Central Annals of Sports Medicine and Research

Cite this article: Dorofieieva EE, Erdmann WS (2015) Wrong Trunk Position when Standing, Sitting and Lying with Pain behind the Sternum in a Recreational Runner: A Case Report. Ann Sports Med Res 2(4): 1028.

*Corresponding authorDorofieieva EE, Dnepropetrovsk National Medical Academia, Dnepropetrovsk, Ukraine, Tel: 380-504-706-747; Email:

Submitted: 23 March 2015

Accepted: 27 April 2015

Published: 29 April 2015

Copyright© 2015 Dorofieieva et al.

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Keywords• Recreational runner• Squeezed chest• Behind sternum pain• Straightened trunk

Case Report

Wrong Trunk Position when Standing, Sitting and Lying with Pain behind the Sternum in a Recreational Runner: A Case ReportDorofieieva EE1* and Erdmann WS2

1Dnepropetrovsk National Medical Academia, Dnepropetrovsk, Ukraine2J.Sniadecki University School of Physical Education and Sport, Gdansk, Poland

Abstract

Aim: The purpose of this paper was the presentation of a recreational runner who suffered a pain behind the sternum which prevented him from the running and through changing his behavior by straightening his trunk during different activities he managed to run again.

Methods: The paper presents a report on a long time recreational runner aged 66, with overall good health who about a year ago suffered a pain behind the sternum while starting to run. Instead of running he used to perform general fitness training. As a young male person he was a competitor in rowing, a national champion, and a graduate of physical education major. Later on he was a university teacher of theoretical subject. Once a week he used to run for 1.0 to 1.5 hrs. He was also active from time to time in other sports.

Results: The subject underwent medical check-up. All data, including blood test, ECG at rest and during running on a treadmill were within a norm. No pain was felt because of eating disorders. In between a subject changed his behavior. Instead of leaning his body while eating during standing, writing during sitting and reading during lying he remembered to straighten his trunk so his chest was not squeezed.

Conclusion: At present the subject can undergo general fitness training plus 2 km of running and is still progressing.

INTRODUCTIONPain behind the sternum can occur for a variety of reasons

and it does not always indicate a problem with the part of the body directly associated with the pain. Some of the most common causes are, of course, all kinds of heart problems, for example angina pectoris, coronary heart disease and even heart attacks [1]. However, pain behind the sternum may indicate not only heart disease or injury, but also problems with: a) digestive organs (gastrointestinal disorder), e.g. gastro esophageal reflux; b) respiratory system, e.g. pneumonia, asthma; c) musculoskeletal system, e.g. sternal fractures or costochondritis (caused by inflammation of the cartilage in the sternum); d) the nervous system [2-8]. This is not a complete list of reasons for why pain behind the sternum may occur.

Among athletes and other people who practice physical

exercises or other intense and prolonged efforts, pain behind the sternum may also occur. It is necessary to think about prevention to avoid such conditions. Physical activities that are optimal for the body may be the prevention for these conditions.

Chest pain in the athlete can come from a wide variety of sources. Pain may originate from structures within the thorax, such as the heart, lungs or esophagus. However, musculoskeletal causes of chest pain are also present. Musculoskeletal problems of the chest wall can occur in the ribs, sternum, articulations or myofascial structures. Other conditions that should be considered include epidemic myalgia, precordial catch syndrome and referred pain from the thoracic spine [9]. The symptom of chest pain in the athlete can represent anything from a nonspecific musculoskeletal strain to a life-threatening condition such as tension pneumothorax [10]. In any case, the subject should

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consult a doctor. Only a doctor can determine the exact cause for pain behind the sternum and prescribe a treatment.

The purpose of this paper was a presentation of a recreational runner who suffered pain behind the sternum which prevented him from running and through changing his behavior by straightening his trunk during different activities he managed to run again.

CASE PRESENTATIONThe Subject

The subject (male, 66 years old, 181 cm, 79 kg, BMI 24.1) during his youth (13-18 years old) was an oarsman with a training load of six trainings a week (one training: 1.0 – 1.5 hrs.). He was a physical education major student. Then he was a teacher of theoretical subjects. Once a week he used to run 10 to 15 km for one to one and a half hours. He was also active during winter and summer practicing other recreational sports occasionally.

At the age of 55, the father of the subject complained of heart pain. This caused premature retirement of the farther. He was an emotionally sensible man. Later on he did not know whether his pain was for a pathophysiological reason or due to an emotional reason or both.

The subject was rarely sick. About once every three years he would catch a cold. He had almost no other health problems. He was never a smoker during his life and drank only small amounts of alcohol occasionally. Heart rate at rest was about 60 beats/min., blood pressure was 90-110/60-80 mmHg.

