Invention encourages postural alignment to help treat a variety of conditions

By Brian W. Ferrie

Howard Makofsky, DHSc, PT, OCS, constantly seeks better ways to treat patients with back and neck disorders. Currently an associate professor in the department of physical therapy at New York Institute of Technology (NYIT), he has been a PT for almost 30 years, with substantial experience both in the clinic and academia.

Dr. Makofsky also authored the textbook, Spinal Manual Therapy, published by Slack Inc. Furthermore, in the spring of 2005, he invented the PostureJac™, which the professor discussed with ADVANCE last month.

ADVANCE: How would you describe the PostureJac?

Dr. Makofsky: It looks like a modified jacket, made of nylon and PVC, with straps resembling those of a backpack. Other posture support products on the market hold the shoulder girdle in a proper position but don't train the patient. The PostureJac is different because as far as I know it is the only patent-pending, posture-correction device that incorporates handles. As a result, it is not a passive intervention, but rather involves active exercise. By pushing down on the handles, people strengthen the postural support muscles and lift or jack the spine upward.

So it's a type of jacket without any attachment in the front because we don't want something to interfere with the ability of the shoulders to come down and back, enabling the spine to be "jacked up." I like to sum it up by saying the PostureJac enables people to stretch what's tight, mobilize what's stiff and strengthen what's weak. Patients are sometimes concerned about developing dependence, but if we develop dependence it's upon exercise, which is a good thing. Their experience after using it is to feel taller, lighter and stronger. In fact, people are often told by family and friends that they look taller; their appearance having changed over time.

ADVANCE: What led you to invent this device?

Dr. Makofsky: My 28 years of being a therapist, teaching for more than 20 of those years, and doing research on posture. I looked at different approaches, including PT methods, alternative approaches such as the Alexander Technique as well as the writings of Ida Rolf. This led me to an understanding of what was missing in most postural approaches—the appreciation of upward direction in the spine. Upward direction was mentioned by Alexander and Rolf but not explained biomechanically. So I began to understand physiologically what was happening. When the shoulders assumed a more optimal alignment, they tended to prop or lift the spine up against gravity.

I incorporated that concept into my first invention, called the Occivator®, in 2003. The Occivator is currently used in PT clinics throughout the United States. After I invented it, therapists asked me to address the need patients had for something they could use on a home program basis when they left the PT clinic. So that's when we developed the PostureJac, which people can wear and take with them to work, on business trips or even vacations.

ADVANCE: Could you describe what the Occivator is?

Dr. Makofsky: It is an over-the-door or wall-mounted unit with a head strap. Patients manipulate a pulley system, which pulls the back of the head up toward the ceiling. It specifically addresses forward-head, rounded-shoulders posture by adjusting head position. The PostureJac addresses poor posture from the trunk up. They both access what I call the "spinal corkscrew principle."

If you look at a corkscrew, when the arms are pulled down, the cork comes up out of the bottle. That's because the center of the corkscrew is thrust upward. I saw this comparison between the corkscrew and the human body, which really went into the design of both the Occivator and the PostureJac. The shoulder girdle comes down and the spine goes up. That was consistent with what other people had written about but never explained physiologically.

ADVANCE: Is there a certain amount of time that patients typically use the PostureJac for?

Dr. Makofsky: We suggest two to three times a day, perhaps a five-minute workout each time. There are at least 10 exercises provided with the device. We also include MyoPressers™, which are wooden balls that can be attached to the shoulder straps and placed on myofascial trigger points. Some people use these all day long, in the office or the classroom. They put the balls over the myofascial trigger points in the posterior shoulder muscles and press on them every hour, to prevent headaches or neck stiffness from developing by controlling the tension in their shoulder girdle.

ADVANCE: Are the MyoPressers also your invention?

Dr. Makofsky: Yes. The PostureJac can be used for exercise purposes for posture correction without the MyoPressers and for trigger point release with them.

ADVANCE: What specific conditions is the PostureJac most helpful for?

Dr. Makofsky: I've been studying data in the literature on forward-head posture and various musculoskeletal conditions. And there is impressive evidence from peer-reviewed journals, especially in the past five years, to support the connection between forward-head posture and chronic tension-type headache, temporomandibular disorders (TMD) and shoulder impingement. These are conditions with evidence to support the use of posture correction therapies. Then there are other conditions with lower levels of evidence, including people with breathing disorders, because their posture affects the mobility of the ribcage. So when people put the PostureJac on and engage the handles, they feel able to breathe better.

