Altering the Ideal

[Barrett Dorko]

The threads regarding juggling (http://www.somasimple.com/forums/showthread.php?t=2244) and the usefulness (http://www.somasimple.com/forums/showthread.php?t=2338) of our profession have led me investigate further Ramanchandran’s “Laws of Aesthetics” referred to in the podcast (http://www.nyas.org/snc/podcasts.asp?PartnerCD=iTunes&TrackCD=pcast) regarding synesthesia he did recently. I think that in this brilliant lecture there is a good deal of support for some ideas I’ve had regarding evaluation and care the past several years, so I decided to start this thread.

“Aesthetics” from dictionary.com
• Of or concerning the appreciation of beauty or good taste: the aesthetic faculties.
• Characterized by a heightened sensitivity to beauty.

What Ramachandran attempts to do with reason and evidence from modern neuroscience is to explain how and why it is we are drawn to certain shapes and images. Having done this, he answers the age-old question “What is art?” in a way that I find both intriguing and clinically relevant. The primary thrust of his premise is that there are “universals” of perception that cut across cultural boundaries. These commonly held perceptions of beauty and correctness are a function of our evolutionary inheritance as manifest in neural patterns that cannot be easily ignored or changed without a clear understanding of their presence and power. I will attempt in this thread to address the issue of their usefulness as well as the inappropriate effect they have upon the care we provide and the health we seek.

Let’s start with these questions: If posture is a certain “shape” we seek to achieve, how is the ideal justified biomechanically and how is it related to the aesthetic ideal? Is it possible to change the ideal and subsequently alter both what draws our attention and the goals of care?

[Barrett Dorko]

A man’s errors are his portals of discovery

James Joyce

I don’t think I have to spend any time here describing the ideal of human posture. This meme is so firmly entrenched in our culture that it drives most people to behave in ways that are literally painful.

If you don’t think so, try this: ask your patient with spinal or limb pain to simply stand before you. Offer no other command or suggestion. Observe the distance between their feet, ask them if they feel a certain tension building in their body, especially in their symptomatic area, and then ask them to bring their feet further apart. Ask again about the tension and the intensity of their symptoms.

Do this 5-10 times today and then let me know what you hear. We’ll get back to the Laws of Aesthetics after a couple of posts from those following this thread.

[EricM]

Barrett I have been asking patients exactly that question over the last year or so and am always amazed at how they seem to just deflate a little (and always grin - seriously, its like I've just told a joke or something) when I tell them its OK to stand whichever way they are most comfortable.

eric

[Barrett Dorko]

Thanks Eric. I see precisely the same thing. This moment is an especially important one for all you’re about to teach beyond that, I’m sure you would agree.

So here’s the deal: We are compelled to focus our attention upon those things we recognize as aesthetically pleasing (beautiful) and in this we don’t actually have much of a choice. Ramachandran traces this to portions of the brain known to become active when we see certain shapes that, to us, convey some psychological comfort or nutritional support. These images or objects have some distinct cultural variance but he has discovered that some intersect across cultures and he has subsequently listed ten specific aspects of “universal” appeal, referring to them as “Professor Ramachandran’s suggested ten universal laws of art.” I got this directly from his book A Brief Tour of Human Consciousness.

I think I’ll be choosing several of these “laws” as we go on, but the first that struck me was #6; Symmetry. Remember that Ramachandran is not suggesting that our attraction to this aspect of anything else has a thing to do with the health, well-being or function of that object, but only to how that aspect serves to make us feel better while in its presence.

Does anybody else out there think that creating symmetrical appearance (or range of motion or strength for that matter) is often overrated as an approach to care?

To me, this is just one simple example of how we are driven to judge and "correct" what we see in our patients, not on the basis of what we know to be important about health, but because of an instinct deeply rooted in our own survival.

And because it’s hidden well within our own unconscious we haven’t noticed this tendency. Still, it drives some portion of everyone’s practice – even mine. Isn’t it time we brought it to light?

There’s much, much more.

[Diane]

I am loving this thread. Go Barrett! :D

[christophb]

In most of the people I saw today, I’ve already addressed the issue. However, one gal had right lower abdominal pain that didn't change in either position, was constant, blah blah... didn't really soften until I found some common ground with her and she became more natural, breathed deeper and left pain free.

Another lady. I literally barked a command "stand before me" and demonstrated non-verbally my intention of an upright posture. She complied and had discomfort. Had her walk around a bit to forget what I had said, then calmly asked her to stand (while I just relaxed my body). She stood with feet further apart, more relaxed and had a bit less pain (when I finally told her to stand in the loose NS position (ABD/ER) pain decreased further. I just thought it was interesting how my non-verbals and voice tone changed her response.

Chris

[Diane]

Chris,
Gotta love those mirror neurons!
About "altering the ideal" in general, I like when I get the people in as patients who are about as opposite me as is possible to get, i.e., they are tall, upright, taut, not roundy-shouldered like I am (well, I'm roundy-everything, really...).

They've been stabilizing their cores and working out and pilate-ing and can run for miles. I have little or no ab tone, never have, can run a couple blocks, maybe, if I run about as fast as I can walk... (even so I get out of breath before too long, not much cardio. Yet my resting pulse is around 50, their's is often much higher.)

They look at me and see a short, soft, and pudgy middle aged woman, with no pain. Well, OK, I'm quite bendy, I'll give me that.

I look at them and see a huge struggle going on between them and their nervous systems as they have struggled to conform to some magazine picture or conceptualization of how they ought to look; i.e. hard and contoured and toned.

This situation is an affront to their sensibilities. It doesn't seem fair to their visual cortex that they've worked so hard on themselves, yet they end up in pain, and I who appear to have been allergic to most gyms most of my life, have not.

My job is to reassure them, get them to let their nervous systems and them let go of each other. Not try so hard. Do nothing. Relax their abs enough to be able to breathe down through their ribcages instead of out against them.

The other group I love are the ones that are in my category, who come in in pain, and believe they've brought it on themselves for not being diligent enough, not trying hard enough, always being too lazy, never fighting to acquire a flat belly wall. They think I'm going to tell them to get busy. They are visibly relieved when I tell them they don't have to do that, that it will make no difference to their pain one way or the other, that they won't have to train themselves to Olympian standards to feel better. I'm living proof of it.

I see my job with these ones to reassure them, teach them to let their breath travel down through their ribcage instead of out against it.

Plus pain education, SC, changing kinesthetic input, neuromodulating, all that stuff.. doing minimal to nothing.

[nari]

Symmetry..

Don't we like order as opposed to chaos? Ballet dancers look the perfection of symmetry in how they move and interact with others. (Out of sight they fall in a screaming heap, probably) This helps to consolidate the meme of perfectly straight, toned flesh on bone as per DaVinci's drawings.
Perhaps the belief in good posturing is thought of as an evolutionary thing - apes don't stand according to rules of order...so we have progressed. ;)

I have not 'corrected' posture for over 16 years. Got out of the habit/meme in acute neurorehab where we don't give a rabbit's foot about posturing; what counts is function. I was challenged once by a neuropsych, who meant well, reminding me several times over a period that a mutual TBI patient of ours needed physio to correct posture.
"Why?" I asked. She flushed and said: "Well, that is what physios do".
From there the conversation deteriorated; but in the end, she understood that despite the fact her own posture was...well, slouchy and bulgy, she had no pain anywhere. I didn't hear another reminder from her.

The posture myth/superstition needs deconstructing. In public, preferably.
Particularly those trainers who run fitness ball classes...

Nari

[stregapez]

Er, I've had a different experience with the fitness thing - I never went to a gym, nor worked out my whole life until about 4 years ago ~ (I'm well into adulthood) And overall I started to fel WAY better, in spite of increasing age, since I started working out. This includes WAY less back and neck pain and tension (the mid-back pain i get when i sit at computer very much not withstanding) I've always been thin, regardless of working out, gaining no weight as i get older ~ fast metabalism i guess ~ so that's never been a factor.

I don't overdo it though ~ every other day I other day i do cardio or resistance. On off days i take the dog for a short walk.

