Authors: Irvin, Robert Edwin
Article Type:
Research Article
Abstract:
Where pain of the musculoskeletal system is present, commonly, this pain is without objective evidence of disease, trauma, or disorder. Absence of an apparent cause for common pain prompts the consideration of mechanical stress as a contributing factor. The principal stress of the musculoskeletal system is postural. By posture it is usually meant the distribution of body mass with respect to gravity. Past efforts to predict chronic pain by postural analysis or to reduce such pain by strengthening, conscious control or splinting of posture has had marginal success. Past failure to relate posture to pain is attributable to (1) ubiquity
…of sub-optimal posture that precludes clinical comparison to those with optimal posture; (2) presupposition that the causal relation between posture and pain is of the observational class of causality rather than the manipulable kind; (3) a definition of posture that is too narrow to complete the picture; and (4) inadequate methods for reduction of postural asymmetry to an extent that is sufficient to elicit a significant and enduring effect on sub-optimal posture and related pain. Posture can be defined more broadly as the stance of the body performing within the boundaries of posture and which is mediated by the Postural Control System towards greatest stability (Fx. 1). The stance of the body is the arrangement of the body with respect to gravity and other accelerative forces. The postural boundaries are the set of forces that resist acceleration and thereby provide the limits within which one functions stably, and this resistance is currently approximated by six principal sources of resistance to acceleration: viscous, elastic, neuromuscular, rigid, viscoelastic, and inertial. The Postural Control System is located in the brainstem and modulates body stance to more economically and stably effect and resist acceleration. The rigid boundaries can be so with respect to compressive, tractive, or tensile qualities that permits three kinds of motion: translation, rotation and oscillation. An example of postural boundaries that are rigid with respect to compression and tensile character are the bones that bear weight. In contrast, ligaments provide a tractive rigidity and musculotendons a relatively elastic boundary. Joint surfaces are considered boundaries that are rigid but not perfectly so. Of fundamental importance are those joints that are lowermost in a column of the musculoskeletal system namely: (1) the feet and ankles that support the entirety of the musculoskeletal system and; (2) the base of the sacrum that supports the vertebral spine. This broadened definition of posture leads to a greatly enhanced manipulability of posture in the upright stance and alleviation of more than two-thirds of common pain by the coherent combination of (1) manual manipulation to reduce somatic dysfunction; (2) foot orthotics to optimize the amplitude of the arches of the feet and vertically align the ankle; (3) a heel lift to level the sacral base; and (4) a group of therapeutic postures configured to minimize restriction of peripheral soft tissue reflective of the earlier posture, all aimed to optimize posture. Mediated by the postural control system, manipulation of postural boundaries accordingly modifies the structure and function of the entire musculoskeletal system. Typically, this relief is maintained by foot orthotic and heel lift alone without maintenance by manual manipulation, medication, or exercise.
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Keywords: Posture, Sacral base, Short leg syndrome, Orthotics, Heel lift, Idiopathic scoliosis, Idiopathic pain, Postural arthralgia, Space adaptation syndrome, Akathesia
DOI: 10.3233/BMR-1998-11202
Citation: Journal of Back and Musculoskeletal Rehabilitation,
vol. 11, no. 2, pp. 89-130, 1998
Price: EUR 27.50
