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Postural Syndrome

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You've probably heard people say, "Sit up straight, keep your shoulders back and don't slouch." Children usually get that advice from their parents, and like all good advice it should last a lifetime, because poor posture can lead to a painful condition called postural syndrome.

Postural syndrome can cause physical changes to the body and painful side effects. Most people with the condition notice their shoulders are rounded and tend to droop forward. Muscles that connect the shoulders and the back of the neck to the head then tend to pull the head forward. The resulting position can cause constant, aching pain, stiffness and even burning in the upper and middle back areas, as well as in the shoulder, neck and head. Over time, poor posture can also lead to the development of trigger points (tight muscle fibers), which can refer pain throughout the back and neck, as well as cause headaches.

Poor posture usually develops gradually in people who sit improperly for long periods. Think about how much time you spend sitting. You probably sit in your car, at work, when you're eating meals and when you're watching television. And if you're like most people, you probably tend to sit with a forward bend, which causes your shoulders to become hunched over. This is the opposite of good posture, which is a state of musculoskeletal balance that involves a minimal amount of stress or strain on the body.

Over time, poor posture can cause a muscular imbalance in the body. Normally, there are balanced tug-of-war games happening between the chest muscles (pectoralis) and the upper back muscles (rhomboid, middle trapezius and inferior trapezius) and between he muscles that bring your chin to your chest (anterior scalene and sternocleidalmastoid) and the muscles in the back of your neck (upper trapezius). No muscle group wins, because they all have equally strong players.

The impasse ends, however, when chronic poor posture gives the chest muscles the advantage. The chest muscles then become tight and short, tugging or pulling the shoulders forward. Chronically tight chest muscles cause the muscles behind the shoulders to become relatively weak. At this point, the stronger muscles pull the spine out of its normal alignment, causing postural changes. Now the shoulders are slouched forward and the head, because of its connection, must follow. In an effort to hold the head up to compensate, the muscles in the back of the neck then become tight, ending the other tug-of-war and causing the head to jut forward.

If you have postural syndrome or just poor posture, it's important that you see your healthcare practitioner as soon as possible. Postural awareness and adequate care can help restore muscle balance and joint health, but since it may have been many years since you started ignoring your parents' advice, it may take some time for you and your healthcare practitioner to fix the problems.

Anatomy

If you take a look at people with good posture, you will notice several curves that are part of their spine. Their neck and lower back will curve inward, and their shoulder blade area will bend outward. These are the normal curves in people whose bones, joints, ligaments and muscles are healthy. The way the muscles and ligaments connect to the spine and the way the vertebrae are aligned determine this good posture.

Normal spines have an S shape, which consists of three main sections: the cervical at the top, the thoracic in the middle and the lumbar at the bottom. All three sections support the body by holding it in an upright position.

Four major muscle groups that interact with the cervical and thoracic spine help provide this support (although there are several smaller muscles that also play a role). The first is the pectoralis, which is a powerful chest muscle that allows you to bring your arms across your body, as if you were squeezing a large ball. The second is the rhomboids, which are between the shoulder blades and allow for rowing movements. The third is the scalene and sternocleidalmastoid (SCM) muscles in the front of the neck, which allow you to bring your chin to your chest, rotate your neck and bend your neck to the side. The fourth is the trapezius muscles, which are at the back of your neck and allow for neck extension, rotation, side-bending and pulling the shoulders up.

Normally, all these muscles work as a team and stay balanced with one another. They're playing tug-of-war, but no one is winning. The pectoralis, scalene and SCM in the front pull with equal force to the rhomboids, trapezius and suboccipital muscles in the back.

Postrual syndrome occurs when poor posture disrupts this balance. The anterior chest muscles become so big and so tight that it's difficult for the weaker muscles in the front of the neck and back of the shoulder blade to support the spine. These weaker muscles become tired, yet still try to hold their position. It becomes uncomfortable for them, however, and they give in again. The battle also places stress on them, and over time they can develop pain that leads to tension in the shoulder, neck and head regions.

Because it takes so long for this imbalance to develop, it's very common for patients with postural syndrome to get discouraged when they first try to fix their posture. That's why it's important for you to see a chiropractor if you suspect you have the condition. You and your chiropractor can work together to fight the syndrome that's putting you in a slump.

