long-term untreated postural problems

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    Jun 10, 2007 5:31 AM GMT
    Hey guys,

    I thought this would be a good place to get some feedback! first of all, some background info on myself:

    i'm 21, almost 22 years of age and for various reasons I did not get off on the right foot with sport and general physical exercise from a young age. Consequently, I more or less avoided any intense physical activity up to the present in favour of investing my energies into practicing the piano. Now, my poor posture at the piano (leaning forward, weak lower back, extended arms, weight mainly in right foot) in addition to a very strange manner of walking and holding my weight (tending to lean to one side, weight shifting between knees, head and neck pulling downwards and generally somewhat hunched) has over time most probably contributed to my specific postural problems, of which I have been able to identify (it has taken a long time for me to realise!) the main symptoms:

    - pain in my lower-RIGHT back (i think it is muscular)

    - twisted pelvis (upper body at different angle to lower)

    - weight tends to right side of body when sitting or standing

    - upper right abdominal muscles more developed than left

    - weak core/lower and inner abdominals

    - shoulders tend to curve forward

    - right leg bent outward

    - right foot not flat, weight on right side (problems with ankle)

    - severe neck problems, extremely tense muscles have developed with large 'knot' on right side, neck not straight

    - left shoulder/arm appears to be more 'out of line' than right

    I also had sciatica for some time, however it was in my LEFT leg (now disappeared)

    For about 6 months or so now I have been gradually stretching and strengthening several muscle groups - nothing extreme. I have had significant improvements but I obviously still have far to go. I also had several orthopedic sessions with some results.

    Any help or info you could suggest would be greatly appreciated.

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    Jun 10, 2007 12:17 PM GMT
    Go see your primary care doctor. Tell them about your pain and concern and that you'd like physical therapy. You'll go see a theripist who will show you simple exercises and techniques for stretching and training to re-align things. Physical therapy has helped me combat low back problems, repair my rotator cuff that torn 2 times last summer in one month, and neck injury/pain due to a car accident. They are life savers. After working with them you can move to a athelitic club/gym and continue working on your strength and conditioning. Hopefully you have health insurance.

    Have fun
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    Jun 10, 2007 1:17 PM GMT
    WOW...a long list of issues...How do we start..

    Let's break this down. Let us talk about posture, and then your symptons...

    Posture is dependent on the following:
    1. Environmental/ergonomics: The height of the chair, piano, etc, all has to be condusive to your body to promote proper posture. Too high the chair will promote trunk slumping and neck extension, etc.
    2. Internal/structural: From the way you described yourself, I am wondering if you have some form of spinal alignment impairment such as lateral scoliosis or spondylolisthesis. Long term poor posture also promotes adaptation of muscles and soft tissues to various lengths that is ineffecient at keeping proper posture. Also poor functional/movement patterns and bad habbits.

    NOW, let's talk about your symptons. Your descriptions are not very specific. For example, "Sciatica" is a very old and poor description of radicular pain pattern, named after a nerve. It does not tell you if the radicular pain is caused by the Piriformis Syndrome where the pirimoris muscle is compressing the Sciatic Nerve, or it is a foraminal stenosiis caused by facet joint osteophytes, or caused by a disc bulge or heriation pressing on the nerve root, or a mis alignemnt of the vertebre such as scoliosis or spondylolisthesis jamming into the nerve root, or even contral stenosis... So "Sciatica" is really a poor term described by someone who is not sure what is causing your pain.

    ANOTHER IMPORTANT thing to point out. Muscle spasm pains are ALWAYS a 2ndary REACTION to something else. It can be over use from poor posture, poor ergonomics, prolonge activities without a break, or more seriously, a protective painful spasm in reaction to some other structure generating pain like a disc etc. SO the pain in your back, although can be a simple muscular pain from posture over use, can also inidicate more serious issues...

    The way you describe your symtons, you sound hihgly asymtrical, and this make me suspect spinal lateral scoliosis, and possibly with spondylolisthesis. Scoliosis is the multiple curvatures on the spine from side to side. This would explain the asymtry in weight bearing and through out your extremities. Spondylolisthesis is slipping of one vertebrea forwad in relation to the others. You may even have sacroilliac issues.

    The above spinal and pelvic alignment impairments, no soft tissue or exercises will improve them. You need to see an ortho doctor right away and discuss your options, IF indeed you have the above issues...

    BOTTOM LINE: Go see an ORTHO as soon as possible.
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    Jun 10, 2007 1:42 PM GMT
    Do this simple test at home:

    Have someone stand behind you, and then with both knees straight, just slowly bend forward and try to reach your toes.

