THE POSTURE THEORY AND DA COSTA’S SYNDROME

The Posture Theory explains the cause of many health problems, but more specifically, it is a way of explaining the cause of chest pains, palpitations, breathlessness, faintness, and fatigue which occur in the absence of any evidence of heart disease. Those symptoms are characteristic of a common medical condition known as Da Costa’s Syndrome which was named after Jacob Mendez Da Costa who, in 1871, was the first medical researcher to note that they seemed to occur as a set in many individuals. Those symptoms can occur at any time, but particularly during exertion. Therefore The Posture Theory is essentially a way of explaining the symptoms of Da Costa’s Syndrome which could perhaps, in relevant cases, now be referred to as The Posture Syndrome.

Da Costa’s original 1871 research article

Da Costa’s reported his observations of almost 300 patients, and provided the basis for the diagnostic criteria which included the typical features of chest pain, dizziness, breathlessness, palpitations, and fatigue that were associated with a poor physique, a thin chest, marching at double quick pace, hard field service, and viral infections, and he noted that the waist belt of the knapsack seemed to be aggravating the symptoms. The pulse was influenced by position, such as stooping, laying on the left and right side in some cases, and the back in others, and the condition was relieved by improved physique. Recommended treatment included not wearing clothing which constricts. Reference: Da Costa, J.M. (January 1871) “On Irritable Heart,” The American Journal of the Medical Sciences

The Cause and Nature of the Symptoms of Da Costa’s Syndrome

Neck ache, and lower back pain

These symptoms involve a dull ache in the neck, or sharp pain in the mid neck, or sharp pain between the shoulder blade and the neck, or cricks in the neck, and dull aching in the lower back. They occur because a stooped spine (kyphosis) throws the weight of the head, shoulders, and chest forward to put a mechanical strain on all of the bones, muscles and ligaments of the spine. Furthermore, when the upper spine is stooped the neck is more arched than usual, disposing to neck ache, and any scoliosis, or sideways curvature of the spine will put more strain on one side disposing to aching at the spinal joint central to the curve. That can in turn dispose to aches, numbness, pins and needles, or other sensations in the shoulder, arm, and muscle relating to the nerve coming from that side of the neck joint.

There may also be a compensatory increase in the forward and sideways curve of the lower spine which can increase the mechanical strain and incidence of low back pain.

Lower left-sided chest pain – The most typical pain is a sharp stabbing sensation occurring perhaps 2 or 3 times in a year (or more rarely) in the lower left side of the chest, and is probably due to postural strain on the structures between the ribs which produces a tendency to the pain. It may occur at any time when sitting relaxed or standing, and it feels as if a 3 inch sewing needle is suddenly stabbed in and out of the ribs and is over within a fraction of a second, as if a nerve has been pinched. It’s occurrence on one side of the chest is probably related to sideways curvature on the spine (scoliosis) placing more pressure on one side, and stretching the ribs apart on the other, and it occurs on the opposite side of the curve. It occasionally occurs on the right side as well.

There is also a dull ache occurring in the same location, and is probably due to strain from the pressures of constant posture, but the pain does not actually occur except when running, and then only rarely. When it does occur, it happens every time the persons foot touches the ground, so that the ache may be felt 100 times in a one hundred yard jog along beach sand.

The third type of chest pain occurs in the extreme left side of the chest, and is due to severe cramp in the muscles of the chest under the arm. It is equivalent to severe cramp in the calf muscle of the leg. It has been described as being brought on by muscular effort, such as cranking a car engine, in which case it is on one side of the chest related to which arm was used to crank the engine. Exactly the same pain can be felt on both sides of the chest where it is brought on by prolonged laughing, and it may be accompanied by difficulty breathing, because inhaling expands the chest and stretches the muscles and aggravates the severity of the cramp. The cramp will also be made worse by trying to lift or move an arm because such movements also stretch the muscles of the chest, so that the person has to stay in a semi crouched position, and the pain will cease only when laughing stop.

According to a website called About.com Orthopedics, inflammation of the rib cartilages can be caused by repetitive pressure on that area of the chest, which is seen in some athletes, such as competitive rowers. The inflammation of the ribs is also called ‘costrochondritis, and Tieze’s syndrome. See here – such athletes lean forward repetitively, in a similar way that clerical workers lean forward to read and write at a desk. See my diagram here.

Breeches of my copyright

See also costrochondritis here, and my report on the copyright theft of my observations and ideas about cause here.

Palpitations of the heart – This symptom involves the perception of the heart beating in combination with it tending to accelerate and pound faster and faster in an alarming way which does not seem to slow very easily. It can occur at any time of the day or night but often just after laying down to go to sleep. The problem seems to relate to laying down in the normal way, but can be prevented by laying down on the back slowly and resting with the head slightly raised on three pillows for a few moments, and then removing a pillow, and resting on two, and then one. The gradual movement backwards seems to offset the symptom. The problem also seems to be worse in any situation where the pulse rate is likely to increase such as when a person is anxious just before standing in front of an audience to give a speech.

