CT Postural Restoration

[EricM]

Rogue Science

[bernard]

Hi All and Welcome to Olly.

I'm frustated. I was told that diaphragm, as lungs and many/all things in chest/belly were already asymetrical.

As Nari, I think that the poor balanced (often pain free) patients are the results of muscle activation/relaxation governed/dictated by brain.

Your statements tell us that it is possible to have a reverse opportunity? acting on muscles will change the brain?

[nari]

I keep reminding myself of CP patients, who are about as asymmetrical as one can get, with what seems to be very overloaded segments. Yet they are not in pain, apart from various common complaints that fit within the scope of 'usual' complaints such as worn menisci, etc.
Asymmetry and pain are not related; the brain does not object to asymmetry.

Nari

[Barrett Dorko]

Check out post #51 in the "Posture and Pain" thread. I think it relates pretty well to this discussion.

Where are the rest of the PRI practitioners? Is Olly the only one willing to speak? Why is Hruska himself silent?

[Bas Asselbergs]

Asymmetry. Assuming most of the population is not ambidextrous, and being a moving bipedal animal, often using vehicles and tools and machines and pencils and mouses (!) with a distinct dominant side - and assuming we do not know when we are dysfunctional, because apparently it doesn't always cause pain or discomfort - we are all going to be eager subjects for postural restoration - FOR THE REST OF OUR LIVES. I can't help but see a big flaw in the logic of the whole theory.

I do not doubt for a minute, that the actual therapeutic intervention will have success, but I doubt that it has anything to do with the minutae of the techniques, and all to do with the perception and nervous system of the patient receiving the treatment.

I have to commend you Olly, on your obvious courage to jump into a thread with such a critical flavour, and on your enthousiasm for the technique. I think the gap between what I have learned to see as "key" to therapy is just too far removed from what you see as the key.

I must add that I would have responded very differently 10-15 years ago, when my level of understanding was such that the proposed mechanism underpinning Postural Restoration, would have been very alluring....

[Jon Newman]

Bas, you're correct that those on this site often are critical and Olly may not have had an appreciation for this as demonstrated by asking us to make some very large assumptions and to humor him, neither of which are likely to help get across any important points. I agree that those using the approach see results (not unlike those using MFR). I even note that some of the "restoration" techniques are similar to mine (spending some time on diaphragmatic breathing for example) but with a different explanation for why doing such a thing might be important for something like pain.

In an earlier post Olly asks what is supposed to be rhetorical question but I'll try to answer it anyway.

How can asymmetry not be a problem when it puts uneven loads on joint surfaces and muscles are forced to work asymmetrically and inefficiently?

Joints have a certain capacity to handle uneven loads, they always have. In fact, unless there is an asymmetrical force across a joint, it won't move.

[Bas Asselbergs]

Jon, well said.
Olly, my first reaction to that question was: "Since when is it up to me to prove a negative?" The question is rife with assumptions: "uneven" - measured how exactly? "Inefficiently" - measured how exactly? "Asymmetrically" - measured how exactly? I am saying I do understand the train of thought and the seemingly logical process here, but it does not exactly a process that stands up to Occam's razor, is it?

[Barrett Dorko]

Jon and Bas,

As always, some inciteful and, to me, perfectly appropriate questions. I'm assuming Olly doesn't find this as amusing as he had previously, but you never know about such things.

Olly,

Write your fellow PRIers and ask them to join us. You've been doing the heavy lifting alone and that's just not fair. I'm sure they've got something to say.

[Diane]

Barrett, "incite"ful or "insight"ful or both?

[ollyhall]

Hi all, I find it comical that without ever meeting me Mr Dorko seems to think he knows how I'm taking all of your criticism. I entered this forum believing that it was a site to further knowledge by talking with other therapists about approaches they are using. So far not one of you has asked a qustion in a manner that belies true interest, rather the mood of the group appears very confrontational and eager to put down any approach that you do not understand. Before I start to answer your questions again, I would like to know what you all do, what approaches do you use and just in case I am not familier with your approaches I would appreciate a short synopsis of what you do and why.

Some of you have neat little quotes on your replies, so let me share one of my favorites with you all.

"Han som tror han er ferdig utlaert er ikke utlaert men ferdig!" Nils Arne Eggen. Roughly translated it means "If you think your learning is finished, you are not learned but finished!"

Olly Hall, PT, PRC

[BB]

Hi Olly,
Again, thanks so much for participating here. I think some of us were getting scared that you weren't coming back and the discussion would cease.

Since I'm here, I'll kick it off, especially since my road travelled is probably similar to others.

My approach, in treatment of those in pain, is to consider the nervous system. Since pain is an output, and not an input, I find it important to consider why this output has come to be. Why is the body under the impression that it is being threatened, and is therefore attempting to use pain to bring about resolution. Then, I hope to unravel what needs to happen to bring about this resolution.

