Postural Restoration

[Diane]

It's now on order along with "Assassination Vacation." About the pixelated comment, one of your other recommendations from long ago, Temple Grandin, was interviewed yesterday on a daytime talk show here.. (I took a 4 day weekend. Because I felt like it).

Her advice to parents with a child who is "gifted" in one narrow sense, and utterly devoid of interest in any other human endeavor (autistic), was to make the most of that single focus. If the child's interest was horses, then use the theme to engage them in art (drawing horses), books (about horses), public events (to do with horses), the art of conversation (with other people who love horses), biology (how horses work), history (transportation, human relationship with horses through the ages), etc.etc.. broaden the child into life by using their interest as a lubricant for that purpose. Brilliant woman. Use the pixel and show the child how it connects to all the other pixels, and end up with a child who may always be a geek but who can be a slightly more socially confident geek.

This may seem a bit off the topic of postural restoration perhaps, but not altogether. Here's the thing:

One could view the whole profession (in the US) as a geek, by virtue of its fixation on the pixel of posture. So, then, using Temple Grandin Educational Theory, how can we connect the pixel of posture long enough to the other pixels to make it possible for the profession to see through it to other pixels?

Maybe it (PT in the US) can't understand yet that it's possible to see posture from any other pixel, that it's only one pixel, that there is a whole world in PT and it's not just about posture, but clearly, if posture is an obsession, or at the very least a conceptual organizing tool that has been overly reinforced, then for better or worse that's the square that PT in the US is on, and anything not connected to that will produce apathy/disregard, frustration/anger, discombobulation/confusion, and/or anxiety.

Actually I can think of a lot of other pixels the US is stuck on, culturally, but for now let's just stick to one subgroup, PT, and its own pixel, posture.

[Barrett Dorko]

Diane,

More accurately, it's pixel. Here's nice definition.

Perhaps I can now begin to rehearse a lecture about posture just being a pixel that won't make so many students mad at me.

Nah, probably not.

[Diane]

(Doh..) I went in and corrected the spelling, clearly not one of my own obsessive pixels. I took the spelling from your post about Sarah Vowell;

geeks understand that the big picture is pixilated..

Thanks for the def.. a pixel is a good visual metaphor for a meme. Sharp or fuzzy or anything in between, either contributes clarity to the big picture or doesn't..

[Diane]

Here's a difference between a Canadian PT meme and the posture meme of the US PT community.

Here (in Canada) we have this "movement" meme. We call ourselves, on TV ads even, the "movement specialists." We talk about how PT "will move you", how we "get" everyone "moving" etc etc.. I never realized up to now how awfully simple and yet brilliant this meme is.

The posture meme by comparison is static, doesn't have any fluidity to it.

[Jon Newman]

Hi Diane,

The theme being promoted by the APTA for "Physical therapy month" this October is:

Physical therapy: Moving you to better health.

[Diane]

Jon, a "step" in the right direction..

[Jon Newman]

The most recent step in the postural direction can be found in the the current issue of Spine.

Spine. 2006 Jul 1;31(15):E507-E512.

Three-Dimensional Spinal and Pelvic Alignment in an Asymptomatic Population.

Gangnet N, Dumas R, Pomero V, Mitulescu A, Skalli W, Vital JM.

From the *Bordeaux University Hospital, Spinal Disorders Unit, Department of Orthopaedic Surgery, Bordeaux; daggerLaboratoire de Biomecanique, Ecole Nationale Superieure d'Arts et Metiers-CNRS, Paris; and double daggerEuropean Association of Research Groups for spinal Osteosynthesis, Paris, France.

STUDY DESIGN.: A 3-dimensional (3-D) analysis of asymptomatic spinal and pelvic alignment. OBJECTIVE.: To obtain 3-D reference values of spinal and pelvic parameters, vertebral and intervertebral orientations. SUMMARY OF BACKGROUND DATA.: Referential values of spine and pelvis alignment are essential for the assessment of posture and balance. However, only 2-D referential values have been reported using standing sagittal radiographs, and, to our knowledge, no 3-D referential values have been reported to date. METHODS.: A biplanar radiographic technique was used to obtain the 3-D reconstruction of the spine and pelvis of 34 asymptomatic standing subjects. The 3-D values were calculated for most of the spinal and pelvic parameters. In addition, 3-D vertebral and intervertebral orientations were computed, and the apical and junctional zones were investigated. RESULTS.: As reported in 2-D, a large variability and particular correlations were observed for the 3-D spinal and pelvic parameters. However, significant differences were found between 3-D and 2-D values. The 3-D vertebral and intervertebral sagittal rotations showed specific features in the apical and junctional zones of the asymptomatic spine. CONCLUSION.: These data may be used as 3-D referential values of spinal and pelvic alignment.

[nari]

Diane,

The concept of learning by pixels is another way of looking at what one is doing to the whole picture.
In my Painting program (Painter5) I can select broad sweeping strokes on the blank canvas, with camel brush or charcoal, or whatever, but zooming in to 300% allows me to see what I have missed. Sometimes I want them left out ( a raggedy line, say the side of a distant mountain) so it appears hazy; sometimes I decide not. So at 3-400% zoom, I might change, say ten or twelve pixels that are the wrong shade,and back on normal (100%) those teeeny pixels (totally invisible on the screen canvas) can change the entire appearance of the big picture. It is great fun, and has overtones to what previous posts have been saying.

