“You coming over to see the New Year in?” asked my sister, munching what I imagined was a handful of salted pretzels in the shape of small Christmas trees.
“Yes if I can do your posture.”
“What’s that?”
“You know, where you stand in your underwear and I stick dots on you.”
“Sure.” She didn’t need convincing, and as a blood relative was beholden to support my requests as long as I turned up with two bottles of something excruciatingly dry with an alcohol content that prevented you from driving anything other than an electronic wheelchair within the next 24 hours.
“Is she doing me?” said a voice in the background, my mum, no doubt trying to find when Downton Abbey was on. Not having had a TV for the last 10 years, period dramas pass me by unless any of the characters have interesting postural faults, not the kind of thing usually reported on in the review section of The Telegraph.
“Mum says are you doing her too?”
“Happy to. Don’t drink anything ‘til I’m done though, ok?”
“Don’t drink anything, it’s New Year’s Eve!?”
“I know. Postural sway. I need to minimize it.”
Many therapists believe there is a link between posture and pain. Postural assessment is carried out in order to help with diagnosis, inform treatment plans and monitor postural change. Most therapists do this with visual assessment alone, the inter-rater reliability (degree of agreement among raters) of which is poor, and despite reasonable intra-rater reliability (degree of agreement among repeated administrations of a test by a single rater), it's unlikely a therapist can visually detect what could be a clinically significant minor change in posture. For many years researchers have been looking into ways to measure posture more accurately and more reliably than with visual assessment alone. This is where my research comes in. Whilst there are ways to do this in research settings, there are none that are yet viable for practicing clinicians to use in situ. My PhD involves the development of a postural assessment app from existing software which has already been validated for use on a PC, which was initially designed for use with patients with scoliosis.
Mum stood first, fresh from a bath and eager for me to finish so she could cover herself in moisturizer. “No you can’t put it on,” I said sternly as she sat in a bathrobe snacking on savories from small china bowls, “otherwise my dots won’t stick.” I agreed she could keep her socks on. She was 80 after all. My sister was next. I only had to admonish for laughing during the procedure.
Once the self-adhesive dots have been applied to specific anatomical landmarks, software can be used to calculate the angles between the dots from photographs. The angles that are calculated describe different types of posture in different parts of the body, more so in the spine. There are other apps on the market but it is not known how reliable these are. Unlike these commercial apps, the purpose of my PhD is to create an app for data collection. It will be used in year three of the project by chiropractors, to record the posture of their patients with back and neck symptoms. Use by chiropractors is important because the project is joint-funded by the Royal College of Chiropractors and Teesside University. The patients of participating chiropractors already complete a validated Patient Reported Outcomes Measures questionnaire. Combining this data with the additional photographic posture data, we will hopefully identify whether postural change occurs as a result of chiropractic intervention and whether there is a relationship between posture and pain (symptoms). In the future we hope we can identify whether any postures increase the likelihood of a subject developing back or neck pain, and whether changing back or neck posture reduces symptoms. If we can do this, we can then advise people proactively and reduce their likelihood of developing symptoms in the first place.
With my sister and mum in their New Year’s Eve underwear I worked consistently, palpating the required anatomical points, peeling off and applying green dots to them. The initial satisfaction of fixing self-adhesive dots to skin wore thin after an hour. I took the 12 photographs knowing that photographs taken by candlelight would not be of publishable quality but were adequate for my purpose, which was simply to have some images with which to practice using the software. “Can we drink now?” asked mum and my sister together? “You can drink now,” I said.
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