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Barrett's Forums This discussion is devoted to the latest advances in neuroscience and the clinical phenomena it explains.

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Old 28-05-2006, 02:50 PM   #1
Barrett Dorko
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Default Postural Restoration

Two days ago I wrote something about The Postural Restoration Institute in the "Five Questions" thread and now I feel that this deserves it's own place in our discussion of pain and its management. Specifically I wrote, "Obsessed as I am with theory and practice and, well, science, I found the web site for the Postural Restoration Institute and the name of its main guy, Ron Hruska.

Now that we have it, those viewing this thread can easily contact them about the issues of posture and clinical practice that occupy so much of our time. Perhaps after reading the "science" portion of the web site some questions regarding what is proposed and concluded there might pop into your head. Boy, I know I sure have some! (ha,ha)

It would probably be best if I didn't make this request for more information myself. I seem to have become some sort of "participant repellent," for lack of a better term. I contend it has something to do with my hair.

So, anybody interested in inviting Mr. Hruska over here?"

I spent a portion of the morning reading through the Postural Restoration Institute’s web site and find myself both confused and fascinated.

Last week’s student was not the first therapist I’ve come across who seemed to have been sold on the theory and principles of practice Ron Hruska promotes but for the life of me I cannot generate any personal enthusiasm for what I’ve read there. Consider this from the “science” section of the site:

“Individuals experiencing symptoms at the knee, hip, groin, sacral-iliac joint, back, top of shoulder, between the shoulder blades, neck, face, or TMJ, will demonstrate inability to fully adduct, extend or flex their legs, on one or both sides of their body. They usually have difficulty in rotating their trunk to one or both directions and are not able to fully expand one or both sides of their apical chest wall upon deep inhalation. Cervical rotation, mandibular patterns of movement, shoulder flexion, horizontal abduction and internal rotation limitations, on one or both sides will also compliment [sic] the above findings. Postural asymmetry will be very noticeable, with one shoulder lower than the other, and continual shift of their body directed to one side through their hips.”

Aside from the misspelling of “complement” this is written well enough I suppose, and I understand what he’s saying, but I’m left with two impressions:

1)Who doesn’t display most of what he says to the extent that the word “usually” would apply? I've got most of this; why don't I hurt? As has been pointed out on this site in other threads, asymmetry is the norm, not the problem.

2)Just how exactly does this therapist justify his conclusions about function and consequent methods of practice? Is it pure empiricism? Is there evidence (and I mean good evidence) to support this? Why isn’t the verifying literature cited along with the conclusions? If it’s only available at his courses, why should I have to pay for such a thing?

I presume that these courses are increasingly popular and my fascination with this revolves around our therapeutic community’s willingness to unhesitatingly accept what is proposed there. Is it the word “posture” that draws them? Is the teacher especially charismatic?

Let’s get Ron over here and talk about this. I'd also like to see the student who objected to my problems with Hruska's theory join in.
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Old 28-05-2006, 06:08 PM   #2
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I checked out the site.. some nice artwork there.

This has nothing to do with the debate on this thread, but I was struck by the resemblance between Ron Hruska and my favorite Canadian comedian. Could they have come from the same part of the human gene pool?

About the overall concept, it seems like many others, trying to work backwards from what is "seen" into some sort of management plan, seems quite Sahrmann-esque that way; overall, like trying to put the egg back into the shell, or the gas back into the hose. In general, I think these approaches all look at the body through the wrong end of a telescope, and don't take in the whole view; they magnify some things, obliterate others, focus on the stuff that's "wrong", don't look at why the body might behave as it does.
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Old 28-05-2006, 09:22 PM   #3
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Barrett,

That could be a very interesting discussion I think. I'd be glad to invite him, sometime in the next few days to a week (after I read his web page) but I'm only a CMT so...I don't know if he would take me seriously.

You know, it does keep occurring to me that the average person having opinions that differ from the general consensus of this mesage board (not to mention those who know less than the average poster here) might feel a little intimidated to post here, as they would feel outnumbered. I'd guess it's the same on other e-groups or boards too. The lack of overlap and intercommunication leaves something to be desired at times. It would be super if Mr. Hruska would post here! And he would be considered, at least by me, a brave soul too

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Old 28-05-2006, 09:50 PM   #4
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If I do write him I will make sure to correct any typos first

Also, I didn't mean to indicate above that I have any bias one way or the other

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Old 29-05-2006, 12:44 AM   #5
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I think you're right. It would be better for a fellow PT to invite him.

