Product Sales in Your Practice
Part 5 - BackRest Supports - Give the Spine a Break When Sitting
By Stuart A. Firsten, DC
Editor’s note: Articles in this series have introduced protocols for effective health product sales in chiropractic practice. Last month cervical pillows were discussed – previous topics covered have included ethical and medical legal issues, and MI Sales Tax exemption. A “Product Recommendation Form” for better documentation and to facilitate staff involvement in the sales process was also described. Part 5 of this series presents information to help you evaluate backrest seating support features and requirements for your patients. Parts 1- 4 of “Products Sales in Your Practice” are available online at http://www.chiromi.com/practice_tips.htm .
Sitting for extended periods of time is common in our sedentary society - whether at home, work or while commuting. Most people think of sitting as restful, however seated postures have been shown to increase intradiscal pressure and place more stress on the spine. Prolonged sitting has even been implicated as a risk factor for the development of back problems. Inadequate lumbar seating support and poor seating design also contribute to increase strain on sensitive spinal tissues, leading to injury and recurrent episodes of pain. Adequate lumbar seating support on the other hand is generally regarded as being beneficial. A well fitted backrest support can fill the gap between the lower spine and the seat back helping to promote the natural lordosis, complement forward pelvic tilting, and inhibit slouching.
Back pain related to sitting is a common complaint seen in chiropractic practice. Associated clinical presentations are varied when tissues are stressed from prolonged sitting with inadequate lumbar support. Unfortunately most available seating has no mechanism of support and therefore does not support the lower spine as necessary. As a result portable lumbar seating supports or backrests are often recommended by chiropractors - to improve seated posture and as an adjunct to care. Backrests should be considered for any case where maintaining the lumbar lordosis in a neutral position can facilitate the healing process.
The right backrest can help stabilize the spine to provide relief, prevent future injury, and help patients feel more comfortable. There are many types available and it may be difficult to know which ones to inventory or recommend. Inquiring about the type of chair the patient uses at home or work can be useful in determining which type of backrest to suggest. Additionally, patient’s unique requirements for backrests necessitate individualized levels of firmness and support. Even the seats in the vehicle that a patient travels in or the chairs they sit on throughout the day may influence which type of backrest will work best for them. Such factors need to be evaluated before recommending a backrest to suit your patient’s personal needs.
Lumbar supports like cervical pillows need to fit right to be comfortable. They also need to provide adequate support to encourage correct posture and to limit injurious strain to the lower back. The requirement for support also changes depending on the type of seating surface used. For example a soft chair with a lot of seat depth usually requires a firmer support. Conversely a firm chair with a shallow seat may require a less aggressive backrest to be well tolerated. People also come in different body sizes. Thigh length is variable and needs to be considered as well as seat pan depth for a backrest to support the lordosis adequately in various chairs and to be effective. Many shorter individuals slouch because of seat pans that are too deep for them – thus causing a reversal of the natural lumbar curve. Shorter individuals therefore may do best with a full spine backrest that reduces seat depth and that can attach to the chair. Taller patients will prefer a narrower profile backrest that will not sacrifice valuable seat depth and will allow them to scoot all the way back in their chair.
When seated the backrest should maintain the natural lordosis and keep the spine from slouching for optimal more balanced alignment. A firmer backrest accentuates the lordosis, and a softer backrest allows the low back to flatten out. More support is not always better. Patients with acute pain usually will not tolerate an aggressive or overly firm backrest very well. An adjustable backrest may be a better option when trying to accommodate the varying needs for many individuals. A good backrest should provide support and also conform to the shape of the users spine when sitting - distributing pressure evenly while maintaining the spine in a neutral alignment.
The benefits of a properly fitting backrest for lumbar support when sitting are generally appreciated. Research has shown that backrest supports can be beneficial. Unfortunately it remains difficult to know which brand or size backrest will work best in each specific case and doctors often find inconsistent results when recommending only one type of backrest to every patient. A backrest that provides relief for one patient may cause pain or aggravate the symptoms of another. The solution is to find a backrest that fits best for each individual patient that provides adequate lower back support that they can tolerate in the seat or chair that they sit in most through the day. In some cases more then one type of backrest may be required. For example, a patient may do best with one style of backrest in their office chair and another style for their car.
The most common types of backrests recommended by chiropractors include preformed solid polyurethane foam pillows or cushions. There are however many other types of designs to consider which may be better suited for your patient including – solid molded shells, those with an adjustable air-bladder, visco-elastic foam, synthetic fiber stuffed, buckwheat hull stuffed, and cylindrical rolls or D-shaped designs. Even rolled up towels have been recommended from time to time. Following are descriptions of each and reviews of their main features and benefits.
- Various shapes and sizes available. Pre-formed shape to support the lordosis. Usually with wings on either side to hug the lower back. Used in lumbar rolls that are commonly recommended by physical therapists. May include strap for attachment to chair. Some manufacturers provide same pillow in several sizes or firmnesses. Density, resiliency, firmness vary from brand to brand.
: Inexpensive. Cover usually is washable.
: Difficult to fit. One size does not fit all. Preformed shape often not tolerated well by users. May be overly aggressive and provide excessive support. May push user forward in chair awkwardly with resultant loss of seat depth and upper back support. Foam breaks down or softens and level of support changes over time. Not readily portable.
– Specialized type of urethane foam originally developed by NASA for the space program. Also known as memory foam, temperature sensitive foam, or slow recovery foam. Has improved pressure relieving properties. Conforms to body shapes. Density, firmness, resiliency vary from manufacturer to manufacturer. Some are temperature sensitive and soften with body heat.
: Pressure relieving qualities. Less compromise of blood flow in area being compressed. Selection of different sizes available.
