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Posture & Pain

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  • #46
    So glad Ian sent in his article. I had not seen this thread.
    I would like to hear what folks have to say about what I was taught by Sahrmann about posture before I became, although somewhat stubbornly, a neuronut.

    She doesn't necessarily care if a curve is "abnormal" by 20 degrees or whatever unless she can somehow correlate it with painful positions/movements. For example, if someone has neck or shoulder pain, she will lift the scapula and ask for a difference. If this reduces the pain, the static posture will be significant in determining her "movement impairment syndrome" but if not, she moves on. She determines if this is part of a significant pattern through observing various movements and looking for other correlations.

    Now, her explanation for how this has become a problem is what I think we can maybe discuss. I have never heard her make mention of motor control in its relation to lower brain centers, sympathetic/parasympathetic response, and she basically only acknowledges that the problem could be due to "nerve tension." This is obviously a big weakness in the theory of her approach. However, a strength could be in her explanations in regards to function. For example, if a person spends their whole day leaning to the right because the file drawer in the desk is on that side, tissues adapt over time, shortening, possibly resulting in a posture that leans to the right.

    If this is the case, the shortening is not protective, but adaptive. Now, the right sided nerve roots are being compressed without relief, and an abnormal neurodynamic may be the result. I believe that Shacklock would classify this as an excessive closing dysfunction on the right.

    So, is this abnormal neurodynamic the result of (cause and effect type) an adaptive posture instead of a correlation? Does this adaptation model, based on repetitive, compulsive function, hold up?

    Cory Blickenstaff, PT, OCS

    Pain Science and Sensibility Podcast
    Leaps and Bounds Blog
    My youtube channel


    • #47
      There is a very interesting posture thread going on that I believe will likely approach my above question inevitably....

      But, before this one gets too far down the list, I wanted to post my next point, not leaving it as it was in my previous post.

      In our brains building of the contexts of pain, the various bits become associated with each other. The environmental surroundings, the chemical state of the body, emotional undertones, and the state of the motor system, etc. As pain is a sympathetic state, the fight/flight response gets our motor system ready to act. The movers are put on alert, the genitals protected, etc.

      Since the threat causing a pain output is context driven, one aspect of that context can remind the body of the rest, ie. many triggers for pain. Thinking of the functional aspects of posture I stated above, our functional positions may cause stimulation of the motor system in ways that are similar to the motor effect of the sympathetic activation. If this is enough to remind us of a painful context...viola, we have pain.

      Thinking this way, we don't need to have people memorize a million rules for every position they might find themselves in if they can learn to recognize their triggers.

      Yes, no, maybe? If yes, thoughts on best ways to help them recognize?

      Cory Blickenstaff, PT, OCS

      Pain Science and Sensibility Podcast
      Leaps and Bounds Blog
      My youtube channel


      • #48

        Forgot to qualify that genitals remark! I was thinking about why sympathetic causes hip IR instead of using the big strong mover of the gluts, since those are the types of muscles that tend to get activated elsewhere in the body. Then I thought it was probably the sympathetic survival mechanism to protect the genitals. Thanks for that one unconcious brain centers!

        Cory Blickenstaff, PT, OCS

        Pain Science and Sensibility Podcast
        Leaps and Bounds Blog
        My youtube channel


        • #49
          Seems logical, Cory.
          The triggers you mention are referred to as neurotags - little pockets of nonconscious memory all around the brain. I think these produce pain nonconsciously; we are reminded quite sharply of previous trauma and events.
          The way it works, I think is this: phobias, which many people have in some form - spiders, heights, snakes, etc -are something we know we have but probably are a result of an unfortunate encounter waaaay in the past which we may not remember.

          But there are those responses we don't understand at all; like sudden pain in the back or knee for no obvious reason. The brain has perceived a threat which we do not know about and we search for reasons/causes, often with no success.

          Recognising triggers or those neurotags is difficult without creating fear avoidance. Not for us, but for those patients who take on some of the rigid advice we hand out as a general rule. Fear of flexion, bad posture, the wrong chair, the wrong way to move full stop.... We know that sitting too far from the bench and stretching forward repetitively hour after hour will lead to pain; but other situations are much less easy to predict.

          I'm not sure, then, if the abnormal neurodynamic could predictably result from the sort of posturing Sarhmann refers to. Certainly very repetitive neural movements such as described by Butler and Shacklock would.

          Last edited by nari; 09-06-2006, 08:44 AM.


          • #50
            Is this the thread you mean Cory?
            Postural Restoration?
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            "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

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            • #51

              As far as I know, whether or not another hurts simply can't be seen - only heard. Even then, verbal deception, intentional or not, is rampant, especially when illness is present. The TV series House makes this point repeatedly.