There are probably three factors contributing to the symptom. The first is the curved shape of the upper spine, the second is the shape of the chest, and the third is the shape of the heart. The heart and ribcage can be compared to a bird in a bird cage. If the birdcage is large then the bird can flap its wings comfortably, but if the bird cage is small then its wings will bang against the wire frame of the cage, and if a person has a small ribcage, then the beating heart will pound against the chest wall and be more easily noticed. If the person becomes worried that there is some indication of heart disease then the worry will accelerate the rate and make the problem worse.

The perception of heartbeat can also be compared to the pulse rate which no-one is aware of until they place their fingers over the artery in their arm. With slight pressure on the fingers nothing can be noticed, but by pressing the fingers against the artery its wall can be felt each second as a pulse of blood passes through it. Similarly if the heart is squeezed into a small chest, then its beating may be more readily noticed each time it pounds against the chest wall.

Similarly people with broad and deep chests and rib cages have hearts which are pyramid in shape and they would sit stable in the chest, but people with long narrow or flat chests tend to have bowling pin shaped hearts which would tend to wobble about when beating fast, and that would produce a different and perhaps more alarming sensation.

Consequently the palpitation may be felt when a person lays down at night because, as they lay back the curve of the upper spine straightens out and drags the front of the chest backwards and compresses it against the heart, so that its beating can be felt. That may explain why the symptom can sometimes be prevented by laying back slowly. or by sleeping in a semi-sitting position with the head raised and the spine remaining curved in a C-shape to maximize the size of the chest space.

The palpitations may also perhaps relate to excess amounts of blood pooling in the veins of the legs, so that when the person lays on their back, the sudden removal of the gravitational load on the blood causes and excess volume to flow toward the heart chambers with temporary greater force.

In other respects such patients, and anyone else who has problems with a pounding heart when giving speeches, the symptom can be prevented or relieved by having a small glass of wine a few minutes earlier to relax the heart muscle (alcohol is a muscle relaxant which passes immediately through the stomach wall to the heart muscle nearby). It may also be useful to take a few slow, regular, and deep breaths to stabilise the position of the diaphragm which the heart sits on, and to use a prepared speech, so that the element of doubt is removed from the talk.

NASA

I developed these ideas more than 30 years ago and have been improving them ever since, because they are effective. Recently, on a Channel 9 TV morning news programme it was reported that astronauts returning from space flights had a problem with faintness. A spokesman from NASA attributed to the lack of gravity in space. They had developed a new method of treating the problem which involved exercising on a stationary bike with their head and spine tilted back, and said it was effective because it reduced the effect of gravity on the blood in the body.

Their ideas are essentially the same as some of the ideas that I developed. See more in the faintness section here

This is a quote from the Medical Unit, or the abc NEWS website

“The exercise program is intended to help the heart grow in some patients and in others to condition the heart muscle and prevent fainting. “It involves exercises that avoid gravity,” Jaeger said. “And for the first time ever we actually have a way to turn around the person’s symptoms and actually cure them.” For Chandler, the prescription is simple. She eats salty food to keep her blood pressure up, tilts her bed when she sleeps to keep her blood flowing, and she exercises on a recumbent bike. “I actually bought a recumbent bike,” she said. “I will be using that more often now to build up my heart muscle. I want to be at my best.” Chandler and some others are now free from fainting spells, thanks to a little help from “The Right Stuff.” See here

(Note that in some people where the cause has been short term, such as astronauts, the condtion probably is curable, but for many people the ailment is not due to a temporary or long term lack of exercise, and is manageable, but not curable).

Leaing forward is the cause, leaning back is the cure

According to my theory it is repeatedly leaning forward which compresses the air in the chest and strains and damages the blood vessels below the chest that eventually causes faintness. According to NASA the cure involves exercising while laying back on a recliner bike, which takes the load of gravity of the blood.

When the spine is straight and the chest is deep the heart has a lot of room to function normally.	When the spine is stooped and the chest is shallow the heart is occupies a much smaller space and is in closer contact with the breastbone. Consequently its beating is more easily felt as it pounds against the breastbone. (the breastbone is also called the sternum)

Breathlessness – This symptom takes the form of an air hunger where the person takes a full and deep breath until inhaling reaches its limit and can’t go any further. However they still feel as if they have not got enough oxygen so they forcibly attempt to breath even more deeply, like a forced yawn, and then they have to take another two or three full breaths in quick succession. The person then breaths at a normal rate for a few minutes and may then have to reach for breath and forcibly inhale again. Occasionally the person may bend at the hips, place their hands on their thighs, and arch their back and expand their chest to inhale with greater force and effectiveness.The symptom may occur every few minutes or every few hours or only once or twice a month, and may occur at any time of the day or night, regardless of whether the person is sitting, standing, or resting, or laying, and it occurs more frequently in cold weather, and more often when walking, especially up a hill, and much more often when slowly jogging, in which case the quick successon of forced breaths may be required as often as every 10-50 yards. see also here, and : ref 22 Wolf S. 1947

There is sometimes a slightly different but similar symptom which involves the need to take deep yawns.

The symptom is also aggravated by wearing any tight clothing which restricts the expansion of the chest during the inhalation phase of the breathing cycle. For example having a snugly fitting and inflexible belt strapped around the chest can cause extreme respiratory distress during the inhalation attempt.

