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Raising the Bar in Rehab


Published January 25, 2013 7:27 PM by Lisa Mueller
When I first made my transition from acute care to outpatient orthopedic practice (just over a year ago), I studied for a while on the special tests, diagnoses and treatment techniques. Performing evaluations felt similar to being a student -- like there was so much to ask, so many things to consider and not enough time to complete it all! I focused on the big things initially -- special tests, treatment techniques and anatomy. But I'm now remembering a lot of the "smaller" components contributing to my patient's presentation.

One of those areas has been asking my patients about their sleeping posture, the quality of their mattress and pillows. I actually had, as Oprah would describe, an "Aha" moment with one of my patients with low-back pain when I finally remembered to discuss sleeping posture during one of her sessions. I felt like I'd already tried everything with this patient -- manual techniques, stretching, core stabilization etc., when she told me that she had been away for the weekend and sleeping on the hotel mattress made her back feel better.

Aha! Yes, Lisa, remember? The memories of my professors discussing sleep positions came flooding into my brain. I explained rolling a towel into the bottom of a pillowcase to provide better cervical alignment, discussed the impact of side-lying, supine and prone positioning on the vertebral column and the patient soaked up the information like a sponge. After trying a new sleeping position with additional pillow support, the patient was symptom-free.

Interestingly enough, the Wall Street Journal wrote about the same topic this week, which included a physical therapist discussing how important sleeping posture is for prevention and avoidance of orthopedic pain. It's a quick read, but a good review overall, and a good reminder to include sleeping assessment with each patient. The article also includes a short description of positions recommended for back, shoulder and neck pain that may be beneficial for patients to read.

What about you? Do you educate your patients on their sleeping posture? Are there similar topics you review with each of your patients?


I'm traveling a lot for work now....I really notice the difference depending upon the mattress, the pillow(s), and the ambient noise on how well I sleep and how my joints feel in the morning.

A very good topic!

Dean Metz January 27, 2013 10:00 PM

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