I am unconcerned about the "numbers" of therapists here who might question another about their theory or who might disagree with their answers. This isn't a tea party, and no one proposing some method of patient management should be hesitant to discuss what they do and why just because they might be offered information they don't care for.

Mr. Hruska has had many students and his site has a page full of testimonials from those who think he's done some amazing work. They are welcome to join in.
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Old 29-05-2006, 02:19 AM   #6
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Ok, good call.

I suppose I wouldn't mind it being a wee little bit like a tea party though (I find tea parties are good for your autonomic state)

Dana

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Old 29-05-2006, 02:20 AM   #7
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Diane’s comment about “working backwards from what is seen in order to create a management program” is precisely the issue addressed in an essay I wrote a few years ago. See The Alien View.

It says in part: “If you’re still with me, this is what I’m proposing: Physical therapy procedures for painful problems have rarely contained a reasoning that “traveled in the opposite direction” as is so clearly explained by Wilson. Instead, they commonly employ a “from the outside in” method of thinking that ignores the full reality of painful sensation. Instead of considering the subtle brain chemistries that might contribute to something like central sensitization, they look at the muscular activity evident to palpation and make all kinds of assumptions about its meaning without actually considering the many contributions of the nervous system and its vast chemistry. Therapy without such careful and well informed thought is little more than personal training, and poorly done personal training at that. I think that this is how we’ve arrived where you see us today; clinics where people in pain have their exercises counted for them by somebody other than a PT, and no real time is ever spent in unique and personal caring for individual problems. Protocols developed for generic problems (there is hardly such a thing) for all “typical” patients (no such thing) drive the system.”

As I recall, my pursuit of this line of reasoning really aggravated a therapist who does a lot of trigger point manipulation. He made it clear that my insistence on an inside-out vision of problems and their solving was downright insulting. Hope that doesn't happen again.

The attitude of the person whose theory is being questioned, I mean. Not my insistence on defense.
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Old 29-05-2006, 03:14 AM   #8
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Nowhere else is this more relevant than in post-surgical protocols; developed as a generic therapy across the board for young and old, for a 'standard' procedure. Admittedly, the protocols are developed in cahoots with the PT (in Australia, anyway) but it is mainly done to keep surgeons on side. It demonstrates that we are there to treat the side-effects of the surgery in the first instance.

Peripheralists will argue that reducing nociception in the periphery reduces the pain experience; hence the sticking of needles, ultrasound and/or thumbs into various structures. This appears to work for some PTs and patients.

Barrett, I know you have talked about peripheral stimulation / quasi-nonnociceptive therapy before.

Can you elaborate again your thoughts on this?

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Old 29-05-2006, 01:41 PM   #9
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Nari,

I presume you mean a simple distinction between neuromudulation and ideomotor activity. While the former might provide distinct pain relief via the gating mechanism and, perhaps, the blood flow some massage can elicit, the latter addresses the origin of the pain - the mechanical deformation.

I always cite the example of a poker player requesting a massage while still playing (a common practice). They hurt, I presume, because they haven't moved in a way that effectively reduces the troublesome mechanical deformation unique to them. Of course, if they do they will quite possibly reveal their thinking. Remember that ideomotion expresses a dominant thought, and that thought leads to movements that reveal our thinking as well as our movement toward a reduction in neural tension - these two things are sides of a common coin. It makes sense to let both out, of course.

Hruska doesn't seem to think that instincts such as this play a role in comfort. I doubt he knows about them. He seems to think that some ideal of symmetry or sequential muscular contraction will solve painful problems and lead to enhanced performance. To me, this is a remarkably superficial view of human activity. Its popularity has everything to do with Ramachandran's theory of aesthetics detailed in the "Altering the Ideal" thread found in "Barrett's Forums" here. Until therapists read enough of the latest neurobiology this will never change. There is no possibility that that will ever happen.
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Old 29-05-2006, 10:19 PM   #10
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Thanks, Barrett.

I thought it may be helpful for fencesitters for you to elaborate a little more on what seems to confuse them. I know your essays go through it all, but your summary above spells it out well. So does Rama..

