It begins with posture.

Hi, I’m Deb Gulbranson, co-creator of the course Osteoporosis Management: An Introductory Course for Healthcare Professionals. Along with my partner, Frank Ciuba, we have created a program based on the works of Sara Meeks, whom we taught with for many years.

We know that posture is important, and we may include it in our evaluations, but how do we objectively measure it? How much time do we spend on education, training, exercises, and return demonstration? Chances are, not as much as we should.

Optimal alignment affects our breathing, balance, efficiency of gait, digestion, AND bone density.

In order to increase bone density, we need to weight bear through the skeleton, not in front of it. Compression fractures occur along the anterior aspect of the vertebral bodies. Strengthening the back extensors has also been shown to increase bone density. Therefore, someone with a hyper-kyphotic posture of the thoracic spine is at risk for fracture due to increased pressure anteriorly and overstretched, weakened musculature posteriorly. Statistics show that 1:2 women and 1:4 men will have a fragility fracture due to low bone mass.

How do we objectively measure and describe a person’s alignment?
A quick and simple way is using a wall and measuring tape. Have your patient stand with their heels, sacrum, and thoracic apex of the spine against the wall. There are two options to measure using the OWD or the TWD. Occiput to Wall Distance or Tragus to Wall Distance. The Tragus is the small bump of cartilage in front of the ear canal. Both OWD and TWD have a positive relationship with the Cobb angle, and although they’re not as specific, they are both equally effective. It’s a matter of preference. Frank prefers the TWD since it’s easier to see and measure. However, the score does not tell you how far away from the wall the head is. There will always be a positive number based on the size and shape of the head.

I prefer the OWD because whatever the measurement is, it tells me how far forward the head is. 0 equals optimal alignment. The downside is that it’s a little harder to pinpoint the most prominent point of the occiput.

In both cases, the measurement gives us a baseline to measure against. These can be used as screens in a health fair, during a PT screen for patients without a diagnosis of low bone density, and certainly as part of a full eval for patients with known osteoporosis, a compression fracture, or even osteopenia.

These measures, taken periodically, can be very motivating for patients. Generally, we see not only a decrease in the hyper-kyphosis distance but also an increase in height.

This is only one of several ways to assess and describe posture and alignment. We hope you’ll consider joining us to learn more about the treatment protocols and exercise programs in our upcoming Osteoporosis Management course on April 26^th.

AUTHOR BIO
Deb Gulbrandson, PT, DPT

Deb Gulbrandson, DPT (she/her) has been a physical therapist for over 49 years with experience in acute care, home health, pediatrics, geriatrics, sports medicine, and consulting to business and industry. She owned a private practice for 27 years in the Chicago area specializing in orthopedics and Pilates. 5 years ago, Deb and her husband “semi-retired” to Evergreen, Colorado where she works part-time for a hospice and home-care agency, sees private patients as well as Pilates clients in her home studio and teaches Osteoporosis courses for Herman & Wallace. In her spare time, she skis and is busy checking off her Bucket List of visiting every national park in the country- currently 46 out of 63 and counting.

Deb is a graduate of Indiana University and a former NCAA athlete, where she competed on the IU Gymnastics team. She has always been interested in movement and function and is grateful to combine her skills as a PT and Pilates instructor. She has been certified through Polestar Pilates since 2005, a Certified Osteoporosis Exercise Specialist through the Meeks Method since 2008, and a Certified Exercise Expert for the Aging Adult through the Geriatric Section of the APTA.