Barriers to Care: Opioids Are Cheap and Easy

Barriers to Care: Opioids Are Cheap and Easy
New research on coverage policies confirm what my patients and I have known for years

By Sherry McAllister, DC

A recent study published in JAMA Open Network seems to confirm what I and my patients have known for years: health insurers are steering their members toward pharmacological, often opioid-based, management for chronic pain.

The study, “Coverage of Nonpharmacologic Treatments for Low Back Pain Among U.S. Public and Private Insurers,” shows that payer-imposed barriers to care such as $60 copays, visit limits and onerous medical necessity determinations, are disincentivizing their members away from   nonpharmacologic care, even though the care is widely covered. This is despite the substantial evidence supporting the effectiveness of chiropractic care and physical and occupational therapy for chronic pain. Meanwhile, according to an associated commentary in the publication, Christine M. Goertz, DC, Ph.D. and Steven Z. George, PT, Ph.D., cite research that the preferred generic opioid prescriptions cost members only $10 a month.

To that avail, I have a patient with chronic uncomplicated low back pain who finds great relief with chiropractic. Unfortunately, this patient can only receive care if all the allotted paperwork, authorization and deductible has been met. Problematic is that this patient typically needs one treatment every few months to contain her discomfort. This makes managing chronic pain extremely difficult, as many insurance companies allocate payments based on an acute phase patient, ultimately leaving the patient and doctor frustrated by the paperwork and high out-of-pocket costs. This is just one example of many I could share regarding the hurdles both parties are facing.

In light of the nation’s opioid epidemic, as recommended by the CDC, FDA and IOM, nonpharmacological clinical pathways need to be the first-line approach for chronic pain. However, study lead author James Heyward, MPH, a research data analyst at the Johns Hopkins Center for Drug Safety and Effectiveness, finds little collaboration within these health plans to prioritize evidence-based, nonpharmacologic care protocols after interviewing 43 medical and pharmacy health plan executives.

From the study:

“Overall, informants indicated a low level of integration between coverage decision making for nonpharmacologic and pharmacologic therapies, such as through the use of step therapy requirements that encourage use of physical therapy before initiation of long-acting or extended-release opioids.”

In my own practice, I have found that many of my patients’ primary care physicians opt for pharmacologic care options as a first choice to manage pain rather than a nonpharmacological approach simply because they are not familiar with the options. One of my patients mentioned that her primary care physician knew very little about chiropractic and instead gave her a number of reasons why taking a medication would be just as good of a choice to manage pain instead of opting for a drug-free approach. The primary care physician went as far as to say that my patient could just simply come back in when she needed a refill. If the primary care provider lacks the understanding, then the patient cannot be fully informed of the safe, effective, drug-free options that are available, which perpetuates the barriers to care and further fuels the reliance on prescription medications.

Steps to reverse the trend

While there are multiple drivers behind the country’s opioid public health crisis, this study indicates that health plans can take steps to help reverse the course. They include:

1.Copay reduction for evidence-based and effective interventions such as chiropractic care and physical and occupational therapy

2.Decrease unnecessary administrative obstacles such as medical necessity reviews for conservative, cost-effective care

3.Reconsider limitations on number of visits to encourage members to make such care part of their long-term, chronic pain management strategy, preventing the need for pharmacologic interventions

4.Increase collaboration and coordination between medical and pharmacy health plan leaders to help incentivize members to pursue nonpharmacologic interventions for chronic pain

5.The Centers for Medicare and Medicaid Services should seek input from the entire spectrum of healthcare providers and professionals, including doctors of chiropractic and physical and occupational therapists, as they design policies and guidelines for the newly passed “Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act

The bottom line is patients deserve and desire drug-free clinical pathways. A recent Gallup-Palmer College of Chiropractic survey report showed 79 percent of Americans want to explore all nonpharmacological treatments for pain before considering an opioid. It is up to all stakeholders, including physicians and health plans, to help remove barriers to evidence-based, effective and preferred therapies for chronic pain.

About the author:

Sherry McAllister, DC, is executive vice president of the Foundation for Chiropractic Progress and Foundation for Chiropractic Education. A not-for-profit organization, Foundation for Chiropractic Education (501c3) and the Foundation for Chiropractic Progress (501c6) provide information and education regarding the value of chiropractic care and its role in drug-free pain management

Optimize!