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Old 30-05-2006, 09:00 PM   #11
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I've looked carefully through the institute's web site and cannot find any indication there of what a course actually costs. I wrote a couple of days ago requesting this information and will let you know what I hear.

The woman from Minneapolis has not yet looked in here, as far as I can tell. As I said, I've not personally asked Mr. Hruska to help us with this discussion.
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Old 30-05-2006, 10:50 PM   #12
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Barrett

I found under the 'course' tab:

(Basic?) course, 15 hours $350

Advanced Integration Course $700

So for $1050, one can learn to stand tall.


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Old 30-05-2006, 11:13 PM   #13
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Thanks Nari,

I don't know how I missed that. The question remains, how have they drawn the conclusions stated in the "science" section of the site? It appears that in order to become "certified" a good deal of related research (of a sort) and case studies are required, so there must have been something done over the years. I wonder where it's been published?

I also remain uncertain just what exactly it is they're treating.
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Old 30-05-2006, 11:25 PM   #14
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Disobedient musculature? Nonconforming sarcomeres? Aesthetically displeasing presentation?

I'd like to know too.

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Old 01-06-2006, 08:51 PM   #15
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Late yesterday afternoon I sent the following email to the email address for general information on the PRI web site:

I am hoping this email finds its way to Ron Hruska and the other faculty at the institute:


Recently a thread was begun on Soma Simple.com regarding the theory and practice promoted by the Postural Restoration Institute. We would appreciate some input from your staff regarding your practice and invite you to take advantage of this opportunity to speak directly to therapists from many countries.


Soma Simple's front page: http://www.somasimple.com/


Barrett Dorko's Forums, where this thread may be found: http://www.somasimple.com/forums/forumdisplay.php?f=80


The thread itself: http://www.somasimple.com/forums/showthread.php?t=2444


We look forward to your joining us.

Barrett L. Dorko P.T.

Nothing in reply yet, but it's early. I'll let you know.

In the meantime, anybody else have something to say about this approach? It seems that my troubled student from a week ago hasn't yet arrived here.
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Old 02-06-2006, 01:31 PM   #16
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Sorry - no. All I thought when I read the name "Postural Restoration" was: to what?
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Old 02-06-2006, 05:16 PM   #17
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I asked for confirmation that someone had recieved my message and just got this:

Barrett-
Your message has been received. Janie, director of Postural Restoration Institute, is out of the office until Monday June 5th. She will be able to respond once she returns.
Thank You-
Bobbie

Perhaps others here can ask a couple of questions before then.
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Old 05-06-2006, 07:00 PM   #18
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Today this arrived:

Dear Barrett-

Thank you for your recent email bringing our attention to PRI discussion. While Ron Hruska is currently out of the country, he will be returning soon. I have also forwarded this thread to PRI Certified therapists and faculty.

Sincerely,
Janie Ebmeier, PTA
Education Coordinator, Director of Certification
Postural Restoration Institute
5241 R Street
Lincoln, NE 68504
Phone (402)467.4111; Fax (402)467.4580

Sounds like we're getting closer to the therapists actually following the theory proposed on the site.
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Old 05-06-2006, 10:00 PM   #19
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I wonder what sort of outcomes they are reporting? I also wonder if they are engaged in any type of research? Even a case study?

All this money and "certification" - for what? They don't appear to be engaged in efforts to advance the treatment of the conditions they purport to treat through the research process.

I wonder where all the money goes. Oh, yeah.

J
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Old 05-06-2006, 10:12 PM   #20
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I would like everyone to please note that Jason said this and I didn't. No telling what I might be thinking though.

I'm willing to be patient waiting for a reply here and feel that the end of this week should be sufficient for at least one of the "certified therapists and faculty" to come up with something. I feel that the questions Jason has asked and those previously listed in the thread should be enough to get us started.

It's unfortunate that my student in Minneapolis has chosen not to participate. She was adamant in class that this work was well-referenced, logical and effective. She wanted details regarding the work Luke Rickards is doing in Australia and wrote down his name.

It sure didn't seem that she was done objecting to my lecture. Where is she?
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Old 06-06-2006, 09:11 PM   #21
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Here's the reply received today.