It will be easier to describe the influences of my technique than to describe them, because in approaching the patient in the above manner, I don't use a toolbox, but rather a framework. I'm sure you understand.
The big influences for me were first Sahrmann, after which I used very tissue stress based explanations, similar to yours above so far. Next up was Butler and Shacklock with Neurodynamics. At this point I began to see that pain cannot be explained in terms of tissue stress. As Lorimer Moseley said, "nociception is not necessary nor sufficient to cause pain." So, an incorporation of the physiology of pain, and the nature of the nervous system was incorporated. Lastly, has been the influence of modern neuroscience. The work of Patrick Wall, Joseph LeDoux, Damasio, and others helps to paint a picture of how pain is very context driven, with tissue stress being just one of many, many facets of that context.

As Jon said, your technique likely brings about results, no doubt. I think where we are concerned is with differences in explaning why your approach brings about the results that it does. It is not a lack of understanding, nor a lack of eagerness to learn that is in our tone (In fact, I think that if you read through some of the threads you'll see that an eagerness to learn and foster learning is one of the many strengths of this site). Instead it is a tone that doesn't trust that a mechanical or tissue stress based explanation will hold weight throughout a pain physiology perspective.

Critiques here can no doubt become harsh, but all we are looking for is an equally strong defense. Not defensiveness, but defense of theory.

Thanks again for posting!
Cory

[Jason Silvernail]

Olly-
I think you're right, in that this is a tough crowd.

Here's my thought on this: those on this board are used to having long debates, here and elsewhere, with many in the therapeutic community who are not aware of what we consider to be (and have references to prove are) basic facts of neuroscience and pain physiology.

The practitioners we have encountered and debated think only in "biomechanical" terms, equating pain to various aspects of strength, posture, or flexibility. Of course, the reference list proving these things are false is quite long, but for whatever reason these myths persist in the therapeutic community.

While we remain mystified why this persists, we are doing our part to help reduce this continued misinformation through contact with students and other practitioners.

When a new practitioner enters to debate these issues, while the process may seem new and fun to them, it is actually a rather "same-old, same-old" process for us, and I suppose our patience and tolerance for those without this knowledge is growing thin. Of course, these myths have been passed down from instructors and CEU courses, so it's difficult to be frustrated at individuals, just the process by which it happens.

So, the dripping irony and cloud of smug that seems to hang is directed at the process of misinformation and the myths, not individuals who are so indoctrinated.

In other words, nothing personal.

I'm not sure if that helps or not, but there it is.

Jason.

[Jon Newman]

Hello Olly,

I do think this site is for furthering knowledge by communicating with others although not without criticism. Without that, knowledge will likely be elusive. Those who have asked questions have a "true interest" in pain physiology and have trouble accepting the premise of postural restoration or are trying to understand what the premise is in the first place. My questions and concerns are legitimate and I'm dissapointed that you see that as otherwise. I won't try to defend some of my comical quips, they are what they are.

[Cory]

Hi all. I am also a PRI certified therapist. I am fairly new to the use of the message board and don't get time to check often but I will jump in as I can.
I have to give props to Olly for diving in and hope I can assist in the discussion.

There seems to be an underlying debate about the issue of asymmetry. PRI does not say that we are not, or should not be asymmetrical. On the contrary it has actually looked at the most common pattern of asymmetry that appears in almost all individuals and describes what one should expect to find. The issue of how much asymmetry is more likely the issue. When a person begins to become so patterned that they can no longer move or shift out of an asymmetrical position that they begin to develop other compensatory strategies for movement. This patterning can be a result of asymmetrical muscle strength and flexibility, articular changes, neurological changes such as visual midline shifts, etc.

These compensations can cause further patterns of asymmetry in other regions of the body, or can lead to pathological localized adaptation or damage to the tissues and structures in response to the excess strain or load.

Using a framework that relies on recognizing these patterns, the degree of asymmetry, the ability to move and function within the pattern as well as out of it, we can more effectively aim our treatment at bringing the asymmetry back under control, not completely be rid of it.

Looking at posture and position is a lot more than "attending to a plumb line", and I feel needs to be addressed. One can not assess and treat a shoulder pathology (impingement for example) without also looking at the resting position of the shoulder complex and the postural patterns that direct that position. Those patterns include the position of the the ribcage, breathing dynanics, position of the trunk on the pelvis, the pelvis on the lower extremities, and so on.

Thanks for the very stimulating discussion.
Cory

[Barrett Dorko]

Olly says, "So far not one of you has asked a qustion in a manner that belies true interest..."

This is quite simply untrue. Well, it might be true if you define "true interest" as "a readily pliable belief that the body exists as anyone else chooses to describe it - no evidence required."

I've spent an entire career trying to get people intersted in my own ideas and had little or no success. The fact that so many here are questioning you so readily certainly implies an interest. Is it the word "true" that changes your definition of this?

Olly, when you say you find me "comical" I have to assume you see humor in what I've said. Is it wrong for me to assume otherwise? When you don't mention that you find things funny and I can see nothing funny (to me) going on, I can reasonably assume that your mirth in dimishing. If so, maybe you shouldn't use the phrases "get a kick out of" or "comical" when replying.

This will help to avoid confusion.

Now, back to those answers we've been waiting for.

[nari]

Olly,

I'm surprised that you think we are not interested in learning more (see your quote); I thought asking questions was one way of learning about another's approach or thoughts.....apparently that is not the case.

Can you clarify what you mean by a lack of interest?

I can't go past what is written above by Jason. Bas and others, as what I think clinical work is about, and should be about.

