24-Hour Posture Management

An approach to managing posture throughout the day while sitting, standing and lying down to protect body symmetry and preserve functional mobility.

What is 24-hour posture management?

24-hour posture management is a term referring to the management of our body posture when sitting, standing and lying down throughout the day to reduce postural asymmetry and maintain functionality in muscles, tissues and bones.

Postural management is particularly useful for patients who are unable to shift around independently due to a physical disability. When patients are unable to reposition independently, they are at risk of developing postural deformities and secondary complications such as muscle contractures and tissue damage. To reduce complications derived from postural deformities, the 24-hour postural management approach underlines the importance of utilising a tailored combination of equipment to support posture and daily functions throughout the day. The approach aims to create a cohesive picture describing the collective effects of everyday posture and positioning on our health.

Why does bad posture lead to deformities?

Our body shape and mobility are affected by our body positioning and the forces of gravity. The human body perpetually withstands the forces of gravity to maintain balance and function. Without good posture or physical activity, certain muscles will become inactive. Unused muscles will shorten and weaken because the human body is biologically designed to minimise energy expenditure. Weaker muscles are less able to counteract the forces of gravity, and the muscle imbalances lead to body shape deformities. As gravity affects our bodies throughout the day, body posture should be maintained for 24 hours. On the other hand, muscles can shorten due to overuse. When an individual remains in one position for an extended period, the muscles are constantly contracted and shortened. Over time, the overused muscles are likely to become tight. Consequently, the 24-hour posture management approach aims to protect the body from damage caused by postural asymmetry occurring in everyday life.

Illustrative example of spinal deformity

The forward head posture is a common example of a condition caused by repeated poor posture. Individuals who spend long periods sitting in front of a desk have their heads extended forward for long hours. When the weight of our heads is at the front of the body’s centre of gravity, it strains the ligaments in the neck. With repeated exposure, the spine changes from its original shape which can result in neck pain and headaches. Other examples of postural deformities include scoliosis, kyphosis and windswept legs; different types of conditions can arise from different postural habits.

What are the effects of bad posture?

It is widely accepted that posture is protected through movement. In the absence of regular active movement, there can be significant musculoskeletal deformities over time.

Effects of bad posture include:

Imbalanced Muscle Tension: Muscles work in pairs to stabilise and move joints. Poor posture disrupts the balance in paired muscles which causes some muscles to become overactive and tight, while others weaken and lengthen. This imbalance can pull bones and joints out of their natural alignment.
Increased Pressure on Joints: Misaligned posture places uneven stress on joints, leading to wear and tear over time. For example, the hip and spine are particularly vulnerable areas which are susceptible to deformities such as scoliosis or pelvic obliquity when subjected to prolonged stress.
Altered Skeletal Growth (in Children): For children, whose bones are still developing, poor posture can lead to permanent deformities. Asymmetrical sitting or lying positions can cause uneven bone growth and lead to conditions such as windswept hips or kyphosis.
Reduced Circulation and Tissue Health: Poorly supported posture reduces blood flow to muscles and soft tissues, which can lead to contractures or fixed deformities. Without intervention, complications and deformities become harder to correct.

How does the 24-hour posture management approach help?

The 24-hour posture management approach ensures that individuals with physical disabilities maintain optimal body alignment across all positions: sitting, standing, and lying. To illustrate, a wheelchair user can spend 8 hours in a seat to support a midline sitting position but neglect their posture for the remaining 16 hours of the day. In progressive conditions, individuals might need greater assistance and support over time if left untreated. Managing posture in our day-to-day lives can prevent body shape deformities, pressure sores, muscle shortening, contractions, and respiratory issues. Consistent posture management throughout the day is crucial for preventing long-term complications and promoting overall health and well-being.

Targets of the 24-hour posture management approach

How to manage posture throughout your day.

Effective postural care goes beyond one position or equipment—it’s about the cumulative effect of all positions throughout the day. We are more likely to experience beneficial and long-term outcomes by incorporating a cohesive 24-hour plan with support from equipment designed to optimise postural care for sitting, standing, and lying. Whether through clinical seating, standing aids, or night-time positioning systems, the 24-hour posture management approach creates a foundation for optimal health, independence, and well-being.

Strategies to manage posture:

Alternative seating: A change in position or softer materials to support relaxation.
Tilt in space: Available on powered and manual bases to redistribute weight.
Custom moulded seats: Great for targeted pressure relief and positioning.
Standing frames: Helps to maintain bone density, digestion, breathing and joint ranges.
Standing wheelchairs: Enables regular independent change of position during transfer.
Mollii suit: Targets spasticity and mixed muscle tone for pain relief and functional control.
Orthopaedic beds: Alleviate back pains, and improve spinal posture when sleeping.
Sleep systems: Positioning aids to keep neutral alignment overnight.
Exercise programmes: Improve muscle imbalances, endurance and posture.

Integrating consistent posture management into your lifestyle:

Seating goes beyond your wheelchair:

A patient’s healthcare chair needs to mirror the support principles of their wheelchair. When transitioning out of a wheelchair, the patient's healthcare chair needs to assist with pelvic alignment, and lateral support and provide consistent pressure distribution to avoid postural asymmetries.
Hygiene seating, such as shower chairs, must also maintain these postural principles to protect alignment and stability during personal care tasks.

Introducing movement and load-bearing when standing:

For non-ambulatory individuals, standing frames and walkers can play a crucial role. They promote weight-bearing which helps maintain bone density, support joint health, and reduce the risk of musculoskeletal changes accelerated by spasticity or altered tone.

Positioning during rest:

Bed positioning is critical as many individuals spend 8 to 12 hours in bed. Poor positioning when resting can lead to fixed asymmetries, particularly in children and teenagers during growth phases.
Growth hormones, which are released during sleep, can exacerbate adaptive postures if proper alignment isn’t maintained. Night-time positioning systems ensure the body remains symmetrical, reducing the risk of permanent deformities as the child grows.

Managing posture helps with the development of normal movement patterns and the realignment of the skeletal structure. A neutral posture can improve functionality in the body, and patients can find it easier to breathe, balance, swallow, digest and stay mobile. Health complications such as deformities, pressure sores, muscle shortening, contractions, and other health complications. In progressive conditions, individuals might need greater assistance and support over time if left untreated. The 24-hour management approach helps patients develop the ability to position themselves comfortably, stay mobile, gain confidence and move with greater independence.

Consultation with a clinical assessor

Posture management should be carefully tailored to every patient’s health needs and lifestyle goals while accounting for their anatomical baselines. Our clinical assessors specialising in neurophysiology, rehabilitation engineering, and postural assessments can identify the most effective strategies and equipment to best support a patient.

We will explore a broad range of mobility products with you from custom moulded seats to neuromodulation suits, and journey with you as you try different products.

C all us to arrange an assessment. Our clinical assessments take place in our private assessment room for £250. We conduct home assessments for individuals who are unable to travel for £500. For home assessments, we will bring seating equipment and mobility products in a van to your home.