In a society where we’ve so long approached our health from the medical perspective of diagnosing a problem and treating it, drug- and surgery-free chiropractic care’s approach of enabling the body to operate at its maximum is a unique concept.

But when you look at chiropractic care from that angle, not waiting until low back pain or tech neck sends you to the doctor of chiropractic for relief but proactively strengthening your body’s neuro-musculoskeletal system before issues arise, you climb to a new level of well-being. And that is why the Foundation for Chiropractic Progress recognizes October as Optimizing Health the Chiropractic Way Month.

While medical care will always play an important role in your health, ideally, in working together, your doctor of chiropractic and primary care physician will strike a balance that reduces your need for reactive treatment. Sound utopian? Numerous studies show that those receiving chiropractic care use fewer pharmaceuticals, spend less time in the hospital and live independently longer.

Even more, with the positive lifestyle changes that doctors of chiropractic incorporate with spinal adjustments, patients report that they feel if their bodies are finally functioning at 100 percent. As one put it, he felt better after his visit with a doctor of chiropractic in places he never knew felt bad!

The reason is simple. Your body’s central nervous system is housed in the spine, where it transfers messages from your brain to muscles and organs throughout your body. But when something is out of alignment, the connection is interrupted, like calling on your cell phone from high in the mountains. The signal might get through but you’re going to spend a lot of time asking, “Can you hear me now?”

By developing a better relationship between structure and function, your doctor of chiropractic’s hands-on therapy triggers your body’s innate capacity to heal itself.

It doesn’t stop there, either. Working hand in hand with your doctor of chiropractic, you can take steps to prevent future problems and optimize the benefits of your recent chiropractic care. Maintain good posture, preventing your spine from slipping back into its familiar misalignment. Get a good night’s sleep, which relieves the stress on your spine and joints and gives your body time to recoup.

Develop an exercise routine, taking time to walk around during the work day and learning to stretch at your desk while anchored to a screen. Talk to your doctor of chiropractic about proper nutrition; it really makes a difference!

And pamper yourself on occasion, whether going in for a massage or taking a little time, with lights down low, to listen to some soft music and restore the soul.

Finally, make an appointment now for an annual check-up with your doctor of chiropractic. Just as your dentist regularly cleans your teeth and looks for cavities, your DC can tell if an adjustment is needed, even before symptoms surface.

Are you optimizing your healthcare options? October is a good place to start … see what chiropractic care can do for you!

September is Drug-Free Pain Management Awareness Month

You might wonder why, with 115 Americans dying every day from opioid overdoses, F4CP even needs to raise awareness about available drug-free pain management. Then, among all the statistics pouring out, comes one pointing out that less than 20 percent of the public consider chronic pain a major health problem.

Chronic pain affects more people than diabetes, cancer and heart disease combined, according to the PAINS Project. While it might be easy to dismiss the overdoses as an urban problem confined to junkies in dark alleys, the truth paints a far different picture. For starters, 80 percent of heroin addicts began with prescription painkillers, reported the National Institute on Drug Abuse.

Even more telling, 66 percent of the 63,632 overdose deaths in 2016 involved prescription or illicit opioids. Prince and Tom Petty put a public face to the epidemic, but it reaches much deeper, from those struggling with chronic pain to teens raiding their family’s medicine chest and unborn babies who have no choice in sharing their pregnant mothers’ addictions.

But, as the 2017 Gallup-Palmer College of Chiropractic annual report discovered, 78 percent of Americans prefer to try other ways of dealing with their chronic pain before filling a prescription. And a growing number of groups, including the American College of Physicians, have called for drug- and surgery-free chiropractic care as a first line defense in fighting back pain.

Statistics, most recently a study involving active-duty military personnel, back up their support. The findings, reported by JAMA in 2018, found that chiropractic care, when added to standard care, brought moderate short-term improvements.

It’s a finding mirrored in other statistics. Ninety-five percent of Americans who sought chiropractic care in the past year said it was effective, according to the 2017 Gallup-Palmer College report, and 97 percent of them said they would see a doctor of chiropractic again if the pain returned.

Then there are public accounts, such as Ret. Army Staff Sgt. Shilo Harris, who was seriously injured in Iraq when his Humvee hit an Improvised Explosive Device (IED). Once addicted to his prescription painkillers, he now says his doctor of chiropractic “saved my life.”