Wrong life style while standing, sitting, and lying

As a scientist, administration worker, and educator the subject conducted a lot of work in the sitting position. In order to change his body position from sitting to standing he introduced morning and noon eating while assuming a standing position. Unfortunately, for several years his standing position while eating was that presented in Figure 1A. This is not the correct position with the trunk bending down over the plate. After realizing his pain behind the sternum was due to the wrong trunk position, he changed his posture to that presented in Figure 1B.

For over 40 years, the subject used to write on a type-writer then on a computer keyboard, usually at first for about four then for about six or more hours daily, also on week-ends (except one month every year when he was on leave traveling). His sitting position was with a bent upper trunk, sitting at a distance from the chair’s back, with his head leaned over the keyboard. The bending angle of the upper trunk was 140 degrees (Figure 2A). When the subject was about 40 years old he felt a pain behind the sternum during an enormous amount of writing while preparing a book. Taking this into account the subject remembered he needed to sit with a straight and vertical trunk (Figure 2B). But this was not kept all the time. From time to time the trunk moved downward.

Problems with health

When the subject was 64 years old he suffered from skin cancer. There was small (less than 1 cm) skin change. The subject stopped training for about three months in order to come back to full health. The cancer cells were surgically cut-off. The subject

was told that such kind of cancer (epithelioma) has no appearance in other parts of the body and usually has no return.

While resuming running training, the subject could not do this because of a pressing pain behind the sternum (at the level of bifurcatio trachea). The pain appeared just after running about 200 m. It prevented the subject from running further. The subject continued training but of a different kind. After move-up/warm-up he did general fitness exercises with and without a load of 1 to 5 kg imitating athletic throws, game throws, lying on the grass doing several exercises with the trunk, running two sprints of 30 to 50 m (some pain was felt after that). After a break of about five minutes he lifted dumb-bells, did squats, twists etc. with a load beginning with 3, then 15, up to 25 kg. The first part of the training took about 45 minutes and the second about 15 minutes. He performed this kind of training for about one year. He also felt some pain while going upstairs three floors while holding a heavy bag with documents. No pain was felt because of eating disorders.

Medical check-up

The subject met a cardiologist. He conducted a medical check-up. He ordered blood tests and ECG. All data including cholesterol were within the norm. Cholesterol data was as follows: HDL equaled 61 mg/dl and LDL equaled 89 mg/dl. ECG was obtained at rest and during a running test on a treadmill with inclination up to 14°. The test after 8 min. ended. No specific abnormalities were noted. No pain was felt, perhaps because the subject started to change his life style about two months earlier.

A B

150° 150°

135° 135°

Figure 1 Standing position while eating: A) negative B) positive.

A B

150°

140°

Figure 2 Sitting position while writing on a keyboard: A) negative B) positive.

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Change in life style

The subject as a biomechanics specialist wanted to solve the problem of his pain. If there was nothing wrong with the circulation system and metabolic processes, the source of the pain had to be in another area. The subject realized that for several years (since he was about 50 years old) he started to read books in bed for about one hour before sleeping. While lying and reading the subject assumed a position of the body with a bent upper part of the trunk and with squeezed chest. This could be the source of his pain as it occurred several years before when sitting in the wrong position while writing on a keyboard. His position in a bed was similar to that shown in Figure 3A.

The subject changed his position in the bed while reading a book. He assumed a vertical position of the trunk and tried not to lean his head (Figure 3B). In addition he did not read every day before sleep. Similarly the subject did not intend to assume a fetus-like configuration of the body, i.e. with total curve of the trunk, when he started to sleep lying on his side.

DISCUSSION AND CONCLUSION

Improvement in running abilities

After changing his position while lying and reading the book and also keeping a positive position while standing and sitting when writing on a keyboard, after about three months the subject tried to run a longer distance than just 200 m. At first he ran 400

A B

110°

130°

Figure 3 Position in a bed while reading a book: A) negative B) positive.

m, then 600 m. No pain behind the sternum was present. After another month the subject tried to run a longer distance. He ran about 1 km plus two 50 m sprints. Almost no pain was present. Actually he continues general fitness training plus about 2 km of running. He can go up the stairs again quickly with no pain either.

CONCLUSIONIt can be said for a generally healthy person who trained 1–2

times to week, a pain that appeared behind the sternum was from a biomechanical reason. The subject assumed the wrong position of the body while he was standing and sitting and especially when he was lying in a bed and reading a book. Change in life style while standing and sitting in a chair and while lying in a bed was beneficial for withdrawal of the pain during running. No pain was present either while going upstairs or holding a heavy bag.

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Dorofieieva EE, Erdmann WS (2015) Wrong Trunk Position when Standing, Sitting and Lying with Pain behind the Sternum in a Recreational Runner: A Case Report. Ann Sports Med Res 2(4): 1028.

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