Poor posture is a powerful “activator and perpetuator” of myofascial trigger points
Poor posture is a powerful “activator and perpetuator” of myofascial trigger points (Simons et al. 1998) and is always worth considering in chronic trigger point syndromes. Postural muscles tend to have a greater percentage of type 1 fibers. This characteristic may lead to a more resistant type of trigger point. Human beings are four-limbed animals, and like our cousins, we are designed to move around and hunt for food. We are sure that if we put a gorilla in a chair all day, he'd develop a bad back!
In both the developed world and the developing nations, many occupations involve prolonged sitting, often at a computer screen. In evolutionary terms, this form of daily posture is relatively new.
Whilst ergonomics is a booming industry, focusing on the interactions of people and their working environments, not all workplaces can afford to implement anything more than basic ergonomic interventions. For many clients, long and monotonous days spent in front of a computer screen often lead to chronic and maladapted postures. Where possible, it is essential to identify the postural abnormalities and how they impact the client's symptoms, and offer to remedy the situation via ergonomic advice, treatment, and/or exercise.
The most common mechanical maladaptations are:• Head-forward posture (upper crossed pattern, Janda)
Trigger points are typically common in the following postural structures: upper trapezius, levator scapulae, sternocleidomastoideus (SCM), erector spinae, musculoligamentous apparatus of the lumbar spine, gluteus medius, and gastrocnemius/soleus complex.
Postural Trigger Points and “Cross Patterns”
Osteopathic, chiropractic, and other physical therapeutic modalities have all observed “cross-patterned” relationships within the body, from upper to lower and left to right. Janda (1996) recorded the two most common “crossover” postural strain patterns—upper and lower. Myers (2001) has further explored and developed these observations in his seminal book Anatomy Trains. These myofascial strain patterns have a profound effect on the pathogenesis and chronicity of trigger point development. Trigger points can be found throughout the muscles listed below.
Upper Crossed Pattern Syndrome
This can be observed in the “round-shouldered, chin- poking, slumped posture,” which also compromises normal breathing. In such cases, pain is often reported in the neck, shoulder, chest, and thoracic spine (these areas are often restricted). An oblique cross can be drawn through the glenohumeral joint, indicating the functional “crossover” changes in muscular relationships. The main muscles in the upper cross pattern affected are shown in Figure 3.3 below.
Lower Crossed Pattern Syndrome
This can be observed in the “sway-back” posture, with weak abdominals and gluteals and overtight erector spinae, quadratus lumborum, TFL, piriformis, and psoas major (see Figure 3.4).
Some clients may have manual or repetitive activities in the workplace; these may well have a role to play in trigger point pathogenesis or maintenance. Many clients spend their time at work sitting; Figure 3.13 illustrates an ideal sitting posture at work.
Habitual Activity, Hobbies, and Sports
Similarly, it is important to ask the client if they perform any repetitive or habitual activities apart from at work. Standing all day on one leg, for example, may well overload the TFL muscle. Sitting in a cross-legged position may affect a range of muscles, such as the hip flexors (iliopsoas), the buttock muscles (gluteals and piriformis), and the thigh muscles (quadriceps). Heavy smokers may develop trigger points in the shoulder (deltoid) and arm (biceps brachii) muscles.
Certain hobbies and sports may also lead to an increased incidence of trigger point pathogenesis. It is important to enquire carefully about such activities. What is their level of competence? Do they warm up, and cool down? How competitive are they? Is their level of activity realistic for their age? Posture? Body type? Physical health? You may want to explore these areas further. It is often useful to run through these activities and set the client certain activity goals to achieve in between treatment sessions.
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