The breathlessness can also sometimes be caused by leaning toward a desk or bench which involves bending at the waist or rib line. That type of bending pushes the breastbone backwards and compresses the chest and abdomen, and restricts the upward and downward movements of the diaphragm, thereby restricting both the chest and abdominal phases of breathing, so the symptom probably results from an anatomical strain or damage brought on by many years of constant or repeated compression of the lungs or diaphragm. The postural pressure may have damaged the lungs so that the amount of oxygen passing from the lungs to the blood stream is impaired, or it may have damaged the diaphragm (the main breathing muscle) and altered its natural and normal function. The exact anatomical basis for the symptom is not clear.

A related feature of Da Costa’s syndrome is CO2 intolerance, and also, distressing symptoms are brought on by wearing a gas mask, and it probably relates to the confined space of the mask, and the build up of excess vie CO2 in that small space. With normal breathing in fresh air, the CO2 dissipates immediately.

This is a quote from J.M.Da Costa’s original research paper of 1871 page 25 . . .

“it was astonishing that the respiration was so little hurried. And, as a general rule, it may be stated that this curious disorder presents the anomalous condition that increased action of the heart does not give rise to increased frequency of breathing; we find in it a peculiar pulse respiration ratio.” (end of quote) He then cites some examples of me with pulse rates of 124 and respiration of 25, and pulse of 146 and respiration of 26, and pulse of 192 and respiration of 26, and he gives one exception to the rule.”(end of quote) (Some authors make the mistake of thinking that this symptoms is panic induced hyperventilation)

A stooped spine compresses the air in the lungs and a small chest restricts the volume of air in the lungs and disposes to breathlessness, also called dyspnea, and lung and breathing disorders. A broad based rib cage allows for slow deep breathing, whereas a narrow base disposes to shallow and rapid breathing, congestion of the lungs, lung infections such as chest colds, and abnormal function of the lungs, and abnormal function of the diaphram breathing muscle, which results in faulty CO2 metabolism,. Seventeenth century women wore extremely tight corsets which deformed their ribs into a funnel shape, and led them to die young with lungs which were described as being in a state of “withering rottenesse” see references: Anthropometamorphosis. Nineteenth century women who wore tight waisted whalebone corsets would typically heave with breathlessness brought on by the slightest emotion or exertion. Note however, that the breathing of Da Costa’s syndrome involves slow and shallow respiration, which may be why there is a build up of oxygen debt which requires them to occasionally take extra deep breaths two or three times in a row, to make up for that lost oxygen intake. (i.e. it is definitely not the type of rapid and shallow breathing seen in anxiety or panic).

“All crooked or constrained bodily positions affect respiration injuriously. Reading, writing, sitting, standing, speaking, and working with the trunk of the body bent forward are extremely hurtful by overstretching the muscles of the back, compressing the lungs, and pushing downwards and backwards the stomach, bowels, and abdominal muscles.” Reference: George Black, M.B., Edinburgh, (1910), The Doctor at Home and Nurse’s Guide-Book, revised edition, Ward, Lock & Co., Limited, London, Melbourne and Toronto. pages 77-78.

Faintness and dizziness – The type of faintness is a sense of light headedness, and a feeling as if about to lose consciousness and fall to the ground, and it can be associated with unstable or low blood pressure. Some patients do actually faint from time to time, but others often feel a sense of faintness but never actually lose consciousness, and the symptom may be slightly or much more distressing than any normal sense of faintness, and occurs in response to minor, or sometimes very slight movements of the body. Sometimes there is another sensation, especially with rotation of the body, of an odd and distressing sensation in the chest, as if the heart is about to stop beating.

The faintness most commonly occurs when getting out of bed and standing up suddenly in the morning, (orthostatic intolerance) and can be prevented by getting up slowly, and first sitting on the side of the bed, and then standing slowly and walking off at a casual pace. The symptom may occur throughout the day at any time especially if the person gets out of a seat and stands up suddenly, rather than slowly, and it may be a more or less constant feeling, or occur several times a day or a week, or several times a month.

It may also occur when the person leans forwards at a desk and in very extreme cases if they lean forward to write 10 times, they will feel faint each time, and sitting up and leaning back slightly each time will relieve the faintness, so the sense of faintness comes and goes 10 times, and continues in that manner until the person stops repeatedly leaning forward. (note: scroll down to fig.15 for a leans forwards at a desk link which reports on corsets, leaning forward to write, and scientific pressure measurements in 1887).

The problem is greater if the person is squatting as they lean forward.

The faintness also occurs whenever the person is subjected to centrifugal forces such as when they are a passenger in a car which speeds around a curve in a country road, or if they are a passenger in a swirling amusement park ride, or on an up and down or winding roller coaster, and in fact, many patients avoid such entertainment activities altogether. It also occurs when a lift in a tall building accelerates to start its upward journey, and decelerates to stop, and in a plane which accelerates at the start of its flight , or suddenly drops in a down draught, or decelerates to land.

The symptom also occurs sometimes to an extremely alarming degree when a patient is placed on a tilt table, and it is moved up and down and rotated sideways at various angles to get different X-ray images of the patient.

