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Postural Syndrome (Neck)

(Also known as Postural Dysfunction)
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.
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.
When standing or sitting slouched, the bend in your upper back and arch in your upper neck increases. In addition your shoulders typically move forwards. This places considerable stretching force 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.

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 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 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.

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.

Diagnosis of postural syndrome
A thorough subjective and objective examination from a physician 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.

Treatment for postural syndrome
Most patients with this condition experience no pain once their posture is corrected. This may be all that is needed to fix their problem. It is vital that posture is corrected during the provocative activity to prevent recurrence. Physical therapy treatment can assist with symptom relief and can help to address any factors that may have contributed to the development of the condition.
For patients who experience symptoms when sitting at desk, it is essential that they improve the ergonomic set-up of their workstation and use an appropriate chair. For athletes who experience their symptoms while riding, it is essential to ensure that their bike is set-up correctly to reduce the likelihood of symptom recurrence.
Patients with postural syndrome should also perform pain free flexibility, strengthening and postural exercises (such as Pilates) to improve posture, activity tolerance and to ensure the neck is functioning correctly. The treating physical therapist can advise which exercises are appropriate and when they should be commenced.

Achieving good posture
Good posture in any position is vital to ensure there is minimal stress on your spine and you are 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:

Sitting posture
When sitting, it is important to have an ergonomically correct chair allowing 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 (figure 5). Regular breaks from sitting are recommended with standing, walking or lying and should occur regularly enough to prevent pain onset.

Standing Posture

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 be in a slight arch. This position should be maintained during standing or walking.

Lying posture
In lying, good posture can be obtained by lying on your back with a contoured pillow supporting your neck. Your knees may be straight or bent and can be supported by a pillow for comfort.
Since people's necks are different shapes, the ideal pillow for you may be different to the next person. Trial and error will determine which pillow is most suitable. As a general rule, the ideal pillow should be most comfortable, enabling you to maintain optimal posture and allowing you to wake up feeling best.
Ideally, the use of several pillows while lying on your back should be avoided since it places your neck into poor posture. If you are used to sleeping in this position with several pillows, it is recommended you gradually reduce the height (or number) of your pillows over time provided there is no increase in symptoms.
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 since it places considerable stress on your neck. This occurs because your neck has to turn 90 degrees to allow you to breath. If you must sleep on your stomach, try placing your head on the edge of the pillow so you don't have to rotate your neck as far to breath.

Physical therapy for postural syndrome
Physical therapy treatment for postural syndrome can significantly help to reduce symptoms, ensure an optimal outcome and prevent recurrence. Physical therapy may comprise:
  • postural education and retraining
  • 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 roll for sitting
  • xercises to improve strength, posture or flexibility
  • activity modification advice
  • biomechanical correction
  • clinical Pilates
  • ergonomic advice

Contributing factors to the development of postural syndrome

There are several factors that may contribute to the development of postural syndrome. These factors need to be assessed and corrected with direction from a physical therapist and may include:
  • joint stiffness (particularly of the neck or upper back)
  • a sedentary lifestyle
  • poor core stability
  • muscle weakness (particularly the deep cervical flexors and scapula retractors)
  • muscle tightness (particularly the pectorals, upper cervical extensors, upper trapezius and levator scaplae muscles)
  • a lifestyle involving large amounts of sitting, bending, slouching, shoulders forwards activities or lifting
  • decreased fitness or fatigue