As I said, i did mess up my hands for awhile lifting free weights, but i bet if i'd been using resistance machines, and had strengthened my hand muscles first, it'd not have happened like that (if i'd had good advice, or known better)

But, yeah, main point is general level of tension and muscle hypertonicity in neck and back is way less since exercising (especially if i stay off the computer) Headaches are about 75% less frequent, pms symptoms are much less...Some of all this could be due to other things as well (worrying less, vitamin/mineral supplements etc), but i'm pretty sure it's partly from exercise. I'm sure different bodies are different. I do think at this point, all other things being equal, my emotional state has more to due with how my whole body feels (includng my soft-tissue anatomy)than anything ~

I have no idea what my posture even is. I can only assume the "stand up straight , be stiff and tuck your stomach in" thing is a reality of society some people have to deal with. But I don't really experience that . I've been either self-employed or unemployed for a very long time, and my friends are definitely not the type to expect good posture. I still get back aches lately. Mostly it seems to be from sitting at the computer. Social interaction will make me physially tense at times; this includes when i find myself either bored, disgusted or having to be inauthentic (as well as more serious things like upset, hurt, or angry), but postural expectations don't seem to have much of a part for me.

I agree moving freely, both physically and mentally is probably one the essential ingredients to keeping healthy.

I also think exercise is a good thing ~ for me anyway

Dana

[christophb]

Just as it happens, I was cruising around a martial arts forum and found this link posted today.

http://www.agoodposturedoctor.com/POSTURE.HTML

Chris

[stregapez]

I did notice today i stand with my feet close, so I am going to try to standing with my feet further apart more, just to see how it feels. It could be frequently tending to stand with my feet close is something i learned from observation rather than comfort .

Dana

[Barrett Dorko]

As it happens, I attended a ballet in person earlier this week so now I am an expert on all things balletic. It was an excellent production of Movin’ Out, inspired by and performed to the music of Billy Joel. Several in this troupe originated their roles on Broadway.

Needless to say, the performers looked wonderful and their movement was nothing short of spectacular. I know however that all of them suffer from a great deal of pain regularly. After directing The Company a few years ago, legendary filmmaker Robert Altman said he “came away with a great melancholy for these young women who have ruined their bodies and can no longer do anything else.” He was talking about the ballet dancers he met.

The issue I want to explore specifically is why we are drawn to what I agree is a beautiful physical presentation even after we know how painful maintenance of it will be. I don’t think the dancers can be blamed. After all, they love what they do, and I don’t feel anybody should be faulted for that.

As far as it goes, I was compelled to keep looking at the piano player/vocalist perched above the stage. My appreciation for the unique creativity of that artist has grown as I’ve learned more about the ability of creative movement (http://www.barrettdorko.com/PrestigeDay.htm) to relieve pain. I’m now drawn to this more than I am to the totally choreographed dancers.

Ramachandran’s premise is that our attraction to art is rooted in the neuronal patterns that we possess as the end result of Darwinian selection. Kind of a powerful thing to overcome, don’t you think?

Tomorrow I’ll write a bit more about his thoughts about how this has led us around without our knowing it.

I think that this is the perfect time for a quote from Zen and the Art of Motorcycle Maintenance by Robert Pirsig:

The real purpose of the scientific method is to make sure Nature hasn’t misled you into thinking you know something you actually don’t.

[Luke Rickards]

Classic link Chris. The first four points under 'Symptoms of poor posture' are not even symptoms.:confused:

Luke

[nari]

Good example, Chris.

Wafts over one like a blast from the past (about 15 years ago! :rolleyes: )
Especially the remedies recommended to fix it all up. Permanently ;) ...and if not permanently fixed - why 'correct' in the first place.

Jazz ballet is probably a little kinder to the body than classical; but is still damaging. However, I agree that dancers love dancing, or they wouldn't do it.
And I agree that doing something one really likes, despite ill-effects, is still important to one's cognitive welfare. Irish dancers probably destroy their LE venous systems...but what the heck.

We can watch a beautifully artistic presentation and feel moved; the fact the performers might fall apart doesn't count. That is their problem; not ours. They perform for our enjoyment (and theirs) and entertainment. After all, the historical audience enjoyed watching guillotines coming down and the religious being fed to lions; and bullfighting....
All in the name of being entertained, I think.

Nari

[bernard]

Hi All,

My good posture is the shape I can maintain, at ease, with the least neural activation.

Symmetry? I'm not sure.
I saw on National Geographic an experiment with contradictory results.

They took some of the most known beautiful women faces of the world.
They looked if beauty was related to the symmetry of the face shape. Most of the faces were not symmetrical (around 90/95 %) but not more.
They tried to correct with some computer tools the faces to make them fully symmetrical. Strangely, the same observers found the faces were certainly beautififul but something was found equally unpleasant.
When the normal picture and the corrected one were put together, all the observers preferred the natural portraits.

[bernard]

Int J Neurosci. (http://javascript%3Cb%3E%3C/b%3E:AL_get%28this,%20%27jour%27,%20%27Int%20J%20Neurosci.%27%29;) 2005 Aug;115(8):1165-73. Related Articles, (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=16040358) Links (http://javascript%3Cb%3E%3C/b%3E:PopUpMenu2_Set%28Menu16040358%29;) http://www.ncbi.nlm.nih.gov/entrez/query/egifs/http:--www.metapress.com-images-Profiles-www-logo-metapress-100.gif (http://www.ncbi.nlm.nih.gov/entrez/utils/lofref.fcgi?PrId=3396&uid=16040358&db=pubmed&url=http://taylorandfrancis.metapress.com/openurl.asp?genre=article&issn=0020-7454&volume=115&issue=8&spage=1165)
The face, beauty, and symmetry: perceiving asymmetry in beautiful faces.

Zaidel DW (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Zaidel+DW%22%5BAuthor%5D), Cohen JA (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Cohen+JA%22%5BAuthor%5D).

Department of Psychology, University of California, Los Angeles, California 90095-1563, USA. dahliaz@ucla.edu

The relationship between bilateral facial symmetry and beauty remains to be clarified. Here, straight head-on photographs of "beautiful" faces from the collections of professional modeling agencies were selected. First, beauty ratings were obtained for these faces. Then, the authors created symmetrical left-left and right-right composites of the beautiful faces and asked a new group of subjects to choose the most attractive pair member. "Same" responses were allowed. No difference between the left-left and right-right composites was revealed but significant differences were obtained between "same" and the left-left or right-right. These results show that subjects detected asymmetry in beauty and suggest that very beautiful faces can be functionally asymmetrical.

PMID: 16040358 [PubMed - indexed for MEDLINE]

Brain Cogn. (javascript:AL_get(this, 'jour', 'Brain Cogn.');) 2005 Apr;57(3):261-3. Related Articles, (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=15780460) Links (javascript:PopUpMenu2_Set(Menu15780460);) http://www.ncbi.nlm.nih.gov/entrez/query/egifs/http:--linkinghub.elsevier.com-ihub-images-PubMedLink.gif (http://www.ncbi.nlm.nih.gov/entrez/utils/lofref.fcgi?PrId=3048&uid=15780460&db=pubmed&url=http://linkinghub.elsevier.com/retrieve/pii/S0278-2626%2804%2900269-6)
Appearance of symmetry, beauty, and health in human faces.

Zaidel DW (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Zaidel+DW%22%5BAuthor%5D), Aarde SM (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Aarde+SM%22%5BAuthor%5D), Baig K (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Baig+K%22%5BAuthor%5D).

Department of Psychology, University of California, Los Angeles, Box 951563 Los Angeles, CA 90095, United States. dahliaz@ucla.edu

Symmetry is an important concept in biology, being related to mate selection strategies, health, and survival of species. In human faces, the relevance of left-right symmetry to attractiveness and health is not well understood. We compared the appearance of facial attractiveness, health, and symmetry in three separate experiments. Participants inspected front views of faces on the computer screen and judged them on a 5-point scale according to their attractiveness in Experiment 1, health in Experiment 2, and symmetry in Experiment 3. We found that symmetry and attractiveness were not strongly related in faces of women or men while health and symmetry were related. There was a significant difference between attractiveness and symmetry judgments but not between health and symmetry judgments. Moreover, there was a significant difference between attractiveness and health. Facial symmetry may be critical for the appearance of health but it does not seem to be critical for the appearance of attractiveness, not surprisingly perhaps because human faces together with the human brain have been shaped by adaptive evolution to be naturally asymmetrical.