The symptom is due to a weakness in the circulation of blood in the body (hence the term neurocirculatory asthenia) and is often seen to a minor degree in many fast growing teenagers who have a condition called sway back, probably because that posture puts pressure on the chest or kidneys. However many teenagers grow out of their sway back and the symptom becomes a thing of the past, but in other people it starts in adulthood and takes a more persistent course. It is also more common with people who have a stooped upper spine and a flat chest, probably because the downward postural pressure on the chest impedes the blood flow from the legs to the heart and brain. That constant pressure may actually stretch all of the blood vessels below the waist so that they become more elastic, or so that there is an abnormally disproportionate amount of the bodies blood below the waist which is more subject to being displaced by any type of gravitational or centrifugal force. To a lesser extent this is evident as orthostatic hypotension related to varicose veins below the garter line of the leg, where pressure impedes the upward flow of blood and damages the tone of the leg veins so that blood tends to pool in them and be delayed in it’s return to the heart when the person stands up suddenly.

The faintness is also likely to be a problem if the person wears a tight collar which reduces blood flow to the brain, and can be relieved by loosening the collar, and was very common amongst nineteenth century women who wore tight waisted whalebone corsets. Those women routinely relieved their fainting spells by unlacing their corsets and laying on their backs with their head and shoulders slightly elevated on the arm of a chaise lounge, in the then common fainting rooms, A similar beneficial effect on spinal posture and the symptom can be achieved by laying in a modern recliner chair tilted slightly back.

A milder from of this could be the orthostatic hypotension caused by wearing leg garters which results in varicose veins below the garter line, where excess blood pools, and is delayed in it’s upward flow when the person stands up suddenly, and which occurs because those veins have lost the strength to respond appropriately. The symptom of faintness or dizziness in Da Costa’s syndrome would also occur in response to any gravitational or centrifugal force acting on the body, except much more readily and severely, which is why such patients avoid entertainment activities like roller coaster rides, whereas healthy people find the experience exciting and enjoyable..

The dizziness is a slightly different sensation which sometimes involves a sense of obscure fuzzines at the back of the head in an area just above the top vertebrae of the spinal colum, and or, a sensation of the inside of the head, or the outer walls and ceiling of a room swirling, but not always, and it seems to occur as a mixture of dizziness and faintness, with a sense of being about to lose consciousness. It is most commonly brought on by bending the neck back to look up at items on tall cupboards. It is probably the result of that neck position putting pressure on the blood vessels in the neck and interfering with the efficiency of blood flow to the brain.

Dizziiness also occurs to a more significant degree than normal with rotational movements of the body. This is probably because, with normal posture, the head is balanced directly above the spine, but when a person has a stooped spine the head is thrown forward by at least six inches forming a radius about the spine, and therefore the outer extreme of the head turns in a large circle with a diameter of at least twelve inches, thereby throwing blood outwards from the neck with greater centrifugal force. Therefore, in persons with an abnormal stooped curvature in the upper spine, the dizziness can be relieved or minimized by deliberately forcing the spine to be straight and thereby positioning the head directly about the spinal colum with the head more slowly rotating about the spin of the feet.

The dizziness may also be partly due to a weakness in the blood vessels below the chest where some of the blood in the lower body is thrown excessively outwards with the spin and reducing blood flow to the brain.

In the nineteeth century women wore tight waisted corsets for most of their lives. Such corsets compressed the stomach and forced the liver, spleen and kidneys downwards, straining and permanently stretching the attachments, such as the ligaments, blood vessels, and nerves which held them in their correct place in the midriff. Consequently the liver and spleen etc hung loose and would slide up and down and side to side excessively in response to gravitational or centrifugal forces such as roller coaster rides or even such minor movements on the moving tilt table (here). Those forces would therefore also temporarily and excessively stretch the blood vessels and weaken the blood flow to the heart, which probably explains why the patients feel an extreme sense of distress in their chest, and an extreme and reduced blood flow to the brain would account for the alarming sense of to-ing and fro-ing faintness with each change of direction. See also here Furthermore as the liver etc. swung loosely against the abdominal wall, or downwards against the blood vessels from the legs the affect would be magnified. Poor posture also pushes the liver, stomach and spleen etc. downwards (visceroptosis). Nineteenth century corset wearers would typically faint with the slightest emotion or exertion, and would relieve the faint by unlacing the corset and laying on a chaise lounge which had an arm at one end so that the woman could rest against it with her head and shoulders slightly elevated, and with her legs free to extend at the other. Some were housed in purpose built fainting rooms.	Some people feel palpitations of their heart when they lay down on their backs too suddenly. That is probably because they have loose livers etc which slide toward their heart and they can therefore feel its beating, in a similar way to the fact that they can feel the pulse in their wrist if they apply pressure from their hand onto the wrist artery. That would explain why the problem can be avoided by laying down very slowly and gradually. In the early twentieth century some surgeons cured the problems by sewing the liver etc onto the diaphram to keep them in a more normal position. However the symptoms returned again in a year for reasons which were not understood but it may have been because the patients kept wearing corsets or slouching and pushing down against the weak surgical stitching until it gave way.	When a person with a loosely attached liver and stomach stands up the liver etc slides downwards and makes the lower abdomen bulge excessively into a pot belly shape. That would put pressure on the blood vessels which bring blood from the feet to the heart, and may explain why some people feel faint when suddenly standing up as they get out of bed in the morning, or at any other time. That would also explain why the faintness can be minimised or avoided by standing up gradually, and walking off slowly for a few seconds.

