Postural adjustment: case study of 5 subjects with pain and co-morbid insomnia

Abstract

Background: Chronic pain and sleep disturbance are the most prevalent complaints as aging advances globally [1]. Side lying is the most adopted sleeping position by the elderly [2] and persons with sleep apnea, cardiac condition. But side lying is also pin as the risk factor for neck pain, shoulder pain, hand paresthesia and lateral hip pain [3–5]. Study Objective: To evaluate the outcomes of postural adjustment in side lying in chronic musculoskeletal pain and sleep disorder. Materials and methods: Five subjects with chronic co-morbid insomnia, shoulder pain, nocturnal paresthesia of the hand and morning migraine in their preferred side lying position. This physiotherapy approach consisted of 3 direct contact sessions and online monitoring for 12 months and included: a) Functional Assessment); b) Pain Management training; c) Therapeutic home exercise program; d) Postural adjustment in side lying with the application of a customized topper with a breach at shoulder and hip level. Ethical considerations: this study follows the principles of the Declaration of Helsinki. Results: *: Morning Migraine; T1: first assessment; T2: intermediate assessment; T3: last assessment; NC: No Complaint. ”All subjects showed improvement by this approach. By the intermediate assessment (T2), the pain/paraesthesia had decreased to almost none, and the sleep and limitations in activity had improved completely by the final assessment (T3).P During online monitoring of these 5 patients, the reappearance of pain and paraesthesia was reported every time they sleep without their customized topper.” Discussion and conclusions: Assessment of the preferred sleep position on the usual sleep system of the person with pain and co-morbid insomnia is essential to identify any postural malalignment, which could be a risk factor for these two conditions but is not a common practice in physiotherapy management. A customizable topper should be use as a physiotherapy tool to promote a painless posture and assist the passive and active assisted postural correction. This is the first study to measure the outcomes with this described method, consequently, further research is recommended to test and validate this approach.