Chiropractic Care

Have you ever seen someone with excellent posture? How do you perceive them? They seem confident, right? They look as though they can carry the whole world on their shoulders. With commitment from you, your chiropractor can get you to that stage, using effective chiropractic care.

Initially, your chiropractor may perform an adjustment, also called spinal manipulative therapy. This involves a quick, strategic thrust with his or her hands or a device called an activator tool, which restores joint motion, relaxes tight muscles, increases blood flow and decreases inflammation. By performing this on the cervical spine (in the neck), and possibly the thoracic spine (in the mid back), your chiropractor can help loosen tight muscles that may be contributing to your postural syndrome.

Trigger point therapy is another technique your chiropractor may use. A trigger point refers to a portion of muscle that is in a state of contracture, which usually occurs in the middle of a muscle, called the muscle belly. In this state, the muscle fibers are shortened and tense, resulting in tight, painful nodules or knots. Patients with postural syndrome often experience these trigger points in the relatively weaker muscles like the rhomboids, the trapezius and the suboccipitals, and may also experience headaches, as trigger points can refer (move) pain to the head.

To perform trigger point therapy, your chiropractor will press down on these nodules, usually with his or her thumb, which separates the contracted muscle fibers. When he or she releases the pressure, usually within 10 seconds, an influx of fresh blood washes out irritants (like lactic acid) and brings in oxygen and minerals, relieving pain and releasing the knot.

In the initial stages of caring for postural syndrome, your chiropractor may also manage your condition with physiotherapeutic tools like ultrasound and interferential current (IFC). Ultrasound refers to any sound wave that has a frequency above the range the human ear can perceive. To produce these waves, chiropractors use a machine that channels electricity through a crystal located at the end of an applicator. The crystal vibrates in response to electricity, and the machine allows users to alter the electrical current to affect the waves' frequency. Depending on the waves' frequency, this can increase blood flow, decrease pain, reduce muscle spasm, lessen nerve root irritation, break down scar tissue and speed healing.

IFC works in a similar fashion, but instead of sound waves it involves a painless electrical current. IFC machines send this painless current through the skin into nerve fibers below, which causes the body to produce endorphins, its natural painkillers. By aiming the impulses at the thoracic or cervical spine, your chiropractor can cause endorphins to interrupt the flow of pain signals from the affected tissues to the brain, as well as decrease pain and inflammation and help speed up the healing process.

While all these conservative care can help, you should remember that there's only so much your chiropractor can do in his or her office. You will also need to make several lifestyle changes and become more aware of your posture.

To that end, your chiropractor will probably suggest that you take a close look at your home and work environments to determine what factors are affecting your posture. The way you sleep and what you sleep on have a dramatic effect on your back health. Sleeping on your stomach, for example, is like looking to one side for eight hours straight, which can cause excess stress on muscles in the neck, force spinal joints into awkward positions and affect the natural curve of the spine.

If you're sleeping on a soft mattress, you should also look into buying a new one. A soft mattress doesn't offer much support for your back. Instead, you should sleep on a firm one and use a good pillow to keep your spine in its natural curve. It's also good to sleep in the proper position, which is on your side with a pillow between your knees or on your back with a pillow under your knees.

Now let's take a trip to your workplace. Any job that requires you to sit for a long period of time can cause postural trouble in the future, so if you sit at a desk for hours you should learn proper postural positions. Your chiropractor can provide you with in-depth advice, but at the very least you should make sure you sit straight with your feet flat on the floor, your chin up, your low back resting tightly against the back of the chair and your elbows supported.

While practicing good postural habits will help you prevent your condition from worsening, you must begin an exercise program to counteract muscle imbalances that have already developed. Your chiropractor will probably prescribe stretching and strengthening exercises to help.

Stretching exercises will focus on chest muscles and the muscles at the back of your neck, as well as weak muscles in your mid shoulder blade and the muscles under your chin, and will help lengthen any tight muscles that can pull your spine into an abnormal curve. By strategically strengthening the same four muscle groups, you can eliminate any muscle imbalances that now exist. One tool that can help with this is a fitness ball, which you can use to perform exercises that will improve your posture by building torso and trunk strength and stability.


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