Fatigue related to sleep problems and exercise limitations – Some patients report that they have suffered from fatigue for as long as they can remember so they were probably born with the problem, and some report that they know that they are now troubled by fatigue, but they cannot recall any particular time or incident when it started, and others report that it started over a period of time (months or years) when it seemed to gradually get worse without being particularly troublesome until it became so severe that they had to rest, and that they had to rest for months or years to recover, and that they never fully recovered . They may in fact report that the fatigue accrues in an obscure way until they reach a state of extreme exhaustion again, and the process of recurring severe exhaustion may happen three or four times over a period of a decade before they decide to restrict their lifestyle as a means of preventing the relapses. The fact that the fatigue does not respond in the expected manner of being relieved by rest or sleep and the fact that it tends to accrue over a period of weeks or months is one of its significant differences from normal fatigue, which a person can easily recover from by getting a good nights sleep etc.

During the development of the ailment the instability of blood pressure, breathlessness, faintness, and dizziness, and fatigue seem to occur as a linked sub-set of Da Costa’s syndrome.

In the extreme case the fatigue involves restlessness, wakefulness, the inability to sleep for days or weeks at a time, but later waking up several times at night and not being able to get back to sleep again, and waking up tired, and tiredness occurring several times throughout the day are features. The tiredness sometimes but not always responds properly to rest, and has the characteristics of a sleep disorder. The symptom has sometimes been derogatorily referred to as TATTS (tired all the time syndrome), which reflects ignorance about the different qualities in the nature of the symptom, and the sometimes profound severities of the condition which bare no resemblance to normal tiredness, and continues to produce confusion in diagnosis.

The bouts of fatigue may occur for weeks or months undiminished, because there is no effective treatment or medication for the problem, other than long term rest, mild exercise, and the passage of time, which is why many patients avoid the factors which induce them, and lead generally quiet and moderate lifestyles.

There is also an exercise disorder where the person is so weak that their heart may pound each time they lift their foot of the ground as they walk slowly along the street. They may be walking or jogging last in exercise training programmes and have to reach for breath several times each 20 yards or so, and if they exert themselves suddenly or sprint fast their heart will pound violently and they will feel faint and dizzy and fall to the ground and crawl about restlessly because restricting their movements causes extreme physical distress inside the chest. Consequently they have to give up the sporting activities that they have participated in regularly in the past, and, because of the distressing nature of the symptoms, most of them refuse to participate in remedial exercise programmes, or drop out of the course soon after starting.

The fatigue seems particularly linked to the faintness which occurs when leaning forward, either toward a desk, a bench, a washing machine, or the kitchen sink etc. As another example, in order to clean low windows on a house it is necessary to squat down and lean forward. Each time the person leans forward they feel faint, and if they choose to ignore the problem and keep repeatedly leaning forward until all of the windows are finished, and then stand up, they may feel faint and weak and exhausted. After only that half an hour of minor effort in the morning they will have to spend the entire afternoon resting in bed, and may still be exhausted when they wake up the following day.

The link between faintness and fatigue probably occurs because leaning forward compresses the chest, heart, and lungs, and then the increased air pressure in the lungs impedes blood flow from the feet to the brain. In that regard there is an experimental procedure called the Valsalva’s Manouver which is used in scientific laboratories to artificially produce the symptoms of stress in the absence of any psyhological factors. When this manouvre is being used the patient is asked to pinch their nose shut, and keep their mouth closed and exhale with force. As the air cannot escape from the lungs the pressure builds up and impedes the flow of blood from the feet to the brain. The brain and nervous system then react with a reflex that stimulates and contracts the blood vessels of the legs, which increases the blood pressure to force the blood to go upwards through the compressed vessels in the chest. Hence there is a relationship between air pressure in the lungs, the nervous system, and blood pressure.

>Consequently if a person was constantly or repeatedly leaning toward a desk or bench for many years they would also be blocking blood flow from the feet to the brain and putting a lot of pressure on the blood in the veins below the chest. Such long term pressure might affect the tone of the walls of those vessels, or gradually damage them, and weaken the upward flow of blood, and become a disorder of circulation (i.e. vascular dystonic circulatory asthenia). In fact this form of fatigue has been called neurocirculatory asthenia – a weakness of circulation, and neurocirulatory dystonia – a disorder of circulation due to abnormal tone in blood vessels). The weakness of blood flow to the brain would account for poor concentration, poor memory, and problems with wakefulness and sleep which are all common in DaCosta’s syndrome. Furthermore the weakness of blood flow from the feet to the heart would account for the faintness which occurs when standing up suddenly, or when standing up from a squatting position, and it would also explain the weakness in the bodies response to sudden, vigorous, or rapid exertion.