Nari

[Diane]

Nari, exactly. But one needs to develop Painter 5 mental vision that can be kaleidoscopic in essence.. not just zero in on something then backout again, but be able to see all round at the same time, what effect is this having on that, what is this bit doing to that bit over there, maybe more a spiral-ized movement of mental vision/set of cognitive goggles than just straight forward telescopy.. ordinary PT education will never help us get our minds where they need to go, all by itself. The mind definitely needs to be broadened out by knowledge of other disciplines.

[Raulan2]

Hello All,

I have been enjoying your discussions and am happy to find others who will consider the neuro aspect of things. I am an associate faculty member at the Postural Restoration Institute. I have been questioning myself as to whether I wanted to respond here. I felt like a lot of assumptions were made when Ollie was here and I would like to help correct and clarify where we are coming from. I am also interested in what I can learn from this group when you challenge my, and (PRI) concepts. I feel confident somehow that you will.

Please let me begin by saying that I attended a course by Mr. Dorko in Jan of 06 and found it refreshing to see a course that was presented with solid scientific material. I attended the course because there was one word in the course title that interested me and that was "neural". I have been seeking as much understanding of the nervous system and how it plays a role in all aspects of pain issue. I am basically a solo practitioner, but due to some early successes of retraining neuro-muscular patterns I was invited to share office space with a Neurologist. So I feel like those who incorporate PRI concepts aren't as different as you might think.

The first concept I would like to clarify is that we are built assymetrically, always have been, always will be. This includes not only anatomical consideration, but neuroligically also (lateralization). PRI concepts are not about making someone symmetrical, rather how do we help assymetrical beings function in a world that at times requires symmetrical functioning. Secondly, posture is a reflection of the nervous system. and I am not trying to make anyone sit, stand, drive, etc. in any one "proper position", since there is obviously no such thing. I feel that US PT's have done enough damage in that area in the last 25 years. My key goals for a patient with pain would be to allow that person to obtian proper neuro-muscular patterns so they can sequence respiratory kinematics.

My question to the group is: can ideomotor activity overcome and change established neuromuscular patterns?

I look forward to your comments. I feel confident that we can challenge each other in a constructive way. My current life situation allows me time to visit the forum 3-4x/week. If I don't respond quickly, please be patient. I think I am fairly thick skinned, so don't think I got my feelings hurt and left.

Raulan Young.

[nari]

Diane,

True words, but it entirely depends on how far one zooms in. Mesodermists zoom in on one muscle and stay there; but if one zooms to, say 200%, the details become clearer but the entire structure of the picture is never lost.

Raulan,

Good to hear from you.
Without hesitation, I would say that ideomotor activity changes established n/m patterns; what I do not know is how long this change remains in place for the benefit of the organism; I suspect it is rather like a fluid - it will find its level but may need practice to do so.
I agree that PTs in the past were, and some are still now, obsessed with the concept of normality according to Gray's Anatomy pictures and not physiology.

Hope you can stay.

Nari

[Barrett Dorko]

Raulan,

This is what you said that stuck out for me:

"...a world that at times requires symmetrical functioning."

So what's the big deal? How do you suppose that this leads to trouble? What is the origin of the pain here? Is it somehow different than what we've proposed all along?

Also: Why did Ollie leave when we asked him about the head bones? Do you guys really think they become distorted in a fixable way? How do you determine any of that?

Please list specifically the "assumptions" you speak of. Don't just tell us we've made them and leave it at that.

Where's your boss/mentor/teacher?

[Jon Newman]

Hello Raulan,

Can you describe a bit more narrowly what you mean by "established neuromuscular patterns"? I'm thrown a bit by the "established" part.

[Barrett Dorko]

Jon,

Great question. Learning new patterns of behavior is the provence of coordinative exercise such as those proposed by Feldenkrais. This can take remarkably little time and can become "established" with a little practice.

Ideomotion will contribute to this sort of change to the extent that it corrects the mechanical deformation that led to the painful movement to begin with. Reducing that should certainly help.

I don't know of any evidence that strengthening is required to change "established" neuromuscular patterns.

[Raulan2]

Barrett, The assumption was that when we use the term posture, it was assumed that we are trying to get people to conform to some ideal position.

Jon, Established patterns are those dseveloped by the patient, this may be due to job duties, ADL, compensatory activity to trauma, etc.

Barrett, This is important to me because it helps me understand tissue pathology, imbalances in muscle tone, mechanical deformation of tissue.

The concept that I am wrestling with is this: If a person has patterned themselves to the point wherethey have restrictions in movement due to tissue restriction. Doesn't this then limit the unconcious movement. Ideomotor movement would be limited, not by my expectation of where they should move, but their unconcious proprioceptive realization that movement is only available in some directions.

Barrett, In your Essay on Simple Touch you state, "I'm just trying to elicit unconciously motivated movement, diaphragmatic breathing and a restoration of a resting posture that reduces stress".

Interesting choice of words. I contend that if a person develops neuromuscluar patterns that becoms so assymetric that they have an inability to have normal kinematics of the trunk/ribcage that "diaphragmatic breathing" is not possible, and ideomotor activity will not overcome that.

If you help that person retrain muscle recruitment patterns, and reciprocally inhibit the dominat groups of muscles the you restore their ability to have a zone of apposition of the diaphragm, then ideomotor activity will have a wider opportunity to manifest itself. I don;t know if that makes sense to the group?