What is postural syndrome?

Postural syndrome of the neck is a relatively common condition that causes pain in the neck without significant damage or trauma to tissue. Patients with this condition only experience an ache or pain during activities placing sustained stress on normal tissue.

The mechanism of pain onset in this condition can be demonstrated by gently bending your index finger backwards until you feel a stretch (figure 1).

Figure 1 – Finger stretch

At this point there is no tissue damage or pain, however if you maintain this position for long enough, your finger will gradually become painful or ache. Once the finger is released and allowed to change position, the pain or ache will ease. Postural syndrome in the neck occurs in a similar fashion and typically occurs due to sitting or standing in poor positions for prolonged periods of time (figures 2, 3 and 4).

When standing or sitting slouched (figures 2 and 3), the bend in your upper back and arch in your upper neck increases (figure 4). In addition your shoulders typically move forwards. This places considerable stretching force and increased load on the joints and muscles of your neck and upper back and will gradually cause an ache or pain if sustained for too long. When this occurs the condition is known as postural syndrome.

 

Figure 2 – Poor standing posture

 

Figure 3 – Poor sitting posture

 

Figure 4 – Poor posture

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Causes of postural syndrome

Postural syndrome is a condition that is caused by adopting poor posture over a prolonged period of time. This may occur in any position such as standing or lying, but is particularly common during sitting (e.g. at a computer, watching television or driving). 

Postural syndrome is also relatively common during everyday activities that encourage the arms to move forward in front of the body such as cooking, cleaning, gardening or ironing. 

In sport, postural syndrome is often seen in athletes whose activity involves prolonged bending forward postures, such as cycling, hockey players, baseball catchers and wicket keepers in cricket. 

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Signs and symptoms of postural syndrome

Patients with postural syndrome typically have normal, pain-free movement. Symptoms are only experienced when poor posture is maintained for prolonged periods. This can occur in any position (e.g. sitting, standing, lying etc.). 

Pain is typically experienced as a dull ache or burning sensation in the neck and can sometime be accompanied by symptoms in the upper back or shoulders. Occasionally, headaches may also be present. Usually the pain associated with postural syndrome will quickly ease upon moving or changing positions, thereby taking the strain off the affected structures. 

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Diagnosis of postural syndrome

A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose postural syndrome of the neck. Investigations such as an X-ray, MRI or CT scan may be required, in rare cases, to rule out other conditions.

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Achieving good posture

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View the complete article - Postural Syndrome (Cervical) (Members Only).

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Prognosis of postural syndrome

The prognosis of patients with postural syndrome is excellent provided the patient is motivated and compliant with physiotherapy treatment, advice and exercises. Most patients can achieve pain free status immediately upon correction of poor posture. Retraining movement patterns and performing appropriate exercises is essential to prevent symptom recurrence. 

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Physiotherapy for postural syndrome

Physiotherapy treatment for postural syndrome can significantly help to reduce symptoms, ensure an optimal outcome and prevent recurrence. Physiotherapy may comprise: 

• Postural education and retraining (see posture)
• Exercises to improve strength, posture or flexibility
• Soft tissue massage (particularly to the upper cervical extensors, pectorals, upper trapezius and levator scapulae muscles)
• Electrotherapy (e.g. ultrasound)
• Dry needling
• Postural taping
• Postural bracing
• Joint mobilization (particularly to the lower neck and upper back)
• The use of a lumbar support for sitting
• Activity modification advice
• Biomechanical correction
• Clinical Pilates
• Ergonomic desk setup advice
• Ergonomic mobile phone advice
• Bike setup advice

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Contributing factors to the development of postural syndrome

There are several factors that may contribute to the development of this condition. These factors need to be assessed and corrected with direction from a physiotherapist and may include: 

• poor posture
• poor ergonomic set-up
• joint stiffness (particularly of the neck, upper back or hips)
• a sedentary lifestyle
• poor core stability
• muscle weakness (particularly the deep cervical flexors, spinal extensors and scapula retractors)
• muscle tightness (particularly the pectorals, upper cervical extensors, upper trapezius, levator scapulae, abdominals, hip flexor and hamstring muscles)
• a lifestyle involving large amounts of sitting, bending, slouching, shoulders forwards activities or lifting
• decreased fitness or fatigue
• a lifestyle involving excessive use of computers, laptops or mobile phones
• inadequate recovery periods from poor postural positions
• use of an inappropriate pillow during sleep

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Exercises for postural syndrome

The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, the initial exercises should be performed 3 - 5 times daily, whilst the intermediate and advanced exercises should be performed twice daily.

All exercises should only be performed provided they do not cause or increase symptoms. Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate and advanced exercises. As a general rule, addition of exercises or progression to more advanced exercises should only take place provided there is no increase in symptoms.

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Initial Exercises

Chin Tucks

Begin sitting or standing tall with your back and neck straight, shoulders should be back slightly (figure 9). Tuck your chin in as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Keep your eyes and nose facing forwards. Hold for 2 seconds and repeat 10 times provided the exercise is pain free. Repeat 3 - 5 times daily.

 

Figure 9 – Chin Tucks 

Shoulder Blade Squeezes

Begin sitting or standing tall with your back and neck straight (figure 10). Squeeze your shoulder blades together as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Hold for 5 seconds and repeat 10 times provided the exercise is pain free. Repeat 3 - 5 times daily. 

 

Figure 10 – Shoulder Blade Squeezes

Neck Rotations

Begin sitting with your back and neck straight and your shoulders back slightly. Turn your head looking over one shoulder as far as you can go without pain and provided you feel no more than a mild to moderate stretch (figure 11). Then repeat the exercise turning your neck in the opposite direction. Keep your neck straight and don't allow your head to poke forwards during the movement. Repeat 10 times to each side provided the exercise is pain free. Repeat 3 - 5 times daily.

 

Figure 11 – Neck Rotations (right side)