How does it relieve the pain? According to Harvard Health, the spinal manipulation relieves the pain and improves the body’s functions, helping it to heal itself. Doctors of chiropractic often include physical activity, nutrition and other lifestyle changes in their treatment plans. And in talking with doctors of chiropractic, we often find that it was their own positive experience in receiving chiropractic care that prompted them to become a DC themselves.

If you see one of our new billboards around the country, you’ll see our simple message that says, “Back pain? See a chiropractor.”

Now you know why.

The Dreaded Crash!

One minute, you’re thinking about how good that Italian sausage you just picked up is going to make your spaghetti dinner taste. The next, a blur of white racing in from the next lane drives any thought of dinner from your mind.

You’re in a crash; police car lights are flashing and first-responders want to know if you’re all right. It’s a dizzying experience as your mind inventories everything that happened and absorbs all that’s changed.

And as surely as you’ll send your vehicle to the shop to assess the damages, think about what you need to make sure you’re OK. If there are injuries, you’ll want to head to the hospital for medical attention. You’ll immediately want to see your doctor of chiropractic, too, even if you don’t notice obvious symptoms.

Ask Jess Caruso, who in a Palmer College of Chiropractic blog discussed the chiropractic care she received to treat the debilitating effects of a crash. She revealed that it was what led to her decision to become a doctor of chiropractic herself. She doesn’t even want to imagine what her life would be like today, she said, if she had continued to rely on prescription drugs for relief.

This is why the Foundation for Chiropractic Progress has designated August as its Personal Injury and Motor Vehicle Accidents Month. Consider these points if you are involved in a personal injury crash:

• With the incredible force involved in a crash, your body takes a real jolt. Even a low-speed fender-bender with a speed change of 2.5 miles can apply intense pressure to your spine, neck, and soft tissues. But the adrenaline of the moment might mask the collision’s effects. By waiting to see your doctor of chiropractic, what might have been averted by a simple adjustment could surface days or weeks later as chronic pain. The earlier you address it, the sooner your body can heal itself, naturally without drugs or surgery.

• For insurance purposes, it is important to document your injuries within three days, whether it is discovering a fractured wrist in the emergency room or neck pain caused by soft tissue injuries, most commonly known as whiplash, by your doctor of chiropractic. When you wait a week or longer to seek help, your case loses credibility as your need for chiropractic care increases.

• If you experience symptoms such as blurred vision, headaches, dizziness, neck stiffness, or pain in the lower back, shoulders, or arms at any time following a crash, immediately see your doctor of chiropractic. Again, the sooner you receive chiropractic care, the better chance you have of avoiding long-term chronic problems.

• The bottom line is that you want to do everything you can to protect your quality of life. Early intervention can decrease the inflammation and scar tissue that threatens your mobility by relieving pain and restoring range of motion. It’s the TLC you give your vehicle without a second thought; why would you think twice about doing the same for this complex mechanism we call the human body?

In the Game

One of the fastest growing branches of chiropractic care has wrapped itself around sports. It comes as no real surprise. For years, professional athletes have embraced its preventative and restorative benefits, to the point of now including doctors of chiropractic on their healthcare crew.

What’s fueling the growth? Celebrity testimonials from the likes of golf great Tiger Woods, tennis legend Venus Williams, and football’s Tom Brady, who said, “As long as I see the chiropractor, I feel like I’m one step ahead of the game.”

But don’t underestimate studies such as the one measuring a markable increase in distance for golfers who received chiropractic care and the word-of-mouth power of those who’ve discovered for themselves the many benefits.

As the Foundation for Chiropractic Progress turns its attention to sports-oriented chiropractic care, our theme for July, here are a few things you might consider:

 

• Athletes, especially in high-impact sports such as football, hockey, and rugby, take a beating. Even the gentler sports, such as baseball, take their toll with repetitive strain. Many of us wondered how much longer Texas pitcher Nolan Ryan could stay on the mound before he retired at 46. But a doctor of chiropractic, by maintaining flexibility and range of motion, can lessen the risk of injuries and develop a stronger connection between the spine and the nervous system, leading to quicker recovery from minor injuries. The Olympic games is a great example. A doctor of chiropractic accompanied the Aruba team to the 1976 games, the USA team came aboard in 1980 during the winter games in Lake Placid, and in 2010, chiropractic care was fully integrated into treatment of athletes in the polyclinic at the winter games in Vancouver.

