Postural Restoration

[Raulan2]

Ron Hruska is currently trying to balance his clinical practice as well has his schedule for teaching courses. He also travelled with University of Nebraska Womens Volleyball team to China for a tournament. His main priority currently is final steps in publishing a book outlining these concepts. We at the Institute often receive criticism that we don't have published text for these concepts. It is Ron's goal to remedy that as soon as possible. Once that is accomplished then it will be easier to have these types of dicussions, and challenges to our concepts on a morebroad spectrum. So for now youwill have to be satisfied with a lesser and slightly more endomorphic faculty member.

[Jason Silvernail]

Raulan-

Thanks for continuing to post.

A few questions -
1. Regarding these soft tissue restrictions you mention that prevent ideomotion from fully expressing itself.
A. do you have a valid and reliable method for discovering and identifying them? I assume you are aware of the extensive research existing in the literature demonstrating the poor reliability and questionable validity of spinal motion palpation/manual spinal diagnosis.
B. if indeed a soft tissue contracture can be identified, can the forces provided by manual therapy or exercise be of sufficient force, duration, and direction to change the tissue, given what we know of human physiology? I would refer you to Threlkeld's excellent article in 1992 in the journal "Physical Therapy" for the background on the basic science of this issue.

2. When you say Mr Hruska is looking to "publish text" - you mean a textbook or manual of some kind, as opposed to a peer-refereed document such as a review article or case series? If so, how does the publication of non-scholarly material (read: opinions) help PRIs concepts become more scientifically accepted?

Thanks again.
Jason.

[Raulan2]

Jason-
great questions. I am not using manual spinal motion, or palpation. We at PRI use myokinematic funtional performance grading, and assessments to determine position of the body in tri-planar motion(which identifies neuromuscular patterns). Of course I use goniometric ROM measurements, but I interpret that with empahsis on myokinematic function, not osteokinematic, or arthrokinematic.

When I refer to restriction this could include some adaptively shortened connective tissue, but it also includes understanding contractile tissue that has been utilized repeatedly in mal-adapted positions and becomes hypertonic. I will give you an example. If the left hemipelvis were oriented forward in the transverse plane with respect to the right. Then the left hip will adapt into an externally rotated position to allow for gait. the left posterior hip capsule, and more imprtantly, the deep hip external rotators (obturator internus, piriformis, gemelli, etc.)will be functioning in a shortened, hypertonic state. It is my experience that this limitation is usally related to the contractile tissue, more than the connective tissue. I am aware of those articles and that is why I agree with this groups criticism of MFR.
Yes currently Mr. Hruska is preparing a text. but if you go to www. postural resotration.com, education tab, references section you will find an extensive list of references by topic. One of the criticisms of PRI (somewhat deserved )is limited outcome based studies. Currently in my clinic we are in the process of conducting a case series. Ron is just completing a case series. We are diligently trying to get as many research projects underway as possible(Elon University in North Carolina, and Loma Linda in CA). We are not unlike this group, these concepts are understood and acccepted by those in clinical practice, but not as readily in the world of acedemia. There have been several studies done 8-10 years ago with PRI concepts regarding pelvic-fermoral relationship and the use of the Protonics Neuromuscular Repositioning System. The concepts are PRI concepts, www.protonics.com, references tab. I will clarify that Protonics and it manufacturer Inverse Technology are not affiliated with PRI.

Mr. Dorko cites excellent scientific based articles and texts as reference. Are there any studies with the use of Simple Contact as a treatment?

[Diane]

Raulan, it sounds like the focus of treatment or concern in PR is the "bungee cord" system, i.e, contractile tissue that won't eccentrically lengthen (for whatever mysterious reason). Would that be accurate?

[Raulan2]

The mysterious reason is that the body is putting a demand on those muscles for functioning in an improper manner. That could be due to developed neuromuscular patterns due to compensation from trauma, pathology, weakness of agonistic muscle groups. When I am treating a patient my main concern is to normalize tone. I am attempting to retrain muscle recruitment patterns to reciprocally inhibit dominant muscle chains. (See website for explanation of polyarticular chains). My main concern is not strengthening, but rather retraining proper recruitment of agonistic or antagonistic muscles chains in order to normalize tone and allow for proper length/leverage, and the ability of the nervous system to recognize proprioceptively that these muscles can now be recruited in a proper manner.

