This article is designed to help users and carers in the public domain to learn more about good posture when sitting in a chair or wheelchair. It is not intended for clinicians. This article was put together by BHTA industry expert members.
What is posture?
Posture is the way we hold ourselves or body segments in relation to one another and their orientation in space. Body positioning can be intentional or unintentional.
Body segments (1):
Posture has two main purposes:
Antigravity – to provide the rigidity needed to maintain an erect posture against gravity
Interface with the outside world – to orientate body segments to interact with the environment
The body structure is a very complex system. It is naturally unstable but highly flexible, which allows for a wide variety of postures but also makes it very vulnerable to damage.
TIP: Posture is influenced by body shape and size, the supporting surface, and even health or emotional state
Why is good posture important?
Enables independence
Encourages interaction
Promotes physiological function
Manages comfort levels and quality of life
When poor seated posture is adopted over prolonged periods of time, a person can experience:
Muscle fatigue and associated pains e.g. lower back pain or neck pain
Organ dysfunction e.g. breathing and digestion
Limitations in activity e.g. difficulty with eating and drinking
Limited range of movement in joints and/or altered body shape
Other health issues e.g. pressure ulcers, bowel and/or bladder problems
What is good posture?
Good posture (2):
Facilitates effective functional performance
Is energy efficient
Does not harm the body systems
TIP: Failure to manage posture can result in many health complications
What is postural management?
Postural management is the use of any technique to minimise postural problems and enhance health (3). It must be individualised, targeting all body segments. It must also take into consideration the full 24-hour period.
How might someone who is having difficulty with their posture sit?
Seat height being too high results in insufficient foot support, reduced stability, and can increase risk of sliding down the chair.
Seat depth being too long can encourage sliding down the chair and can increase the risk of pressure ulcers.
Seat width being too wide can make the pelvis move unequally and encourage leaning to the side.
TIP: Select a chair to suit body shape and size
Why might someone have difficulty managing their posture?
Neurological impairment
Changes in body shape and size
Little or no active movement
Movements that are difficult to control
Lack of body awareness and/or sensory impairments
Difficulty communicating discomfort
Where can you get further information or advice?
Contact a healthcare professional for advice on postural management.
Case study:
Mr. A, a 35-year-old gentleman diagnosed with cerebral palsy
Mr. A has muscle spasms and stiffness
He has a curved spine and struggles to sit upright
Without a chair that is set up to his body shape and size, he is at risk of pain, not being able to eat or drink safely, and developing pressure ulcers
With the appropriate chair, he is more comfortable, and his risk of pressure ulcers is reduced. He has a more stable upright position, making it safer for him to eat, drink and communicate, and manage his muscle problems
References:
Pope PM (2002) Posture management and special seating In Edwards S (Ed) Neurological Physiotherapy London: Churchill Livingstone
Pope PM (2007) Severe and Complex Neurological Disabilities: Management of the Physical Condition London: Butterworth-Heinmann
Farley R, Clark J, Davidson C, Evans G, MacLennan K, Michael S, Morrow M, Thorpe S (2003) What is the evidence for the effectiveness of postural management? International Journal of Therapy and Rehabilitation 10(10):449-455
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