• Studies abound on the benefits of chiropractic care when there is a sports-related injury. A 2001 study by Duke University found almost immediate relief of headaches originating from the neck after spinal adjustment. Similar results were found on studies of shoulder and ankle injuries. Better yet, the treatment is drug-free and non-invasive, avoiding risk of addiction to a prescribed opioid painkiller.

• Finally, chiropractic care can enhance your performance. A 2012 study reported in the Journal of Manipulative and Physiological Therapeutics found that a group of national level judo athletes improved their grip strength by 16 percent following three visits to a doctor of chiropractic. And a 1997 report in the Journal of Vertebral Subluxation Research found that chiropractic care improved muscle strength and distance jumps among baseball players.

 

Want to stay on top of your game? Put a doctor of chiropractic on your team and see for yourself the difference it makes.

Happy 123rd Birthday Chiropractic

Happy Birthday, Chiropractic!

It’s a chiropractic birthday party, it’s time to sing.

It’s a chiropractic birthday party, let the good news ring.

Doctors of chiropractic take care of your health by aligning your spine.

Doctors of chiropractic ensure that the family is feeling fine.

It’s a chiropractic celebration with party hats to lift.

It’s a chiropractic celebration where great health is the gift!

ACOG Committee on Obstetric Practice Addresses Pain Management – F4CP Responds

On May 17, 2018, The American College of Obstetricians and Gynecologists’ (ACOG) Committee on Obstetric Practice released an important and timely committee opinion addressing postpartum pain management.

The advice of the ACOG Obstetrics Practice Committee is consistent with federal guidelines and recommendations seeking to increase the use of non-pharmacologic approaches to pain management and a minimization and elimination of the use of opioid containing products whenever possible, according the Foundation for Chiropractic Progress (F4CP).

“Pain and fatigue are the most common problems reported by women in the early postpartum period. Pain can interfere with a woman’s ability to care for herself and her infant,” notes the nation’s OBGYN community. In addition to interfering with the ability of a mother to care for her child, the use of opioids puts infants at risk. In April 2017, the U.S. Food and Drug Administration (FDA) announced labeling revisions advising “breastfeeding is not recommended while using medicines that contain codeine or tramadol because of the potential for serious adverse effects in the infant due to opioid overdose.”

ACOG carefully explores the impact of non-steroidal anti-inflammatory medications (NSAIDS) and codeine (opioid) containing products. Unfortunately, the ACOG opinion statement does not offer any guidance to obstetricians or mothers about available non-pharmacologic approaches to pain management.

For advice and recommendations relative to the non-pharmacologic management of postpartum pain, the Foundation for Chiropractic Progress consulted the clinicians involved in a ground-breaking interprofessional collaboration involving Life University’s Vital Life Health Center (VLHC) and Atlanta Birth Center (ABC) located in downtown/midtown, Atlanta, Georgia.

“As a chiropractor at the Vital Life Health Center I collaborate daily with the midwives and staff of Atlanta Birth Center providing chiropractic care throughout the pregnancy of many ABC clients,” comments Bryna Waters, D.C. “The most gratifying clinical opportunity for me is to adjust a mom-to-be, and see her go onto complete a normal delivery much faster than her progress had been up to that point.”

“Chiropractic is helpful at all stages of a pregnancy. It accrues to a safe and typically expedited labor and delivery,” according to Dr. Waters. The relationship is equally exciting from the perspective of the midwives responsible for the management of the pregnancy, labor and birth process at Atlanta Birth Center. “It is clear to us that our moms and babies benefit from chiropractic care in pregnancy, birth and postpartum. We have seen shorter, easier labor periods, less pushing times, overall increased likelihood of vaginal births and more successfully established breastfeeding relationships when they have the advantage of chiropractic care,” notes ABC Director and midwife, Anjli Hinman.

The interaction and cooperation involving chiropractic care and midwifery care does not stop at the birth of the newborn as chiropractic care is an essential part of the postpartum period for many clients of Atlanta Birth Center. Ms. Hinman stated, “We agree with ACOG that pain and fatigue are amongst the most common problems reported by women in the early postpartum period for many new mothers. We work with our chiropractic colleagues, massage therapists, physical therapists, cranio-sacral therapists, lactation consultants, maternal mental health therapists and our naturopathic care provider to bring as many resources, skills and clinical interventions as possible to our mothers and newborns to avoid the use of medications whenever and wherever possible. It is an approach we find our clients are looking for and interventions that work.”