Dear Barrett-

This morning I was able to share with Ron Hruska the recent postings/discussion about Postural Restoration from Soma Simple. We strongly encourage those with an interest in the science to consider attending one of the four courses offered by our Institute (Myokinematic Restoration and Postural Respiration are both appropriate for introduction of the science). Each course is two days in length and corresponds with a very detailed course manual of nearly 200 pages. Since there is a great deal of material covered in each course it is best to discuss questions following at least one course attendance. I am also happy to answer questions that can be sent directed to this email address. We very much appreciate your invitation and hope that you will consider learning more through our educational courses.

Sincerely,
Janie Ebmeier, PTA
Education Coordinator
Postural Restoration Institute
5241 R Street
Lincoln, NE 68504
Phone (402)467.4111; Fax (402)467.4580




So,it appears that information from PRI comes at a price.
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Old 06-06-2006, 09:18 PM   #22
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And if you pay good money for something called "science", then it must be worth every penny, right?
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Old 06-06-2006, 09:32 PM   #23
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Please ;Could i comment :note:

I like to reserve a place

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Old 06-06-2006, 10:06 PM   #24
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Ooh, "Myokinematic Restoration" - it sure sounds like science!
:sad:

J
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Old 06-06-2006, 10:37 PM   #25
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Another case of 'this is my science', perhaps.

There seems to be an epidemic of PTs, DCs, et al, all claiming to have discovered their special way of beating round the bush - at a price, of course.

I think they will run out of neologisms soon...there is a limit on how many ways one can mangle the word -myo-.......

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Old 07-06-2006, 01:09 PM   #26
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"myoathrokinematic re-educational patterning"
"myologic de-pathologisation"
"myofibric reorganisational therapy"
"my god it's a plane"
"myographic restructuring"
"myotonic balancing"
"myomy - it's hot"
"myofascial cosmetic postural correction" (grab the hair at the top and pull hard....)

you're right nari...I'm running out. Should I do a copyright on these?
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Old 07-06-2006, 01:19 PM   #27
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It's like a sandwich, a little myo makes things better.

Perhaps a better closing for their letter would have been this
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Old 08-06-2006, 03:39 AM   #28
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Quote:
I am also happy to answer questions that can be sent directed to this email address.
Barrett,

Is it possible to post or to send me the above referenced email address? I think I can come up with some reasonable questions to ask and perhaps I can post the answers here.

Thanks.
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Old 08-06-2006, 03:49 AM   #29
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Jon,

It's janie@posturalrestoration.com

This afternoon I got an email from Raulan Young, an associate faculty member of PRI. He detailed things such as the "polyarticular chains and zone of apposition" that Mr. Hruska speaks of. I suggested he post what he said here. If he doesn't it won't be because he doesn't know how.
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Old 08-06-2006, 04:09 PM   #30
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Hi Barrett,

I have gotten a kick out of reading your Postural Restoration thread and peoples assumptions of what it is. I always appreciate hearing the views of other open minded therapists. I am a Postural Restoration Certified therapist and I’ll try to answer the questions you have asked.

You mention that asymmetry is the “norm not the problem”. I believe this statement is a reflection of therapist’s frustration of not knowing how to treat the problem. How can asymmetry not be a problem when it puts uneven loads on joint surfaces and muscles are forced to work asymmetrically and inefficiently? Postural restoration does not just say that you are asymmetrical, but that you will be asymmetrical in very specific patterns (ie a common compensatory pattern – read the common compensatory pattern which is cited on the PRI website in the Educational Resources section under References. This is by the way a very good reference list that will give you articles that support the approach and are the evidence that the approach is based on).

If you can accept the existence of a common compensatory pattern, then it makes sense that any isolated segmental deviation from this pattern will necessitate excessive lengthening of soft tissue. One example of this is that the common compensatory pattern will limit adduction, IR and extension of the L hip. If a person tries to compensate for these limitations during gait the L iliofemoral ligament will become lax. Have you ever had patients whose hips click when performing a Thomas test. Pay close attention and you will find that the vast majority of clicks occur on the L side.

