(Also known as Postural Dysfunction)
What is postural syndrome?
Postural syndrome of the upper back is a relatively common condition that causes pain in the upper back without significant damage or trauma to tissue. Patients with this condition only experience an ache or pain during activities placing sustained stress on normal tissue.
The mechanism of pain onset in postural syndrome can be demonstrated by gently bending your index finger backwards until you feel a stretch (figure 1).
At this point there is no tissue damage or pain, however, if you maintain this position for long enough, your finger will gradually become painful or ache. Once the finger is released and allowed to change position, the pain or ache will ease. Postural syndrome in the upper back occurs in a similar fashion and typically occurs due to sitting or standing in poor positions for prolonged periods of time (figures 2, 3 and 4).
When standing or sitting slouched (figures 2 and 3), the bend in your upper back and arch in your upper neck increases (figure 4). In addition your shoulders typically move forwards. This places considerable stretching force and increased load on the joints and muscles of your upper back and neck and will gradually cause an ache or pain if sustained for too long. When this occurs the condition is known as postural syndrome.
Figure 1 – Finger stretch
Figure 2 – Poor standing posture
Figure 3 – Poor sitting posture
Figure 4 – Poor posture
Causes of postural syndrome
Postural syndrome is a condition that is caused by adopting poor posture over a prolonged period of time. This may occur in any position such as standing or lying, but is particularly common during sitting (e.g. at a computer, using a mobile phone, watching television or driving).
Postural syndrome is also relatively common during everyday activities that encourage the arms to move forward in front of the body such as cooking, cleaning, gardening or ironing.
In sport, postural syndrome is often seen in athletes whose activity involves prolonged bending forward postures such as cycling, hockey players, baseball catchers and wicket keepers in cricket.
Signs and symptoms of postural syndrome
Patients with postural syndrome typically have normal, pain-free movement. Symptoms are only experienced when poor posture is maintained for prolonged periods. This can occur in any position (e.g. sitting, standing, lying etc.).
Pain is typically experienced as a dull ache or burning sensation in the upper back and can sometimes be accompanied by symptoms in the neck, lower back or shoulders. Usually the pain associated with postural syndrome will quickly ease upon moving or changing positions, thereby taking the strain off the affected structures.
Diagnosis of postural syndrome
A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose postural syndrome of the upper back. Investigations such as an X-ray, MRI or CT scan may be required, in rare cases, to rule out other conditions.
Treatment for postural syndrome
Achieving good posture
Prognosis of postural syndrome
The prognosis of patients with postural syndrome is excellent provided the patient is motivated and compliant with physiotherapy treatment, advice and exercises. Most patients can achieve pain free status immediately upon correction of poor posture. Retraining movement patterns and performing appropriate exercises is essential to prevent symptom recurrence.
Physiotherapy for postural syndrome
Physiotherapy treatment for postural syndrome can significantly help to reduce symptoms, ensure an optimal outcome and prevent recurrence. Physiotherapy may comprise:
- postural education and retraining (see posture)
- exercises to improve strength, posture or flexibility
- soft tissue massage (particularly to the upper back and pectoral muscles)
- electrotherapy (e.g. ultrasound)
- dry needling
- postural taping
- postural bracing
- joint mobilization (particularly to the upper back)
- the use of a lumbar roll for sitting
- activity modification advice
- biomechanical correction
- clinical Pilates
- ergonomic advice
- ergonomic mobile phone advice
- bike setup advice
Contributing factors to the development of postural syndrome
There are several factors that may contribute to the development of postural syndrome. These factors need to be assessed and corrected with direction from a physiotherapist and may include:
- poor posture
- poor ergonomic set-up
- joint stiffness (particularly of the upper back or hips)
- a sedentary lifestyle
- poor core stability
- muscle weakness (particularly of the scapula retractors and upper back extensors)
- muscle tightness (particularly the pectorals, abdominals and hamstrings)
- a lifestyle or occupation involving large amounts of sitting, bending, slouching, shoulders forwards activities or lifting
- inappropriate chair or workstation set-up
- decreased fitness or fatigue
- a lifestyle involving excessive use of computers, laptops or mobile phones
- inadequate recovery periods from poor postural positions
- use of an inappropriate pillow during sleep
Exercises for postural syndrome
The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, the initial and intermediate exercises should be performed 3 – 5 times daily, whilst the advanced exercises should be performed twice daily.
All exercises should only be performed provided they do not cause or increase symptoms. Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate and advanced exercises. As a general rule, addition of exercises or progression to more advanced exercises should only take place provided there is no increase in symptoms.
Begin sitting or standing tall with your back and neck straight, shoulders should be back slightly (figure 9). Tuck your chin in as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Keep your eyes and nose facing forwards. Hold for 2 seconds and repeat 10 times provided the exercise is pain free. Repeat 3 – 5 times daily.
Shoulder Blade Squeezes
Begin sitting or standing tall with your back and neck straight (figure 10). Squeeze your shoulder blades together as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Hold for 5 seconds and repeat 10 times provided the exercise is pain free. Repeat 3 – 5 times daily.
Rotation in Sitting
Begin sitting tall, with your arms across your chest. Keeping your legs still, gently rotate to one side as far as you can go without pain and provided you feel no more than a mild to moderate stretch (figure 11). Hold for 1 – 2 seconds and repeat 10 times to each side, alternating sides, provided the exercise is pain free. Repeat 3 – 5 times daily.
Rehabilitation Protocol for postural syndrome
Some of the most commonly recommended products by physiotherapists to assist patients with this condition include:
- Postural Supports
- Therapeutic Pillows
- Ice Packs and Heat Packs
- Lumbar Rolls for Sitting
- Car Supports for Driving
- Sports Tape (for postural taping)
- McKenzie Treat Your Own Back Books
- McKenzie Treat your Own Neck Books
- Foam Rollers (for upper back stretches and Pilates exercises)
- Resistance Band (for postural strengthening and Pilates exercises)
- Spikey Balls (for self massage)
To purchase physiotherapy products for this condition click on one of the above links or visit the PhysioAdvisor Shop.
Find a physiotherapistin your local area who can treat this condition.
- Correct Posture
- Postural Taping
- Mobile Phone Ergonomics
- Ergonomic Computer Setup
- Bike Setup
- Choosing a School Bag
- Correct Lifting
- Neck Diagnosis Guide
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