Nari

[Diane]

Hi Olly, Cory (#2) (BB is also "Cory"),

Thanks for sticking with the discussion so far.

This whole site exists because none of us are especially interested in what I call "empire building". Instead, we have this weird idea that it's good to exercise our synapses together and individually, understand nervous system processes and promote that. We don't exist to construct yet another system based on misbehaving mesoderm, how it looks, how to make it look different/better, how to poke it or pop it hoping that will take care of pain problems. Nor do we exist to promote other systems based on these pretexts. So you can't sell us your course, or expect us to let you promote it here freely; so if that's your real intent, sorry.

Collectively we would like to see the profession move away from "mesodermal thinking", which completely
1. obliterates/makes invisible any understanding of the actual mechanisms that underly human behavior, response to treatment, physiology, movement, and pain;
2. provides the world with a plethora of guru driven treatment "systems" and/or "techniques" that all tend to contradict one another and make a few people (the most persuasive ones) rich, at the expense of the many (those who forever remain confused about which "tool" to use for what type of mesoderm they think they should try to fix).

We can't see how your system differs in any remarkable way that would persuade us to leave this set of understandings/convictions we've attained, back onto the merry go round of "this works, so buy it and try it."

It sounds like your founder saw things a certain way, and thought, yeah, this is THE way, and starting selling it. Sounds like you guys bought it, and that now you are salesmen for it. We know the role.. and have successfully avoided it, so here we are and here you are and here we all are, together talking.

Several posts ago I quoted a long list of statements made as fact by Olly, then asked "So I'd be interested in having all of the above translated into "neuro", if possible.."

I was told I was getting an answer, but instead got assumptions based on structure instead of answers based on neural function or dysfunction. I was even told it was going to be made as simple as possible for me.. well, I want to let you know just in passing, that frankly, I prefer complex. There's nothing about nervous system function that is simplifiable without skipping over it completely, which is what happened, for not a word was spoke about nervous system anything.

To answer the question about how I work; I'm a sole practitioner in a cash-based practice doing manual therapy, getting "instant results" quite frequently, by focusing on neural entrapments and helping the patient's brain unload them itself, the Diane way. Posture improves by itself I guess, much of the time, not always.. really I don't care about that as much as I care about how patients perceive being in a body, if it's more comfortable/useful for them post than it was pre. I've been a PT for 35 years.

Maybe we are a tough crowd, I don't know.. Maybe there are some less grizzled PTs out there you can sell your system to; I stopped buying. Finally.

[Diane]

Me again... this just arrived in my mailbox from Ian, who has perpetual problems with his ISP in Scotland. He has asked me to post it here.

Postural reply ……….

Its possible to assume that people on the board are in a group or in some way know each other or support a technique based ethos . Nothing could be further from the truth . I don’t ‘know’ anyone here and have little interest in branded techniques to solve the confusion which is ongoing pain .
My opinion is that groups headed by charismatic figures are almost religious rather than neutral questioning systems of enquiry .
To navigate human suffering and ongoing pain, science may provide many answers especially modern neuroscience which many here are interested in .
However, there are changes happening ……We now know that the brain is the organ of pain and many influences determine the sensitivity of a persons body .
Tissue ischeamia is a typical source of pain in modern western countries due to a low grade threat response engendered by a very different society than we have evolved to live in . In order to influence people rather than idealised images of a stationery body in a clinical environment models based on onion rings (biopsychsoical framework) helps to see the wood for the trees . There is an increased acceptance of integrating issues outwith traditional orthopaedic thinking . Importantly people like Hadler in the U.S have repeatedly broadcast what drives people to therapy and treatment and it is not what we would like to think . It is suffering and coping which determine for many the tolerance to discomfort and I think Physiotherapy is overcomplicating this issue dramatically.
What we need to become more interested in is eliminating threat responses and promoting self reliance wherever possible . There is an explosion of interest in placebo mechanisms which we constantly skirt round in the search for the technique which may prove more successful than the last one we paid to learn!
For me the framework needs to integrate stress biology and basic brain processes of pain . This is the academic bit but I see a real role for personal development and understanding of input /output processes when interacting with others (see the explosion of research into mirror neurons).This is where the effect of touch, education and the understanding of the ‘art’ of therapy comes in –motivation ,humour and the immeasurable aspects of care .
I think its good to have a movement practice oneself in order to understand the effect of movement on ones own matrix . Many of the postural ‘corrections’ and ideomotor principles although explained using esoteric language have bee understood first hand by practitioners of chi kung and mediation for a lot longer than therapists have been in business and they cost nothing!
So all in all Physiotherapy developed to meet the needs of wartime combatants based on orthopaedics and biomechanics is evolving . I think there is a need to integrate basic neuroscience with well proven psychosocial data in order to eliminate the myriad of competing tissue based constructs . Basically I ‘believe ‘ an awareness of mediation and mindful movement would assist most benign pain states that I commonly see as for the most part it’s a glitch in the matrix rather than any gross peripheral problem that is largely being influenced ?
However the biggest factor is seeing the individual in front of you for who they are --an individual and for this I see a need to provide very simple treatments with a an awareness of the complexity of the patient .This complexity ranges from understanding common issues with fear avoidance /the effect of social and personal isolation / the effect of misperception of effort which may need motor awareness training ,the effect of a persons language on their brain output (narratives affect brain construction) and the basic reasoning of adaptive and maladaptive sensitivity …….There is not a brand to teach you this its ‘my’ integrated approach utilising information by Hadler ,Wadell, Damasio, Gifford ,Dan Dennett ,Patrick Wall and Jon Kabat Zinn!
What happens commonly is to define yourself by the technique one follows and as we know very few in physiotherapy have got much to offer when isolated …….its the understanding that is more important I feel!

ian

[nari]

Ian and Diane said it all better than I could.