Why don’t we all hurt? Well, in many ways I think most people do hurt to a certain degree. A common compensatory pattern will change length tension relationships of muscles throughout our bodies and because of this certain muscles will become overworked and trigger points will develop – as an example how many people have trigger points on their vastus lateralis or in the sub-occipital area – this is a form of increased tension that may not initially register as pain, but as physical demands increase these can very easily become tender and bothersome, maybe not at that specific location, but the increased tension in these muscles will necessitate altered function elsewhere in the body. Back muscles are also likely to become tight and painful, as we are in a twisted state that puts the L hemidiaphragm in a poor position to work. In this position our spine is twisted, putting strain on facets, ligaments and disks and our back muscles work to lift our anterior ribs in an effort to compensate for the inefficient use of our diaphragm. Looking for evidence of a poorly positioned L hemidiaphragm? Check how many of your patients have a rib flare on the L vs the R.

How do we treat posture? Well there’s a lot more to it than telling patients to stand up straight. We treat the polyarticular muscle chain imbalances that pull us into a twisted common compensatory pattern. Because the pattern is asymmetrical so are our treatment interventions. We will work on L hamstrings to inhibit an active L hip flexor, we’ll work a L abdominal oblique to oppose the poorly positioned L diaphragm, we’ll work a L adductor, R glut etc, etc etc. Our manual techniques are also asymmetrical and are typically applied to the thorax which expands asymmetrically (read the articles on the reference list that talk about Thixotrophy). We work on equalizing expansion so that we can breathe in a relaxed state and rest.

Ron Hruska is a very charismatic man and a great teacher, but if he could not show instant changes in patient ROM and strength (improved length tension relationship) people would not be buying into his approach so wholeheartedly. I would be interested in any other approach that could with one exercise (not even using manual techniques for simple patients) could correct a L Thomas test, L ober’s test, equalize trunk rotation, allow full R shoulder internal rotation, full L shoulder flexion, full L horizontal abduction, full cervical rotation L as well as more. In all of these examples I mean creating complete equality not just minor changes in the direction of equality.

Postural restoration is an approach for therapists who understand that the body needs to be treated as an interconnected and interdependent being not on a joint by joint basis. The therapists who take postural restoration classes will typically make postural restoration the basis of all of their treatments rather than mixing and matching techniques from different approaches to make a treatment. This is somewhat unique that one philosophy/technique will dominate your entire practice. A dissertation is currently being written on this phenomenon, which I believe will be published within the next year. If you look at the reference list on the postural restoration website, I think you will find it is one of the most evidence based practices anywhere. Ron has devoted his career to developing the approach and it’s clinical application as well as teaching others. It is up to others to participate in research to validate what is very obvious empirically. Discussions into formal research have been started and hopefully research will start soon.

I can’t recommend Postural restoration classes highly enough. If you can take a course with an open mind and if you have a thorough understanding of anatomy and biomechanics, I am very confident it will alter the way you practice in future.

Many thanks for the questions and interest in PRI

Oliver Hall, PT,PRC
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Old 08-06-2006, 06:03 PM   #31
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Oliver-
Thanks so much for coming here and engaging in a discussion with us. It shows some courage to come here given some of the previous posts, especially from me.

I disagree with most of what you've said, but look forward to engaging the debate in way where we can all learn.
More to come.

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Old 08-06-2006, 06:40 PM   #32
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Hi Oliver,

I'm glad you've been able to find our humor humorous, (understandably) not everyone does. My first question is about this concept of idealized symmetry. Isn't lateralization of function considered normal development?
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Old 08-06-2006, 06:49 PM   #33
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Hi Jon, you asked a question that we hear very frequently with Postural restoration. Yes, lateralization is normal, however regardless of if someone is L or R side dominant, the clinical presentation is the same, it does not switch sides to accomodate handedness. The L hip will still be more limited in adduction and extension and the R shoulder will be more limited in internal rotation.
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Old 08-06-2006, 06:52 PM   #34
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Hi Olly,

What clinical presentation are you talking about? Maybe I don't understand what it is you are fixing in the first place. Are people coming to you because they note a decreased hip adduction on the left and lack of internal shoulder rotation on the right?

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Old 08-06-2006, 06:57 PM   #35
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Olly,

I once attended a lecture by a renowned professor of embryology. There were a lot of manual therapists in attendance interested in symmetry and he strongly made the point that asymmetry of structure and function begins at the very first cell division of a fertilised ovum and continues until the end of life. This is totally normal. As I am sure Jason will point out more thoroughly, there is very little to no evidence that asymmetry causes pain.

