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Clinical Review

Assessment and management of medically unexplained symptoms

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

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Re: Assessment and management of medically unexplained symptoms

In 1975 I had many health problems which my doctors and specialists were not able to explain, diagnose, or treat effectively, so I decided to study them myself.

I began by making detailed observations of my symptoms and was eventually able to get my conclusions published in a series of fourteen essays in the Australasian Nurses Journal between 1978 and 1983.

For example, I noticed that I sometimes had the sensation of breathlessness when I leaned toward a desk or bench, and it seemed to affect me more when I wore a tight shirt, or a tight belt.

When I looked at illustrations in books of anatomy I drew the conclusion that leaning forward was compressing my lungs from above, and that tight shirts were preventing their outward expansion, and tight belts were resisting their downward expansion, so that I was inhaling less air with each breath.

I therefore treated and prevented the problem by leaning back and sitting up straight, and wearing loose shirts, and I stopped wearing belts and used shoulder braces instead.

I then presented that conclusion in an essay called To Breath or Not to Breath which was published in the May 1978 edition of that journal.

I also concluded that downward compression of my ribs was causing strain and occasional brief stabbing pains between them, and cramps in the chest muscles.

I also recalled that leaning toward a desk had caused aches in my left and right kidney area, and that leaning forward was the main cause of my abdominal pain, especially on some occasions when I bent down to tie up my shoe laces.

I further concluded that it was due to the lower tip of my sternum or breastbone digging into the junction of my stomach and oesophagus, and that I could relieve the pain by leaning back, and prevent some of it by wearing moccasin shoes which didn’t have shoe laces, and could be slipped on without bending.

However, I also observed that I would sometimes feel faint when I leaned forward, but I wasn’t able to determine why until I read about a procedure called Valsalva’s manoeuvre, when I was able to conclude that leaning forward was compressing the air in my chest, and the blood vessels, and reducing the flow of blood between my feet and brain.

I also noticed, on one particular occasion, that when I squatted down to clean low windows, I felt more faint and dizzy than usual, and because I had several windows to clean I did that for about half an hour, and when I was finished I was exhausted for the remainder of the day. I therefore concluded that the compression of the air in my chest was causing the fatigue.

I noticed that the symptoms were similar to those of the type of shock which was caused by blood loss from a wound, and I presented those conclusions in essays, one of which was called “Hypothetical Shock Mechanisms” which was published in the April 1980 edition.

During that time I was able to conclude that all of the symptoms were due to leaning forward, and noticed that I had an abnormal forward curvature of my upper spine which contributed to the problem, so I prepared an essay about how I had produced a framework of ideas to connect a framework of symptoms to the framework of the human body, and called it “The Matter of Framework” which was published in June 1980.

I then wrote summaries in which I referred to the idea as The Posture Theory, and sent them to other journals.

Also, throughout that period, and for the next 18 years I was curious to know why I had so many problems and other people didn’t, and I was able to determine that I not only had an abnormally forward curvature of my upper spine, but also an abnormally shallow chest, which meant that when other people leaned forward their sternum or breast bone moved forward, over, and around their chest and abdomen, whereas mine went backwards and compressed everything within.

I also began experimenting with desk height in the early 1990’s by making a six inch high platform on the centre of my desk, and then added another one on top of that, and then I tried reading and writing on tall benches, and then placed an angled platform on top of that, until I eventually learnt to type, and then to use a computer, and then place the screen just below eye height, and the keyboard at elbow height, and for the first time was able to type without getting any significant symptoms.
The cause of those symptoms which had previously been a mystery had become explainable.

Competing interests: No competing interests

30 March 2014
Max Allan Banfield
Unit 6, No.6 Hartman Ave., Modbury, South Australia 5092