“If more mothers had access to the range of care services we are able to provide our patients at the Vital Life Health Center and Atlanta Birth Center, the childbirth process (and developmental stages following) would be easier, safer, cheaper and more satisfying for everyone involved,” Dr. Waters offered.

Vital Life Health Center is an Atlanta-based, Life University affiliated collaboration providing chiropractic, functional neurology, and personal injury care. The Vital Life Health Center is a specialty clinic bringing unique assessment competencies and clinical skills together in a patient-centered neurologically-focused care environment.

Atlanta Birth Center is based on the birth center model of care, we believe pregnancy and birth are normal life events and should be women-centered. This model includes prenatal care, mind, body, spirit and social well-being, postpartum support, and much more to women in the Atlanta metro area. This birth center model of care cannot be duplicated by a local area hospital. We invite you to use our community of providers to learn more about the importance of a birth center care.

Foundation for Chiropractic Progress is a not-for-profit organization, providing information and education regarding the value of chiropractic care and its role in drug-free pain management. Visit www.f4cp.com; call 866-901-F4CP (3427). Social media: FacebookTwitterLinkedInPinterestYouTube.

F4CP Implements National Billboard Advertising

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Foundation for Chiropractic Progress Implements National Billboard Advertising

In honor of National Drug-Free Pain Management Awareness Month in September, the Foundation for Chiropractic Progress, along with six of its Group Member State Associations, are placing billboards throughout the U.S.

The billboards will support the Foundation’s goal to position chiropractic care as a safe, effective and drug-free first-line approach to manage back pain prior to utilization of drugs and surgery.

The placements are expected to reach nearly 8 million consumers.

Orlando, Florida
August 6 – September 2, 2018
SR 528 NS 100ft W/O Sand Lake Rd
Facing South West

Los Angeles, California
September 3 – 30, 2018
SUNLAND BL WL
600ft S/O SAN FERNANDO RD

Facing South

Des Moines, Iowa
September 3 – 30, 2018
SE 14TH ST WS  100ft N/O PARK AV
Facing North

Detroit, Michigan
September 3 – 30, 2018
N/S I-96, .4 MWO SOUTHFIELD 
Facing West

Nashville, Tennessee
September 3 – 30, 2018
S/S I-40E @ 906 2ND AV S
Facing North East
Austin, Texas
September 3 – 30, 2018 
I-35 S W/S 1000ft S/O LOOP 4
Facing South
Minot, North Dakota
November 1, 2018 – November 30, 2018

1500 South Broadway (US Highway 83)
Facing Northbound traffic


Mandan, North Dakota
November 1, 2018 – November 30, 2018

Corner of Century & Centennial Road
Facing Westbound traffic


Fargo, North Dakota
November 1, 2018 – November 30, 2018

4301 Main Avenue
Facing Eastbound traffic


Grand Forks, North Dakota
October 15, 2018  – November 15, 2018

DeMers W/O 20th
Facing Westbound traffic


Jamestown, North Dakota
October 15, 2018  – November 15, 2018

10th St SE Between 9th & 10th Ave
Facing Westbound traffic

For more information or to view each billboard placement design, email Marketing Director alexis@f4cp.com

Too high a price

Too high a price

Why, months before our “Drug-Free Pain Management Awareness” campaign in September, are we choosing to bring up the opioid epidemic? To answer this question, we point to a Centers for Disease Control and Prevention (CDC) release about the toll it took in 2016, when more people died from drug overdoses in a single year than in the Vietnam and Iraq wars combined.

It is no surprise that the CDC says synthetic and classic opioids today account for six of every 10 drug overdose deaths, given that another CDC study found that one out of every four Americans prescribed long-term opioid painkillers struggle with addiction. It’s a national tragedy that deserves our continuous attention.

As doctors of chiropractic join with other healthcare providers to explore the intricacies of chronic pain and the combination of treatment options, beginning with drug-free, non-invasive chiropractic care, a myriad of pain-related issues continue to surface. Deserving careful consideration are the risks of over-the-counter pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen.

