Posture is the way we hold ourselves or position our body segments in relation to one another and their orientation in space1.

Good posture2:

  1. Facilitates effective functional performance
  2. Encourages energy efficiency
  3. Does not harm the body systems

Basics of good sitting posture3:

  • The body is conformed to the supporting surface symmetrically
  • Body weight is distributed equally over the maximum surface area
  • A balanced and stabilised body that can adjust to change
  • Body segments are supported and aligned as much as is possible
  • Upper limbs are free from their load bearing role for function

During the provision of specialist seating, all body segments should be considered. With the support of a health and care professional, follow our practical tips for achieving a good sitting posture:

1. Pelvis

  • The pelvis is the foundation for a good sitting posture as it dictates what happens to the body segments above and below
  • The pelvis must be stabilised in all planes of movement, with consideration of posterior pelvic tilt, anterior pelvic tilt, pelvic obliquity and pelvic rotation.
  • Aim to correct if the pelvis can be corrected, but remember to accommodate any fixed postures
  • CareFlex offers specialist seating with tilt-in-space, ramped bases, and pelvic belts that can aid pelvic stability following a comprehensive risk assessment
  • It is also crucial to ensure the back angle is set according to hip range of movement and the elevating leg rest is used appropriately according to hamstrings muscle length

2. Thighs

  • The position of the thighs helps to stabilise the pelvis
  • Aim to keep the thighs level so that the soft tissues on the underside of the thighs don’t become overly compressed to reduce the risk of pressure injury
  • Keeping the thighs in midline with the knees positioned slightly apart will also encourage lateral stability
  • Postures that can challenge thigh level, alignment and support are windsweeping and leg length discrepancies; pommels, stepped bases, lateral thigh support pads  and an increased seat width can help address these challenges

3. Lower legs and feet

  • Pelvic stability and trunk functionality are dependent on adequate lower leg and foot support
  • Aim to align and fully support the lower legs and feet to encourage equal weight distribution
  • Obesity can present a challenge in achieving optimum alignment as larger calves or oedematous lower legs can position the lower limbs too far forward restricting knee flexion
  • A channeled or w-trough leg rest can help maintain alignment
  • An angle adjustable foot plate may be indicated for fixed foot deformities

4. Trunk and spine

  • Trunk and spine support is essential for comfort, stability and function
  • Aim to fully support the trunk and align the spine as much as possible to reduce the risk of pressure injury and postural deterioration
  • An unsupported trunk will require more effort from the user to maintain their position and therefore result in fatigue
  • Postures that can challenge the trunk and spine are scoliosis, increased thoracic kyphosis and increased lumbar lordosis
  • CareFlex specialist seating offers a range of back support options that can be tailored to the user, including flat, waterfall, contoured and articulated backs
  • Lateral support, anterior support or a multi-adjustable back may be indicated for more complex postures

5. Upper limbs

  • Upper limb support is essential to prevent drag and relieve stress on neck and shoulder muscles
  • However, upper limb support is not there to support the trunk; adequate trunk support should be achieved first
  • CareFlex arm rests offer a comfortable surface to support the arms; there is also the option to add a tray for function
  • Transfer arms may be indicated for users who complete side transfers in and out of the chair

6. Head and neck

  • Head and neck support is vital for breathing and safe eating and drinking
  • Support is particularly important for those users who lack head control or those who fatigue
  • Aim to keep the head and neck in midline so that the user’s line of vision enables interaction with their environment
  • Head support can be restrictive so consideration is needed of the user’s comfort; CareFlex offers a range of head and neck support options, ranging from firm inline head rests to soft profiled head rests, that can meet individual users’ needs
  • An increased thoracic kyphosis or scoliosis can affect the user’s ability to achieve alignment; an articulating or multi-adjustable back may be indicated

7. Critical angles for sitting

  • It is essential that the critical angles for achieving a good sitting posture are also considered; an individual requires the ability to achieve 90° hip flexion and achieve 90° knee flexion
  • This can be affected by contractures, reduced hamstrings muscle length and a posterior pelvic tilt
  • Back angle recline, negative angle leg rests and chamfered cushions can help accommodate any postures affecting the critical angles for sitting, and appropriate use of elevating leg rests is essential
  • CareFlex also offer a tailored solutions service for when bespoke adaptations may be required, such as a split base for fixed hip flexion deformities and a hanging foot rest for fixed knee flexion deformities

Read more on how CareFlex specialist seating can help or view our range of specialist seating products.

References

1

Ham R, Aldersea P, Porter D (1998) Wheelchair Users and Postural Seating A Clinical Approach London: Churchill Livingstone

2

Pope PM (2007) Severe and Complex Neurological Disabilities: Management of the Physical Condition London: Butterworth-Heinmann

3

Pope PM (2002) Posture management and special seating In Edwards S (Ed) Neurological Physiotherapy London: Churchill Livingstone