Inspiring courses that seem to have the 'a-ha' factor are endemic. We all attend courses which more or less, fill gaps in knowledge.
Some tend to make more gaps, so we go to more to fill them...and so on.
Eventually we end up with a plethora of methods and then start looking at subgrouping patients in order to slot in the dozen or so methods. Some patients don't fit the grouping and subgrouping, so more courses to establish predictive values, grouping analyses, normative values, proving Fred's courses are invalid and Joe's courses great.......
We always hope someone else in our profession will show the way.

Wrong.

It's up to us to work it out as best as we can from grass roots/basic physiology concepts, the opinions of gurus and do lots of tossing out of 'methods' which do not sit well with basic knowledge.

I think on this site, we do that, without any worshipping of gurus. They can be useful, or add to confusion.

Nobody ever said it was easy, but at least it is honest.

Nari

[Jon Newman]

There seems to be an underlying debate about the issue of asymmetry. PRI does not say that we are not, or should not be asymmetrical. On the contrary it has actually looked at the most common pattern of asymmetry that appears in almost all individuals and describes what one should expect to find.

What should one expect to find in a painless person and is anything other than these expected finding likely to be painful?

These compensations can cause further patterns of asymmetry in other regions of the body, or can lead to pathological localized adaptation or damage to the tissues and structures in response to the excess strain or load.

What is the difference between normal localized adaptation and pathological localized tissue adaptation?

Using a framework that relies on recognizing these patterns, the degree of asymmetry, the ability to move and function within the pattern as well as out of it, we can more effectively aim our treatment at bringing the asymmetry back under control, not completely be rid of it.

This sounds like getting people to be more aware of how they move.

Looking at posture and position is a lot more than "attending to a plumb line", and I feel needs to be addressed. One can not assess and treat a shoulder pathology (impingement for example) without also looking at the resting position of the shoulder complex

I don't look at the resting position of the shoulder in order to direct my treatment of individuals with impingement syndrome, yet people that come to me with this diagnosis typically improve. I've found that when they attend to qualitative aspect of movement more so than quantitative aspects that they do just fine.

...and the postural patterns that direct that position

I find this interesting. Can you expand on the idea of postural patterns directing an end position?

[Barrett Dorko]

I think I've got it.

Asymmetry isn't important, painful, unusual or pathologic unless it becomes so.

Is that it?

Note: This is not actually meant to be funny but please feel free to laugh. I will make no assumptions regarding your reaction.

[Randy Dixon]

Barrett,

You always invite people to post here, yet when they do so you always seem to take offense at what and how they present it. There is something to be said for genuineness, but it doesn't preclude the possibility of politeness. Olly, and now Cory, has virtually walked into a room full of strangers and presented his ideas. Ideas which everyone else in the room disagree with and which they continually debate among themselves about. This isn't easy, it shouldn't be made harder. If you really wish others to share in this discussion and this forum, rather than the same handful of people engaging in an ideological love fest, then perhaps you could try to be more respectful of the people who take your invitation to post here, even if you remain disdainful of their ideas.

Olly,

I have some sympathy for your approach. I believe that you see the compensation patterns you describe, I see some of them myself. I also think, as do most of the others here, that you probably get good results doing what you do. The problem is that there are why's not being addressed. Why did the polyarticular links, kinetic chains, muscles, whatever make the adaptions they did? Why do they continue and how? How does moving the skeletal and muscle structure resolve these problems, in the course of normal movement they will at some point in time reach the positions you place them in, why don't they remain that way? What is missing in your explanation is that the musculoskeletal system isn't steak and sticks, what controls it is the nervous system. Muscles don't "shorten", joints don't become "tight", they have altered neurological signals. If they were the result of "pathological localized adaptation or damage to the tissues and structures in response to the excess strain or load" you would not see instant or quick results, the tissue would take days or weeks to repair itself.

So if you agree there is a neurological component in what you do perhaps you can explain it in those terms.

If you disagree an explanation of why not would also be helpful.

Also, if it is neurological, is what you are doing the most effective way to address it. I'm not saying it is not.

[Barrett Dorko]

Randy,

You're way off base. After 70 posts on this topic the position of the PRI people can be succinctly stated as I did. Olly's earlier comments regarding his amusement were his own and not mine. I've shown no one any disrespect whatsoever. You've been watching me participate on the BBs for years. What makes you think I'm suddenly interested in being told how to behave?

As with the MFR discussion six months ago, the unanswered questions are piling up. I'm no psychic, but I don't anticipate any change in their status.

