yo, SCI_OTR, seating challenge:

[-scott-]

you seem to be a smart guy.

here's a challenge for ya (or anyone else for that matter). What would you suggest to optimally help my posture? I have a lot of back pain & the reason is that my lumbar curve is out of whack:

[SCI_OTR]

I have to be careful here because there is a fine line between discussing wheelchair and seating issues in general terms versus providing individual seating recommendations as a health care professional. Although it sounds as though you may already have done so, I would recommend an evaluation by a physiatrist or orthopedic specialist followed by an assessment by a seating therapist experienced in SCI.

Looking at your x-ray, however, it does appear your lumbar curve is excessive. A therapist would benefit from seeing your xrays, but would still need to do further assessment of your posture to determine if anything can be done to correct it.

I have a couple of guys who have similar lumbar curves when in a wheelchair. While it is difficult to correct--preventing further progression would be a primary objective. Your Crossfire and Jetstream back appear to provide good support. One thing I would want to ensure is that your pelvis is not sliding under the backrest.

Looking at your profile picture..

[IMG]/forum/customprofilepics/profilepic6942_4.gif[/IMG]

I think I may know the etiology of your excessive lordosis...

[-scott-]

Thanks. I'm not looking for professional recommendation, just an opinion. Consider this a candid discussion. I've already consulted professionals.

As for your analysis, yes, you've identified the problem... sort of. My new chair does help give me decent support, but it's not the issue. Over the years I've experienced chronic back pain, and to offer some relief, a lumbar pad between my back and the wheelchair back is often used. Similarly, I have (more so in the past) slept on my back with a pillow under my lower back to give more support. Obviously this can contribute to what is illustrated above. I have already identified this.

What the X-Rays don't show are some bony protrusions of the vertebrae on my lower back (think what occurs if you slump over). They're not super problematic, but the add'l lumbar support helps alleviate pressure/pain from that. However, it may have contributed to the excessive curve in the opposing direction, lower on my spine, as seen above.

Interestingly enough, I do blame my chairs. I transfer to drive, and the contours of a normal automotive seat have been much more comfortable. My shower bench (a flat-surface Quantum) actually provides me with better back posture when I sit on it.

Over the years I've used cushions that I more or less sink into, which I do think is a factor that hasn't helped my spine. While they provide pressure relief, they may have impacted my back in negative fashion. I've used Rohos, Jay2s, and a Stimulite. Currently I use the Stimulite on my manual chair and a Roho on my power. Both cushions are soft. The manual chair has the ergo seating, which I had hoped would help. I think it does a little, but it's not a night & day difference.

So, given the facts above, is there anything that comes to mind that might help? I've thought through a lot of different options, and a seating clinic is more or less worthless at this point. I know what fits me, but I'm at a little bit of a loss in determining what would be beneficial for my back itself.

Again, I just figured I'd ask. I'm not expecting a solution, but just another perspective. This has been an ongoing problem that I've just had to deal with. It doesn't slow life down all that much, although it sure is a pain... pun intended.

cheers.

[SCI_OTR]

Yo Scott,

At the time of this post, there have been 145 views for this thread and only our replies (Can you feel the tension in the air?). I just spent about 15 minutes typing a response, then mistakenly hit the button on my mouse which I programmed for "browser back" and lost it.

I had an extremely long day, and will share additional thoughts based on the most-recent insights you shared and my experience with a Jetstream back on that TiLite ZR tomorrow. I've seen pics of your Crossfire, but have not seen the seating on your powerchair. Can you post a pic of your powerchair from the side?

Later.

[CapnGimp]

In Opera, which I use exclusively, all you have to do is hit the page back button, You can cycle forward and back as many times as you have had pages in that session(since the browser was opened) I do it often. Never loose a THAANG. Kills me to hear this problem stated regularly.
Use a REAL browser,lol OPERA.
Don't have any suggestions for the seating questions, sorry. Hope you get a solution Scott.
I have heard this problem discussed by RAMON OT on WCJ, he made molds of the patient and fabbed the backs for them. The people had the curvatures forward and backward, not sure of the termin.

[SCI_OTR]

I'm a Firefox user myself. Depending on which forum I am on, my posts sometimes persist. Unfortunately, this is not one of them. Capn, I shall reply to your pm in the next couple of days when I'm more-awake.

[-scott-]

no rush. thanks though.

I'll get a pic of the power chair later; I'm using it currently & will be out running around town much of today... stay tuned... but if it matters, the chair is a bare bones TDX4, 1-1.5" worth of dump, roughly 90 degree seat angle (between seat pan & back), solid Invacare back, & a tight leg angle. It's already optimized the best as I can get it.

[CapnGimp]

I'm a Firefox user myself. Depending on which forum I am on, my posts sometimes persist. Unfortunately, this is not one of them. Capn, I shall reply to your pm in the next couple of days when I'm more-awake.

No hurry on mine either, it will be a while before I start the process.

[SCI_OTR]

Scott,

Would this be consistent with the forces acting on you spine with your current backrests? (With the notable exception of forces causing pressure against your spinous processes). New pic w/ labels.

