Sports Medicine
Sports Injury Prevention & Rehabilitation

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Postural Syndrome

What is postural syndrome?
Postural syndrome of the lumbar spine is a condition where pain is felt in the lower back, however, there is no significant damage or trauma to tissue. Patients with postural syndrome only experience an ache or pain during activities placing sustained stress on normal tissue.
The mechanism of pain onset in postural syndrome can be demonstrated by gently bending your index finger backwards until you feel a 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. Postural syndrome in the lower back occurs in a similar fashion and typically occurs due to sitting or standing in poor positions for prolonged periods of time.
When sitting slouched, your lower back goes into its maximal bend (similar to touching your toes). This places considerable stretching force on the joints of your back and will gradually cause ache or pain if sustained for too long. Similarly, when standing in poor posture considerable stress is placed on the joints of your back. This will gradually cause ache or pain if maintained for too long.

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 standing, sitting or lying. Pain is typically experienced as a dull ache in the lower back region and can occasionally be accompanied by symptoms in the upper back or neck. Usually the pain associated with with this condition will quickly ease upon moving or changing positions, thereby taking the strain off the affected structures.

Treatment for postural syndrome
Most patients with postural syndrome of the lower back experience no pain once their posture is corrected. This may be all that is needed to fix the problem. It is vital that posture is corrected during the provocative activity to prevent recurrence. Specific stretching and strengthening exercises can also help to improve posture and activity tolerance.

Achieving good posture
Good posture in any position is vital to ensure there is minimal stress on your spine and you remain pain free. As a general rule, good posture can be obtained by ensuring there is a straight line from your ear, to your shoulder, to your hip. Here are some recommendations on how to achieve good posture in various positions:

When sitting, it is important to have an ergonomically correct chair which allows you to obtain optimal posture. Your bottom should be situated at the back of the chair and a lumbar support placed in the small of your back. Your shoulders should be back slightly and your chin should be tucked in slightly). The height of the chair should ideally allow your hips and knees to be at right angles. Regular breaks from sitting are recommended with standing, walking or lying and should occur regularly enough to prevent pain onset.

In standing, good posture can be obtained by standing against a wall. In this position, your heels, buttocks, shoulders and head should be in contact with the wall, and your eyes and nose facing forward. Your lower back should have a slight arch.


In lying, good posture can be obtained by lying on your back with a contoured pillow supporting your neck. Your knees may be bent or supported by a pillow for comfort. If lying on your side, it is important to lie as straight as possible and to avoid curling up into the fetal position. A pillow may be placed between your knees for comfort. Lying on your stomach is generally not recommended as this places considerable stress on your neck.

Physical therapy for postural syndrome
Physical therapy treatment for postural syndrome can significantly help to reduce symptoms and prevent recurrence. Physical therapy may comprise:
  • soft tissue massage
  • electrotherapy (e.g. ultrasound)
  • postural taping
  • the use of a posture support/brace
  • mobilization
  • the use of a lumbar roll for sitting
  • dry needling
  • exercises to improve strength, posture or flexibility
  • education
  • activity modification advice
  • biomechanical correction
  • clinical Pilates
  • ergonomic advice