image) — is associated with becoming dependent on help for activities of daily living (ADL). These activities include such basic self-care tasks as bathing, feeding, toileting, maintaining continence, dressing, and transferring in or out of a bed or chair.

Spinal posture was evaluated in 804 participants (338 men, 466 women, age range: 65–94 years) who were independent in ADL at baseline. They defined dependence in ADL as admission to a nursing home or need of home assistance. During the 4.5-year follow-up period, 126 (15.7%) participants became dependent in ADL, 7.6% died and 0.7% moved out of town.

The subjects who had the greatest angle of spinal inclination, were 3.47 times more likely to  become dependent in ADL than those with the least spinal inclination, even after adjusting covariants such as age, sex, back pain, and stiffness.

Hyperkyphotic Posture Predicts Mortality in Older Community-Dwelling Men and Women:
A Prospective Study

Deborah M. Kado, MD, Mei-Hua Huang, DrPH, Arun S. Karlamangla, MD, PhD,
Elizabeth Barrett-Connor, MD and Gail A. Greendale, MD

Journal of the American Geriatrics Society Volume 52 Issue 10 Page 1662 – October 2004

Objectives: To determine the association between hyperkyphotic posture and rate of mortality and cause-specific mortality in older persons.

Participants: Subjects were 1,353 participants from the Rancho Bernardo Study who had measurements of kyphotic posture.

Measures: Kyphotic posture was measured as the number of 1.7 cm blocks that needed to be placed under the participant’s head to achieve a neutral head position when lying supine on a radiology table. (ie on their backs on a hard and flat table) Individuals with hyperkyphosis cannot lie flat with their heads touching a flat surface unless they hyperextend their necks.

Participants were followed for an average of 4.2 years, with mortality and cause of death confirmed using review of death certificates.

Results: Persons with hyperkyphosis defined as needing one block to achieve a neutral head position had a 1.44 times great rate of mortality than those without hyperkyphotic posture.

normal“With increasing kyphotic posture, there was a trend towards greater mortality.”
“Hyperkyphosis remained a significant predictor of increased all-cause mortality.”
“In models adjusted for age and sex, hyperkyphosis was significantly associated only with deaths due to atherosclerosis.”
“For deaths due to atherosclerosis, participants with hyperkyphotic posture had a significant 2.4 times greater rate of death.”