Dorsalgia and Resting Horizontal Positions

When addressing the etiopathogenesis of dorsalgia, we often neglect the potential impact of resting horizontal positions. Yet, their possible adverse effects may be a contributing factor to the onset of various types of back pain, its chronic persistence, recurrences, and therapeutic failures. Pain and rest/sleep are mutually influential factors. Resting horizontal positions can be categorised functionally as either sleeping positions or relief positions (antalgic-corrective). Relief positions are used in an effort to alleviate painful conditions. Their correct setting can be facilitated by the use of positioning aids such as cushions or rolls. To ensure optimal horizontal resting positions, we promote the following basic therapeutic-preventive principles: 1. Maximisation of body symmetry – including the alignment of body segments – since any prolonged asymmetric posture is inappropriate (special attention is given to keeping the head aligned with the trunk), 2. Minimisation of axial system rotation, 3. Minimisation of anteflexion and retroflexion, including of the head, 4. Minimisation of capsular, myofascial, and neural tension. Sleeping and relief positions may be supine (on the back), semi-supine, prone (on the stomach), semi-prone, or side-lying. During position changes, the supportive function of the peripheral parts of the body (limbs, head) should be utilised in order to avoid overloading the axial structure – the spine. The therapeutic-preventive efficacy of appropriate sleeping and relief positions can be enhanced by facilitating a more physiological breathing pattern. Through targeted tactile stimuli (such as hands placed in the inguinal or thoracic region, or the use of expanders around the chest), it is possible to activate under-engaged areas of the diaphragm – most commonly its posterior and lateral attachments – thereby supporting its respiratory, postural, and stabilising functions. Dysfunction in these areas represents a key etiopathogenetic factor in dorsalgia. By facilitating breathing, we also influence the function of internal organs, thus addressing the visceral component of dorsalgia. As part of a comprehensive therapeutic and preventive approach to dorsalgia, patients should be educated about the general principles of quality rest – including bed firmness, choice of pillow, and environmental factors such as temperature and lighting.