Hence there is a link beween posture, sedentary work, constantly or repeatedly leaning forward, Valsalva’s maneuver, and transient, recurring, prolonged, or chronic symptoms of tiredness, faintness, and physical exhaustion. The condition is common in sedentary town workers, and rare in country farm laborers.

The Posture Theory and Postural Valsalva’s ManouverLeaning forward with the mouth shut can compress the air in the chest and block blood flow between the feet and the brain.Chronic damage to the blood vessels below the chest can lead to chronic sleep and exercise disorders. If this is the mechanism for causing a type of Chronic Fatigue Syndrome, then they type could be called The Posture Fatigue Syndrome . . . See a reference with the scientific measurement of air pressure in the chest relating to posture and corsets by Robert L. Dickinson M.D. (November 5, 1887), Questions of pressure and displacement, The New York Medical Journal, here

The Abnormal Response to Exertion, and it’s possible relation to Abnormal Sighing Respiration ©

In Da Costa’s syndrome there is an excessive tendency to sigh which occurs at variable intervals, but it sometimes takes the form which can be explained as if there is a standard depth and rate of breathing and oxygen absorption into the lungs which is not being achieved, for one reason or another, so the person tends to take an extra deep breath every few minutes to make up for the lack of oxygen consumed during that time. Sometimes the inhalation needs to be forced to achieve the depth of breathing required to make up for the deficiency, and sometimes two or three forced deep breaths may need to be taken in quick succession. The need to take the extra sighs may occur every few minutes, or several times an hour or day, or month, and is more frequent during cold weather.

This becomes more noticeable with exertion such as slow jogging where a normal healthy persons breathing rate, volume and absorption increases according to the extra amount of oxygen required for the exertion. However with the type of breathing pattern seen in Da Costa’s syndrome it sometimes seems as if the breathing process does not properly increase to meet the extra requirements for the effort of jogging, so that they may accumulate a greater oxygen debt and need to take two or three extra forced deep breaths every twenty yards or so.

The same problem seems to occur with sudden rapid sprinting but to a much greater extent. The healthy persons breathing pattern adjusts to the oxygen requirements, but with Da Costa’s syndrome it seems as if the respiratory mechanism is slow to adjust, so that after only twenty yards the person may fall to their knees repeatedly gasping for breath, with their heart pounding in their chest, and feeling faint, dizzy, and excessively restless, and crawling about with extreme exhaustion for 15 minutes or more, and be fatigued to a lesser extent for a week or more, before resuming milder forms of exercise.

It may be a matter of the respiratory reflex not working properly so that as the level of exertion increases the breathing becomes shallower or the oxygen absorption less, so that an oxygen debt builds up until the person feels an obvous need for more air, and then forceably inhales to get the extra oxygen required.

The explanation may not be entirely correct in every detail, but it is close enough to portray the difference between the healthy response ot exertion, and the Da Costa syndrome response, and it may or may not be due to a fault with the thoracic diaphram, or the autonomic nervous systems regulation of breathing, and it may due to an abnormality of breathing pattern rather than too much or too little, or to inefficient respiratory efficiency which is worse as the level of exertion increases, and many people with this problem were former athletes who use exercise as a possible means of improving their fitness to recover from the fatigue, so it is not due to a fear of exercise, and it can occur when the person is otherwise relaxed, so it is not due to an anxiety state, and it is probably not due to any disease of the heart.

The purpose of this explanation is to provide a conceptual way of understanding the differences between the normal response to exertion, and the DaCosta’s syndrome response, where the difference is otherwise not recognised, or is trivialised, or misinterpreted etc. It is subject to being tested or disputed or to someone else coming up with a better way of explaining the difference. This explanation was posted on this website on 4-2-08. When referring to this explanation please cite this website as the source, See also: Low oxygen consumption and low ventilatory efficiency during exhausting work in patients with neurocirculatory asthenia, effort syndrome, anxiety neurosis, . . . See also (re: the respiratory disorder is different to hyperventilation) – Hyperventilation and chronic fatigue syndrome . . . and . . . The chronic fatigue syndrome and hyperventilation

Upper abdominal pain – also called epigastric pain. The primary symptom is a dull ache of varying intensity occurring periodically and occupying an area the size of a 20 cent piece in the mid upper abdomen just below the tip of the dagger shaped breastbone, or sternum.

The pain is probably related to slouched posture, sideways curvature of the spine, and chest shape, Poor posture pushes the breast bone downwards, sideways curvature alters the angle of the breastbone, and a flat or funnel shaped chest involves a breastbone which is vertical or receding. Hence when a person with such features leans forward the pointed tip of the dagger shaped breastbone is pushed downwards, backwards, and sideways with a twisting motion into the area where the food pipe joins the stomach, Such repeated action would make the valve like junction sensitive to irritation, and be likely to allow small amounts of stomach acid into the lower end of the food pipe, and possibly also weaken the ligaments and muscles in the area permitting occasional sliding hernia. It might also compress the outlet of the stomach where it joins the duodenum, or partially rotate the stomach and twist it’s outlet and block the flow of gastric acid, which would therefore build up to an excess degree in the stomach and cause tenderness and pain by irritating the stomach wall, and in prolonged cases result in the formation of lesions and peptic ulcers. See also ulcers.