: One size does not fit all. Some brands too soft and provide inadequate support. May freeze solid if left in a car overnight. Tend to build up body heat and feel uncomfortable to user when room is warm or humid.
SOLID MOLDED SHELL
- Various shapes and sizes available. Pre-formed solid molded shell provides lordotic support. Comes in different sizes and heights for lumbar or full back support. Some include a small accessory pillow which can be moved up or down for focused area of support. Others incorporate a pumpable air bladder for adjustable level of firmness. Usually include strap for attachment to chair. Some manufacturers offer several sizes to accommodate various body sizes.
: Durable. Cover may be washable. Accessory pillow or air bladder provide for adjustability and more individualized fit for user defined comfort and level of support.
: Preformed shape may not be tolerated well by users. May push user forward in chair with loss of seat depth. Bulky and not readily portable. Expensive.
- Air bladder provides adjustability of firmness for enhanced comfort and support. Air provides firm support that conforms to fit patients shape. Some have specialized twist valve and self-inflating design. Others require patient to blow up pillow by mouth or include a hand pump mechanism.
: Lightweight. Self inflating style rolls up conveniently for portability. Adjustable firmness for user defined level of support and individualized fit. Attachable to chair. Can be used in most seating situations.
: Those with hand pump prone to failure. Some need to be blown up by mouth and are more difficult to adjust.
– Elastic webbing laced across rigid frame provides adjustability at multiple levels creating zones of varying firmness. Webbing straps can be tightened or loosened to create support where needed to fit users shape.
: Adjustable firmness for user defined level of support and individualized fit.
Attaches to chair.
: Not readily portable.
BUCK WHEAT HULL
- Natural and generally hypo-allergenic. Hulls flow to conform to body shape. Generally roll shaped. Provides firm support that can be infinitely adjusted for user defined level of comfort.
: Firm support. User may be required to unzip to remove hulls when to firm. No heat build up. Lasts for years.
: Bulky. Not readily portable. Very aggressive lumbar support may be too firm for many users.
- Stuffed into compartments usually roll shaped.
: Not overly aggressive for most users.
Disadvantages: Not adjustable. Level of firmness changes over time. Usually provide inadequate support.
ROLLED-UP TOWEL – Common household towel rolled up to form a cylinder. Duct tape or rubber bands used to maintain shape.
: Inexpensive. Adjustable.
: Temporary solution. Tend to fall apart. May provide inadequate support.
When recommending a backrest the most important considerations are to make sure that the backrest is not only comfortable but supportive as well. Consider that the backrest could be overly firm or aggressive for the patient or provide inadequate support in certain seating situations. Patients may need to have a different type of lumbar backrest for each of their seats or chairs. They should be advised that although you believe that a specific backrest is indicated for the management of their condition it is possible that they may have difficulty adapting to the backrest that you recommend. In such cases they should bring this to your attention so that you can access whether they may need more time to accommodate. Keep in mind that some individuals may actually feel better when slouching and depending on their condition sitting without a backrest may be best for them. Advising the patient to discontinue further use may also be necessary occasionally, especially when a backrest seems to be worsening the patients condition, perhaps switching to a different size or style of backrest may be indicated at such time.
It is helpful to instruct the patient on how to use a backrest. The user should first scoot the buttocks all the way back into the chair as they flex forward at the hips. Once the buttock is all the way back in the chair the backrest can then be inserted or positioned so the most prominent part of the support contacts the user at the level of the waistline / beltline. They should then be instructed to slowly sit upright as the lumbar spine is supported by the backrest. If the backrest is adjustable the user should then move the back rest up or down an inch or so to find the most comfortable position, or make any necessary adjustment in firmness to achieve the desired level of support. Patients should also be advised to periodically get up and move around to limit the detrimental effects of prolonged static posture.
Whenever you recommend a backrest make sure to document your recommendation accordingly. Also be sure to explain to your patient why you are recommending a backrest to support the lordosis and lumbar spine more correctly. Provide your patient adequate instructions for usage, pricing, and ordering information or sources if you don’t stock the item in your office. If you dispense the backrest from your inventory be clear with the patient about your return or non return policy and advise them that backrests are recommended or sold without guarantee of results. Staff involvement in the sales process will help you cover the bases - detailed information of these topics can be found in previous articles in this series, “Product Sales in Your Practice”.
A well fitted backrest can help protect the spine from injury by helping to stabilize and support the lordosis in a more neutral position when sitting. In most cases patients who are having difficulty getting comfortable when seated, or who are experiencing increased pain after sitting realize that the chair or seat they are using, and lack of inherent lumbar support may be part of their problem. They will appreciate your recommendations and the benefits of improved lumbar support that they will obtain from a backrest that fits them correctly.
Articles in this series “Product Sales in Your Practice” will explore various health products such as cervical pillows, backrests, lumbar supports, fitness balls, ergonomic chairs, and inversion devices that are often recommended by chiropractors to their patients. Articles will focus on reviewing specific product design features related to health benefits - as opposed to specific product brands.
The "Product Recommendation Form" and MI Sales Tax information described in previous articles are available free of charge at http://www.AirFitBackRest.com/michiro.htm for you to review and reprint for use in your practice. To obtain the “Product Recommendation Form” by fax, email, or regular mail contact FitCare Products at (248) 661-5088 or email email@example.com
Stuart Firsten, DC is a licensed chiropractor in Michigan. His company FitCare Products an MCS Member Supporting Business developed and introduced the new AirFit™ BackRest last year. The AirFit™ is recommended by many MCS members, and hundreds of chiropractors, health care professionals and medical suppliers. The product is also available online to learn more visit http://www.AirFitBackRest.com . To contact Dr. Firsten with your comments or for additional information you can call (248) 661-5088, or email him at firstname.lastname@example.org .
© 2005 Stuart A. Firsten, DC. All Rights Reserved.
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