Muscular imbalance found in examination of posture in torture victims

Skylv,G. (1992). Poster presented at 2nd World Congress on Myofascial Pain and Fibromyalgia, Copenhagen, Denmark. 
 
This article was reviewed by Brittany Burton, doctoral physical therapy student at the University of Minnesota, 2014.
 
A free copy of the article may be requested from Dignity-Danish Institute Against Torture, by emailing library@dignityinstiture.dk.
 
Background: The aim of torture is not only physical but psychological as well, and globally seems to be focused on the vulnerabilities of the victim. Some types of torture are directed at the back, which can consist of blows, kicks, long sustained position (normal or abnormal), or confinement of the person. The victim may find him/herself suffering from somatic symptoms of the musculoskeletal system such as tension of musculature for an extended amount of time following the event. In this article, 56 torture victims were examined and postural abnormalities and muscular imbalance were commonly found. Recommendations are made for physical therapy treatment. 
 
Summary: 56 consecutive torture victims were examined during both standing and walking for postural abnormalities and muscular balance by one clinician. Physiological curves were also evaluated. Results showed that 49 of the victims were found to have muscular imbalance with those having abnormal curving in sagittal and frontal planes, 54 had scoliosis with up to 4 curves and none of the clients had a spine with zero abnormalities. The discussion notes that in all 56 victims a classical depressed pattern was found consisting of “[…] drooping head, increased cervical lordosis, raised shoulders, increased thoracic kyphosis and lumbar lordosis, changed pelvic inclination together with a disharmonic muscular pattern, as described by Janda, with shortened, tight, painful postural muscles in the shoulder girdle, the pectorals, the thoraco-lumbar back stretchers, the flexors of the hips, the muscles of back of the thigh and the calves, combined with flat, hypoactive phasic muscles between the scapulae, the abdominal muscles, the gluteal muscles and the knee extensors (5,6).” Limitations of the study include: This study was not blinded, a controlled study cannot be made on torture victims, and results rely on clinical inspection. There were some areas that had lost sensitivity which need to be treated with extra care as it usually represents a particularly psychologically difficult portion of the torture.
 
Conclusion:  The study demonstrates that torture victims have considerable posture abnormality and muscular imbalance and physiotherapy should be directed at correcting these abnormalities.

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