The final destiny of the aged spine is to eventually succumb to the relentless force of gravity. This final position will almost always involve some form of stooping over and this “picture” seems to worry some of my Baby-Boomer patients and terrify others. I try and reassure all of them but I must admit that I do have some concerns for some. Especially those patients who are beginning to or are already exhibiting a forward-stooped posture where the trunk inclines forward over the pelvis. This forward-stooped posture, when exceeding certain thresholds, is called anterior sagittal balance and is eventually associated with increased pain, reduced function and reduced quality of life.

I recall many years ago, after presenting a spine-deformity paper in Germany, having a robust discussion with a Japanese spine surgeon who questioned whether physiotherapy treatment could alter, reverse, prevent or delay these stooping over postures. I argued that in some cases we could and I am still working on the evidence. However, without a method of accurately and reliably measuring these stooped over posture the data will always be disputed.

I am grateful to finally be able to present the first paper towards my PhD researching sagittal balance. These spinal postures are typically measured by x-ray but as this exposes our patients to radiation and increased cost, this method is unsuitable for repeated measurement and monitoring. There are other non-radiographic methods. How do I know, I searched the worlds medical literature and wish to thank my colleagues on my research team.

The take-home message is that it is possible to measure stooped over posture. Come visit us in the clinic to see how our Formetric works or come visit us to see how we use a plumb-line and ruler. If you can measure it, then maybe you can start to manage it!