Luke

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Old 08-06-2006, 07:26 PM   #36
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It's comments like this from the Omaha World Herald (Dec. 17, 05) that get me to ask the question about lateralization

Quote:
"The body has to work a certain way," Cook said. "What happens is in volleyball, they do the same movements repetitively over and over, so they develop patterns and their body gets out of balance."
For example, a right-handed pitcher who can't throw as effectively left-handed is unbalanced. Volleyball players develop similar asymmetrical tendencies. That imbalance manifests itself in pain and injuries, in fatigue and in concentration lapses, Hruska said.
The reporter, Dirk Chatelain, seems to have paraphrased that last part so perhaps he got it wrong but it makes it seem as if lateralization is being cited as a problem.

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Old 08-06-2006, 07:40 PM   #37
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Hi Olly,
Quote:
I have gotten a kick out of reading your Postural Restoration thread and peoples assumptions of what it is. I always appreciate hearing the views of other open minded therapists. I am a Postural Restoration Certified therapist and I’ll try to answer the questions you have asked.
Glad you could make it over to visit us here, on SS.
To indulge us here a little (for we are trying to clinically reason in a language that is new to many manual therapists), could you tell us what your system is about in terms of neuro function, neuro anatomy, neurobiology, neurophysiology, any one of those or any in combination? Especially the following points you make:

Quote:
You mention that asymmetry is the “norm not the problem”. I believe this statement is a reflection of therapist’s frustration of not knowing how to treat the problem.
Quote:
How can asymmetry not be a problem when it puts uneven loads on joint surfaces and muscles are forced to work asymmetrically and inefficiently?
Forced by what?

Quote:
Postural restoration does not just say that you are asymmetrical, but that you will be asymmetrical in very specific patterns (ie a common compensatory pattern
Quote:
If you can accept the existence of a common compensatory pattern, then it makes sense that any isolated segmental deviation from this pattern will necessitate excessive lengthening of soft tissue.
Quote:
Why don’t we all hurt? Well, in many ways I think most people do hurt to a certain degree.. muscles will become overworked and trigger points will develop – as an example how many people have trigger points on their vastus lateralis or in the sub-occipital area – this is a form of increased tension that may not initially register as pain, but as physical demands increase these can very easily become tender and bothersome, maybe not at that specific location, but the increased tension in these muscles will necessitate altered function elsewhere in the body.
Quote:
Back muscles are also likely to become tight and painful, as we are in a twisted state that puts the L hemidiaphragm in a poor position to work. In this position our spine is twisted, putting strain on facets, ligaments and disks and our back muscles work to lift our anterior ribs in an effort to compensate for the inefficient use of our diaphragm. Looking for evidence of a poorly positioned L hemidiaphragm? Check how many of your patients have a rib flare on the L vs the R.
Quote:
How do we treat posture? Well there’s a lot more to it than telling patients to stand up straight. We treat the polyarticular muscle chain imbalances that pull us into a twisted common compensatory pattern.
Quote:
if he could not show instant changes in patient ROM and strength (improved length tension relationship) people would not be buying into his approach so wholeheartedly.
Why do you think effects are "instant"? (I/m not disputing that they are, I'll take your word that they are.. but why?)

Quote:
Postural restoration is an approach for therapists who understand that the body needs to be treated as an interconnected and interdependent being not on a joint by joint basis.
Quote:
I can’t recommend Postural restoration classes highly enough. If you can take a course with an open mind and if you have a thorough understanding of anatomy and biomechanics, I am very confident it will alter the way you practice in future.
So I'd be interested in having all of the above translated into "neuro", if possible..
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Old 08-06-2006, 11:03 PM   #38
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Hi Oliver

Welcome to the site and a mutual opportunity to discuss separate views.

Asymmetry is evolutional and normal for homo sapiens; if we take the face or head, it is almost without exception, asymmetrical. Even the hair follicles grow in different directions on either side of the head. Would you suggest that this could cause problems? It's not weightbearing, but the head does sit on top of a structure that is very long and also makes considerable demands on subtentorial supports so it can defy gravity.
Another aspect which makes me rather uneasy is to go searching for causes of pain in a normally asymmetrical body. I wonder what picture of 'deformity' or 'abnormality' that gives to a patient.

