Frange C1,2, Staub C3, Coelho FMS1,4, Andersen ML1, Tufik S1, Girão MJBC5, Hachul H1,5
1Universidade Federal de São Paulo, Psychobiology, São Paulo, Brazil, 2Universiadade Federal de São Paulo, Neurology and Neurosurgery, São Paulo, Brazil, 3Ausgeschlafen.ch: Physiotherapy & Sleep Consulting, Zürich, Switzerland, 4Unifesp, Neurology and Neurosurgery, São Paulo, Brazil, 5Universidade Federal de São Paulo, Gynechology, São Paulo, Brazil
Background: The Global Posture Reeducation (GPR) is based on an integrated idea of the muscular system as formed by muscle chains, which can face shortening resulting from constitutional, behavioral, and psychological factors. Although GPR is widely used clinically, literature is still lacking in evidence and mechanisms. The rationale of GPR is to stretch the shortened muscles using the property of viscoelastic tissue and to enhance contraction of the antagonist muscles, thus avoiding postural asymmetry and compensations.
Purpose: The aim of this case report was to evaluate the effectiveness of a GPR program on insomnia and pain.
Methods: The participant was a 43-year-old, married woman who sought treatment for insomnia at the Department of Gynecology of the Federal University of Sao Paulo (UNIFESP) in Sao Paulo, Brazil. She was invited by the research team to participate in the study. At age of 39 she underwent an ovariohysterectomy due to endometriosis, therefore the early postmenopausal stage. She was unable to work for 5 years (school teacher) because of pain. At her first visit in 2015, she complained about insomnia, paresthesia, nervousness, melancholia, headache, vasomotor symptoms (hot flashes and sweating), arthralgia and myalgia, and maximum pain (Visual Analog Scale: 10). Her medical diagnose were systemic lupus erythematosus, deep vein thrombosis and insomnia. She was taking anticoagulants, anti-inflammatories, antirheumatics, antidepressants, hypnotics, and a phytotherapeutic for menopausal symptoms. Her pelvic anteversion, lumbar hyperlordosis, thoracic hyperkyphosis, protracted and inwardly rotated shoulders, knees valgus, and right cavus foot resulted in the postural dysfunction. We had 16 weekly sessions of approximately 60 min each. GPR sessions were focused on stimulating awareness of the body image, balancing muscle function, stabilizing the spine, and correcting any alteration of postural alignment. Outcomes were pain intensity (Brief Pain Inventory and Visual Analog Pain Scale), insomnia severity (Insomnia Severity Index), sleep quality (Pittsburgh Sleep Quality Index) and menopausal symptoms (Menopause Specific Quality of Life Questionnaire).
Results: After 16 sessions, and weekly medical and physiotherapy monitoring, the patient weaned from medications for pain, vasomotor symptoms, insomnia, and depressive symptoms. Regarding posture, position of the shoulders, neck and head had improved. Moreover, she reported an improvement in pain symptoms (Visual Analog Scale: 1), insomnia and menopausal symptoms, global seep quality, and in the general health perception.
Conclusion(s): In the present study, GPR led to a reduction in pain, depressive and menopausal symptoms, sleep disturbance, medication dependence, and improved health perception. It dissociated the sleep-pain interaction. Further studies are needed to confirm the benefits and mechanisms of GPR in treating these symptoms and disorders.
Implications: The therapeutic postures of GPR includes a series of active gentle movements and postures aimed at realigning joints, stretching shortened muscles and enhancing the contraction of antagonist muscles, avoiding postural asymmetry. It adopts that retractions and stiffness of these muscles are associated with lack of postural balance and repercussion in several systems, often with rheumatologic, neurological, and respiratory symptoms. GPR can be a great strategy to improve pain and sleep disorders in menopausal women.
Keywords: sleep, pain, global posture reeducation
Funding acknowledgements: AFIP, CAPES, CNPq, and São Paulo Research Foundation (FAPESP, grant #2014/18722-5).
Purpose: The aim of this case report was to evaluate the effectiveness of a GPR program on insomnia and pain.
Methods: The participant was a 43-year-old, married woman who sought treatment for insomnia at the Department of Gynecology of the Federal University of Sao Paulo (UNIFESP) in Sao Paulo, Brazil. She was invited by the research team to participate in the study. At age of 39 she underwent an ovariohysterectomy due to endometriosis, therefore the early postmenopausal stage. She was unable to work for 5 years (school teacher) because of pain. At her first visit in 2015, she complained about insomnia, paresthesia, nervousness, melancholia, headache, vasomotor symptoms (hot flashes and sweating), arthralgia and myalgia, and maximum pain (Visual Analog Scale: 10). Her medical diagnose were systemic lupus erythematosus, deep vein thrombosis and insomnia. She was taking anticoagulants, anti-inflammatories, antirheumatics, antidepressants, hypnotics, and a phytotherapeutic for menopausal symptoms. Her pelvic anteversion, lumbar hyperlordosis, thoracic hyperkyphosis, protracted and inwardly rotated shoulders, knees valgus, and right cavus foot resulted in the postural dysfunction. We had 16 weekly sessions of approximately 60 min each. GPR sessions were focused on stimulating awareness of the body image, balancing muscle function, stabilizing the spine, and correcting any alteration of postural alignment. Outcomes were pain intensity (Brief Pain Inventory and Visual Analog Pain Scale), insomnia severity (Insomnia Severity Index), sleep quality (Pittsburgh Sleep Quality Index) and menopausal symptoms (Menopause Specific Quality of Life Questionnaire).
Results: After 16 sessions, and weekly medical and physiotherapy monitoring, the patient weaned from medications for pain, vasomotor symptoms, insomnia, and depressive symptoms. Regarding posture, position of the shoulders, neck and head had improved. Moreover, she reported an improvement in pain symptoms (Visual Analog Scale: 1), insomnia and menopausal symptoms, global seep quality, and in the general health perception.
Conclusion(s): In the present study, GPR led to a reduction in pain, depressive and menopausal symptoms, sleep disturbance, medication dependence, and improved health perception. It dissociated the sleep-pain interaction. Further studies are needed to confirm the benefits and mechanisms of GPR in treating these symptoms and disorders.
Implications: The therapeutic postures of GPR includes a series of active gentle movements and postures aimed at realigning joints, stretching shortened muscles and enhancing the contraction of antagonist muscles, avoiding postural asymmetry. It adopts that retractions and stiffness of these muscles are associated with lack of postural balance and repercussion in several systems, often with rheumatologic, neurological, and respiratory symptoms. GPR can be a great strategy to improve pain and sleep disorders in menopausal women.
Keywords: sleep, pain, global posture reeducation
Funding acknowledgements: AFIP, CAPES, CNPq, and São Paulo Research Foundation (FAPESP, grant #2014/18722-5).
Topic: Pain & pain management; Musculoskeletal
Ethics approval required: Yes
Institution: Universidade Federal de São Paulo
Ethics committee: Ethical Committee of Universidade Federal de São Paulo (UNIFESP)
Ethics number: #834146/2014
All authors, affiliations and abstracts have been published as submitted.