Publication Types:
Clinical Trial (javascript:AL_get(this, 'ptyp', 'Clinical Trial');)
PMID: 15780460 [PubMed - indexed for MEDLINE]

[Barrett Dorko]

“Art has nothing to do with realism – it’s not about creating a replica of what’s out there in the world (but rather) it involves deliberate hyperbole, exaggeration, even distortion, in order to create pleasing effects in the brain.”

V. S. Ramachandran in A Brief Tour of Human Consciousness

The pursuit of a physically ideal shape in the bodies of others has been the bedrock of many careers in the profession of physical therapy. Kendall’s insistence on erectness first articulated in 1948 continues to form the basis of our basic education in many institutions despite the fact that there’s never been a study indicating its premise is either accurate or clinically relevant for the vast majority of painful or functional problems we see. If somebody has one that does prove this I’d love to see it. I’ve been asking for this for 25 years and have yet to see one.

So why does this meme (http://en.wikipedia.org/wiki/Meme) remain? Like most things that endure despite their uselessness or evident harm, postural instruction is still with us because of what it does to satisfy our unconscious desire. We want it because “good” posture in others, as Ramachandran says, “creates a pleasing effect in the brain,” and by that I mean in the brain of the person seeing it – not the person doing it. Listen: Better posture in the classic sense pleases the therapist much more than it does the patient.

Try this: Look at yourself in the mirror as you stand relaxed, now come fully erect and notice what that does for you. Now try it without the mirror. See what I mean?

This specific distortion (see the quote at the top of this post) of normal bodily erectness draws our interest and satisfies something within that cannot be denied while it at the same time it will not be easily seen. But we can come to see and understand this if we look deeper into the literature of modern neuroscience or more specifically into what Semir Zeki (a colleague of Ramachandran’s) calls neuroaesthetics.

It all comes down to this: Therapists need to look at themselves carefully first before they can ever hope to see their patients with any real insight.

Of course, there's nothing to that.

[Barrett Dorko]

In 1755 Samuel Johnson published his dictionary, a work that, according to the experts, “defined the English language.” In there you’ll find the definition of the word “posturemaster” – One who teaches or practices artificial contortions of the body.

It’s clear that Johnson himself suffered from Tourette’s Syndrome, often forcing him to spin about as he went through an intricate and prolonged series of movements throughout the day. This was combined with an obsessive-compulsive disorder that was equally severe and obvious to all those who came into contact with him. Still, he became “the single most quoted prose writer in the English language.” Perhaps his disdain for “posturing” comes from this.

From Merriam-Webster's Medical Dictionary: Posture - behave affectedly or unnaturally in order to impress others; 2: assume a posture as for artistic purposes

That last bit about “artistic purposes” fits right in here.

[Diane]

When I do this little antigravity exercise Barrett, especially if I stretch my arms behind me into full internal rotation at the same time, and abdominally breathe several times as if I were doing yoga (I call this "bogus yoga" as per an Ernie Pook's Comeek I once cut out..), I can feel eccentric lengthening going on everywhere, and afterwards I feel terrific, not to mention 4 inches taller. (I do this everyday actually. But no mirrors allowed.):angel:

And I have to confess, I do teach this to patients, as an exercise only, not as a way of life, and teach them to look for the sensations that it can bring. Then I have them walk around a little. It's the feeling of lengthened expansion, tingly skin, and access to their own bungee cords/elastic recoil I want them to experience right away after, and be able to access if they want. :teeth: :thumbs_up

They can only do it and sense it once they are painfree of course, otherwise pain inhibits the experience. I think getting rid of pain is one side of treatment and teaching people to feel good in a body is the other side. And you're right IMO that living life as if one had on a straitjacket is insane, or at least insanely self-conscious/culture/other-driven. :rolleyes: :thumbs_do

[Barrett Dorko]

Diane,

I teach exercises all the time as well. Their purpose and mine (as I suspect is yours) is to enhance awareness, and as Milgram says, "It is our awareness that leads to our liberation."

Again, my intended focus in this thread is the effect upon us when we see something else, and how often we work to make that something else please us by changing its shape. Every time a therapist choreographs a posture for their patient they should think about whether or not they are doing this for their sake or for the patient's sake. Too often (not always) I contend it is the former and not the latter.

Sara Halpern writes in Look at my Ugly Face - Myths and Musings on beauty and other perilous obsessions with women's appearance: "...we look at ourselves in mirrors, windows and as we are reflected in the reactions of others. There is pleasure in our looking, and a yearning for something we may not normally articulate (read "actually look like")."

Therapists who focus on their patient's appearance, whatever they want it to be, are entering into a realm of aesthetics more powerful and complex than they might realize. If they don't read Ramachandran they won't ever know why they actually do this and will instead rationalize their emphasis on postural training with anecdote rather than defendable theory.

When I point this out, no matter how gently, some grow sullen. Perhaps it is because what I'm bringing to the fore is their deepest desire to look like something they're not. If I take away this bit of their practice, how might they begin to feel?

Does that make sense? Anybody disagree?

[stregapez]

I don't know much about theories on posture and related pain or disfunction, so until i do i can participate only so much. Soon I'll be taking classes in orthopedic massage, so i assume i'll get some exposure there. I've always had the impression it's believed by some that certain postural habbits tend towards strain of soft-tissue in unatural ways, that end up causing hypertonicty and pain, and that at least much of this is based on actual experience and knowledge of the body,as opposed to aesthetics. Seems true with me (like the sitting at computer in the wrong position thing, which is not anything imposed on me by outside forces)

I've never had any experience advising on posture, nor being advised...much.

I did encounter a Rolfer recently who seemed (to me anyway) have some flakey ideas about posture, which when i tried them on made me feel stilted and tense. (Almost shared an office suite with the guy ; glad i didn't, though it did seem slightly more desirable than sharing a very lovely office, and bathroom, with a lady who does high colonics, to get rid of "toxins" :rolleyes: )

After reading this last night I talked about posture and social expectations with a good friend who's significantly younger than me , and he says his generation could care less about posture. Basically, he said noone but his parents and teachers ever told him to sit up straight or cared about his posture (not in job environments etc). We surmised my generation cared/s more, and the ones preceeding me did more than that. I've never really thought mine did too much, but then again i'm good at isolating myself from things that seem bogus and unhelpful . I'd guess part of the posture awareness thing is a genuine effort to help, based on experience and understanding of anatomy and physiogy, and another part is probably detrimental effort to make everyone look a certain way.

My 25 year old friend thinks the second doesn't really exist much; that it's mostly a matter of sound science. He also assumes he has crappy posture that's bad for him, and that he should develop better posture.He says the only time his back doesn't hurt is when he's at the computer, where he's spent most of his life.

I really like his slouchy posture and his unstilted, easy movement..and his beer gut...I don't usually even look at the guys at the gym...

Does anyone know anything about Trager? I'm about to be sharing an office part time with a Trager practicioner. I notice a lot of Trager Mehtod people also tend to be into The Alexander Technique. Anyone know anything about the Alexander Technique?

I think i'm going to get "Tragered" on Monday


Dana

[Barrett Dorko]

In 1997 Sherwin Nuland M.D. wrote this in The Wisdom of the Body: “The greatest feat of the humanizing process is the recognition of beauty, both the beauty we find around us and the beauty we can create. Beauty in and of itself would seem to have no direct consequence to the DNA’s survival needs and that alone makes it recognition one of the supreme accomplishments of the human mind: Beauty of image give us the sense of enrichment, even of spirituality, that goes well beyond our constant seeking of mere survival.”

Nuland did not have the advantage of Ramachandran’s neuroscience obtained largely through careful experimentation and advanced imaging techniques. Perhaps this explains why what he says is almost entirely wrong. The fact is, the things we find beautiful are perceived in this way precisely because their presence enhances our survival.

It is not that we become human when we find things beautiful. We become human when we find that something is not beautiful but love it anyway. This appreciation for the non-beautiful object is a function of our understanding and thoughtfulness – and those are the qualities only humans can have in abundance.

It follows that therapists who attend less to appearance and more to the deep models we cannot see that they become, well, more human. To say nothing of more knowledgeable.

Again, this thread is not suppose to be about posture and its relation to pain. People who want to make that case or ask about it might start another thread.