Finally, there is no evidence that asymmetry causes pain. Not that I have noted; apart from some sense of pleasant change if one moves out of a very asymmetrical position, such as slumped for hours with a lateral shift which stresses the neural structures. But that is a temporary thing, which can self-correct once movement begins.

You have not (yet) mentioned the brain's role in pain generation. I am interested in what you think about that aspect.

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Old 09-06-2006, 01:36 AM   #39
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Yesterday I received an email from Raulan Young, another of the PRI Certified people and an associate faculty member of the institute. He also took my course in Twin Falls Idaho in January. I seem not to have had any impact on his thinking, so he joins a long list of therapists who for some reason refuse to fall under my spell. I told him that his words to me would be better sent here but he hasn’t yet taken me up on this so I thought I’d send this portion along:

“Our basic philosophy is the body develops neuromuscular patterns that are asymmetrical in nature and if these patterns go unopposed then dominant groups of muscles will develop and result in a pathomechanical problems.”

So I’m thinking, “Are we doomed?” Is this the kind of thing that happens just because we’re alive and don’t constantly attend to the plumb line? Is the creeping, insidious emergence of asymmetrical functioning some sort of modern day epidemic that the rest of us have missed somehow? How did our species survive all these years while existing in so fragile and (apparently) a non-self-corrective form?

I read this from Olly after I opined that asymmetry wasn’t actually a problem: “… this statement is a reflection of therapist’s frustration of not knowing how to treat the problem.” Well, we’re not going to meet in the middle on this issue. Painful problems have to have an origin, and, so far, this little detail seems to be missing from the PRI “philosophy,” which, by the way isn’t a theory in anything other than a vague sense. Can’t wait for them to clear this up.

I’m in New Jersey this week which perhaps explains my reaction to Olly’s comment that he “had gotten a kick” out of our apparent cluelessness regarding what PRI therapists think and do. Perhaps the explanations on their web site aren’t as clear as they suppose them to be, or perhaps we aren’t all that smart. But immediately to my mind came the scene from “Goodfellas” so brilliantly played by Joe Pesci:

“So, I amuse you? You think I’m funny? You think I’m a clown?”

Well, when Pesci asked these questions it was chilling. I can’t quite convey that here, so use your imagination.
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Old 09-06-2006, 02:53 AM   #40
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Welcome Olli, and thank you for your time here. Your post was interesting and also inspired some interesting questions and observations from other posters which I am hoping you might respond to. . As someone who is still becoming educated on this subject, and is somewhat "on the fence" regarding it I look forward to hearing more debate and hopefully gaining a little more clarity on the issue.

I would especially welcome a response to Diane's suggestion that you explain how assymetry, according to your school of thought, effects the nervous system, and why correcting assymetry would cause it to function in a more beneficial way (hopefully in some detail)

I was born in New Jersey, by the way, Barrett, though i could not say with any honesty that I have always wanted to be a gangster, though maybe for a few moments now and again

Dana
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Old 09-06-2006, 02:59 AM   #41
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Wow, I'm pysched that even though the thoughts I shared with you in an earlier posting have not been embraced, they have at least stimulated discussion. I appreciate all of the new questions you have sent me and I'll try to get to at least some of them. The question that is of most interest to me and I hope to you all is one that Diane posted:

Why are changes instant?

OK, there has been a lot of talk of humor on this thread, so why don't you humor me for a minute or two. I'm going to try to simplify to the greatest degree possible how postural restoration works. Earlier I metioned that it is common to see a rib flare on the L. Let's assume this is due to a poorly positioned L hemidiaphragm (due to rotational influences) that is not adequately opposed by the L internal obliques and transverse abs which then allows the L rib flare. Because our bodies are made up of polyarticular muscle chains, the L hemidiaphragm will not be affected in isolation. Below the L hemidiaphragm, the L psoas whose fibers overlap the L hemidiaphragm will also become more active, rotating the L hemipelvis anteriorly and rotating the pelvis to the R. With the L anterior ribs being in an externally rotated position there is less restriction of airflow into the L side of the thorax than the R (this is why Thixotrophy develops - please read these articles cited in the PRI refernces). With more air being directed to the L the R chest wall becomes tighter and the ensuing rib position puts the R scapula in a position that will not allow full R shoulder internal rotation (this explains the phenomenon of glenohumeral internal rotation difference that is being cited as a predisposing factor to shoulder injuries in throwing athletes).

