Postural Restoration

[Barrett Dorko]

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

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

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

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

I spent a portion of the morning reading through the Postural Restoration Institute’s (http://www.posturalrestoration.com/) web site and find myself both confused and fascinated.

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

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

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

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

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

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

Let’s get Ron over here and talk about this. I'd also like to see the student who objected to my problems with Hruska's theory join in.

[Diane]

I checked out the site.. some nice artwork there.

This has nothing to do with the debate on this thread, but I was struck by the resemblance between Ron Hruska and my favorite Canadian comedian (http://www.cornergas.com/whoswho/?bio=0). Could they have come from the same part of the human gene pool? :)

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

[stregapez]

Barrett,

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

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

Dana

[stregapez]

If I do write him I will make sure to correct any typos first :)

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

Dana

[Barrett Dorko]

I think you're right. It would be better for a fellow PT to invite him.

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

Mr. Hruska has had many students and his site has a page full of testimonials from those who think he's done some amazing work. They are welcome to join in.

[stregapez]

Ok, good call.

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

Dana

[Barrett Dorko]

Diane’s comment about “working backwards from what is seen in order to create a management program” is precisely the issue addressed in an essay I wrote a few years ago. See The Alien View (http://www.barrettdorko.com/articles/alien_view.htm).

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

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

The attitude of the person whose theory is being questioned, I mean. Not my insistence on defense.

[nari]

Nowhere else is this more relevant than in post-surgical protocols; developed as a generic therapy across the board for young and old, for a 'standard' procedure. Admittedly, the protocols are developed in cahoots with the PT (in Australia, anyway) but it is mainly done to keep surgeons on side. It demonstrates that we are there to treat the side-effects of the surgery in the first instance.

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

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

Can you elaborate again your thoughts on this?

Nari

[Barrett Dorko]

Nari,

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

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

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

[nari]

Thanks, Barrett.

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

Nari

[Barrett Dorko]

I've looked carefully through the institute's web site and cannot find any indication there of what a course actually costs. I wrote a couple of days ago requesting this information and will let you know what I hear.

The woman from Minneapolis has not yet looked in here, as far as I can tell. As I said, I've not personally asked Mr. Hruska to help us with this discussion.

[nari]

Barrett

I found under the 'course' tab:

(Basic?) course, 15 hours $350

Advanced Integration Course $700

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


Nari

[Barrett Dorko]

Thanks Nari,

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

I also remain uncertain just what exactly it is they're treating.

[nari]

Disobedient musculature? Nonconforming sarcomeres? Aesthetically displeasing presentation? ;)

I'd like to know too.

Nari

[Barrett Dorko]

Late yesterday afternoon I sent the following email to the email address for general information on the PRI web site:

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


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


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


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


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


We look forward to your joining us.

Barrett L. Dorko P.T.

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

In the meantime, anybody else have something to say about this approach? It seems that my troubled student from a week ago hasn't yet arrived here.

[Bas]

Sorry - no. All I thought when I read the name "Postural Restoration" was: to what?

[Barrett Dorko]

I asked for confirmation that someone had recieved my message and just got this:

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

Perhaps others here can ask a couple of questions before then.

[Barrett Dorko]

Today this arrived:

Dear Barrett-

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

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

Sounds like we're getting closer to the therapists actually following the theory proposed on the site.

[Jason Silvernail]

I wonder what sort of outcomes they are reporting? I also wonder if they are engaged in any type of research? Even a case study?

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

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

J

[Barrett Dorko]

I would like everyone to please note that Jason said this and I didn't. No telling what I might be thinking though.

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

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

It sure didn't seem that she was done objecting to my lecture. Where is she?

[Barrett Dorko]

Here's the reply received today.

Dear Barrett-

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

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




So,it appears that information from PRI comes at a price.

[Diane]

And if you pay good money for something called "science", then it must be worth every penny, right?

[emad]

Please ;Could i comment :note:

I like to reserve a place ;)

Emad

[Jason Silvernail]

Ooh, "Myokinematic Restoration" - it sure sounds like science!
:sad:

J

[nari]

Another case of 'this is my science', perhaps.