This is about why we attend to our patient’s appearance so carefully in the absence of evidence for its relevance. It’s also about what might be done to change that tendency in our profession.

[stregapez]

Nuland did not have the advantage of Ramachandran’s neuroscience obtained largely through careful experimentation and advanced imaging techniques. Perhaps this explains why what he says is almost entirely wrong. The fact is, the things we find beautiful are perceived in this way precisely because their presence enhances our survival.

I'm confused. Maybe i'm misunderstanding, but previously you took ballet dancers as an example of something you believe is widely considered beautiful, but you also seemed to be saying that the art of ballet wasn't something that enhances survival (ie it's something that's "beautiful" but bad for the body)


Again, this thread is not suppose to be about posture and its relation to pain. People who want to make that case or ask about it might start another thread.

This is about why we attend to our patient’s appearance so carefully in the absence of evidence for its relevance. It’s also about what might be done to change that tendency in our profession.

[QUOTE=Barrett Dorko]

Sorry. The reason i brought it up was for the purpose of saying : while i'm not a PT, i have heard/read enough from *some* MTs, as well as other medical people, to think that when they try to help alter someone's posture (and mts do do this too, the orthopedic and "structural" ones especially) they are (thoughtfully and consciously) doing it at least partly based on experience with posture contributing to pain , not based on aesthetics... while others are undoubtedly overly motivated by aestheics. I'll shut up now :)

Dana

[Barrett Dorko]

Dana,

I don't understand your confusion - at all.

Aside from impingement syndrome at the shoulder, posture has never been shown to be related to pain, "experience" of those who do it aside. And this is my point. They say they are doing this because it "works," all real evidence to the contrary. Ramachandran's work implies quite strongly that they're doing it for their own good, not the patient's.

Thoughtfulness and knowledge are not mutually inclusive. People who correct posture, whatever their profession, are obligated to defend this practice with good evidence and construct validity for their theory. These people haven't.

[Jason Silvernail]

Well, I have to say that I was firmly on the posture bandwagon for several years early in my career. I remember especially, reading a PT writer who was commenting on Florence Kendall's presence at an APTA funtion - she said in a pleased sort of way that Florence was correcting the posture of the people who would come to talk to her. She said this as if the message was "isn't it great that after all these years, she still does something important and healthy for people?" Of course, I think this is kind of like a group of physicans remarking that it's nice that the 85 yo senior member of their professional organization went around attempting to bleed people at the conference this year.

Max Planck said, "A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it."

Certainly it is sad to hear of Florence Kendall's passing, and she did many wonderful things for patients and for the PT profession. But the "Posture and Pain" meme she left us with is holding us back. It continues to cloud the minds of students in my clinic as well. One of the things I most enjoy about getting students is clearing their mind with (how did Diane put it?) Occam's Chainsaw. First goes motion palpation diagnosis, then posture and pain, then strength and pain, and on from there.

I have to say that my clinical experience and some injury prevention research has shown that assymetry in muscle extensibility and joint range of movement has been associated with overuse injuries. I'm not sure if such assymetries are compensations post injury or if they develop in another way, but there is some good data about that. I tend to think of this asymmetry as not related to posture or APPEARANCE, but rather to MOVEMENT and function, which we can all agree are different concepts. Happy to post references, if requested.

I think that, with students, I tend to refocus them from looking at appearance to looking at movement and function. Perhaps Barrett looks for the internal rotation at the hip in supine, and I might look for an asymmetry in iliopsoas length for my knee pain patient. I think these findings are those of movement and function, and hence not related to aesthetics or the "ideal".
Thoughts?
J

[nari]

I wonder if it is a bit of both: appearance AND function.

We do it for ourselves, because a 'corrected' posture in a patient looks good to our memes, and makes us feel good. I won't wander off into the power vs helping maze.

We also 'correct' as a preventative, in a belief we are helping a patient to function better and experience less pain. That's hardwired - almost.

Then again, once a patient walks out of the room, saying it feels good, and I will try to keep good posture.... I suspect the aesthetics part is reigning supreme in our brain/s. Their adoption of the correction that we have imposed on them enhances our survival....I think. But I suspect there is more to it.

If students (and postgrads) are told to basically ignore the perfected ideals of static and dynamic posture, we might be giving them permission to actually see the person in front of them and not a skeleton covered in muscle. That would help.

Nari

[Diane]

Nari, permission to actually see the person in front of them and not a skeleton covered in muscle. That would help. It would!
If they still see the skeleton and muscles though, it might help bridge them to the person operating the system if they could also see the nervous system (https://www.3bscientific.com/shop/index.cfm/fuseaction/product.displayProduct/productareaID/3/grpID/65/subgroupID/47/productID/2501/image/zoom.htm). The posture is still depoicted as awfully stiff on this image however; maybe someday I'll be able to photoshop nervous system over pictures of people slumping or moving or sitting or dancing. :) I think that would be fun.

(I've sent for this chart but it isn't here yet.. meanwhile I content myself with viewing it online. There's a red square over the image that you can drag around over whatever area of the diagram you want to zoom in to check, and a nice bunch of arrows at the bottom to navigate around with.:angel:)

[Luke Rickards]

Jason,

I prefer to see posture in relation to function, rather than position, also. The breath is the most potent for me. I will often ask people to assume the 'right posture' (as they see it, or have been shown) - this can be done standing or seated - and then ask whether they can take an easy and deep breath from there. Obviously, this is difficult. Then I ask them to slump into themselves and try it again, now abdominal breathing is easier, but only the lower ribs can expand. Now I ask them to assume any effortless position that allows them to take an easy and near full breath. The result is always a very unforced and comfortable position.

In terms of movement, I find that this is a great place to start SC from.

Luke

[Barrett Dorko]

Most here seem to agree that the appearance of health and its actual presence are often unrelated if not entirely at odds. This seems especially true when you are dealing with the patient who isn’t necessarily unhealthy in the usual sense but who has a persistent complaint of pain. I wrote about this years ago in an essay titled A Kind of Health (http://www.barrettdorko.com/articles/health.htm).

It is this confusion regarding painlessness and health that I think has driven the physical therapy community to behave in ways that make very little if any sense when it comes to patients in pain. For all the talk of function in recent posts I’ve yet to see anyone relate function to pain in a simple test of range or endurance. We all know that there are all kinds of people out there with inadequate function but no complaints of pain. This is the point I make in the essay linked above.

I often quote these words from David Morris in Illness and Culture in the Postmodern Age: “Health no longer refers to the ideal social state that generates it, (and, in fact) good health is no longer the issue. Image is everything. (We are told repeatedly) that the healthy-looking body is the beautiful body and that the beautiful body is the healthy-looking body.” This, of course, is untrue, and the tragedy of our profession is that we both know this and constantly act as if it were true.

The neuroaesthetics we practice require only that we follow our instinct to surround ourselves with beauty. But modern medical science has made it clear that this isn’t enough to promote health and painlessness, the variable nature of “beauty” according to the culture being what it is. I suppose we are overwhelmed by it in the same way fish are overwhelmed by water. This is also why we don’t see it. (I have a Bertrand Russell line about this for my classes) The final irony is that the very culture that anesthetizes (desensitizes) us to these issues makes us especially sensitive to the illusion of a connection between appearance and pain.

At this point in my career I say that painless function is dependent upon something quite difficult to see but not impossible to sense with the right approach to palpation and enough knowledge of the deep models offered us in modern neurobiology.

I suppose that this is what I try to teach. No wonder I typically fail.

[Diane]

Barrett, "it's a long and a dusty road, it's a hard and a heavy load; the people you meet aren't always kind" (song (http://www.nanci-griffith.com/discography/ovorlyrics.html#canthelp)).

I think there is another unconscious cultural meme operating that we need to be aware of and combat; it tells us we're supposed to "suffer" in life, including suffer to be beautiful. Pleasing to the eye. Pleasing to others. Pleasing to supernatural power in hopes it won't smite you silly. Dennett kind of alludes to this obliquely when he talks about most religious groupings being about submission. To me this has always seemed very SM of our culture, of many cultures.

(I quite like the buddhist approach, however, all about acceptance of what is, that only the present moment exists, everything else is illusion, deep breathing, mopping up/eliminating/alleviating whatever you can of suffering while not contributing to any more of it in yourself or others, that there really is no separation between self and other. And I like that one can practice this without having to go do any ritual stuff.)