There is also some evidence to suggest that posture has an influence on the development of fibromyalgia syndrome. There's an additional benefit to people, especially women, with osteoporosis. In fact, Alan Hayhoe, who now is president of the company that manufactures the PostureJac in Toronto, SomatoCentric Systems Inc., became involved because his 92-year-old mother with severe osteoporosis was significantly helped by the PostureJac. Her pain decreased and her mobility and ADLs significantly improved. After Alan saw the way it benefited her, we entered into a licensing agreement during the spring of 2006.

ADVANCE: You typically suggest that patients use the PostureJac two to three times a day for about five minutes each time–but people can do it more frequently than that if they'd like to?

Dr. Makofsky: Yes, they can actually wear it all day. The presence of the PostureJac is a reminder to keep their shoulders in proper alignment. But I do suggest that because tight muscles are going to be stretched and weak muscles are going to be strengthened, as with any other therapeutic exercise regimen, people should enter into it slowly to allow their body to make the adjustment. The three aspects of posture correction I find most important are to restore balance, efficiency and vertical alignment to the body. This will occur over a period of weeks to months. So we don't want people to become too vigorous with their stretching exercises. They could overdo it and become sore, similar to any intervention.

ADVANCE: Although you're currently in the academic realm, when you invented the PostureJac, were you actively involved with patients as a therapist?

Dr. Makofsky: Yes, I was in private practice. I see the PostureJac as a bridge between manual PT and home exercise. It's not a substitute. It's being used around the country and overseas in PT clinics to train patients in proper alignment. Then when they're discharged, they purchase their own PostureJac and continue to use it after they've been properly trained. But training by a PT is extremely important in correct use of the device.

ADVANCE: From the initial stages of inventing it, how did you spread the word so that other therapists would be aware of the device and use it with their patients?

Dr. Makofsky: I was involved in providing lectures and in-service training in hospitals and PT clinics throughout the Long Island and New York City area. People would purchase a set of four PostureJacs (small, medium, large, extra-large) and use it in the clinics. They were so satisfied with the results, the clinics started to order jackets for patients.

ADVANCE: Are you aware of any contraindications for using the PostureJac?

Dr. Makofsky: We are concerned about people with rheumatoid arthritis because they tend to develop hypermobility in the upper cervical spine. We are also cautious with people who have osteoporosis because it does involve extension of the thoracic spine, which is good for many of them, but could be a contraindication for those with severe osteoporosis.

ADVANCE: Considering that at least one woman who benefited is 92 years old, is there no age limit for patients who can use the PostureJac?

Dr. Makofsky: That is correct. We've also used it in patients with Parkinson's disease. They have an impaired sense of postural awareness and the PostureJac helps re-train their brain in how to be properly positioned. It doesn't address the underlying neuropathology but does assist with their sense of proper, upright alignment.

ADVANCE: What process have you gone through to obtain a patent for the PostureJac?

Dr. Makofsky: We submitted an application to the U.S. Patent Trademark office in the spring of 2006. I also received a provisional patent in the spring of 2005, before submitting the formal patent application. The process we're going through now is for a utility patent, which takes a lot longer. It took me two years to get the patent on the Occivator. We also have a trademark pending for the name PostureJac in both the United States and Canada.

ADVANCE: What are your thoughts about the development of this device from first invention to how it's been received and the results it's achieved?

Dr. Makofsky: I think the results have been excellent and we need to publish them. We currently have three research studies underway at NYIT. One is on use of the PostureJac to facilitate the lower trapezius during shoulder elevation. We also have begun a study investigating the use of the PostureJac to train the deep neck flexor muscles, which are critical in patients with headaches. And we are about to submit a grant proposal to NIH that will look at use of the PostureJac to assist adolescents with problems related to backpack use.

There's a great need to address adolescent back pain secondary to use of backpacks. We think that placing a PostureJac under the backpack or manufacturing a backpack with PostureJac handles built into it (patent-pending) can help support the weight. So we have a lot of research yet to do, but are encouraged by the evidence and feedback we've received from therapists and patients around the world. Some of those testimonials can be found on our Website: www.posturejac.com

ADVANCE: Are there any other thoughts you would like to add?

Dr. Makofsky: The PostureJac also assists with Pilates-type exercises. We address the need to restore core stability to the lower trunk with a whole set of exercises. In addition, we found people with shoulder rotator cuff injuries who did very well with the PostureJac through a specific strengthening exercise. So it's a very versatile unit. Considering its influence on the shoulder girdle, craniomandibular and craniovertebral regions, spine and lumbopelvic area, it addresses the mechanics of many different parts of the body.

Brian W. Ferrie is managing editor at ADVANCE and can be reached at bferrie@merion.com