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

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

Nari

[Bas]

"myoathrokinematic re-educational patterning"
"myologic de-pathologisation"
"myofibric reorganisational therapy"
"my god it's a plane"
"myographic restructuring"
"myotonic balancing"
"myomy - it's hot"
"myofascial cosmetic postural correction" (grab the hair at the top and pull hard....)

you're right nari...I'm running out. Should I do a copyright on these?

[Jon Newman]

It's like a sandwich, a little myo makes things better.

Perhaps a better closing for their letter would have been this (http://bau2.uibk.ac.at/sg/python/Sounds/HolyGrail.wav/taunt.wav)

[Jon Newman]

I am also happy to answer questions that can be sent directed to this email address.

Barrett,

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

Thanks.

[Barrett Dorko]

Jon,

It's janie@posturalrestoration.com

This afternoon I got an email from Raulan Young, an associate faculty member of PRI. He detailed things such as the "polyarticular chains and zone of apposition" that Mr. Hruska speaks of. I suggested he post what he said here. If he doesn't it won't be because he doesn't know how.

[ollyhall]

Hi Barrett,

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

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

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

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

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

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

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

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

Many thanks for the questions and interest in PRI

Oliver Hall, PT,PRC

[Jason Silvernail]

Oliver-
Thanks so much for coming here and engaging in a discussion with us. It shows some courage to come here given some of the previous posts, especially from me. :)

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

Jason.

[Jon Newman]

Hi Oliver,

I'm glad you've been able to find our humor humorous, (understandably) not everyone does. My first question is about this concept of idealized symmetry. Isn't lateralization of function considered normal development?

[ollyhall]

Hi Jon, you asked a question that we hear very frequently with Postural restoration. Yes, lateralization is normal, however regardless of if someone is L or R side dominant, the clinical presentation is the same, it does not switch sides to accomodate handedness. The L hip will still be more limited in adduction and extension and the R shoulder will be more limited in internal rotation.

[Jon Newman]

Hi Olly,

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

[Luke Rickards]

Olly,

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

Luke

[Jon Newman]

It's comments like this from the Omaha World Herald (Dec. 17, 05) that get me to ask the question about lateralization


"The body has to work a certain way," Cook said. "What happens is in volleyball, they do the same movements repetitively over and over, so they develop patterns and their body gets out of balance."
For example, a right-handed pitcher who can't throw as effectively left-handed is unbalanced. Volleyball players develop similar asymmetrical tendencies. That imbalance manifests itself in pain and injuries, in fatigue and in concentration lapses, Hruska said.

The reporter, Dirk Chatelain, seems to have paraphrased that last part so perhaps he got it wrong but it makes it seem as if lateralization is being cited as a problem.

[Diane]

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

Glad you could make it over to visit us here, on SS. :)
To indulge us here a little (for we are trying to clinically reason in a language that is new to many manual therapists), could you tell us what your system is about in terms of neuro function, neuro anatomy, neurobiology, neurophysiology, any one of those or any in combination? Especially the following points you make:

You mention that asymmetry is the “norm not the problem”. I believe this statement is a reflection of therapist’s frustration of not knowing how to treat the problem.

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

Postural restoration does not just say that you are asymmetrical, but that you will be asymmetrical in very specific patterns (ie a common compensatory pattern

If you can accept the existence of a common compensatory pattern, then it makes sense that any isolated segmental deviation from this pattern will necessitate excessive lengthening of soft tissue.

Why don’t we all hurt? Well, in many ways I think most people do hurt to a certain degree.. muscles will become overworked and trigger points will develop – as an example how many people have trigger points on their vastus lateralis or in the sub-occipital area – this is a form of increased tension that may not initially register as pain, but as physical demands increase these can very easily become tender and bothersome, maybe not at that specific location, but the increased tension in these muscles will necessitate altered function elsewhere in the body.

Back muscles are also likely to become tight and painful, as we are in a twisted state that puts the L hemidiaphragm in a poor position to work. In this position our spine is twisted, putting strain on facets, ligaments and disks and our back muscles work to lift our anterior ribs in an effort to compensate for the inefficient use of our diaphragm. Looking for evidence of a poorly positioned L hemidiaphragm? Check how many of your patients have a rib flare on the L vs the R.

