POSTURAL PAIN SYNDROME

1. POSTURAL PAIN SYNDROME

2. Definition • Postural 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.

4. Postural pain syndrome • Includes: • 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.

5. Pathophysiology • There 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.

6. Causes and Risk factors • Some of the most common causes: • Slouching in chairs • Driving in hunched positions • Standing badly • Lifting incorrectly • Sleeping on sagging mattresses • Being unfit • Inactivity and the wrong sort of movement • Head and neck strain

7. Causes and Risk factors • Musculoskeletal problems • Work-related back problems • Lower back pain • Repetitive strain injury • Carpal tunnel syndrome

8. Causes and Risk factors • Common risk factors: • Being unfit • Being overweight • Jobs involving lifting, bending or moving heavy objects • Being seated in one place for long periods of time • Frequent use of a telephone without a headset • High levels of stress, anxiety and tension

9. Diagnosis • Difficult for doctors to find the exact cause • Pain usually starts a day or two after the injury has occurred or only after several years.

10. Signs and symptoms • Usually patients with postural pain syndrome have normal and pain-free movement. • When poor posture is maintained for a long time, pain is experienced.

11. Treatment • Physiotherapy may include: • Soft tissue massage • Electrotherapy e.g. ultrasound • Postural tapping • The use of posture support e.g. braces • Mobilisation • Dry needling • Exercises to improve strength of weak muscles. • Improve posture • Stretch short and strong muscles.

12. Treatment • Teach patient about kinetic handling. • Correct biomechanics. • Clinical Pilates

13. Do’s and Don’ts • Do’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.

14. Do’s and Don’ts • Don’ts: (sitting) • Slump sit • Lean forward and downward to reach your work. • Sit with your neck forward for an extended period of time(move around every 20 minutes).

15. Do’s and Don’ts • Do’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.

16. X-Rays

17. Evidence based article Getting your back back to work: pain relief- where to start?

18. Evidence based article • Focus 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.

19. Evidence based article • McKenzie characterized mechanical pain as; • Pain that can be constant or intermittent • Limited range of motion of the back or neck that improves as symptoms diminish • Movements in certain “incorrect,” or exacerbating directions increases the pain while simultaneously decreasing range of motion in the opposite direction.

20. Evidence based article • He proposed three nonspecific mechanical syndromes; • Postural pain syndrome • Dysfunction syndrome • Derangement syndrome

21. Evidence based article • Dental 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.

22. Evidence based article • We 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.

23. Evidence based article • Eg. of an exercise; • Slouch-overcorrect • From an extreme, slouched position to an exaggerated, lordotic posture.

24. Evidence based article • Indications • Periods in the day when no pain is experienced • Pain is confined to areas above the knee • Symptoms are worse when sitting and generally better with standing or walking • Symptoms are worse when bending and with inactivity • If symptoms are better when in supine • Several episodes of back pain have been experienced over the past few years.

25. Evidence based article • Contra 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 trauma • Leg pain below the knee including numbness, tingling or weakness • Malaise • Pain that disturbs sleep

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

27. 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

28. References • http://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/

29. References • http://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