[-scott-]

Not really, and that's what doesn't fully make sense. I'd assume the arrows represent the forces when seated somewhat accurately though.

Here's a crappy camera phone pic of me in the power chair. I have used this chair most frequently over the past few years vs. a manual (practicality). The back extends all the way down to the cushion, so the visible positioning is not as dramatic as your illustration depicts. The tshirt and back upholstery are somewhat deceiving - the chair back is a solid Invacare something (Uniback?). If you look closely, you will see a lumbar pad. It's not very thick though - just a Jay.

I think the Roho may be masking some of the problem as well. Granted, I was lying on my side when that X-Ray was taken, but still...

Anyway, thanks again for your thoughts.

[SCI_OTR]

To any one following this thread,

Do not be deceived by the fancy graphics into believing that the following is anything other than speculation about the etiology of Scott's postural issues. Anyone having any theories or comments please feel free to jump in.

The pic of you sitting in the TDX4 verified how I thought you would look in traditional rehab seating and your comment about feeling that your posture is better when sitting in a regular automotive seat got me thinking.

Of course they do not correspond exactly, but this is your xray superimposed over your TDX4 pic. It needed to be resized and rotated clockwise ~20 degrees, but the aspect ratio is unchanged.

Green arrows represent what I think are the primary areas of support provided by your seating.

Red arrows indicate where additional support could counter forces contributing to an excessive curvature of the lumbar spine and probably anterior pelvic tilt (hard to tell for certain).

What is it about sitting in an automotive seat that is significantly different from sitting in a wheelchair?

1) The backs on most driver's seats are reclined at least 10 degrees if not more (100-120 degrees).

2) Most driver's seats have a higher back than those on manual wheelchairs or standard powerchairs without power seating.

Have you tried sitting in the TDX4 with the back angle reclined to 100-105 degrees and the Infinity Back mounted higher on the back posts? Sitting with the back more reclined could divert some of the load being transferred down your spinal column to the back rest. While too much recline is normally bad because it encourages excessive posterior pelvic tilt, I am guessing yours has an anterior tilt. (Sheering could still be an issue). Having the back higher could shift support onto the thoracic area instead of having nearly all support concentrated in the lumbar region. A higher back could be of greater benefit than simply remounting the UniFlex back higher because it would provide more area on which to distribute support.

While there is a certain amount of logic to what I just stated, I have no clue whether it would actually work. In fact, I believe it more-likely than not will not.

If you did realize a noticeable improvement and you had a 16 or 18 wide seat width, I would suggest looking into replacing the Infinity back with Invacare's Contoura back pan & cushion--which would be closer to an automotive seat. If pressure over the spinous processes was still a problem, pressure could be diverted away from these areas by removing some of the foam from the padding where the dashed line is.

Well that's the best I have to offer for now. Let's do any further discussion through pm.

BTW, is anyone tracking the progression of your lordosis over time?


Take care

[-scott-]

Thanks - I'll PM you Monday or Tues, as I've been out of town all day today and will be out all of tomorrow as well.

I wanted to post back here though to get others thinking. To anyone: feel free to jump into the dialogue.

I sit better in my Crossfire (manual chair) w/ more dump (4-5") and an almost 90-degree back angle, with a *low* Jetstream back. Reclining a back on any chair with minimal dump won't be terribly beneficial, in my opinion, as I need to sit up [as] straight [as possible]. Reclining the back would simply contribute to slumping over and putting my spine in a worse position, wouldn't it?

I'm not discounting your logic, just questioning it w/o thinking through the mechanics completely, as it doesn't click at the moment. Let me chew on this later.

Will get a profile pic sitting in the Crossfire tomorrow (or soon).

More later.

[darkeyed_daisy]

Well Scott...

Didnt want you to feel alone...LOL But this conversation is way over my head... I hope you find a solution soon!!

[-scott-]

hehe... thanks Daisy. I wanted to post this b/c I can't be the only one dealing with this, or at least something similar. It will hopefully get a few gears turning in some minds. As stated earlier, this is nothing new for me & I remain active despite a few bumps in the road. Local doctors &/or therapists have been no help b/c sonething like this, for example, isn't a simple textbook case. I've learned more researching and discussing things on my own.

Long story short, I personally think most wheelchair seating sucks.

[SCI_OTR]

All I know is that I have never encountered a problem which required this much time & effort to illustrate & explain, then put it out there for anyone in the world to see, a suggestion which I have my own doubts about whether it would work!

But it may be a possible solution for a complex problem. The only downside to trying it would be the time required to change the back angle and backrest location back to their original locations.

If the backrest is reclined, the support required to sit upright would come from the backrest instead of the ligaments and facet joints of your lumbar spine. Your pelvis may also rotate back slightly which could also reduce stress on the lumbar curve. My line of reasoning assumes that the flexibility of your lumbar spine is normal or too flexible. If you have limited flexibility, then this may not work as well.

As far as the set up of your Crossfire, I would leave it the way you have it.