How do we treat posture? Well there’s a lot more to it than telling patients to stand up straight. We treat the polyarticular muscle chain imbalances that pull us into a twisted common compensatory pattern.

if he could not show instant changes in patient ROM and strength (improved length tension relationship) people would not be buying into his approach so wholeheartedly. Why do you think effects are "instant"? (I/m not disputing that they are, I'll take your word that they are.. but why?)

Postural restoration is an approach for therapists who understand that the body needs to be treated as an interconnected and interdependent being not on a joint by joint basis.

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

So I'd be interested in having all of the above translated into "neuro", if possible..

[nari]

Hi Oliver

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

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

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

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

Nari

[Barrett Dorko]

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

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

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

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

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

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

Well, when Pesci asked these questions it was chilling. I can’t quite convey that here, so use your imagination.

[stregapez]

Welcome Olli, and thank you for your time here. Your post was interesting and also inspired some interesting questions and observations from other posters which I am hoping you might respond to. . As someone who is still becoming educated on this subject, and is somewhat "on the fence" regarding it I look forward to hearing more debate and hopefully gaining a little more clarity on the issue.

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

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

Dana

[ollyhall]

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

Why are changes instant?

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

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

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

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

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

Olly Hall PT, PRC

[EricM]

But Olly, I have all of the above and don't hurt anywhere. What does that mean?

Eric

[Barrett Dorko]

Eric,

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

Olly,

You aren't just going to answer the questions that "interest" you are you? That's not the way it works here.

[EricM]

Should we be able to predict where we will hurt based on this system, and how much, based on the degree of asymmetry present?
Can't help but sense a whole lot of fuzzy logic in PRI.

Eric

[EricM]

Olly,

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

Eric

[stregapez]

Olly,

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

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

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

Dana

[Diane]

Thanks for your first round of answers Olly. I have more questions, but I'll get in line behind others, let you have time to answer their questions.

[nari]

How instant is instant? Seconds?A few minutes?

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

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

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

Nari

[Luke Rickards]

Let's assume
assuming everything I have said is correct

Well, that's just the problem. How does it work if we don't assume this?

Luke

[Jon Newman]

Olly, I'm getting the sense that your minute or two might be up.

[EricM]

Rogue Science (http://www.theonion.com/content/node/49180)

[bernard]

Hi All and Welcome to Olly.

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

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 (http://www.somasimple.com/forums/showpost.php?p=18686&postcount=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]

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]

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]

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,
:D 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. :D 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]

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?
Olly:Due 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?

[aléa]

I hope so, but there is a difference between looking for function and looking for posture.

[bernard]

Aléa,

As human and PTs, we are trained to see symmetry and harmonious movements. It taste "good" to our neurons but there is no direct relation between posture and pain. The primer may enhance the second but we do not know if it creates it.

Posture is a snapshot of a living people. A snapshot doesn't tell you anything about the movement content.

[Jon Newman]

I don't think this conversation is going to progress in terms of concordance of explaining the underpinnings of our therapeutic approaches. As a reminder, this is what the invitation was all about in the first place, versus telling us what is already on the website. Here's the original questions asked in the first post.

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

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

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

Upon reflection, there should have been no confusion regarding the tenor of the thread. I don't think what appears on the website or the very little offered by those at least making an attempt to represent PRI justifies the consequent method of practice, assuming I understand what that exactly is. In actuality I'm left unsure of what the consequent method of practice entails. I get that they do some diaphragmatic breathing (in an ultra fine grained method that also invites critical analysis) but what else goes on in treatment (regardless of how it is explained)? Is there any concordance at this level with other approaches?

[Barrett Dorko]

I see that this thread is about to drop off the top of the front page and I'd like to see it remain there for another day at least. Over 1600 views is meaningful, and the intense interest this subject has exposed, I assume, extends beyond the potential for personal conflict and comment that it might produce. I know some viewers are hoping for more of that.

