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Pain / Condition

Postural Syndrome

What is postural syndrome?

Casual people queueingPostural syndrome is an umbrella term for condition where pain can be felt in several common locations all the way from the lower back to the neck and shoulders. Even hands and upper limbs and the feet and lower limbs can have pain that is directly or indirectly related to postural syndrome. For example direct pain would be trigger points and ischaemic pain in the buttocks or posterior thigh from prolonged sitting, whereas indirect Lower limb pain may include adaptive shortening/tightness in the hip flexors giving anterior hip pain or even referring pain down the ITB region and lateral knee.

In a typical (and early) Postural Syndrome there is no significant damage or trauma to tissue. Patients with postural syndrome only experience an ache or pain during activities placing sustained stress on normal tissue.

The mechanism of pain onset in postural syndrome 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. Postural syndrome in the spine occurs in a similar fashion and typically occurs due to sitting or standing in poor positions for prolonged periods of time. 

When sitting slouched your lower back goes into its maximal bend (similar to touching your toes). This places considerable stretching force on the joints of your back and will gradually cause ache or pain if sustained for too long. Similarly, when standing in poor posture considerable stress is placed on the joints of your back. This will gradually cause ache or pain if maintained for too long. Again, if identified early enough by a physio and if there is a change of this posture/s and strengthening of the muscles to protect especially the osseo-ligamentous structures of the Back and Neck – the pain almost resolves.

healthy_postures_03Signs 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 standing, sitting or lying. Pain is typically experienced as a dull ache in the lower back region and can occasionally be accompanied by symptoms in the upper back or neck. Usually the pain associated with this condition will quickly ease upon moving or changing positions, thereby taking the strain off the affected structures.

Treatment for postural syndrome

Most patients with postural syndrome experience no pain once their posture is corrected. This may be all that is needed to fix the problem. Actual timeframes will vary depending on how long the postural problem has been there and obviously what structures have been stressed and/or damaged. In most cases it is the muscular system that has been weak or failing and thus pressure is taken by the osseo-ligamentous structures. As these structures and the surrounding muscles try to “carry” the load trigger points (knots) can form and this atmosphere is now ideal both chemically and mechanically to set off Neural (nerve) irritation (or compression). Once a “pinched” nerve is involved the cascade of events ends in local and global hypertonic muscles (guarding the irritated nerve tissue) that is often the “stiffness” that a patient will feel when they finally “relax” and or at rest (going to bed or waking times!).

It is vital that posture is corrected during the provocative activity to prevent recurrence. Specific stretching and strengthening exercises can also help to improve posture and activity tolerance.

How to achieve Good Posture

Good posture in any position is vital to ensure there is minimal stress on your spine, nerves and muscles and that you remain 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:


When sitting, it is important to have an ergonomically correct chair which allows 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. The height of the chair should ideally allow your hips and knees to be at right angles. Regular breaks from sitting are recommended with standing, walking or lying and should occur regularly enough to prevent pain onset.


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 have a slight arch.


In lying, good posture can be obtained by lying on your back with a contoured pillow supporting your neck. Your knees may be bent or supported by a pillow for comfort. If lying on your side, it is important to lie as straight as possible and to avoid curling up into the foetal position. A pillow may be placed between your knees for comfort. Lying on your stomach is generally not recommended as this places considerable stress on your neck.

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Physiotherapy for postural syndrome
Physiotherapy treatment for postural syndrome can significantly help to reduce symptoms and prevent recurrence. Physiotherapy may comprise:

  • A thorough and expert clinical Assessment
  • Identification of cause vs. symptoms
  • ergonomic advice and education
  • postural taping
  • posture correction
  • Curve Reversal Exercises
  • Biomechanical Correction
  • Posture Correction support/brace
  • Spinal mobilization / manipulation
  • Lumbar Roll for sitting @ desk/car/any chair
  • Dry Needling / Western Acupuncture
  • Exercises to improve strength, posture or flexibility
  • Activity modification advice
  • Soft/Deep Tissue Massage / Trigger Point Therapy
  • Electrotherapy (e.g. ultrasound)
  • Clinical Pilates

Some GREAT Physio products available for postural syndrome

We stock and may recommend some of the latest and best products to speed recovery and prevent pain in patients with this condition including:

    1. Posture Supports / Braces
    2. Self-Massage Balls
    3. Pocket Physio ®
    4. BakBalls ®
    5. Foam Rollers
    6. Lumbar Roll/ Chair Supports
    7. Back Braces
    8. Bed Pillows
    9. Ice Packs or Heat Packs and Heat Patches
    10. Whole Body Vibration Machine
    11. McKenzie Treat Your Own Back Books
    12. Theraband for postural strength training

Learn How to get your Daily Dose of Life Changing Exercise to relieve your pain and a multitude of health conditions by learning a few ways to “tweak your week” to make your body work more so it hurts less!

Movember & Dr. Mike; Diagnosing and Treating Sitting Disease

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