[Jon Newman]

Randy I don't see people taking offense to someone coming on to discuss their ideas. I do see offense taken when people refuse to discuss ideas without charging (must attend the course) and I do see people taking opposition to what is being presented.

To a priori treat someone as if they cannot participate in a debate of ideas is disrespectful of that person's abilities in my opinion. Olly and Cory are likely to have enough fortitude to withstand disagreement from others and if not, they may benefit from developing it because this bulletin board is not the only place that might disagree with them and it doesn't appear that the person who originally presented these ideas to them is willing to publicly help them out. I've seen this before and it might represent a more veridical source of disrespect.

[Jon Newman]

An additional thought: My use of "humor" used during the thread likely contributed to Olly getting on the track he did and was unhelpful. Point taken.

[stregapez]

Barrett, I may have misunderstood you, but beginning with the reference to the Goodfellas movie and the Joe Pesci character (being offended and angry because he thought he was being treated "like a clown") I saw the same thing Randy did (I think). You seemed to me to be offended, and seemd to be retaliating verbally. I didn't view Olly's wording as at all offensive in context (ie when he sad he "got a kick" out of the thread.) Why? Mostly because in your very first post here you said "ha ha," literally, as regards how your view of PRI....And it was obvious you found it laughable. So isn't it understandable, as well as predictable, that people from PRI might, unless they were absolute "saints" respond in kind?

Olly, I tried to frame my questions in a way that would both acknowledge your description of what you view as a pathological postural condition, and bridge it to some of the questions that had been previously asked by other posters (I was trying to "humor" both sides , with the hope of getting some actual interaction going)

I agree some of the comments here have been contentious (in a bad way; ie maybe even a little hostile) and i think it's kind of unfortunate. However, I think about 2/3 to 3/4 of the comments and questions have been quite fair, if somewhat contentious in a good way (ie challenging, yet not impolite) and i still hope you and/or Cory (welcome Cory!) will try to overlook the personality issues, and address the questions. Like the other posters here, I don't feel they have been answered. Since the brain, partly via the rest of the nervous system, is the only part of the body that can feel pain, I also find it essential that things be explained in terms of the nervous system. I think once you began to do that here, there would, in turn, be more responses and then you would be able to perhaps better challenge the seeming disagreements. Many of the disagreements might remain for most here, but the issues would be more clearly defined.

I can understand everyone's annoyance at not having questions answered, but at the same time I think a little pateince would have helped (though I could be wrong)

Olly, I am a massage therapist. I mostly do Swedish relaxation massage, with some gentle rocking and passive stretching and passive ROM mixed in. I get some very good and immediate results with both physical and mental tension/unease, and pain (and it seems even with both long-term pain and stress at times). I'm not sure how it works exactly, though I think I have a partial understanding , and have attempted to address that issue in some old theads. I don't pretend to be a scientist (especially not at this point) but I am trying to learn and to be open-minded. I'm would surmise some posters here don't think what I do has all that much value, yet I continue to read (and post) here as I feel I may have some things to learn from the people here (who I think are pretty well-versed in modern pain theory and research)

Dana

[EricM]

Being one here who has met Barrett personally a number of times, I had been thinking of how he had been restraining himself. We are who we are and no one here should feel like they have to apologize for just being themselves. When you read closely, none of what may seem like personal attacks are in fact that way at all. Olly is a complete stranger to me and I’m sure a really great guy (girl?). What are questioned are ideas and that should not be taken personally.

I really don’t think anyone here doesn’t get what PRI is all about. It’s quite straightforward and since we were all ‘raised’ within a biomechanical, ‘mesodermal’ philosophy we can all see how it is just another twist on the same old stuff. Just enough mystery is left on the web page to draw a person in, that’s marketing for you. Therapists are desperate to cling to anything that might help them treat those painful problems that just never seem to get better. No one here is denying that PRI probably helps some people. So does massage, manipulation, MFR, and even ultrasound for that matter. All for the same problem, and that’s the problem. When multiple modalities can each work for exactly the same problem by claiming to have an effect on different tissues and systems, can any of them be correct? How confident would you be infront of a tribunal defending your theory to a higher authority? When you account for the nervous system a logical defendable theory for recovery presents itself. When you finally understand how the nervous system is really functions in pain states, biomechanics, strength, posture etc become largely irrelevant in your reasoning. When we talk with our patients and our colleagues about why what we are doing works, we have to look beyond traditional explanations because they simply are not defendable. For most, this is not an easy step to take. It takes a great deal of courage to deconstruct what you have always held to be true. Everyone posting on this site would give the shirt off their back to help with this process, for free, for anyone willing to take that step. But you have to be prepared to face the hard questions.

As for myself, I am 32 years old, with 3 years of practice behind me and am glad to have discovered the people here as early in my career as I did.

eric

[Barrett Dorko]

Dana,

To your credit, the first five words of your last post are certainly correct. After that...well, when I said "Ha, Ha" I was referring to my own rather obsessive tendency to question things - not the things I am questioning. I don't find anything laughable about Hruska's theory. Disturbing yes, comic no.

Olly made it perfectly clear that he was amused at all the speculation regarding this theory and practice. I didn't say so at the time but I find a comment like that patronizing. I figured I'd let Joe Pesci say it for me. By now you might have figured out that I think some screenwriters are far more clever than I am. So shoot me.