I'd have to assume as well that the PRI practitioners out there have had their eyes on this and their chance to participate is passing by so I'd like to encourage them once again to answer some of the questions that have been quite respectfully asked regarding their theory. I know there are a number of you out there though Ron Hruska himself has made it clear he doesn't want to say anything at this time. Please remember that the questions are asked respectfully but that your answers might make some of us howl. There's no fixing that.

In 1905 Einstein had his first paper published in a German physics magazine. Of course, what he wrote was pure theory. The writing generated a lot of interest and debate so he rather famously wrote to a fellow physicist, "I am very happy to see that our colleagues are looking carefully at my theories - even if it is in hopes of destroying them."

I tell every class this story in hopes that they will come to understand that a scientist never mistakes a theory for their own self and that a criticism of one is never a criticism of the other. Can't therapeutic theory be like that? If a therapist cannot tolerate an attack upon their thinking can they be described as a scientist? Don't our patients deserve science behind their care?

[Barrett Dorko]

It's Sioux Falls South Dakota, Omaha Nebraska and Des Moines Iowa for me this week - otherwise known as "PRI Country." I've driven over 300 miles now through three states and let me tell you, they all look pretty much the same.

Maybe the amazing symmetry of the surrounding landscape forms the subtext of PRI's theory. Maybe the straight rows of, well, whatever it is they grow around here, has had some sort of mesmerizing effect on the practitioners of this method and thus has driven them to appreciate if not actually desire to see the same perfect line in their patients. I'm just speculating here, and without any of the PRI practitioners to talk to I'll just have to conclude I'm right - though I doubt it.

I can't help but think of Tomas More's line near the end of that great flick A Man for All Seasons: "The dictum of the law is 'Quin tace con secere.' Translation: "silence gives consent."

Today a woman familiar with Ron Hruska's strong and forthright defense of his work over the years expressed real surprise at his decision not to join us here.

All I could do was shrug my shoulders.

[Bas]

Barrett, as long as you don't provide a bulletted list of manual technical progression with a strong focus on A) musclelength, B) joint position, or C) posture, you're going to have an uphill battle. Unless you can present techniques that tap into the universal vibrational connection we all share but need lots of help with....
Maybe one other shortcoming of your approach is that you don't spell out what to see, feel, hear or do - AND, to add insult to injury, you don't even tell anyone exactly where and HOW to move!! Now, what are your students to do, for heaven's sake? Think and explore by themselves, with only understanding as tool?
All kidding aside, I am sorry that Olly and Cory 2 have left the building; although I can understand their decision. I would love to see more of the proposed assessment and treatment ideas, and how they justify them scientifically - but like all trademarked courses with advise to "take them to find out what they actually mean" (my interpretation of the "official response of the PR group), I refuse to hold my breath.
And, yes, I will become abrasive at times, when asking pointed questions is considered aggressive, or condescending, or denegrating etc etc. If professionals are set up to take a lot of money to teach an approach, they should be ready and even willing to proudly present the answers to questions about the approach!

Oh well.....I must be getting crankier - I am 54 after all....

[nari]

Don't worry, Bas. Another ten years and you'll wonder why you weren't more philosophical about the whole thing.

But it is true that Barrett does not supply information from A-->Z, so PTs can go back and regurgitate it like cormorants; I recall one course I did many eons ago where everything was written out on sheets: for discs, do A,B,C,D; for facets V,W,X,Y,Z...the only difficulty was that we couldn't remember the order without the sheets...half kidding, but that was how it was. Rote stuff.

Nari

[Jon Newman]

I recently listened to a podcast of Daniel Dennett and during the question and answer part of the podcast he got on to discussing different types of memes. There is the type of meme that is almost embarrassing, like some crazy jingle that you find yourself singing all day long. Then there are things like "the calculus meme" that don't seem to reproduce easily or naturally and they require care and nurturing for their survival. Then he goes on to remind his audience

Every time you say it or read it you make another copy in your brain.

Every time you say it or read it you make another copy in your brain.

Everyone! Every time you say it or read it you make another copy in your brain..

I think "posture" is like a jingle meme and about as useful and neurobiology is like a calculus meme. I know how people feel about calculus so I won't say anything about its usefulness (but it is).

