Clinical Review

Assessment and management of medically unexplained symptoms

BMJ 2008; 336 doi: (Published 15 May 2008) Cite this as: BMJ 2008;336:1124

Re: Assessment and management of medically unexplained symptoms

In a a discussion in BMJ of 30-3-14 I provided a summary of an essay called The Matter of Framework which was published in the Australasian Nurses Journal in June 1980, where I presented my conclusion that poor posture was the cause of a wide diversity of previously unexplainable symptoms.

However, I looked in the mirror and my posture appeared to be reasonably good, but a few years later I decided to turn and look at my side view, and that was when I could see how significant the problem was.

My upper back was very curved in the forward direction, much more so than the normal slight curve, and my lower spine was arched forward, where the combination produced a very distinct S-shape in my spine from my neck to my hips.
My head was also upright, which in combination with the forward curve of my upper spine produced a significant backward curve in my neck.

I therefore became curious about why I had that shape when most people didn’t.

A few more years went by when I was cleaning out some cupboards and found an old photo album and decided to look through the pages.

I saw a photo of myself when I was about 3 years old, when my spine was upright and my physique and complexion were exceptionally good.

I then saw a photo when I was about 7 years old and I was thin, very round shouldered, and slouched, and wearing spectacles which made my left eye look larger than my right, so I then became curious about what happened during the intervening years.

I could recall being told that I had contracted measles at the age of five, and that it infected my left eye muscles in such a manner that it turned inwards and gave me a squint, or cross-eyed appearance, and that I had two operations to try and correct it but they were unsuccessful.

I was then given a patch to wear over my right eye, so that my weak left eye would be forced to function and return to normal strength, but it didn’t, so i was then prescribed with spectacles where the lens in the left side had greater magnification to equalise the vision in each eye.

That explained why my left eye appeared larger in my photo at age seven.

I also had hepatitis for several months at the age of six, which probably involved a lot of nausea, vomiting, and poor appetite, and consequent weight loss in which case my bones and muscles would have become thinner and weaker and my spine would have slumped and remained in that position.

One of the reasons for putting so much time into determining the cause was to get a clearer understanding of how to fix the problems, and the most obvious solution was to sit up straight.
However, when I did that I soon noticed that my back muscles were being strained, and it was unsustainable so I tended to slump again, so I needed to find out why.

As I continued to study the problem I found that when a child is young their bones are soft and pliable, like the trunk of a young tree which is easily bent, and it hardens toward adulthood, like the trunk of a fully grown tree.

Consequently I had been trying to straighten curved bones with muscle, which is why just sitting up straight wasn’t effective.

I was eventually able to develop the standing computer posture which was reasonably effective, and which I have also described in my comments in BMJ of 30-3-14.

Competing interests: No competing interests

20 April 2014
Max Allan Banfield
Unit 6 No.6 Hartman Ave., Modbury, South Australia, 5092