Most of us, when we think of pressure injuries, immediately think of pressure cushions. And yes, pressure cushions are brilliant, but they are not the be-all and end all of the problem. In fact, the use of a pressure cushion, on a chair that is unsuitable, only exasperates the problem.

This is important because instinct is to simply add a cushion to increase comfort. But comfort is not the primary issue. Alignment is. Addressing comfort, without ensuring the correct alignment and support, only increases the risk of injury.

The formula is simple: Alignment first. Then comfort.
Comfort is the result of alignment.

The importance of posture, CANNOT be overstated. Even more so for the wheelchair-bound or mobility inhibited.

ALIGNMENT BY DESIGN
The human body is a living machine. Constantly adapting and adjusting. Even if parts of the machine are damaged, it still has certain rules that need to be respected, in order to ensure the optimum performance and health of the rest of the body.

Many of us, at some stage or other, live a life with less mobility than we would like.
Regardless of these experiential limitations, these rules still apply.

That means, in short, that what we do, and how we do what we do. is still important, regardless of our realities or limitations.

What we do, and how we do what we do. is still important, regardless of our realities or limitations

Your spine has 3 natural curves that provide the most stable position for your back. These curves require support. Depending on your circumstances more or less, this support will in part come from you, and in part, from external, supportive aids.

HOW ALIGNMENT AFFECTS YOUR BODY
Why is posture so important? And what exactly does that even mean to someone who spends their entire day in a seated position?

The answer is simple: alignment

A body that is not able to align, is under duress. Which means, a part of your body is over-compensating and under immense pressure – which puts you at risk of injury or pressure ulcers.

Correct posture requires that each part of your body is in the right position in relation to the next part of your body, whether seated or standing, from your head down to your feet.

It means, your head is centralized, your back as straight as possible, shoulders back and feet comfortably, flat on the ground. No slumping. No leaning.

This is the bodies optimum position. When sustained, weight is evenly distributed, and pressure is evenly applied. And you experience maximum comfort.

When weight is evenly distributed, and pressure is evenly applied. You experience maximum comfort.

If you critically assess your current position, are you able, to comfortably maintain this position alone? Is the wheelchair or chair correctly sized and set up to support your body in natural alignment? Are your feet, legs, back, arms and head comfortably in contact with, and supported by your seating?
If yes, then your weight is evenly distributed across the footplates, armrests, seat, and back of the chair.
If not, then you need to critically assess your seating position. What needs to be adjusted to ensure correct alignment?

ALIGNMENT FIRST. COMFORT SECOND.
You can usually tell just by looking at a person that they are not comfortable, stable, or supported by their chair. They might be leaning to the side, or leaning forward. They cannot comfortably rest their arms on the armrests. Their feet may be dangling, or knees too high, or they might have their arms crossed to stabilise themselves in the seat.

Each of these factors creates friction, and forces the body to compensate, increasing the weight going through one side of the body. The final result: pressure injuries.

Now, let’s say your chair is perfectly fitted to your proportions. Your weight is evenly distributed across the footplates, armrests, seat, and back of the chair. If I were to insert a pillow beneath you, the dynamics would completely change. The integrity of the support would be jeopardised.

The principle holds. The first priority is always to ensure the correct alignment of the body.
That your seating enables and supports that alignment. And that any additional aids added thereafter to increase comfort, do so without jeopardising the alignment.

The first priorty is always to ensure the correct alignment of the body. That your seating enables and supports that alignment.

A simple case in point: When correctly seated and supported, your feet bear up to 19% of your body weight. When incorrectly adjusted, by for example inserting a cushion, this weight is redistributed. What went to your feet, and should go to your feet, is now going through your seat, increasing the pressure on your bottom. The result, increased risk of injury and pressure sores.

PRINCIPLES TO ENSURE ALIGNMENT
So, what do you need to consider when selecting or setting up your chair that you are forced to spend a considerable amount of time in?

There are always 4 principles at play.

1. Load of the body
Load directly relates to alignment. When the body is correctly aligned, the weight is evenly dispersed.
When weight is evenly distributed, the body is in natural alignment, and pressure is reduced.
That means, the feet, legs, back, arms and head should always, ALL be in contact with the seat. Arms should be able to comfortably rest on the armrest. Feet comfortably resting on the foot supports. Knees perfectly inline with hips etc etc

2. Postural support
Postural support refers to the width of the seat. A correctly proportioned seat should support the back, arms, and head of the user. It keeps the core centralised. No slumping or leaning?
If a seat is too wide, or uneven, it does not provide postural support or effective repositioning, and the body is forced to compensate.

3. No Ability for Repositioning
There should be just enough space (and stability in the base) for you to comfortably reposition yourself and adjust your own weight.
This is important, as repositioning increases blood oxygenation, and reduces the risk of pressure ulcers. Repositioning should happen a minimum of once every 2 hours. So you need to have enough space alongside your body, and enough stability beneath you, to be able to adjust your position alone, even if just slightly.

4. Use an Appropriate Surface.
In other words, as above, the base of the chair should be solid, even, and stable enough that you can comfortably place your weight on your palms, and adjust your body posture.

And that’s it.
The bottom line is: if the rules of alignment and posture are respected, comfort is the reward.
If not, simply applying a pressure cushion, will be ineffective.
Your first priority must always be to ensure the correct alignment of the body.
If your seating correctly supports your alignment, then your weight is evenly distributed, pressure is evenly applied and you experience maximum comfort.
If these 4 principles are correctly applied, you have the right foundation in place.

Related articles:
Learn more about how to set up your chair, to support your body
Life in a chair: 5 keys to comfort

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