OK, assuming everything I have said is correct (please also look at your patients and observe how many have a R shoulder that is lower than the L - again think uneven air flow and thixotrophy), would it not make sense to try to hold down the L anterior ribs either manually or by using a patients L internal obliques and transverse abdominal? This would in theory reposition the L hemidiaphragm into a Zone of Apposition (Paul Hodges and Simon Gandieva have done some wonderful work on the ZoA). With the diaphragm in a relaxed state the L psoas and iliacus (as the continuation of the polyarticular muscle chain) would also be able to rest so that the L hemipelvis would no longer be anteriorly rotated and the pelvis as a whole would not be rotated to the right. The repositioning of the L hemidiaphragm by aquiring a zone of apposition would also necessitate better expulsion of air from the L side of the chest and force more airflow into the R side of the chest. The increased airflow into the R side would alter rib and scapula position on the R side and therby allow full R shoulder internal rotation and also level the patients shoulders.

To aquire this position on a plinth is relatively easy and the challenge is to coordinate opposition muscles throughout the body to maintain this balanced state even when standing and indeed with all levels of activity.

This is about the easiest scenario I could come up with for you and this is by no means the only technique or exercise that is needed to correct patients alignment. I know it sounds too good to be true, and trust me when I was first introduced to the approach I was sceptical, and then when it was demonstrated I was perplexed to say the least. Having been able to study under Ron, it now makes perfect sense, and it is very rewarding to be able to have an approach where each time I evaluate a patient I can show them how their bodies move and then, either with exercise or manual technique I can instantly correct a positive Thomas test or restricted R shoulder internal rotation. It does wonders for HEP compliance when patients see and feel that the exercises are indeed affecting changes in their bodies.

For the interested and the sceptics alike, my best recommendation is to take a PRI course or try to observe a PRI certified therapist in your area so that you can see with your own eyes exactly what we do.

Olly Hall PT, PRC
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Old 09-06-2006, 03:04 AM   #42
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But Olly, I have all of the above and don't hurt anywhere. What does that mean?

Eric
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Old 09-06-2006, 03:48 AM   #43
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Eric,

I'm guessing you just don't hurt yet, but I don't actually know why any of this stuff hurts yet.

Olly,

You aren't just going to answer the questions that "interest" you are you? That's not the way it works here.
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Old 09-06-2006, 03:54 AM   #44
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Should we be able to predict where we will hurt based on this system, and how much, based on the degree of asymmetry present?
Can't help but sense a whole lot of fuzzy logic in PRI.

Eric
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Old 09-06-2006, 04:03 AM   #45
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Olly,

You wrote that at first you were skeptical of PRI. What is it you were skeptical of and what changed your mind?

Eric
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Old 09-06-2006, 04:06 AM   #46
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Olly,

(Sorry to have spelled your name wrong above ~ wasn't any attempt at humor there, just spaciness)

So, a few questions come to mind directly relating to what you said above : Would you expect the above scenario to necessarily or typically cause pain? , What type of pain would it tend to cause? Why would it cause pain (in nervous system terms)? And are there any studies yet indicating that this type of assymetry causes pain ?

In case it's of import/of interest, I am right handed and my right shoulder is higher, by the way, but I have no back or torso pain unless i sit for long static hours at the computer for days, or do hip hyperextension exercises. I'm 40

Dana

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Old 09-06-2006, 04:13 AM   #47
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Thanks for your first round of answers Olly. I have more questions, but I'll get in line behind others, let you have time to answer their questions.
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Old 09-06-2006, 04:14 AM   #48
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How instant is instant? Seconds?A few minutes?

The complexity of reasoning and special names for vague areas of the body is a bit of a worry. I don't think one can make up new names without a good deal of backing from the scientific community.

One should not have to take a course in order to understand the basic theory behind how a muscle group behaves under stress, normal comfortable positions and in sport.

Can you elaborate on your views on how the brain and CNS fits into what you have said so far? Much appreciated.

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Old 09-06-2006, 04:21 AM   #49
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Quote:
Let's assume
Quote:
assuming everything I have said is correct
Well, that's just the problem. How does it work if we don't assume this?

Luke
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Old 09-06-2006, 04:28 AM   #50
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Olly, I'm getting the sense that your minute or two might be up.
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