We observed statistically significant differences in the cervical spine and scapulae between women with CPP and control women. We believe that the changes observed in women with CPP resulted from a vicious cycle of pain and antalgic postures acquired over time. The mean duration of symptoms among women with CPP was about five years, and postural impairments over time can contribute significantly to the maintenance or worsening of pain [11, 17–20]. Nevertheless, we cannot conclude that women with CPP always show the same postural pattern. First, although we observed an association between CPP and postural changes, the control group, consisting of women who did not report any type of pain, also presented with several postural changes. We believe that postural changes among controls occurred because posture depends not only on pathologic condition, but on several other factors, including habits acquired by individuals throughout life, their work activities, and even their emotional and psychological states. Second, our study design did not allow us to determine whether postural changes were the cause or consequence of CPP. However, identifying postural changes is an important part of evaluating women with CPP because improvements in posture can contribute to improvement in CPP symptoms.
In this study, posture was assessed in a strictly clinical manner, with the examiners recording the static posture adopted by the women. This method of assessment was used because we wanted to determine the efficacy and reproducibility of this type of evaluation so that it might be incorporated into clinical practice in the evaluation of women with CPP. Because of its simplicity, this type of examination can be easily performed during ambulatory patient care at any level of assistance, thus minimizing factors that may worsen or perpetuate CPP and helping to refer these women to specialized services. However we recognize that, scientifically, more objective forms of postural assessment such as biophotogrammetry are necessary. However we believe that the method described here may be useful in assessing the effects of physiotherapy and/or advice to alleviate pain in women with CPP who have musculoskeletal changes.
Our findings also support the importance of multidisciplinary care, involving physicians, physical therapists and psychologists, for women with CPP. In this series, musculoskeletal changes were associated with CPP in at least in 34% of the women in the CPP group, indicating that a more detailed assessment of women with CPP is necessary for better diagnosis and to provide more effective treatment for these women, including control of situations that may reduce the pain threshold.