Luke, what a neat exercise.

[stregapez]

Ok, maybe i don't understand what is meant in the pt profession by posture, but i don't think that's it, so i'm stymied.

Here's the thing. Some examples :

1)If I sit at the computer with no back support (a posture), and bent forward, my back and shoulders will quickly sart to hurt and or get tense. If I remember to use the back of the chair as support ( a different posture) it will take much longer for my back to start hurting

2)If I read in a chair with my neck bent for a long time (a type of posture) my neck may start to hurt (it will at least hurt when i extend it after reading for a long time) whereas if i keep my neck in a neutral position ( a different posture) this doesn't happen

3) If I keep the telephone under the side of my neck for 20 min (type of posture) it ends up making my neck feel bad, especially when i return it to neutral again) whereas if i hold the phone with my hand and don't hold my neck abducted for 20 minutes I don't have a problem.

4)I have the beginings of osteo arthritis (no i've never run), plus probably some other isues from falling on my knees on concrete (no not doing sports, on a friend's porch over a dolley in the pitch dark). If I sit with my legs crossed for long (a certain posture) they will start to hurt. If I sit with them apart (different posture) they won't

5) In this thread, someone used the example if people standing with their feet together as a habitual (aesthetics based, i'm inferring) posture and suggested seeing how it felt with legs apart (a different type of posture) that does, in fact, seem easier on my knees at least

Dana

[Diane]

Dana, think of your nervous system. Think of it in physical terms. It's like a tree, except upside down: the root ball is at the top (brain), the spinal "trunk" goes down instead of up, and the branches flow down and out instead up up and out.

It's threedimensional, multiply branched, hugely twigged, and has a massive number of tiny leaves.

There is skin all around it.. in fact the leaf canopy is embedded in skin.

Can you see how different positions could affect it, bend it, twist it, distort it? Can you think what might happen if it is sensitized somehow? Do you really think "good" posture has anything to do with relieving pain? Or do you think maybe slumping or turning the feet out might actually relax the system...?

[stregapez]

I don't have a complete picture of what the average pt (or anyone really) considers "good" posture. I gave some examples above. The crossed legs thing is a good one ~ I've seen suggestions by mts not to sit with legs crossed, and it hurts mine to keep them crossed, so that, for example, seems like a valid suggestion. As far as slumping, I told you, if i sit bent at the computer for long it messes my back up. if I sit straightish *with back support* it doesn't nearly as much. Maybe that's different for someone else; i don't know. I don't really know how to have this conversation because i don't know what the points of contention even are. I agree sucking in your stomach probably doesn't create comfort and ease or lessen pain, but that's just one issue.

Dana

[Barrett Dorko]

Dana,

It isn't the posture you're in that is the problem but rather whether or not that position exceeds the tolerance of your nervous tissue for the mechanical deformation it creates. If you don't know the origins of painful sensation then what I just said won't make much sense to you.

Perhaps you'd like to start a separate thread on that issue and how posture affects it. As it is, this thread doesn't concern those basic issues of care.

[BB]

I think that Dana's points do have relevence here, to me anyway, because she is making the point that performing some postural changes that are consistent with what is also aesthetically pleasing, she can alter her pain response.

I think one reason that PTs get so caught up in the "right" posture (please refer to chart such and such, to see that your spine is 2 degrees off from the normal) is that it does, in fact, change pain in people to a degree. As a result of Kendall and many others, PTs are pretty well versed in the positions that place the least stress biomechanically through the joints and muscles. So, by assuming these "correct" postures, people often will reduce the mechanical deformation on their nervous system, to a degree.

The problem, is that all these aesthetic postures, in the typical PT sense, have never taken the nervous system into account.

I posted on the Abdominal stabilization thread how feldenkrais said that posture is not only about position, but how that position is attained. We can, I think, reduce pain through changing posture, but are most likely doing so by compensating with another dysfunctional mechanic.

As for a study about posture and pain:
Differences in measurements of lumbar curvature related to gender and low back pain.

Norton BJ, Sahrmann SA, Van Dillen FL.

See the "useless core strengthening" thread for the abstract. I've posted this article before but it never gets much attention. Probably because sahrmann is not popular here.

Regarding tests of function, endurance, and pain:
One test I have used before to relate these, is to have a pt. wear a heart rate monitor, perform a typically painful task. I look for the raise in heart rate associated with a sympathetic response, note the time, and I've got my precious objective number.

Great discussion! Thanks everyone
Cory

[stregapez]

I think that Dana's points do have relevence here, to me anyway, because she is making the point that performing some postural changes that are consistent with what is also aesthetically pleasing, she can alter her pain response.



That was part of my point, maybe with the exception of (not) crossing the legs, since crossing your legs, at least if you're female , is often perceived as more attractive, and sexier, than having them side by side (or even splayed, which is sometimes more comfortable for me)

Thanks much Cory. I'll check out the threads and the abstract.

And if I continue discussion of what I've been talking about i'll do it in a different thread; no problem.

Sort of on topic (I think) I do think health and standard definitions of beauty sometimes correlate, though sometimes not too.

I also think beauty is subjective for many people. Lately I think rounder (even overweight) men are more attractive, and sexier I guess, but I'm not convinced that thin men don't tend to be healthier in some ways (and the roundish one i love keeps telling me i want him to be unhealthy as exhibited by me telling him he looks good even though he's not thin) The general health and beauty topic thing would be an interesting discussion, but i'm afarid to continue that here either, plus i have other issues i ought to focus on on this board.

Thanks all, again, for providing a place for discussion.

Dana

[nari]

Performing acts of daily living, including sitting and lying without pain, is a goal many, many PTs and others would love to attain.
The problem I see is a visual one; how can we effectively teach what is invisible? Imagining the nervous system is easy for some of us, but for your average patient who is unaware of its strategic role and only aware of muscle, bone and ligament...downright difficult.
And it is difficult for biomechanical PTs to look past muscle and body shapes, because they are visibly dynamic.

Can we find a really effective way to imprint nervous systems on PTs' minds? Can we ever run lectures and talks on pain management without reference to this muscle or that one??
It is going to take years to 'convert'. No wonder Barrett finds it hard to mitigate the biomechanical flow.

Perhaps this concept of downplaying the visible stuff will become the major function of this board with a logo of the upside-down tree that Diane mentions.

Nari

[Diane]

This image of a tree (http://www.oregonscenics.com/oak-trees.jpg) is not bad for 30 seconds of looking.. but I don't know how to turn it upside down at the moment. :)
And it needs a visible root ball.

[nari]

Diane

Do you have photo-manipulation software of any kind?

I may be able to play with it with my Painter5 software and I could certainly have a go at putting in the rootball. (Endless possibilities with good ole Painter) If I end up with anything similar to that criterion I'll send it off to you...but don't hold your breath....


Nari

[Diane]

You go Nari Van Gogh. :)

[EricM]

Maybe you'd like this tree Diane.

[Barrett Dorko]

The need to understand the “invisible” aspects of dysfunction isn’t new. Some time before he died in 1541 the German mystic/physician Paracelsus said this:

The physician should speak of that which is invisible. What is visible should belong to his knowledge just as anyone (can) recognize symptoms. But he becomes a physician only when he knows that which is unnamed, invisible, immaterial yet has its effect.

Discussions regarding the nature of how the body actually functions (as opposed to how it appears to function) are perfectly appropriate for this forum. This thread is about why we focus on the surface with a tenacity that we can’t seem to relinquish. Ramachandran gives us good reason to suspect our instincts drive us, and with some work these can be controlled. I’m reminded of Schopenhauer’s admonition regarding unconscious desire and our consequent behavior:

You are free to do what you want – but you aren’t free to want what you want.

Today I believe that many therapists stay with postural examination and correction primarily because understanding what can’t be seen requires more study than they’d prefer to do. Not a popular opinion, I know.

[nari]

Barrett

I don't think we are really wandering off thread - just looking at concepts which may help to visualise the invisible. OK, we are distractible, I agree...

Eric
That is a splendid tree. Not a muscle in sight.

Nari

Addit: A major glitch: Painter5, being the grand old age of 10 years, can't import pictures from anywhere except within its own network. Including Word.... bother.

