In an ideal world, every patient would be a perfect fit for our chair, have excellent neck mobility, and could lay upside down if we needed them to. But, it's not a perfect world, is it??
In the ACTUAL world, patients come in all different shapes and sizes, have different mobility issues, or reasons as to why they "can't lay all the way back."
How do we deal with these?
As much as I'd like to hold perfect posture and ergonomics with every patient, I work clinically in the real world, and I know this isn't always the case. So, in this post, I'd like to share some (hopefully) helpful suggestions on how to navigate these difficult situations.
As a general rule, it's good practice to have the patient "scoot" all the way to the top of the chair, so their head is completely on the headrest. No matter how tall or petite the patient is, this rule applies. Cushions can help with patient comfort if needed. I try to achieve this with all patients, from kids to the elderly and everyone in between. Is it always possible? No, but that's my goal for every patient.
If we have a full-bodied patient, it's useful to stand or raise your stool up high as much as possible to keep yourself in neutral. The higher you are in these situations, the better. This allows for the patient's mouth to be at elbow level without having to "chicken-wing" your arms.
If we have elderly patients, there are a few tricks that can help get them into position:
Pre-recline the chair about 30 degrees before they even sit down, so they have less of a distance to go once you start reclining them.
Have a cervical cushion already in place, so they feel support right when they sit down (if the neck is supported, they are much more compliant, trust me)!
Lay them back in small increments while you talk with them; this helps them to acclimate to the different positions while they are distracted by your talking (even better if you're asking them questions as you slowly recline).
Remember, it will not be perfect all the time. Try to achieve proper ergonomics 80% of the time, so that when you do have a challenging situation, you have "gas in the tank" to help you when you break neutral posture.
And as always, when you know you're in an unhealthy posture, take a 20-second microbreak every 20 minutes to give your body a rest and get blood flow to those overworked muscles.
Our job is physically challenging (not to mention mentally and emotionally draining) but the little things we do each day while in practice will either make or break us! Pay attention to the small details, you're worth it!