    If the person who is looking from behind you tells you that your shoulder blades are at uneven heights when you forward bend, you have scoliosis. For the shoulder blades to be uneven in thoracic trunk flexion, this is already at lease moderate, not minimal, degree of scoliosis.

    Now if you cannot even go down or get up from trunk forward bend without using your hands on your knees to help and stabilize, you have a instability issue in the spine, and it can be both muscuolar and joints but more likely joints and possible spondylolistehsis.

    Also ask the person behind you to see if your hips are at even heights.. Also, ask him or her to notice if there was any shifting while you forward bend...
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    Jun 10, 2007 1:50 PM GMT
    ONe more thing.

    You need to rule out other possible issues such as bone length discrepency, upper neuron impairments, and a host of other possible systemic pathologies.

    A slumping trunk with a slumping neck is not the usualy postural dysfuntion you would see, as a slumping/forward beninding trunk most of the time comes with extended neck, so you are not forced to look down to the floor. This is why I also suspect upper/central neuron issues...

    When is the last time you went to see a doctor.....???
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    Jun 10, 2007 2:33 PM GMT
    Chiron: After ruling out any serious medical causes, you might want to investigate Feldenkrais:

    I've had several clients with chronic pain and a couple of actor/musician clients with movement problems do this work with good results. Feldenkrais is especially sensitive to problems in the performing arts.

    Dunno, if they are in Australia.

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    Jun 10, 2007 2:38 PM GMT
    They should have Feldenkrais in Australia... The basicas are taugh in standard PT schools now days but to be certified you need to take their course. I think the origin may actually be an Australian PT's invention...
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    Jun 10, 2007 2:42 PM GMT
    No, on 2nd thought, it may originated from New Zealand..
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    Jun 10, 2007 2:50 PM GMT
    Wrong again... He is from Eastern Europ and practice in Europ and the middle East then all over the world. I just remember from school days with intro clases that it is very big in Australia, and you can tell me if that is true or not... And yes, it is big with performing artits...
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    Jun 10, 2007 6:07 PM GMT
    A similar program is the Alexander Technique. If you can find an instructor that specializes in musicians, they may be able to help you with your playing posture, as well as your overall posture. While this will not address any medical problems, it may help you improve your posture while playing, as well as improving your playing. It's important to note that there is no evidence verified in peer-reviewed journals that this instruction can treat any illness, but there is widespread use of it in performing arts institutions (I became aware of it when I friend was instructed in it at the North Carolina School of the Arts).
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    Jun 11, 2007 2:53 AM GMT
    In dealing with many long-term issues I've had, yoga has always been suggested. It's easy to start out at a beginner level at a good studio in your area, and won't be as costly a therapy to try.
    Good luck with it man.
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    Jun 11, 2007 3:05 AM GMT
    I'll chime in here for Iyengar yoga. I've talked to people who started an Iyengar practice because of problems FAR worse than yours. One woman had had spinal surgery where they opened her up from both sides, put pins down her spine, all this awful stuff, and it got to the point where she had to walk back and forth to the grocery store several times just to bring home the ingredients to make a simple meal, she could carry so little. If I actually detailed everything she told me, it would sound like a fabricated, totally absurd story. Suffice it to say, she had some serious, serious problems.

    Now she runs races.

    She's not the norm, of course, and she committed hardcore, practices every single day, went to study in India with BKS Iyengar and his daughter Geeta several times, etc. But I have found no more therapeutic practice in my life than Iyengar yoga; it has helped me deal with mal-formed knees, flat arches, a mountain-biking accident where I tore every ligament in my right shoulder, a host of wrist problems -- carpal tunnel syndrome, de Quervain's tenosynovitis, ulnar pathology, all sorts of stuff. Oh yeah, and my ulnas are malformed, too, kind of like my tibias.

    The more highly certified an Iyengar instructor, the better they'll be able to help you. Here's a list of all the certified ones in Perth:


    All the teachers in Perth are Introductory Level 2, which is certainly to where they'll be able to help you with your issues. A really diligent asana practice and I guarantee you will see massive improvements quickly, within a year, and more as time goes on.

    Of all the schools of yoga, Iyengar is the one most focused on rehabilitation, injury prevention, and recovery, so I'd recommend it far above any other yoga school, for your situation.
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    Jun 11, 2007 3:17 AM GMT
    But please, as I, and also Obscenewish, have recommended" Go see a doctor first to rule out more serious stuff.