What Eric says is perfectly true and justifiable and when Olly offered that quote about someone "thinking their learning is finished" I have to wonder who he thinks he's referring to. Certainly not the regular posters on this BB.

I'm searching the old memory banks for another movie line in reference to that one, and I'll let you know.

[stregapez]

Barrett,

I don't know what to say. For one thing I think communication via the internet is more likely to be misunderstood than in person. It's quite possible Olliver and some other people thought thought the same thing as me... Also, ironically, to be honest, a bunch of times in posts I've thought you were being quite patronizing (in this thread and elsewhere) and overly-defensive in a personal way. That doesn't mean i don't find most of your posts intelligent (and also very interesting), but not infrequently they make me want to cry or go run for some Tums And sometimes I think you are sabatoging your own desires to get more people to participate here. The Pesci thing, to me, just seemd so confrontatonal , and melodramatic, especially directed at someone you don't know. If had had been a joke it would have been funny ...now shoot me, or edit me.

Anyways, enough of that here, unless people really want to talk about comunication (if so that should proly be a different thread)

I still hope very much the PRIers come back and that a real conversation concerning their theories and practices (and yours) emerges.

Dana

[stregapez]

Eric,

I don't disbelieve you, the point is that apparently the average person doesn't have enough information to disbelieve the posture-focussed people either, even trained PTs. Like I said, I'm on the fence, though I tend to agree with you more. If people here wanted a real converation to happen, I just think it would be better to start with Beginner's Mind sort of thing (or at least pretend you are) rather than start off attacking the PRI theories before they've even explained how they work in nervous-system terms. But maybe i am wrong

Dana

[Barrett Dorko]

This BB obviously isn't for beginners. We all treat patients here and I presume some relevant schooling would precede that job. What we have here is the skeptical mind. This requires a provisional approach to claims and is by no means an "attack" of any sort. Skepticism continuously "applies the methods of science to navigate the treacherous straits between 'no nothing' skepticism and 'anything goes' credulity." (From Skeptic magazine) The "beginner's mind" closely resembles the latter.

Dana, If you feel I've said something patronizing provide a quote, don't just accuse me of this. I'm not going to bother trying to find what you consider "over-sensitivity" on my part. I'm guessing you can't read my mind so you wouldn't actually know about this.

It has been quite a while since Olly was asked to describe his work using some neurology. This is a reasonable request, to say the least. But his last response included this: Before I start to answer your questions again, I would like to know what you all do, what approaches do you use and just in case I am not familier with your approaches I would appreciate a short synopsis of what you do and why.

I'm guessing we haven't completed our assignment yet.

[Jon Newman]

Fair enough. The vast majority of my approach to pain management can be (over)simplified to the use of education/communication and to the promotion AROM of a certain quality. If the patient is insufficiently strong but has excellent pain management, I use resistance training. If they are insufficiently flexible but have excellent pain management I use stretching. Often times I find that once they are able to self manage their pain they are uninterested in the latter two aspect of therapy described above but I provide it as needed and desired. I'm quite sure you're sufficiently familiar with the above procedures such that I don't need to do a synopsis. If I'm wrong, please start a new thread and I'd be happy to participate in answering questions to the best of my ability.

[EricM]

Ditto that Jon. I guess I would add that a fairly large contention of mine is honesty in my interactions with my patients. Perhaps I'm overly sensitive here but I like to do my best to explain things in terms of what is most probably happening. To me that implies using the language of neurophysiology. If I happen to do something that looks like PRI I would try to explain it in these terms. It's my opinion that we do our patients and our profession(s) a diservice to do otherwise. I cringe at the thought of being a propagator of faulty memes.

eric

[Diane]

I cringe at the thought of being a propagator of faulty memes.

Me too.
At the risk of this thread careering toward going off topic, I'd like to point out that it is an individual responsibility in our lovely postmodern age to be careful of one's memes, as each of us exists as a locus of information, like it or not. Each of us has to be our own "higher authority."

Some of us, formerly in oppressed roles, embrace the job, happy to at last have the chance to take it on; others bemoan the loss of conventional conservative structure that kept everyone in a heirarchy (with white men at the top just under the construct called "God"); and most don't even know and/ or couldn't care less.

Please note, just because there aren't any "higher authorities" doesn't mean the job of higher authority is up for grabs by would-be gurus; none of us can afford to support them anymore. It means that you have to be careful what to trust, cultivate skepticism as was suggested above.

[stregapez]

Barrett,

Ok, I apologize for making vague allusions like that, but I didn't want to take the thread off track and cite examples . By the way, I also didn't mean to imply I thought it was the totality of your personality (and I am also fully aware one's personality is unlikely to be fully expressed on a message board anyway) . I'm about to shoot you a pm to explain part of what i meant

Jon,

I would be interested hearing more about what you mean by pain managment by education, but I don't know if that's something you want to elaborate on here, or if it' maybe something that should be obvious to me from other threads.

Whats' AROM, by the way?