  • Managing the pain with NSAIDs and acetaminophen is like constantly replacing the tires on your car instead of getting the alignment that’s causing them to wear out in the first place. It is far better managed through the first-line option of spinal manipulation – eight out of 10 who seek chiropractic care for pain say they experience significant relief – and, if needed, subsequent physical therapies and medical procedures to address the cause of the pain. Yet 70 percent of new neck and back pain sufferers say they relied on NSAIDs such as Advil, aspirin and Aleve and 45 percent took acetaminophens, such as Tylenol in the first year, according to the 2017 Gallup-Palmer College of Chiropractic annual report.
  • A U.S. experiment recently reported in Journal of the American Medical Association (JAMA) found that NSAIDs and acetaminophen are better at easing the intensity of chronic pain in the back, knees and hips than prescribed opioid painkillers, but they still come with risks. While NSAIDs are not addictive, they can cause internal bleeding and kidney damage. There is also a well-established link between their use and heart hazards, according to Harvard Health Publications. Acetaminophen is generally considered safer, said the Mayo Clinic, but taking more than the recommended dose or mixing it with alcohol increases the risk of kidney damage or liver failure. These risks increase with age and additional health issues.
  • If you must take NSAIDs or acetaminophen, take the lowest recommended dose and only increase it if necessary for pain, recommended Harvard Health Publications. Make sure you’re monitored for possible side effects, and stop taking them when your pain subsides to the point where you can find comfort with hot baths or cold packs. Remember, too, that you have options in treating your pain. Stay as active as possible and watch what you eat. Talk to your team of health providers, including your doctor of chiropractic, about what treatments are available.

If there is one common thread in all of this, it’s that we’re paying too high a price for the hope of stopping the pain. Maybe by raising consciousness now and during our “Drug-Free Pain Management Awareness” campaign in September, we can make a difference.

STAND TALL

Stand Tall

By definition, chiropractic care encourages your body to heal itself by bringing it back into alignment. And by doing your part, you can make the lifestyle changes that prevent the conditions that brought you to the doctor of chiropractic in the first place.
posture

Eat better. Become more active. And, in keeping with the Foundation for Chiropractic Progress’ theme for May, practice good posture.

In olden days, proper young ladies would walk for hours balancing books on their heads, perfecting their posture. But times change and, with technology keeping us hunched over our laptop for hours on end and continually checking our mobile devices, we’ve lost our natural curve.

Whether you call it tech neck or millennial hunchback or a pain in the neck, doctors of chiropractic are seeing it show up on younger people these days, and it raises more than aesthetic concerns.

Poor posture leading to postural kyphosis can bring on back and neck pain, poor circulation, shallow breathing, fatigue, muscle tension, headaches and premature aging of the spine. Among the middle-aged and elderly, studies show it increases the risk of falling. But here’s the good news; chiropractic care, including spinal manipulation, can improve your posture and so much more:

• By allowing more room for your lungs and diaphragm to expand, you can optimize your breathing and circulation.
• Keeping your bones and joints in correct alignment allows your muscles to be used as they were meant to be, properly and efficiently. It also reduces the abnormal wearing of joint surfaces – think knees – that can lead to degenerative diseases.
• You’ll decrease stress on soft tissues, too, giving ligaments, muscles, tendons and discs a welcome break. Additionally, your spine won’t become fixed in an abnormal position.
• Finally, it boosts your mental well-being, boosting your mood and simply making you feel good about yourself.
What can you do to help? Here are a few ideas:
• Get rid of the slouch. Use the 90/90 rule when sitting in a chair, keeping your elbows and knees at 90-degree angles. Hold your mobile devices at eye level when checking your messages. And whether you’re working at your desk or watching television from the couch, take a few minutes each hour to limber up.
• Scrap the high heels or at least reserve them for special occasions. The same with heavy handbags and over-filled backpacks, notorious for pulling your body in unhealthy directions.
• When sitting at your desk, keep your head and neck aligned above your shoulders. Put your feet flat on the floor and your back against the back of the chair.

As a study proved, the best results come from a collaborative effort. In this particular case, 30 women between the ages of 20 and 39 were divided into three groups and each was taught how to sit and stand correctly. The first group received spinal manipulative therapy on restricted thoracic spine segments; the second, the therapy as well as stretch and strengthening exercises and the third, stretch and strengthening exercises alone.
All improved their posture, but the second group saw the best results and decreased their curvature of the spine. Where do you stand? It’s up to you!

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