POSTURAL PAIN SYNDROME

DefinitionPostural pain syndrome is pain that develops

in the cervical, thoracic or the lumbar area due to poor posture maintained over a long period of time. Excessive tension is placed on these areas.

Pain is relieved with activity.

Postural pain syndromeIncludes:

Postural overload Causes unbalanced mechanical load.

Postural overexertion Intensity and duration of work is higher than the

capacity of the muscles.Vibration syndrome

Situations where continual compression is exerted on the structures.

Postural pain Bad posture in static positions.

PathophysiologyThere is no significant damage or trauma to

tissue.Pain is only experienced during activities

where constant stress is placed on normal tissue.

When working at a desk, the sustained posture results in reduced circulation to the neck and upper back muscles, which then become tired and fatigued.

These muscles fail to support good upright posture and eventually become overstretched and weak.

Causes and Risk factorsSome of the most common causes:

Slouching in chairsDriving in hunched positionsStanding badlyLifting incorrectlySleeping on sagging mattressesBeing unfitInactivity and the wrong sort of movementHead and neck strain

Causes and Risk factorsMusculoskeletal problemsWork-related back problemsLower back painRepetitive strain injuryCarpal tunnel syndrome

Causes and Risk factorsCommon risk factors:

Being unfitBeing overweightJobs involving lifting, bending or moving heavy

objectsBeing seated in one place for long periods of

timeFrequent use of a telephone without a headsetHigh levels of stress, anxiety and tension

DiagnosisDifficult for doctors to find the exact causePain usually starts a day or two after the

injury has occurred or only after several years.

Signs and symptomsUsually patients with postural pain syndrome

have normal and pain-free movement.When poor posture is maintained for a long

time, pain is experienced.

TreatmentPhysiotherapy may include:

Soft tissue massageElectrotherapy e.g. ultrasoundPostural tappingThe use of posture support e.g. bracesMobilisationDry needlingExercises to improve strength of weak muscles.Improve postureStretch short and strong muscles.

TreatmentTeach patient about kinetic handling.Correct biomechanics.Clinical Pilates

Do’s and Don’tsDo’s: (sitting)

Sit in a chair that supports your back in a slightly extended position.

Hips and knees in 90° .Shoulders in retraction

and chin tucked in to minimise postural strain.

Feet should be firmly placed on the ground.

Do’s and Don’tsDon’ts: (sitting)

Slump sitLean forward and

downward to reach your work.

Sit with your neck forward for an extended period of time(move around every 20 minutes).

Do’s and Don’tsDo’s: (standing)

Put one foot up and change position often.Work at a comfortable height.

Don’ts: (Standing)Wear high-heel, hard heeled or platform shoes for

long periods of time.Stand in one position for too long.Stand with knees locked.Stand bent forward at your waist with your work in

a low position.

X-Rays

Evidence based article

Getting your back back to work: pain relief- where to start?

Evidence based articleFocus is on dental health care workers poor

posture due to their job leading to back and shoulder pain.

Presents a classification system for the treatment of spinal pain created by physical therapist Robin McKenzie.

The approach has had favourable clinical acceptance among therapists and patients and offers a conservative alternative to treating back and neck pain.

Evidence based articleMcKenzie characterized mechanical pain as;

Pain that can be constant or intermittentLimited range of motion of the back or neck

that improves as symptoms diminishMovements in certain “incorrect,” or

exacerbating directions increases the pain while simultaneously decreasing range of motion in the opposite direction.

Evidence based articleHe proposed three nonspecific mechanical

syndromes;Postural pain syndromeDysfunction syndromeDerangement syndrome

Evidence based articleDental workers usually work in a slouched

position.Slouched sitting causes the spinal

musculature to diminish its activity and place increasing stress on the posterior ligamentous structures of the spine resulting in increased length or “creep”

Bogduk defines creep as a constant force, that if left applied for a prolonged period to collagen tissue will result in further movement or length of the ligamentous tissue.

Evidence based articleWe often see significant weakness of the back

extensor and post. scapula musculature.Tightness of the ant. chest and shoulder

musculature in individuals having back and neck pain.

Evidence based articleEg. of an exercise;

Slouch-overcorrect From an extreme, slouched position to an

exaggerated, lordotic posture.

Evidence based articleIndications

Periods in the day when no pain is experiencedPain is confined to areas above the kneeSymptoms are worse when sitting and

generally better with standing or walkingSymptoms are worse when bending and with

inactivityIf symptoms are better when in supineSeveral episodes of back pain have been

experienced over the past few years.

Evidence based articleContra indications

A first episode of back pain that persists for more than ten days

Bowel and bladder symptoms associated with back pain

Back or neck pain caused by traumaLeg pain below the knee including numbness,

tingling or weaknessMalaisePain that disturbs sleep

Feeding an individual a fish takes care of their hunger, while teaching them to fish allows them to survive for life.(unknown)

References Caruso, T.J. and Pleva, D.J. 2006. Getting your back back to work: pain

relief—where to start? International Journal of Mechanical Diagnosis and Therapy. 1(1): 18-28. http://www.mdt-japan.org/therapist/2006IJMDT_1%20(1).pdf#page=19

Retrieved on 4 June 2012.

http://ebookbrowse.com/postural-pain-syndrome-jan08-pdf-d79305710

http://www.bbc.co.uk/health/physical_health/conditions/in_depth/back_pain/causesback_types.shtml#top

http://www.physicaltherapy.zoomshare.com/5.html

http://www.physioadvisor.com.au/8390250/postural-syndrome-posture-pain-poor-posture-.htm

Referenceshttp://www.google.co.za/imgres?

q=postural+pain+syndrome&um=1&hl=en&sa=N&biw=691&bih=352&tbm=isch&tbnid=Tfs1jZ5TgN9n-M:&imgrefurl=http://www.back-in-action.co.uk/Pages/BackPain.htm&docid=T3pa1ZZ_UITSVM&imgurl=http://www.back-in-action.co.uk/Images/Pages/Back_Pain/image003.jpg&w=315&h=400&ei=eRjGT9azDYyYhQe17-XaBQ&zoom=1

http://www.the-good-doctor.net/posture-and-forms-of-middle-back-pain/

Referenceshttp://www.google.co.za/imgres?

q=postural+pain+syndrome&start=82&um=1&hl=en&sa=N&biw=1117&bih=703&tbm=isch&tbnid=wVGjb5CM624Y3M:&imgrefurl=http://erikdalton.com/media/published-articles/forward-head-posture/&docid=xJOUvc0XqBE0KM&imgurl=http://erikdalton.com/images/Fig3_disk_W.jpg&w=300&h=394&ei=HhfGT6usEo-4hAf3nuC9BQ&zoom=1&iact=hc&vpx=877&vpy=312&dur=4188&hovh=257&hovw=196&tx=137&ty=165&sig=112601856111257986843&page=5&tbnh=154&tbnw=118&ndsp=21&ved=1t:429,r:10,s:82,i:26