More and more I am hearing weird statements from people about their ‘diagnosis’. Now I am very aware that a diagnosis can be open to interpretation by the client, who may embellish what their practitioner has explained. However this is surely a very good reason for much consideration to be applied to the words we use when explaining to our clients what we have found, or we suspect, from our assessment of their bodies.
The last thing we want to hear from a client is….
“Oh my god I have an ‘anterior tilt’ and guess what else they said I have…..lordosis!!”
These kind of statements are becoming rife in our industry and they don’t sit well with the way I understand human movement. This is because I feel they imply that we should all have a certain level at our pelvis or the same degree of curvature in our spines.
No I’m not for a minute suggesting that there are no ‘excessive’ degrees of tilt or curves in the spine the problem is how we measure these things.
So the aim of this blog is to challenge some of these statements.
Methods like postural assessment have been a means of benchmarking and understanding how somebody stands. This is fine as a simple start point if you like.
What Does Postural Assessment Actually Tell Us?
Or maybe more importantly why don’t we start with…..what it doesn’t tell us!?
It doesn’t tell us WHY someone is in the position they’re in, nor WHY somebody might be in an anterior tilt or be over lordotic or hyperlordotic. So OK yes we need to take norms, BUT most importantly we need to take the individual in front of us.
They May Misunderstand Us
Also we must be VERY careful about the language we use to explain to a client, or each other, about the positions we are standing in or the degrees of spinal curvature we are presenting with.
For some people a slight anterior tilt maybe perfectly normal and some people may present with a ‘J’ shaped spine that is pretty flat but has a very slight curve just at the bottom and then there are others that have a very ‘S’ shaped spine. These are all normal presentations for those individuals.
So What Exactly Am I Saying?
I’m saying an anterior tilt is not a diagnosis, hopefully everyone’s pelvis will tilt anteriorly and posteriorly for that matter! An anterior tilt is not in itself a problem.
The question is how well does that individual move and function from the inside, rather than how good do they look on the outside.
Also are they symptomatic?
If they aren’t symptomatic it maybe prudent to NOT attempt to alter ‘posture’ but maintain a focus on nutritious quality movement, right?
Now of course how we look on the outside can be an indicator of how well we function on the inside. But how do we measure things or where can we find an evidence based approach rather than simply guessing?
We should always be mindful about what we are using as tools to dictate which exercises our clients need to prepare their bodies for movement.
How do YOU assess your clients?
What are your benchmarks?
Are they evidence based?
How objective are they?
Are there some evidence based tests out there that can help us understand why our client is presenting with poor movement capacity and/or symptoms?
Subjective or Objective?
Postural assessment alone is still pretty subjective. For example if you imagine one shoulder sitting higher than the other the questions would be “is that the upper trap or median nerve elevating the shoulder?” OR “Could it be the QL on the opposite side is tilting the body?” OR “Is there a functional asymmetry at the pelvis creating a tilt there?”
Each of these can result in the same visual or postural presentation.
Those tilts or curvatures of the spine may or may not help us understand how to improve their movement or even symptoms.
So having a benchmark is good and a visual assessment our clients is kind of all we can do. However it’s more about their function and movement than the aesthetics or alignments at bony prominences surely!?
We MUST be careful about what we’re saying to our clients and be mindful of the language we use because what we don’t want is for them to be leaving our practice thinking that an anterior tilt is a problem.
The assumptions that may go along with that ‘diagnosis’ in terms of what they do about could compound the issue.
The solution is to make sure we are considering precisely which language to use with each client. It may even differ from one to another.
Taking the critical thinking approach….
…do I explain this clearly?
…do I make sure they understand what this means?
…do I clarify what I am telling them?
…do I ensure they don’t misinterpret what I am saying?
…will this affect my client?
…will they interpret this?
…do I need to say?
…should I not say?
…do they need to know to benefit?
…is most/least important?
…is another perspective?
…is the best way to explain this?
…will they do with this information?
…do they need to know this?
…do I need them to hear that?
…are they here?
…is this relevant? Or not?
…can I tell them that?
…should I refer them?
…should I use a resource to explain things instead?
…is this acceptable/unacceptable?
…is best to send them?
…can we get more information?
…is there a need to say that?
…will that take us?
…is best placed to tell them this?
…does this benefit?
…makes that decision?
…who is affected?
When you take your time and really consider what you are saying and how you are saying it and to whom, it should enable you to provide enough of the relevant information they need to improve.
Telling a client they have an anterior tilt WITHOUT explaining it can lead to misinterpretation and the belief that this is a bad thing, when in fact it could be perfectly normal for them.
Reassurance of the parts of their bodies that move well is just as important as giving a ‘diagnosis’ BUT let’s stay technically accurate please!
So remember, an anterior tilt is a movement at the pelvis NOT a medical condition!