              I feel that therapists who claim they can "see" exactly what's wrong with their patients are fooling themselves. This is not to say that observation of certain things is useless, just that many are looking at the wrong things and overrating others. Even if we pick the right thing to assess visually (hip position, for instance), that doesn't tell us what the patient's tolerance for it is, so we don't know about the presence or absence of the sensation of pain and we have to ask. Gotta be careful about believing the answer though. In the end, clinical work is full of this sort of ambiguity. Many wish it wasn't.

              In an effort to create others that please us and produce a false veneer of human perfection, pleasing apperance and supposedly predictable dysfunction and pain, symmetry is evoked if not actually worshiped.

              The Altering the Ideal thread is specifically about this.
              Barrett L. Dorko


              • #52
                Yes, I was referring to the Postural Restoration thread. I think that if Oliver returns and attempts to answer the "why does asymetry cause pain" in a neural language, this will be a likely direction of discussion.

                I agree with you about teaching avoidance of trigger positions will almost certainly lead to fear avoidance. A better way to say what I meant would be to teach them to be aware of when the trigger response has been activated, become a better listener to their body responses. Holding the breath or shallow breathing, tightening of certain muscles such as hip IRors, etc. Once they can recognize this, they can learn to stop the cycle, and proceed, without necessarily having to withdraw.

                Hopefully, then we are not promoting symetry, but instead responsiveness.

                Also, I think the only thing that we can predict based on the repetitive positions is tissue stress, and even this would be a very complicated equation. And since tissue stress does not correspond directly to pain it would be impossible to predict the conclusion of pain. I guess that is my personal conclusion to my first question. Hopefully, Oliver will bring us his.

                I wonder how you interpret the ambiguity and use it (as you imply that the ambiguity being present is OK).
                I'm curious if you take the verbal description, deceptive or not, as an indicator of what value or explanation has been placed on the situation instead of an accurate account of the situation itself?

                Cory Blickenstaff, PT, OCS

                Pain Science and Sensibility Podcast
                Leaps and Bounds Blog
                My youtube channel


                • #53

                  I think I too have said before that many PTs treat only what they see or think they see; which is why ideomotion is less acceptable than, say, a method which addresses a joint or a segment that looks 'wrong' according to a norm.

                  The problem is, the 'norm' is elusive and its values vary according to cultural factors and personal attributes. I don't think we will ever reach the point of establishing normative values for anything, let alone how a person looks or moves.

                  After all, a few centuries ago, a fat woman was considered to be ideal and the perfect choice for art work..... Now we admire only beanstalks...



                  • #54

                    OK or not, ambiguity is inevitable. My best guess is that all of this is true at one time or another, unpredictably.

                    I appreciate how much thought you're putting into its interpretation, but this seems beyond me. Please let me know if you ever figure this out. I'll probably still be here.
                    Barrett L. Dorko


                    • #55
                      Good posture is a dynamic behaviour, not a static position.
                      Nick Matheson, PT
                      Strengthen Your Health


                      • #56
                        On a current affairs program tonight they had an Aussi physio plugging his new invention -Spinalsensa.
                        SpinalSensa is a patented medical device developed to treat back pain by monitoring the patient’s spinal curvature and providing feedback to the wearer when curvature is at a pre-determined, inappropriate level.
                        You stick it onto your lower back and it beeps and vibrates when you move into a 'bad' posture.

                        Well, now the problem of pain has been solved I had better go back to uni and do accountancy or something.
                        Luke Rickards


                        • #57

                          The posture police have their final instrument--their "harrow". What's fascinating is that there is an appreciation for the fact that posture is a behavior. What I don't understand is why reducing the repertoire of behaviors is adaptive.
                          "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris


                          • #58
                            If I had a Spinalsensa attached to me, it would squawk most of the day.
                            I think I would be a nervous (pun intended) wreck after a few hours.

                            Why do so many PTs desire to be control freaks? (rhetorical question).


                            PS I checked out Spinalsensa on google Oz - it's all about business and moneymaking, and it won the award in Texas.
                            Last edited by nari; 10-06-2006, 11:54 PM.


                            • #59
                              I remember on a thread about a year ago in talking about posture and giving patients cuing, Barrett asked: What are we going to do next, shock them?

                              I think he meant it as a joke.


                              • #60

                                I prefer this latino version => The SpinalSalsa

                                More pleasurable with this music.
                                Last edited by bernard; 12-06-2006, 08:40 AM.
                                Simplicity is the ultimate sophistication. L VINCI
                                We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON

                                Everything should be made as simple as possible, but not a bit simpler.
                                If you can't explain it simply, you don't understand it well enough. Albert Einstein