In a patient (i.e. a beautician) without pathology I totally agree with the concept that ideomotor movement can release neural tension. My concern is how does that help her the next day in the beauty salon when she is always standing with weight shifted to the right, a compensatory rotation of the trunk to allow to hold her left arm up for 8 hours while styling hair. Where is the carryover?

[Raulan2]

Barrett-
Sorry I did forget to answer questions regarding the bones of the skull, Yes we consider the position of the temporal bones, and sphenoid. The following link explains how we assess this. http://www.posturalrestoration.com/r...ursenotes_id=7

[Diane]

The mysterious reason is that the body is putting a demand on those muscles for functioning in an improper manner.

Are you sure it's the body that's making the demands?

That could be due to developed neuromuscular patterns due to compensation from trauma, pathology, weakness of agonistic muscle groups.

So... are the muscles talking to each other?

When I am treating a patient my main concern is to normalize tone. I am attempting to retrain muscle recruitment patterns to reciprocally inhibit dominant muscle chains.

Are you trying to get muscles to talk to other muscles?

(See website for explanation of polyarticular chains). My main concern is not strengthening, but rather retraining proper recruitment of agonistic or antagonistic muscles chains in order to normalize tone and allow for proper length/leverage, and the ability of the nervous system to recognize proprioceptively that these muscles can now be recruited in a proper manner.

Hmmnn.. I see the nervous system is being referred to. Is that all it can do? Recognize proprioception? Then recruit?

[Jon Newman]

Raulan,

What is the incidence of sphenoid temporal unevenness in the population of asymptomatic people?

[Raulan2]

Diane- It may have been better stated that the physical demands being placed on the body and the body's attempt to perform that function.

I have been referring to the nervous system in more macro terms in order to convey my approach in general terms. I will be glad to break it down in to a more micro level. I will post more info ASAP. But in general, I am not just talking about proprioception and recruitment. My goal is to guide a patient to restore position, and respiratory function to allow the nervous system to function how it wants. I am not trying to force or coerce it. I think you were interpreting my comment as the body can only function in biofeedback type activity. That is not my understanding, Feedforward mechanism and encoding for motor planning involves many systems. I am not only considering proprioception, but since we are asymetric beings living on earth, functioning as bi-pedal upright beings, who need to breath, proprioception is a key component. But you cant talk about breathing without understanding you have just included effects on the autonomic nervous system, and other systems as well. Sorry I dont have the other info at the present time.

Jon- This is something I have thought about a lot. I dont have research data that states the incident, I understand your argument. However, clinically we obviously see varying degrees. Why does it effect one person instead of another? can't answer that. Despite my physical resemblance I make a lousy Buddah at the top of the mountain. Why would an MRI of one person show a space occupying lesion clearly putting pressure (mechanical deformation) on neural tissue, but they are asymptomatic. Why do some people with clearly assymetric posture demonstrate patterns of symptoms, while others do not? Clinically when I manually restore position of temporal bones, or restore rib cage kinematics, there are clear, measurable objective, and subjective changes.

[Bas Asselbergs]

Thanks for being here Raulan. Could you let us know how to objectively measure temporal bone position and ribcage kinematics? I assume that "objectively" refers to a reproducable, valid and reliable test.
Thanks

[Jon Newman]

Bas interesting question.

Raulan, you asked:

Why would an MRI of one person show a space occupying lesion clearly putting pressure (mechanical deformation) on neural tissue, but they are asymptomatic. Why do some people with clearly assymetric posture demonstrate patterns of symptoms, while others do not?

People begin to have pain, (of the type most relevant to PT), when their sensitive tissue has been mechanical deformed beyond a certain threshold. They seek help when it is beyond their tolerance. Perhaps that helps answer those questions.

[Jason Silvernail]

Raulan-

Thanks for your prompt and courteous replies.

1. Regarding "Myokinematic Functional Performance Grading" - have there been any reliability or validity data determined for these findings? While I know it isn't the same as spinal motion palpation, I wonder is there any reason to think these "findings" are any more reliable or valid than spinal assessments?
Has the interpretation of these findings (you mentioned it was "myokinematic" function and not joint movement you were interested in) been studied for validity or reliability?
The reason I ask this question is that many other evaluation systems (such as the classification approach for LBP) are interested in the validity, reliability, and predictive value of their assessments, especially when the use of the treatments can't always be well defended in terms of theory. I believe this is a fair comparison to the PRI concepts.