Dana

[Diane]

Dana,
AROM= active range of motion

[stregapez]

Thanks Diane, I'd have gotten it except for the A

Dana

[Bas Asselbergs]

On June 9, I wrote:
"Olly, my first reaction to that question was: "Since when is it up to me to prove a negative?" The question is rife with assumptions: "uneven" - measured how exactly? "Inefficiently" - measured how exactly? "Asymmetrically" - measured how exactly? I am saying I do understand the train of thought and the seemingly logical process here, but it is not exactly a process that stands up to Occam's razor, is it?"

Clear questions - no answers yet.
With regards to learning - why in the world do people think we are here on the site? Mutual admiration? I have much more interesting things to do with my time than that.

When I see claims of effectiveness of a treatment approach based on the detection of dysfunctional "asymmetry" with what seems like a plethora of biomechanical minutae, I want some clear idea on what it really is based.
To satisfy the need to know who you are talking to, Olly: I am an old PT who has taken Sahrman, Upledger, some of Barnes' courses, Greenman (DO), Kuchera (DO), Maitland, Kaltenborn, even Jimmy Cyriax, David Butler and Vladimir Janda's courses in my many years as a PT on the "hunt" for more. I have taken acupuncture and sports physiotherapy, and manipulation (orthopaedic) specialisation in the Canadian system, have learned an awful lot from the internet (Barrett, Diane, Jon, Ian, Jason, Bernhard etc etc), ......and do much gentle manual therapy, and I am always involved in patient education - whether verbally or non-verbally.

Now, did that make my questions look any different?

[ollyhall]

Hope you all had a good weekend,

OK so you want to know more about PRI and it's neuro effects. Posture and alignment are not just working on muscles and bones, but on every system in the body. It determines the room we have for our abdominal viscera, it effects circulation, it determines the environment around our nerves.

Working hard to breathe due to a twisted diaphragm is going to increase the sympathetic action of our nervous system.
Due to pelvic floor tone we are at increased risk of piriformis syndrome.
Due to accessory muscle of respiration activity we are at increased risk of TOS.
Due to a rotated sphenoid bone the jugular foramen becomes more closed on one side which will affect the Vagus, Spinal Accessory and glossopharyngeal nerves (let me know if you need a recap on the function of these nerves).
Spheniod position will affect vascular flow to the cranium, thermo regulation and hormone balance.
Torsion of the cranium is also going to affect the position of and space for the brain.
Alignment is also going to have an impact on the neural foramina of the spine.

The nice thing about PRI is that these problems are all treated simultaneously, not in isolation. PRI will affect all systems of the body.

Olly Hall, PT, PRC

[Diane]

Hi Olly,
Thanks for coming back in with your additional neuro reasoning added! I see you know some stuff about neural tunnel compression, one of my favorite topics. Also about breathing and autonomics.. More please, these are things I'm reviewing and learning deeper layers of just now.. how does pain as a predominating symptom fit into all this?

As I'm writing this and reviewing earlier posts, I am typing with my right hand, my weight on my left butt cheek, right leg slightly abducted and outwardly rotated compared to the other, my trunk sidebent slightly to the right, and rotated to the left, definitely flared out more on the left lower cage, head tilted left and rotated right... too much info, I know.. but I'll proceed.. after a long time of doing this I get up and do about 5 minutes of ameboid- like streaming ideomotor movement, or less, and it all undoes. Instant results..

So, my understanding so far is that your system is about helping people become aware of their need for developing "zones of apposition," learning exercises that will help them line themselves up (in a mirror?)

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.

Is the goal then, indeed cosmetic? i.e. is it a system that appeals most to the sport crowd or the body building crowd, the fashion model or movie star crowd, the people who need to look good for a living?

I think most of us here are interested in function and reducing pain for a living, and tend to attract patients/clientele who have problems more with how they feel things are "working" physically or with pain levels, than how they look. Not that the two (posture and pain) aren't often "associated".. just that they aren't cause and effect..

Thank you again for your continuing participation.

[Luke Rickards]

Due to a rotated sphenoid bone the jugular foramen becomes more closed on one side which will affect the Vagus, Spinal Accessory and glossopharyngeal nerves (let me know if you need a recap on the function of these nerves).
Spheniod position will affect vascular flow to the cranium, thermo regulation and hormone balance.
Torsion of the cranium is also going to affect the position of and space for the brain.

Hi Olly,
How does one maintain the correct posture of the cranial bones? I assume this doesn't have much to do with sitting up straight.

[Bas Asselbergs]

While I'm waiting for the first series of answers (and i realize I am asking a lot):
"Due to a rotated sphenoid bone the jugular foramen becomes more closed on one side which will affect the Vagus, Spinal Accessory and glossopharyngeal nerves (let me know if you need a recap on the function of these nerves)."
Thank you, no, a recap is not necessary. Having taken craniosacral techniques and having been exposed to the related theory, how do YOU (or postural restoration) propose to
a) measure the rotation;
b) measure the opening of the jugular foramen;
c) and measure the direct effect of the sphenoid position on these nerves?

See, my problem is with the supposition of the sphenoid rotation - a theory, without any basis of testability and reliability. Second, the assumption that the supposed rotation affects the jugular foramen. And then, the contention that somehow this all adds up to specific nerve irritation....

I am afraid I am not going to get any acceptable answers, and at the risk of sounding condescending: been there - done that. As you can see from my history, I have heard and seen many of these "approaches" before and have developed a - for me healthy - dose of scepticism.....And the related alarm bells are making lots of noise.
Bas out.