Regardless of the cause, the pain is induced by repeatedly leaning forward for an hour or more, and when induced it is aggravated by very minor postural movements. For example it may then be aggravated by leaning forward to tie up shoe laces, in which case the person should buy moccasin style, or slide on shoes which can be put on without bending.

The abdominal pain is also aggravated by wearing tight belts about the waist, or tight elastic bands on underwear, so loose clothing should always be worn, and loose waisted trousers can be held up by shoulder braces or suspenders, rather than belts. Sometimes the pain is simply caused by the belt pressure, and sometimes because, when the person slouches the pressure from the belt resists the downward movement of abdominal contents, so they are squeezed from above and below when the person leans forward. On some occasions the relation to pain is obvious but it is usually obscure, subtle, and delayed.

The more the pain is aggravated the worse it gets and the longer the abdomen remains tender to the slightest touch. By aggravating the problem for an hour the pain may persist for several days, and by aggravating it for two or more hours the pain may persist for weeks, and any strong strain on the abdomen, as from digging forcefully into the garden and jolting the abdominal muscles can make the pain persist for months. The pain is also aggravated by stretching the arms upwards or sideways, because the arm muscles are connected to the chest and abdominal muscles and drag on the diaphragm and the junction of the stomach and food pipe.

The pain can be influenced by some foods. Acid foods such as lemons and oranges, and also spicy foods should be avoided. Also the problem disposes to constipation, so high fibre foods should be included in the diet to keep constipation to a minimum, but even some hight fibre foods, particularly cabbage, and legumes (peas, beans and peanuts), should be avoided because they can also aggravate the pain.

If the pain is aggravated in the morning, it may subside in the afternoon, but commonly it may recur and awaken the person at 2.a.m. in the morning perhaps because the periodic peristaltic flow of food residue at night may pass the area of pain and the bulging bowel may nudge the tender area and produce the pain. (Similar to the way in which an egg produces a bulge in the outer surface of a snake as it passes through the inside).

The irritation of that area of the abdomen is near the solar plexus and some aspects of the ailment suggest esophageal achalasia (faulty function of the valve like structure joining the food pipe to the stomach). The fact that the severe pain can sometimes be accompanied by difficulty swallowing and can be relieved by a drug called Somac indicates the probable involvement of heartburn due to more significant leakage of acid, and the fact that it is often accompanied by severe constipation and multiple pains and cramps in the bowel, indicates irritable colon may be an additional or secondary problem.

It is therefore best to prevent the problem by developing good posture during childhood. The pain can be relieved by laying in a recliner chair, especially a dentists chair which is shaped to push the lower abdomen forward and allow the upper abdomen to arch up and take the tip of the breastbone outwards away from the stomach. If the pain is only mild it can often be completely relieved by laying in such a chair for only half an hour, but if the pain is severe then such rest will only produce slight relief. Laying in bed on the back also relieves the problem but in severe cases it may be necessary to raise the head and lift the knees as well to take all pressure of the abdomen. As previously mentioned, it is also useful to always wear loose clothing, avoid acid foods, include fibre in the diet, and sometimes, if difficulty and pain swallowing food or water is present, the drug Somac can be beneficial.

(Gastric reflux is another name for heartburn and is the most common symtom of pregnancy and it is caused by the enlarging womb pressing up against the stomach, and women report that laying down, stooping, or bending brings on attacks. It is relieved by laying on the back with the head and chest slightly elevated).

Click in an out of diagram to see the effects of slouching When a person with a stooped spine and a shallow shallow chest leans forwards the torso buckles at the midrifff and the pointed tip of the dagger shaped sternum stabs or digs into the junction of the stomach and foodpipe.	When a person with a stooped spine and a deep chest leans forward the breastbone moves away from the spine so the stomach is protected from harm. Note the deep chested profile of Luciano Pavarotti and the power in his voice that comes from the air in his large lungs passing through the vocal chords in his throat.

Other types of abdominal pain occurs because the lower ribs and the lower rib (or costal) cartilage of the rib cage press and dig back into the liver and colon and that process then pushes the structures behind them against the back ribs. Consequently there may be tenderness or soreness in the muscles and anatomy on the left and right side of the front of the chest at, or just above or just below the lower rib line, and a variety of pains along the track of the transverse colon, especially on the extreme left or righ sides, and tenderness or soreness in the left and right kidney area and the back muscles at the same level of the torso.

Pain occurs whenever an anatomical tubular structure is blocked because a biological reflex makes the preceding section of the tube go into spasm in an attempt to squeeze the contents forward with greater pressure in order to force it past the blockage. Hence a lot of pain will be experienced if a kidney stone blocks the ureter tube which drains it, and similarly sustained postural pressure on the bends of the colon may start a sequel of blockage, spasm, and pain.