[Barrett Dorko]

I think the tree is great as well, and it fits the thread.

[BB]

Preparedness theory talks of an inherent potential. When monkeys were shown a snake in the presence of their mothers, a fear of snakes developed that did not develop if they weren't in the presence of their mother. Moreover, other less biologically relevant items did not cause the same potency of fear conditioning. In other words the monkeys became afraid of snakes by seeing their mother's reaction, however, the biologically relevant danger of snakes made the response stronger.

Quoting from "The Emotional Brain" by Joseph Ledoux:
Ohman believes that evolution has equipped contemporary humans with a propensity to associate fear with situations that thretned the survival of our ancestors. To the extent that this propensity evolved, it must be based in our genes, and genetic variation must therefore exist.

He thinks that we are instinctually afraid of certain things. I bring this here because of its similarity to our instinctual need for beauty.

So, a visual stimulus goes to both our lower brain centers and higher brain centers, but, as a result of how we are wired, reaches our lower centers first. Therefore our instincual response will be our first one. In order to deal with this reaction, which is not always reliable, we must possess higher center control.

Our instincual response will happen first....nothing we can do about that, but if we learn to be conscious of this reaction, we can recognize its presence and exert higher corticol control to our reaction.

We must learn not to trust our "gut instinct" when looking at our patients, because our gut is responding based on our own survival mechanisms, not those of the person we are trying to help.

Cory

[Barrett Dorko]

Cory,

Exactly. I wish I had said it this way earlier.

[Diane]

Cory, I think you are onto something here. I've read about the monkey-snake thing too, in Matt Ridley's book Nature Via Nurture.

About a genetic basis for appreciation of symmetry; after (finally) getting I-tunes (and a new intel I-mac, which I am loving) and listening to Ramachandran's synesthesia pod-cast about peak-shift etc. (stimulated in our brains no doubt by the ballerinas and figure skaters), I remembered something else about birds.

Ramachandran was talking about the propensity of baby gulls to peck the red spot on their mothers beak whereupon she would regurgitate food into them. (Does nothing for my personal peak shift, but never mind..) Researchers then found that they could manipulate this tendency and get the babies to peck a red spot on a stick, and peck more furiously if they turned the spot into a set of stripes. This is technically what peak shift is, something artificial that stimulated birds harder than mere reality.

It ties into sexual selection, where female birds will choose a mate who has the biggest tail fan or crest or whatever. And female birds are picky about symmetry! Apparently males who have feathers that when fluffed do not provide a pleasing symmetric profile tend to have lost feathers, usually due to parasitic infection. And these males don't get to get close to the females. It's a survival mechanism that evolved in females - presumably the females that weren't as picky didn't survive a parasitic infection bestowed upon them and the brood by the suitor.

We probably still have that gene buried within somewhere and it still likely gives rise to unconscious aesthetic notions about balance and form, which is all fine.., but it really should be down regulated rather than upregulated when it comes to matters of pain and ability in the human organism.

[BB]

Diane,
This makes me think about how difficult it is to get a patient to make a change that is not aesthetically or culturally pleasing (ie. uncontracted abs) as Barrett often talks about.

Are we dealing with the same phenomenon here as well? If so, it may be more than just vanity we are up against.

Cory

[nari]

Ramachandran also refers to the 'universal aesthetics' notion and in his notes to The Artful Brain chapter (note #4), he wonders about the effect of Picasso's work on the masses; its nonconformity of style and distortions of the human face/body only instantly appeals to a proportion of people.

...most people are in denial about it.
...the mind isn't just one "thing" - it involves the parallel activity of many quasi-independent modules. ...when we talk about something as complex as an aesthetic response, it is sure to involve many stages of processing and many layers of belief. (my italics). In the case of Picasso I would argue that the "gut level" reaction - the "a-ha" jolt - may indeed exist in everyone's brain, caused perhaps by early limbis activation. But then in most of us highr brain centres kick in telling us, in effect, "Oops! That thing looks so distorted and anatomically incorrect that I had better not admit to liking it"...
Only when these subsequent layers of denial are peeled off can we begin to enjoy a Picasso....
Ironically, Picasso himself derived much of his inspiration from "primitive" African art.

I might also add, that people will say they love Picasso because of fear of being seen as ignorant and to stay in line with the Arty set. Or am I just being cynical and these people actually like him?

[Diane]

This makes me think about how difficult it is to get a patient to make a change that is not aesthetically or culturally pleasing (ie. uncontracted abs) as Barrett often talks about.

Are we dealing with the same phenomenon here as well? If so, it may be more than just vanity we are up against.

I think we can shift them over to a felt sense of beauty. In fact I think learning to access a beautiful feeling is a key that can let people out of the prison of a pain-ridden existence, but of course they have to learn to let go of their oppressive visual cortex and let their attention come off how they think they "look".

It's hard, because vision is an oppressive sense, and culture has colonized it, and PT culture along with other treatment cultures have perrpetuated it. But on the other hand, as Skoyles and Sagan say in Up From Dragons, the easy access we have to mirrors and pictures and artificial images has only been in the last few centuries. Before that, we existed for thousands of years relying on our internal sensations of well-being and didn't presumably care as much about how we looked or compare ourselves so detrimentally to how others looked. So maybe (because it's already built-in), feeling OK about letting the abs relax and breathing consciously with them is a non-conscious skill set that's on our side, that can be our ally in this little battle.

As more and more info comes out I think this more "sensible" idea will gain leverage. But there are a lot of memes to continue to slay meanwhile.

Picasso was a brilliant drawer; as a child who didn't talk much, he would scratch with a twig pictures of bulls in beachsand that looked so alive they looked like they could breathe. (I thought of that when I saw the slide of the horse drawn by the autistic child in Ramachandran's lecture.) I think the art critic community was sold on him long before he started with the cubism. I think they were by then his slavish adorers who he could do anything with and get away with it.

[nari]

I didn't know about Picasso's early skills; those who were aware of this would accept his change into cubism more readily. I wasn't aware of it, so that is probably why I don't like his funny figures.

Cory,
I think it may be more than vanity - perhaps it is still the idea of strength = wellbeing and fitness. Sometimes that is fine, but not for the chronic pain person. Besides that, the abs are so emphasised these days it is hard to resist the need for tautness; especially in this current climate of obesity.
After all, some people do not mind being fat (we're not talking just overweight here) so vanity is not the only thing. Perhaps excess food and inactivity are the main drivers which overcome vanity.

Nari

[Barrett Dorko]

Well, it took 50 posts and 5 days to get the thread to this point but I think it's been worth it. As originally stated, I wanted this to be about why we looked at our patients in hopes of seeing certain things, not how we did that, and this distinction seems to have been drawn. I can point my classes to this with some confidence in its content.

I think there's a difference between not liking certain forms of art and not getting it. The former probably won't change no matter what but the latter can be altered with education. This can also happen to our vision and interpretation of our patient's appearance. As always, a biologically plausible deep model is essential here.

[nari]

Perhaps the why is related to the template or blueprint which dictates survival for us; and we have to understand this first, before even beginning to change our perception. We can't change that until we understand this template that drives us..
I discussed this last weekend with a good friend (a physio) and her response was that biomechanical efficiency - minimal effort from supporting structures, ease of motion, all tied up with balance - is a result of 'good posture'.

Mechanically, this makes some sense. She then extrapolated into the training aspect, and the theme got muddled; but it was a classic example of mechanical thinking. Head, shoulders, pelvis. etc in balance...until we actually move to do something, and it falls apart. In comes core stabilisation, to protect the prime movers during effort. At that point, the topic faded away...

The desire to change something to fit an aesthetic template is very strong. We tidy up the house so it looks neat and structured; we buy clothes that enhance our perception of neatness, colour, shape. But the messiest houses and daggiest clothes often indicate a person who has moved away from a template of aesthetics and is occupied perceiving other more important things.

If we look at a patient whose bits and pieces don't conform to the template - we 'fix' it up. As far as the patients go, they are usually unaware that their posture does not suit our perceptions, though they have an idea they aren't conforming to the norm.
But, effectively, they don't care much. We do, because we are trained to look for faults, not to recognise natural variances or bodily comfort for the patients.
Until we can move away from this notion of conforming to an aesthetic ideal - I wonder if we will ever get it.