[Crazy Pole]

Hey all (but mostly Luke and other "poppers", maybe Jon, since you were there)

I just sat through an inservice at work today about a "Cuboid Whip" (basically a manipulation) for limited supination and pain in the foot. Apparently it gets the runner back on track and rarely, if ever, will they suffer the ROM limitations again.

It got me thinking, maybe a displaced sphenoid would benefit from a "Sphenoid Whip".

Any thoughts?

Wes

[Jon Newman]

Author: Kouwenhoven, Jan-Willem M. MD *; Vincken, Koen L. PhD +; Bartels, Lambertus W. PhD +; Castelein, Rene M. MD, PhD *

Title: Analysis of Preexistent Vertebral Rotation in the Normal Spine.[Miscellaneous Article]
Source: Spine. 31(13):1467-1472, June 1, 2006.
Abstract: A newly developed CT measurement method was used to investigate axial rotation from T2 to L5 in the normal, nonscoliotic spine.

Objectives. To identify a preexistent rotational pattern in the normal, nonscoliotic spine.

Summary of Background Data. The data available on axial rotation measurements in the normal spine are scant and limited to only a few vertebrae. Systematic analysis of the thoracic and lumbar vertebrae of the normal spine, based on computed tomography has, to our knowledge, not been performed.

Methods. CT scans of the thorax and abdomen of 50 persons without clinical or radiologic evidence of scoliosis were used to measure vertebral axial rotation from T2 to L5 with a newly developed semiautomatic computerized method.

Results. The results of the present study showed a predominant rotation to the left of the high thoracic vertebrae, and to the right of the mid and lower thoracic vertebrae in the normal, nonscoliotic spine, which differed significantly from an equal right-left distribution. This rotational pattern is present in both males and females.

Conclusion. The normal, nonscoliotic spine demonstrates a preexistent pattern of vertebral rotation that corresponds to what is seen in the most prevalent types of thoracic idiopathic scoliosis.

[aléa]

I'm not so sure that the shape of the cranium does influence the abilities of the brain. Many chidren do not have a perfect cranium, they do not turn to be complete idiots.

Looking for a perfect posture leads to a lot of frustration. Perhaps look for balance through the body ?

On the scoliosis : do you think that PT is better than "natural" exercise (sport,...) on its development ?

[Barrett Dorko]

ale'a,

What would "balance" look like? What is it you're suggesting needs to be "balanced" and in what way? How is "balance" different from symmetry?

Olly,

Like Bas, I don't need "a recap" on the function of any nerves. Thanks for asking though. Also like Bas I'm waiting to hear how you eval and change these sturctures.

[Luke Rickards]

Wes,

Re: the Spheniod Whip. I don't know if I'm unique here but I've never considered a rapid blow to the head as an appropriate treatment for any painful condition.

OK, perhaps the thought has crossed my mind a few times, but it was to get me out of misery.

Luke

[Randy Dixon]

Olly,

How is PRI different then than Janda's, Sahrmann's, Egoscue's and other postural philosophies? I didn't see anything you wrote that struck me as different except the terminology.

I guess I'm still also waiting for the why's. It seems like you are putting the cart before the horse.

OLLY:Working hard to breathe due to a twisted diaphragm is going to increase the sympathetic action of our nervous system.

RD: What is causing the twisted diaphragm, uneven muscular tension leading to skeletal adjustment? Isn't this neurological in origin?
Ollyue to pelvic floor tone we are at increased risk of piriformis syndrome.

RD: Why is there increased pelvic floor tone? Same question

Olly: Due to accessory muscle of respiration activity we are at increased risk of TOS.

RD: Hmmm. Ok, let's accept that. Same questions.

Olly: Due to a rotated sphenoid bone the jugular foramen becomes more closed on one side which will affect the Vagus, Spinal Accessory and glossopharyngeal nerves (let me know if you need a recap on the function of these nerves).
Spheniod position will affect vascular flow to the cranium, thermo regulation and hormone balance.

RD: Was the recap thing a joke, an insult or did you really thing you are going to come to forum dedicated to things neurological and lecture on basic nerve function? How do you know the rotated sphenoid is doing any of these things, and same questions as before.

Olly:Torsion of the cranium is also going to affect the position of and space for the brain.

RD: ? I suppose this is related to maintaining the visual horizon, but do you really think you are going to affect the "torsion of the cranium", how much torsion does the cranium allow? That would seem to be an extremely long process if it happens.

Olly:Alignment is also going to have an impact on the neural foramina of the spine.

RD: That seems plausible but if there are no neurological signs suggesting then why would you assume it? If there are neurological signs suggesting it, why would assymmetry be the prime suspect?

In short, none of the reasons why these things happen is explained or why they don't correct themselves.

[aléa]

symetry is static. I'm not looking for symetry.
I'm looking for "muscle balance" (here, i'll get a kick), in their tensions at rest, and more important for coordination when moving. That's different from looking for good posture.

[Barrett Dorko]

ale'a,

It sounds like you're looking for normal, apporpriate and well-coordinated muscular function, both at rest and during activity.

Aren't we all?