Posture Vs Strength

Last weekend I participated in a ‘Strength In Rehab’ workshop in Brisbane Australia.  This was for physical therapists seeking to update their theory and application of strength development for their clients.  There were three of us leading the workshop – Bruce Rawson and Andrew McGough were my co-teachers, which was a real buzz because they had both been Masters students of mine some years ago.  We share an enthusiasm for resistance training as a critical component of effective, functional rehabilitation believing many programs are discontinued at the first sign of pain relief or return to work or sport.

At these sessions we always have the debate regarding postural training versus functional strength training.  Which is more effective?  From an exercise physiology viewpoint a case can be made for both approaches.  The Postural School advocates awareness (proprioception), alignment, control and low loading programs (think Pilates, Tai Chi, Postural Integration, Feldenkrais or Mensendieck/Cesar).  The Strength School advocates a combination of isolated loading and functional integration using loading or speed as the stimulus and insisting on control into fatigue.  Don’t write telling me this is too simplistic, I know but it is a short blog!

The debate is always dominated by we three leaders because we have the microphone.  Not due to any strong evidence base, but because we have all had great success with clients using a strength based program to build resilience in our rehab clients.   Colleagues who favour a postural training approach (and were contemplating a move toward the dark side) also provided anecdotal ‘evidence’ of its efficacy.

I recall an excellent article in the Harvard Business Review a few years back which looked at the implications for organisations when they introduced new management systems or technology updates.  In a thorough analysis the authors concluded that the type of system or product was not the significant factor in terms of efficiency and productivity gains.  More important than the nature of the change was the manner in which it was introduced.  Those organizations who planned the process, prepared the staff, trained the trainers and embraced all aspects positively and purposefully achieved better outcomes than those who were less professional in their implementation.

I suspect it is the same for our rehab debate.  The nature of the program is perhaps less critical than the enthusiasm, knowledge and professionalism of the therapist in delivering the program to the client.  The words, body language and teaching strategies are always going to be stronger from a therapist who fully embraces the intervention selected.  And we all tend to go with our strengths.  Those skilled in Postural Training will do a great job of Postural Training.  Those skilled in Strength Rehab will do a great job of Strength Rehab.

A report in the Australian Journal of Physiotherapy in 2008 looked at 88 computer workers and the effect on their ‘non-specific work-related upper limb disorders’ of two physiotherapy interventions.  Randomly assigned to either a postural exercise program or a strength and fitness program for ten weeks the workers were assessed for changes in pain levels, disability measures and health related quality of life.  At the 3, 6 and 12 month reviews there was no significant difference between the two groups.  Each showed equal improvements and at 12 months 55% of all the subjects reported being pain free irrespective of the intervention.  There was no control group so we don’t know if doing something is better than doing nothing.

We do know, however, that the type of intervention was not a critical factor for outcome in this group of subjects.  I suggest our clients are just like a business organization and respond well to a program that is delivered professionally, with authority and with an expectation of success.  Providing, of course, that the actual program has a scientific basis on which to expect a therapeutic effect.

Reference:
van Eijsden-Besseling, Staal JB, van Attekum A, van den Heuvel WJ. 2008.  No difference between postural exercises and strength and fitness exercises for early, non-specific, work-related upper limb disorders in visual display unit workers: a randomised trial.  Aust J Physiotherapy 54(2):95-101