Doing the dots by Jane Johnson

FHT accredited training provider Jane Johnson writes about posture…

Doing the dots by Jane Johnson

“You coming over to see the New Year in?” asked my sister, crunching 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 she was beholden to support my requests as long as I turned up with two bottles of alcohol.
“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 and 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 of which is poor, and despite reasonable intra-rater reliability, 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. The PhD I have embarked upon involves the development of a postural assessment APP from existing software which was initially designed for use with subjects 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/landmarks 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, and the patients of participating chiropractors already complete a validated Patient Reported Outcomes Measures questionnaire. So, combined 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 it is hoped that 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 prophylactically 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 small green dots to them. The initial satisfaction of fixing self-adhesive stickers to skin wore thin after an hour. I took the photographs, 12 in total, knowing that photographs taken by Christmas candlelight would not be of publishable quality but were adequate for my purpose, simply to provide images with which to practice using the software. “Can we drink now?” asked mum and my sister in unison? “You can drink now,” I said.

For more information about the FHT accredited short course in postural assessment, taught by Jane on behalf of Spark Academy and Consultants, visit

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