    Feldenkrais, Alexander, Yoga, Pilates, they are all great and shown to be very effective, and sometimes more effective than traditional medical care. HOWEVER, there is no reason for you to risk anything.

    The way you describe your entire body asymetry and some of the postural patterns reflect POSSIBLE spinal conditions and also abnormal synergistc patterns of upper neuron impairments. you probably do not have any of that, but there is simple no reason to risk it...

    Do al the above, but don't skip seeing a doctor first...
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    Jun 11, 2007 5:12 AM GMT
    Yes PT(physical thearpy) will help so much. I did Marching Band and Musicals while in high school. I injured my left ankle on stage and thought nothing of it.(just a twist) Well the next year in Marching Band my ankle gave out. I couldnt put any weight on it at all. Thought no big again. Well I started working at an Amusement park and pounding my feet on concrete all day didn't help. Finally went to my PCP and was sent for PT. I did it 3 times a week and it was the smartest thing I did for my self. I also joined a gym so I could continue working out my ankle. I have improved with it so much. Yes slow and steady is the way to go to improve some problems. I think that with your list you might be in PT a while but believe me it works. Even getting to a podiatrist and see what they have to say. Cuz when the feet are outa whack so's the rest of the body.
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    Jun 13, 2007 12:23 PM GMT
    wow, thanks guys! that's a lot of info. i'm sure i'll be able to make good use of all of them over time.

    I have been to see a doctor, but you get good doctors, bad doctors... the GP's are generally not supportive of ortho-specialists, and vice versa. But I have been to see both. The GP gave me a quick once over and cited it as 'mechanical back pain', and assured me not to expect much from the spinal-specialist. But I will give it another try, i'll ask for a referral to a specialist. The spinal manipulation treatment was helpful when I was having regular treatment.

    I will definitely do those tests, NYC, and let you know the specifics of whats going on. You obviously know what you are talking about and of course the more serious possibilites should be examined and ruled out first. It is very refreshing to hear from someone who is both knowledgeable and committed in the field of spinal health (I get the impression you are a treating specialist. If not, perhaps you should be!)

    I will certainly investigate the physical therapy and the structural integration.

    Thanks for the feldenkrais tip, obscenewish, that makes you the 3rd person to recommend this particular treatment, the first 2 being unrelated housemates! So i'll take that as a sign to pursue it ;0

    atxclimber: wow, thanks for the info on lyengar yoga. It sounds ideal for my situation and your friend's story is very inspiring. I will definitely look into it more with the eventual aim of integrating it into a daily routine.

    Thanks again guys, you've been a gr8 help!

    Will let you know how it all turns out.


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    Jun 13, 2007 10:00 PM GMT
    I am a ortho specialized PT, also a clincal instructor for interns on their ortho rotations.

    If you have read my other posts, you would already know that I agree with you on GP's.. They do not know ortho or musculoskeltoal conditions... GP's spend 4 years in med school to study the whoe body, we do 3 years just for these conditions. EVen physiatrists do not know musculoskeletal in detail..they primarily do EMG and treat neurological and systemic related pathologies. You have no idea how many wrong, way, way wrong, or way, way general diagnosis I have seen referred by GP's...

    Anyway, best of luck!

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    Jun 13, 2007 10:06 PM GMT
    By the way.."mechanical back pain" generally tells you the GP has no idea what he is talking about... What is the primary cause of the mechanical back pain..? Muscle spasms are ALWAYS a reaction to something else, over use, inflamtory pain protective mechanism, neurological disorder, etc, etc.. To say you have "mechanical back pain" is like saying you have "Siatica", while the sicatic nerve irritation can be a discogenic, facet, or soft tissue Piriformis impairment.. That usually measnt this health practitioner does not know what is causing your sympton and is poor at differential diagnosis. Without precise differential diagnosis, you are not likely to get the precise and proper treatment because the primary case is basically either unidentified or incorrectly identified...
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    Jun 14, 2007 12:54 PM GMT
    Man, I think you've gotten some great advice here. I have to say though that when my physiatrist sent me to rehab, I got no better at all. They were very attentive and tried very hard to help me, but to no avail. It was only years later that I stumbled upon my own techniques that brought me out of pain. I can't say enough about Rolfing...painful but effective in allowing your body to "fall" into it's natural position. There is one exercise in particular that I swear by as far as keeping my spine in alienment. It's called the Back Bridge. You can see how to do this exercise here.....

    http://www.tacticalathlete.com/bridge2 dot htm