Our bodies are not adapted to maintaining one posture for long periods of time and as we were evolving the norm must have been to be constantly changing posture as we moved around and adapted to circumstances, only remaining in one posture when lying to sleep. Modern living has changed all that and now we have occupations, leisure activities and modes of transport which demand that we stay in one posture for significant periods of time. This is a new development and has resulted in a variety of musculoskeletal problems, especially from our commonest posture now, which sitting.
Postural syndrome is the resulting pain and other symptoms which result from holding one posture for too long or for maintaining an unsuitable posture for shorter lengths of time. Initially we will notice some discomfort after a considerable time in the posture but as we persist in holding that position the time to onset of pain and discomfort will become shorter and shorter. Eventually the time until symptom onset can be very short indeed and limit the activity greatly. McKenzie designated this problem as postural syndrome, found more often in younger persons with poor posture who were often sitting or working inappropriately.
Physiotherapy assessment is the first step in dealing with this syndrome as the physio finds out when the pain comes on and what the triggers in terms of positions and time are. On testing of the repeated movements of the neck or low back there will be little or nothing to find, but keeping the person in their typical posture for a period may bring on the typical pains. A poor sitting posture usually includes lumbar flexion so the low back is slumped, rounded thoracic spine and shoulders, forward held neck and poking chin. This places the head above empty space rather than on top of the slender neck column, making it much harder work for the neck muscles to maintain the position.
This posture stresses the lower neck and stretches all the muscles in this area, forcing the upper neck to extend to keep the head level and allowing those muscles to shorten. Tissue changes over time make the symptoms more troublesome. Physiotherapy education in postural retraining is essential here and the patient must persist with the corrected position. A better lumbar posture will often naturally correct a large proportion of the problem in the neck and corrective exercises can stretch shortened muscles and strengthen weak ones.
Author: Jonathan Blood-Smyth