Severe abdominal pains: After being aggravated by such minor problems as leaning forward repeatedly , or jarring the stomach while digging in the garden, there may follow a period of several months of severe pain. During those periods the pain remains unabated from day to day for weeks or months until it eventually subsides with time, and may be accompanied by severe constipation, severe bowel cramps, multiple sites of diverticula pin head sized pains along the entire track of the colon, sore or frank protruding hemorrhoids, constipative evacuations which on some occasions tear and put split lesions in the ring of the anus to produce bright red streaks of blood in the excreta, and muco-membranous colitis with the passage of opaque slithers of the gut lining. Those pains do not respond effectively to any form of treatment or medication, which is why many patients avoid the minor aggravating factors as a means of prevention. However, in most cases, even when the symptoms are severe, there is still no x-ray evidence of disease, so many doctors trivialise it and treat it as if it is mere indigestion because they either don’t believe, or can’t understand or comprehend what the patient is complaining about. The condition is not, or rarely associated with, or aggravated by anxiety, and can occur, and persist when a person is perfectly calm.

The abdominal symptoms are associated with and, or involve varying degrees of colon spasm which is referred to as Irritable Bowel Syndrome, and were previously regarded as psychosomatic disorders involving “learned Illness Behavior” until the discovery of bacterial and other abnormalities in the colon in the 1990’s. Since then that diagnostic criteria has not been applied to this category of illnesses, and by association are not applicable to the other symptoms of DaCosta’s syndrome. See:(IBS 4.1, 27-12-07).

Kidney ache – This is a dull ache in the area behind the kidneys, either in the back muscles or the kidneys themselves. It can occur after sitting at a desk and leaning forward for several hours and starts on one side, but if the activity continues the ache will start on the other side as well. It sometimes seems to be followed by alterations in urinary function and the development of kidney stones. The ache is also brought on by exposure to cold breezes which is why it occurs more often in winter.

As a general rule winter produces cold breezes and summer produces warm air, but sometimes when walking in summer with a cold sea breeze blowing on the back the chill in the breeze will make one kidney ache, and soon after the next, and once induced the aches will persist for days or weeks after. This problem can be prevented by wearing a padded vest over the kidneys.

The effects of pressure on the kidneys is evident by the fact that people who are having kidney x-rays are required to have a dye injected in their blood so that the trace of the dye passing through the kidneys to the bladder will show up on the image. Patients are asked to lay flat during the x-ray procedure, because, if they slouch, the postural pressure will compress the kidney sand their tubing and interfere with the flow of the dye.

When Benjamin Franklin was 80 years old he had problems with kidney or bladder stones where he wrote “my sitting at the desk had already almost killed me” and “the stone gave me much pain, wounded my bladder and occasioned me to make bloody urine” and said “when I attempted to write the pain would interrupt my train of thinking” and that he had good health except “being only troubled with the stone which sometimes gave me more than a little pain and prevented my going in a carriage where there are pavements” and sometime later he even had trouble with the pain when standing or walking. (when a kidney stone blocks a hollow tubular structure the walls of the tube go into powerful and painful spasm in an attempt to force the fluid within it past the blockage. Pain occurs if the stone doesn’t move and the pressure increases. Postural pressure which occurs when leaning toward a desk would increase the pressure in the fluid, as would the bouncing up and down action of a carriage going over potholes etc, or in severe cases the simple act of lifting the feet up and down as the person walks could have a similar effect.

A summary of The Posture Theory and Da Costa’s Syndrome

The symptoms described above are more consistent to those of Da Costa’s Syndrome than any other ailment.

When studying the symptoms individually there were a lot of apparent differences which sometimes seemed contradictory. For example, the faintness could be caused by standing up suddenly, the dizziness by bending the neck to look upwards, and one of the chest pains could be caused by cranking a car engine, and another type by jogging up and down along beach sand. The stomach pain could be caused by wearing a tight belt all day, or by tieing up shoe laces, and was more likely to occur in relation to various foods in the diet, and the kidney ache could be brought on by exposure of the back to cold breezes. The breathlessness is more likely to occur when jogging, the palpitations can be relieved by a glass of alcohol, and the fatigue involves problems with sleep and exertion.

However, there is one factor which is common to all of those symptoms, and that is that at some time or other, in some way or other, they could all be caused by leaning forward, particularly in activities which require repeatedly leaning forward.

Most people are involved in activities which require them to lean forward but they don’t get such symptoms and that is because, most people have reasonably straight spines and reasonably deep chests. By contrast patients with DaCosta’s syndrome are typically thin and stooped and they have flat chests. It is their physique which causes the problem because when they lean forward their torso bends at the lower rib line and the breastbone is pushed backwards. Consequently when they lean forward they strain their spine and compress their chest and abdomen and everything within to cause the main symptoms of chest pains, palpitations, breathlessness, faintness, and fatigue, and many others not so typical or so commonly seen. Essentially the symptoms are disposed to – and, or- caused by any combination of factors which compress the chest, and restrict it’s size, and thereby compound the mechanical pressure on the rib cage and chest cavity, such as a stooped spine, and small and thin chest, and in some cases, the enlarging womb of pregnancy, and tight waist bands, belts, or corsets, and are more likely to occur in any long term activity which involves repeatedly leaning forward.

Hence the study of those symptoms became a study of DaCosta’s Syndrome, and then The Posture Theory, and then the theory became a study of Posture and Health.