Apart from wandering in circles in this post, I can think of an algorithm about these whys developing. I suspect jon would, too....:)

Nari

[EricM]

I have just received a copy of my associations directory. On pg. 163 (if your interested) (or online at tips (http://www.bcphysio.org/app/index.cfm?fuseaction=pabc.health_tips) there are several "Tips for Mobility" written to inform the public about what physiotherapy can do for you. As if to emphasize the topic of this thread I thought the following statement was interesting.

"Standing or sitting tall not only improves your breathing and prevents pain - you'll look and feel better."

With my own professional association producing such nonsensical statements such as this, is there ever any hope of change?

A few more from the same site...

"...be aware when you're feeling tense, or relaxed. When you're aware, you have better control and you'll feel better!"

"...for minor aches and pains, use an ice pack for up to 15 minutes to help regenerate for the next day."

sigh,

Eric

[Diane]

I just leafed through my new edition of the Canadian PT journal, saw a couple of obits featured prominently, saw that one of the deceased had been in the army before graduating as a PT in 1948.
I think we can blame the army for the posture meme. After all, it was army people who got the profession launched. They are big on symmetry, uniformity, standing tall no matter how uncomfortable it may feel, etc., all that stuff.

[EricM]

Hard to believe it has it really been over a year since this thread played itself out!? I'm reviving it now, as while browsing Deric Bownd's Mindblog, I found the article Esthetic experience and Mirror Neurons (http://mindblog.dericbownds.net/2007/06/esthetic-experience-and-mirror-neurons.html) and thought it would make a good addition here. A link to the pdf for the article can be found near the top of the blog entry.

[anoopbal]

Besides making the understanding of chronic pain more elusive,I think all this advice about having the right posture and movement is only helping in making the condition of the patient worse.

Its a good example of how a health clinician perpetuates the fear avoidance beleifs of the patient, which invariably leads to pain catastrophizing, resulting in maintaining and worsening of chronic pain. I think there is now some solid evidence about the fear avoidance model in maintaining chronic pain.

A good book about our perception of beauty is" Survival of the Prettiest"

Anoop

[Jason Silvernail]

Anoop -quite right. Yes, it must be that they just aren't standing straight enough. That must be the problem [rolls eyes]

Diane-
While I'm perfectly willing to blame the Army for many things, I think the posture thing has gone the way of the dodo. When standing in formation it was emphasized, but when I was in boot camp 15 years ago (god, was it that long ago?) posture got almost no attention.

I think the PT and personal training cultures are far more to blame at this point for the posture myth.

While almost all patients experience a good deal of relief when they find out what I think about posture, there are some who vigorously defend this as important. This has proven (at least for me) a good litmus test of who will be open to instinctive movement and who will not.
Plus, it's important for me to know who to dismiss as soon as possible...

[nari]

I also found that the vast majority of patients were relieved that they did not have to be tin soldiers (no offence, Jason ;). Many older folk were only too happy to 'let go' and relax; but the few gym junkies I saw were less enthusiastic. "But you're a physio" was their response.

Not to mention that the greater part of my life as a PT was spent re-educating 'plumb-line' posture; and such stylised correction probably lasted 5 minutes. Another way of dooming a patient to fail, in their eyes anyway.
In our Yellow Pages there are dozens of non-PTs emphasising posture correction and pain relief. It's a strong message.

Nari

[anoopbal]

Hi Jason

Since you wrote in a recent post about how some injury could be prevented with some emphaisis on the muculoskeletal system, I was wondering if athletes or weight training athletes fall into this category. Mind you, I have seen people doing rouned back stiff deadlifts with no problem too. Just curious, if you see something different in this set of people.

And how do u like Germany so far?

thanks
Anoop

[Diane]

Jason,
I think the posture thing has gone the way of the dodo. When standing in formation it was emphasized

Perhaps it has, for regular daily activities, but it is that formation thing that so impresses the crowds. I suppose I shouldn't have only pointed a finger at the army - there are several male inspired group guarding activities that feature "posture", like cop parades (I don't think the uniforms would allow bending and relaxing to happen even if the uniform's occupant wanted to..), beefeaters, etc etc.

The sight of men marching stiffly in formation does something to peoples' mirror neurons, I suppose, same as ballet does. Or figure skating. Or the show, "So You Think You Can Dance". Extended lines look impressive probably for the simple reason they are so hard to maintain. But that's no reason for ordinary people to try to turn themselves in longlined caricatures of what they are impressed by. Or for PTs to have developed elaborate and baseless justifications to try to turn patients into the same.

[Jason Silvernail]

Diane-
Agreed. There are far too many groups producing the posture meme, though the appearance thing in the military (as opposed to posture itself) is still going strong.

Anoop-
Since you wrote in a recent post about how some injury could be prevented with some emphaisis on the muculoskeletal system, I was wondering if athletes or weight training athletes fall into this category. Mind you, I have seen people doing rouned back stiff deadlifts with no problem too. Just curious, if you see something different in this set of people.

You lost me. Can you clarify what you mean? I don't recall this.

[EricM]

This thread seems to have found it's legs again. I'm going to play devils advocate for a moment. If you or I or anyone thinks that they look better by 'posturing' in some way, and that by looking better they subsequently feel better about themselves, or feel good about the effort they are expending towards bettering themselves, could this not have a positive impact on non-conscious processing involved in producing pain? Is this why work emphasizing correcting posture sometimes does reduce pain?

[anoopbal]

You lost me. Can you clarify what you mean? I don't recall this.


I have to say that my clinical experience and some injury prevention research has shown that assymetry in muscle extensibility and joint range of movement has been associated with overuse injuries. I'm not sure if such assymetries are compensations post injury or if they develop in another way, but there is some good data about that. I tend to think of this asymmetry as not related to posture or APPEARANCE, but rather to MOVEMENT and function, which we can all agree are different concepts.

I tuink I was reffering to the post above. I am not sure if I misintrepreting. But I assume this could be relevant to training athletes since they are prone to overuse injuries.

Thanks
anoop

[anoopbal]

Is this why work emphasizing correcting posture sometimes does reduce pain?

I think its a great point.

I have read about how there was a reduction in low back pain with just patient education without any sort of intervention. I think the same is happening here. , somethingh like a placebo effect.

The patient's strong beleif that if I adopt this posture I am goona get better bcos I have a bad posture and everyone, even my Pt, thinks that why I am getting the pain. And even if there is some pain stemming from that posture adopted, the brain ignores ( or dampnes) bcos of the postive beliefs and emotions associated with it.

Anoop

[EricM]

That's what I was trying to say, thanks Anoop. Unfortunately, unless by chance, this method is unlikely to address the true origin of the problem in any specific or enduring way.

[Diane]

Yup. Pretty hit and miss.

[Jason Silvernail]

Anoop-
I'm not sure what to say here - perhaps this is a chicken and egg thing. I think there is some pretty good data on the shoulder complex, in terms of the "muscle imbalance" concept.
I think there is something to this, but exactly what and in which cases is harder to say.

I think in most cases these sorts of "imbalances" are overdone and over-interpreted as the "cause" of pain. People in pain tend to guard and have restricted motion. This is where the posture person says "aha!" - your xyz is tight, and that's why you're having this problem!
They misinterpret the findings and misinterpret causation.

Having said that - in many patients, I do address some of these issues - I do still prescribe some stretching exercises for many people with more traditional overuse sports-type problems. I have come to see stretching not as improving a muscle's length but in providing motion to oxygenate the relevant nervous tissue. Though I treat many people with mesodermal problems who need mesodermal solutions.

Have I said anything remotely useful in this post?? I need to go to bed...

[Barrett Dorko]

I’m glad to see this thread brought back to life. I often mention it to my classes but find that almost nobody takes the time to dig for it. Now it’s been uncovered again. Thanks Eric.

I said in the first post here, “What Ramachandran attempts to do with reason and evidence from modern neuroscience is to explain how and why it is we are drawn to certain shapes and images.” I want to expand upon that a bit.

The nascent but carefully examined field of evolutionary psychology (http://en.wikipedia.org/wiki/Evolutionary_psychology), also called “sociobiology” and first introduced by E. O. Wilson (http://en.wikipedia.org/wiki/Edward_Osborne_Wilson) (one of my favorite guys) fits here, I think.

