Postural Syndrome - A Modern Biomechanical Phenomenon

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One of the most common causes of neck pain and low-back pain has to do with poor posture. Because the majority of conditions in the neck and low-back fall under the category of chronic repetitive overuse injuries, having a poor posture will increase the load/pressure on the ligaments, joints, muscles, and tendons trying to provide support. In other words, poor posture will predispose and/or increase the chance of developing a repetitive overuse injury in the neck and low-back. The reason for this is that poor posture will lead to the development of a system of muscle imbalances and overcompensation patterns in the body. "Over time, these imbalances will spread throughout the muscular system in a predictable manner." (Janda)

These patterns were first classified and coined by the famous Dr. Vladimir Janda and are known as "Upper Crossed Syndrome" and "Lower Crossed Syndrome". According to Janda, upper crossed syndrome is characterized by the over-facilitation of the upper trapezius, levator scapulae, sternocleidomastoid, and pectoralis muscles, but simultaneously characterized by the inhibition of the deep neck flexors, lower trapezius, and serratus anterior muscles. Similarly, the same mechanism works for lower crossed syndrome. In this case, there is over-facilitation of the rectus femoris, iliopsoas, and thoraco-lumbar extensors; whereas, there is inhibition of the abdominals and gluteus muscles (maximus, minimus, medius). The primary result of this crossed pattern of over-facilitation and inhibition is the development of muscle imbalances and abnormal movement patterns.

The secondary result is the development of compensation patterns, instability, weakness, overuse, fatigue, abnormal wear and tear, joint dysfunction, hypo mobility and hyper mobility, degeneration, etc. It is these secondary problems that are the source of symptoms such as pain, limitation, and discomfort. Thus, the goal of therapy should not only be pain management, but rather correction of the source of the problem. Some specific treatments that can make significant improvements are postural exercises, core strengthening exercises, chiropractic manipulation to increase mobility and function, active release technique, physiotherapy, massage, stretching of the over-facilitated muscles, strengthening of the inhibited muscles, and reintroducing proper movement patterns in the body.

Postural syndrome is very common in western societies. Our lifestyles such as sitting behind a desk for hours on a daily basis, lots of driving, poor diet, poor ergonomics, lack of exercise due to time constraints, and not paying attention to our slouching contribute significantly to developing postural syndromes. To decrease this phenomenon the least we can do is to be a bit more aware of our posture, and learn proper ergonomics while sitting behind a desk. It only takes a small effort to make significant changes.

Dr. Soroush Khoshroo, B.Sc., D.C., A.R.T.