2. I'm glad to see that some studies are underway. No outcome-level studies are published for Simple Contact yet, but like PRI, projects are underway currently.

I think you'll find that most of us here are less interested in outcome studies (though they are important) and more interested in the theory behind the treatment and whether that makes sense in terms of what we know about human physiology. I don't think it's difficult to put together an outcome study and prove that some type of treatment or approach can be helpful. The issue for us as a profession is what is the theory that drives all that treatment. Otherwise we are simply collecting a large number of diverse and at times diametrically-opposed systems of measurement and treatment that while possibly efficacious clinically, don't make theoretical sense.

It might be helpful to think of this problem in terms of Craniosacral Therapy (or Cranial Osteopathy) and Spinal Manipulation therapy for spinal pain. While both certainly can produce helpful outcomes, it is the disparate theory of the two treatments that is problematic, meaning how can they both help if their mechanism is supposedly so different? Without a convincing theory, we just end up collecting more and more little systems of thought and treatment without a true analysis of what we really are dealing with - human physiology and the neurobiology of pain.

I think you'll find most of the posters here are looking for you to explain why what you do works, and to do it in a way that makes sense given what we know of modern neuroscience. Your example to Jon of why nerve tissue can be compressed without symptoms is easily explained and is therefore not a controversy among those here. Your question of why some with assymetry have pain and others do not is also easily explained with modern neuroscience. I would respectfully suggest that if the theory offered by PRI does not explain these findings, then those in your organization are uninformed about modern concepts of pain and neurobiology. Unfortunately, this is the rule rather than the exception in our current medical system.

Those of us here are trying to change that. I wonder if PRI and it's concepts will help that process, or confuse the issue further?

Jason.

[Barrett Dorko]

Jason,

Great post. Like a knife.

One thing: If I'm not mistaken, Luke is looking at the effect of ideomotion on pain rather than the effect of Simple Contact. The method itself (SC) is far less important than the movement it reveals and encourages. Since that movement is instinctive it can't possibly do anything other than help, which is nice of course.

I feel as if the theory, such as it is, behind PRI is being exposed as incredibly weak in the realm of neuroscience. This should not surprise any ectodermalist. Mesodermalist's theories get shredded regularly when we begin to question them.

In Joel Achenbach's wonderful Captured By Aliens there's a line I love: In science, if you don't work hard enough to prove youself wrong your friends will gleefully take up the slack.

The key word there is "friends." By questioning the theory and working to explain its weaknesses (if not its actual absurdities as well) we are being Ron Hruska's friends, not his detractors.

Just thought I'd mention that.

[Diane]

Raulan,

Diane- It may have been better stated that the physical demands being placed on the body and the body's attempt to perform that function.

I have been referring to the nervous system in more macro terms in order to convey my approach in general terms. I will be glad to break it down in to a more micro level. I will post more info ASAP. But in general, I am not just talking about proprioception and recruitment. My goal is to guide a patient to restore position, and respiratory function to allow the nervous system to function how it wants. I am not trying to force or coerce it. I think you were interpreting my comment as the body can only function in biofeedback type activity. That is not my understanding, Feedforward mechanism and encoding for motor planning involves many systems. I am not only considering proprioception, but since we are asymetric beings living on earth, functioning as bi-pedal upright beings, who need to breath, proprioception is a key component. But you cant talk about breathing without understanding you have just included effects on the autonomic nervous system, and other systems as well. Sorry I dont have the other info at the present time.

I appreciate the effort you've made to accomodate me (us) here.. What would be even greater would be if you put the primary focus/emphasis (square one, so to speak) with the nervous system, and explained your technical interventions from its perspective, rather than discussing muscles as if they had any effect on anything, as if they were anything except mesodermal bungee cords carrying out actions dictated by the ectodermal nervous system.

(As you probably have figured out by now we are trying to correct the course of the whole profession by insisting the horse go in front of the cart. Many of us are here to de-brainwash ourselves - cognitive rehabilitation is a major focus here. Some of this will splash on you. It can't be helped - besides we freely use water pistols. :angel: )

Jason, killer post!

[christophb]

Nice post Jason, You've inspired me to try and diagram that idea.

Tufte

Chris