It’s a big subject, but as I read about it, I often return to the idea that our behavior is primarily driven by our need to survive. It follows that those situations that make us feel as if our survival is assured will be sought and created. I may be simplifying this a bit much, but I’m often reminded of this when I see the cultural grow precisely in the directions of symmetry, apparent strength and beauty. Wouldn’t this image in the mirror comfort you? Wouldn’t working to create this body in the mesoderm of a patient comfort a therapist?

Maybe the senseless nature of postural correction has more to do with the survival instincts of the therapist than we’d previously considered.

How are we to change that?

[anoopbal]

Hi Barrett

I think some of your posts have a lot more than it strikes to the eye. Just makes you think twice.

From the post above, You will love this book by Nancy etcoff," Survival of the Prettiest".

http://www.amazon.com/Survival-Prettiest-Science-Nancy-Etcoff/dp/0385479425/ref=pd_bbs_sr_1/002-1231460-5446463?ie=UTF8&s=books&qid=1183412197&sr=8-1

Anoop

[nari]

This could link in, somehow, with the increasing obesity issue in the Western world. We do like symmetry, form, aesthetically pleasing shapes...so why is the earth getting leaner and people fatter and slower?

It would seem as though our need for survival is based on instant gratification of personal needs; readily available food, expensive housing, cars, holidays....and predictability.
If we are promised less pain, more energy, better muscles, better shape with posture correction - then that is a powerful placebo in its sense of predictability. At least for a span of a day or so.
We like promises.


Nari

[EricM]

Anoop the book does look interesting. From what I understand by reading its review, even if it is true that beauty has survival advantages, it is not what patients come to us for. I don't think that upon reflection anyone can make the argument that pain has any correlation with attractiveness, not pain of a mechanical origin anyways, yet that is precisely what many do whether they know it or not. Another fatal heuristic. Yet, the PT profession is built around evaluating the movement of others. Have we been looking for beauty in the wrong places; is it possible to find beauty in relevant observations of movement?

[Diane]

If it's beauty we should be trying to go after or to help our patients find, I think it should be beautiful effortlessness, ease, pain free-ness, beautiful personal relationship to our physicality.

[anoopbal]

Anoop the book does look interesting. From what I understand by reading its review, even if it is true that beauty has survival advantages, it is not what patients come to us for.

True. I meant the book for people interested in learning more about evolutionary psychology and the concept of beauty and symmetry. Lots of info about what we consider beautiful or why we consider it beautiful and how it all began. Nothing much to learn abt the connection between pain and beauty I am afraid.

Anoop

[anoopbal]

This is where the posture person says "aha!" - your xyz is tight, and that's why you're having this problem!
They misinterpret the findings and misinterpret causation

Very true. And most biomechanical studies which looks pain as the end point have found some confounding results. More or less expected, considering the involvement the CNS. However, the problem is that these studies are done by biomechanical experts who always tries to understand and explain the results from just a biomechanical perspective and ignores the neuruphysiology bcos of obvious reasons.

I think now research is getting more and more integrative in every field. You see departments collabarotaing in writing grants and conducting experiments.

Anyway, back to the question, I am just curious to know if there is some benifit to muscle balance or improving movement patterns or focussing on the biomechanical model when it comes to training athletes. What do you think or have you had some experince?

Anoop

[Jason Silvernail]

Anoop-
Good question, it deserves a thread of it's own [hint, hint].

Your thread is here (http://www.somasimple.com/forums/showthread.php?p=34243#post34243).

[Jon Newman]

The Golden Beauty: Brain responses to classical and renaissance sculptures (http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=18030335)

I think someone already posted this summary (http://mindblog.dericbownds.net/2007/12/experiencing-beauty-in-art-biological.html) from Deric Bownds.

[Barrett Dorko]

Jon,

This post sent me scrambling for some words from Elaine Scarry (http://en.wikipedia.org/wiki/Elaine_Scarry), a woman who understands pain as few do and from whom I quote at every course.

She’s also well known for her thoughtful comments about beauty and its effect on the culture and our individual behavior when we sense its presence. This is an intricate topic but very important when you’re trying to get therapists to understand that appearance and pain are essentially unrelated. The problem is that we instinctively react to what we see in ways that may not prove to be therapeutic. Only by examining the instinct can we hope to overcome its expression when we find it other than helpful for our patients.

To get some idea of Scarry’s brilliance I’d recommend this interview (http://www.salon.com/books/feature/1999/11/09/scarry/). Here Scarry connects the concept of beauty to justice and injustice. Years ago I heard her say that in our culture today “the opposite of beauty isn’t ugliness – it’s injury. We think that when someone isn’t beautiful that they need treatment of some sort; they might need surgery.”

In the interview she points out that the words “injury” and “injustice” are the same, and though I’m not sure of the significance of that, I know better than to argue with Elaine Scarry. But what might this all mean for therapists who focus on what they see of the patient rather than what they sense otherwise and what they know about a deep model that cannot be seen?

[Diane]

For a deep model that cannot be seen, they substitute a less deep model that can be, at least in imagination, i.e., the pain-comes-from-joints model.

[Baecker]

What about posture and personality, I am sure I am going to get it but anyhow.

Imagine the extrovert confident type I hardly imagine him/her to in a slouched type of posture. Rather more upright posture etc.. Now for the introvert shy type he/she is normally slouched type, round shoulders etc..

I know this has nothing to do with pain but people just rather like/ find attractive the first type. Same reason many people wouldn't find the hunchback really attractive. Maybe thats the reason we want our patients to look more attractive?

[nari]

Baecker,

You are probably quite right. We, in general, do respond positively to what we consider an ideal presentation of the human figure. Probably half the attraction of watching ballet dancers and gymnasts is their precise choreographic poses. (I actually don't like watching ballet)

If someone walks into a room full of people, a more positive response will occur if he/she is upright, attentive, smartly dressed, well-poised and not slouched and covert. Real estate and car salespeople know this.

Unfortunately it is not necessarily related to the usefulness of that person to society.

Nari

[christophb]

Unfortunately it is not necessarily related to the usefulness of that person to society

or authenticity, I'm generally more suspicious of those confident poised types.

[jlsmithivan]

I just got into this thread and was lamenting my being 10 months too late to comment, that is until now. The whole discussion about posture/culture/beauty/etc and references to Picasso made me think about why people who are not "art educated" still like picasso's work. It especially brought to mind the cover of Explain Pain. maybe picasso had some good insight on how to get us to think "deep" in a way that does not need the tree model. maybe picasso had at least part of the idea using the human body upside down or sideways or otherwise atypically organised/displayed/arranged/disproportionate for a reason and by combining this thinking with the upside down tree we could come up with a better/faster visual learning tool. we could even put some of the inside on the outside "anatomically speaking". i think i may have said something good here. happy new year.

[Diane]

Well, this just appeared on Mindblog (http://mindblog.dericbownds.net/2007/12/motion-perception-and-production.html):

Neural representations of kinematic laws of motion: Evidence for action-perception coupling (http://www.pnas.org/cgi/content/full/104/51/20582).

Looks like there'll be plenty of food for thought in there. I can't wait to tear into this.

[Randy Dixon]

As an introvert, I am going to have to take exception to Baecker's descriptions of introverts/extroverts. You can't judge a personality trait such as this by merely looking. Introverts are not necessarily lacking in confidence, nor or they more likely to have rounded, hunched shoulders, nor are they shy. Extroverts are not confident, outgoing and having "good posture", merely by virtue of being extroverted.

While this may seem picky, it seems that it merely shows how ingrained these ideas about appearance, personality and health really are.

[nari]

I didn't take up on Baeker's description of introversion/extroversion; what I took from his post is that we do partially judge people by the way they look, nonconsciously and consciously.

I agree with Randy - introverts and extroverts do not adopt specific and indentifiable postures. Introverts are not shy, per se, they just aren't interested in the art of chatting, winning over and influencing people. I suspect that some extroverts may actually be overcompensating for lack of confidence.

Nari

[Jon Newman]

The neurocritic has an intriguing blog entry on art and pain reduction. (http://neurocritic.blogspot.com/2008/09/pain-paintings-beholding-beauty-reduces.html#links)