Postural dysfunction occurs when muscles in the neck and upper back tighten or weaken due to prolonged inadequate posture and/or a sedentary lifestyle. This dysfunction is known as shoulder or proximal crossed syndrome. Postural weakness and tightness occur in a diagonal pattern.
- Upper trapezius
- Levator scapulae
- Pectoralis major
- Deep neck flexors
- Serratus anterior
- Middle and lower trapezius
Poor posture can lead to dysfunction of the shoulder joint as well. Postural dysfunction typically presents with a head forward and rounded shoulders posture. This positioning leads to limitations in mobility of the shoulder joint. Research has shown a statistically significant difference in the amount of motion available at the shoulder joint when actively lifting the arm in a forward motion. A study performed by Bullock, Foster, and Wright measured the average motion at the shoulder in a slouched posture as 109.7° and in an erect posture as 127.3°.
Common signs and symptoms of postural dysfunction include a head forward/rounded shoulders posture, tightness and pain in posterior cervical and shoulder muscles, weakness in muscles in the posterior thoracic region and anterior neck as well as decreased shoulder mobility bilaterally. Numbness/tingling may be also occur in the arm and hand due to tight muscles in the neck.
Physical therapy intervention can help to improve posture and decrease the pain and limited movement associated with it.
- Manual therapy: A skilled PT or PTA can perform hands on treatment which includes soft tissue massage/release to tight muscle to improve soft tissue mobility and release trigger points. Joint mobilizations may be performed to the cervical/thoracic spine and/or shoulder joint to improve functional mobility.
- Therapeutic Exercise: The physical therapy team can work together to develop exercises that are specific to your body and dysfunction. Exercises will include stretching of tight muscles to improve mobility and strengthening of weak postural muscles to improve stability.
- Body Mechanics Education: Education will be provided on proper posture/positioning to allow for adequate postural support. Exercises will be geared toward retraining postural muscles.
- Home Exercise Program: These exercises will be provided early on in care and updated throughout your rehabilitation. These exercises are essential to supplement your therapy visits in order to maximize the effectiveness of your visits with a therapist and to allow continued progress of your rehabilitation. A home exercise program will also be used to maintain proper strengthening and stretching at the completion of therapy to prevent future dysfunctions.
- Modalities: The physical therapy team will utilize modalities to help decrease pain and alleviate symptoms in the cervical/thoracic and shoulder regions: moist heat, cold pack, interferential electrical stimulation, ultrasound, phonophoresis, and iontophoresis among others.
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Bullock, M. P., Foster, N. E., & Wright, C. C. Shoulder Impingement: The Effect of Sitting Posture On Shoulder Pain And Range Of Motion. Manual Therapy, 10, 28-37.