[Diane]

The main calculus meme if I remember correctly (and I may not) is the quadratic equation, a useful mathmatical tool for describing irregular shapes and surfaces; a2+b2+c2=x2-y2.
My ectoderm wasn't ready to handle this type of meme in high school and I nearly failed math.. my average was brought down so low I still have the odd bad dream about it. Made it into PT school even with a lowered average though.. later I took Trig/calculus over again (7 years later) in uni for pre med, and my frontal lobes had adapted enough that it sank in rather easily second time round.. missed one little question or the score would have been 100%.

Thoughts, take away points:
1. Some memes like this one, make the brain grow, which is, I suppose why they are introduced in highschool. Other memes (jingle memes) keep the brain locked in a gerbil wheel and dumb it down.
2. The rate of exposure to a difficult meme has to exceed its difficulty or the meme will indeed be lost. Solution: start teaching about ectoderm in highschool. Ok, just kidding about that last part.
3. Difficult memes are less difficult second time round. Graded exposure. Literally. Get graded on how much exposure you've given the meme to your own thought processes. PTs shouldn't be allowed to graduate without passing a basic embryology course.

[Mike Terrell]

I have recently seen the A -> B-> C approach at an MET course. I will say this, it definitely makes therapists feel comfortable. I sensed this in myself. Memorize what different eval findings mean and then perform the appropriate Rx, which you also have had to memorize. This particular course made the material just complicated enough to make you think that it must be the right thing to do and that other courses would certainly be required.

mike t

[Randy Dixon]

I think Bas is right. It is very confusing for a new person to come here and try to understand what Barrett and the others are doing because it goes something like this:

Q: Where should I place my hands.
A: I don't know, wherever they need to be.

Q: What position should the patient be in.
A: Whatever position they like.

Q: So what do I do exactly?
A: Almost nothing. Just place your hands lightly on them and let them move.

You have to admit, that looks pretty evasive and doesn't give someone much to go on. It also seems pretty touchy-feely. It takes a long time for someone to understand the reasoning behind it and most people aren't going to see any reason to devote that time, except of course the possibility of a Cuyahoga Falls cap. People need more of an explanation that is accessible to them, even if providing specifics can actually inhibit understanding. It is like the use of an analogy (or even a simile) to explain a complicated concept. You have to abandon the analogy at some point but its use allows you to get to the next step. Jason's explanation about what he did in "OMG I got it" I think helps a lot of people, there should be a sticky to an explanation like that along with any disclaimers that it is merely an example.

I understand Barretts reluctance to do this. I used to wonder why he tried so hard to prevent giving specific instructions to others, to avoid being a guru, but having recently had some experience with someone who seems to very much like being a guru, I think I now understand some of his reluctance. It almost inevitably leads to a loss of critical thinking, exploration and understanding as well as criticism, perhaps because of this lack of criticism.

If you are serious about reaching more people through this forum then you should also consider more closely the impression presented here. I am a Libertarian, the only thing that ever makes me want to vote Republican is to listen to Democrats talk (my apologies to those outside of the States who may not know the difference). Why? Becasue they constantly talk about the superiority of their ideology (ok) while asserting the reason others don't agree with them is because they are too ignorant, bigoted, or insensitve to understand the issue. Since their goal is to recruit the people who don't currently agree with them this is a poor strategy. A better strategy is to point out where their beliefs and goals overlap and that with only a different viewpoint their beliefs are compatible. This doesn't mean that one can't be relentless and ruthless in pursuit of evidence and facts.

[Diane]

Randy, I think Bas was just being sarcastic, but I also think that you've shone some light into a few corners.. Maybe you would consider being an editor for tone, if we ever write anything, besides these posts I mean. :teeth:

[Diane]

Here is something I just got in an email from my cluey sister. I'll include it for the math humor embedded throughout:
Weapons of Maths Instruction

A public school teacher was arrested today at John F. Kennedy International Airport, as he attempted to board a flight while in possession of a ruler, a protractor, a set square, a slide rule and a calculator.

At a morning press conference, Attorney General John Ashcroft said he believes the man is