Postural Restoration

[Randy Dixon]

Slide C: The nervous system controls the muscles.
Slide D. We can actively modulate the nervous system.

See, it really isn't as simple as it looks.

[Barrett Dorko]

Raulan says: : "...we are asymmetric beings living on earth..."

It is exactly this kind of writing or speaking that I feel obscures the issues surrounding theory that we seem not to be able to pry from the grasp of the PRI practitioners. If we wrongly "assume" that they're concerned with asymmetry maybe it's because they won't stop bringing it to the fore. I "assume" we are asssymetrical because it is a successful adaptation within the evolutionary process. If that's the case, movement toward symmetry would be a bad idea.

When I treat a hairdresser with pain I work to get them to create a system with a greater adaptive potential and more accurate knowledge of what efficient functioning is known to be. It's not that complicated and takes about 10 minutes to teach. Therapists can learn the basics of teaching this in even less time. The multiple courses and elaborate terminology invented by Hruska seem unnecessary to me. The word "invented" is important here.

Raulan, I agree we "live on earth."

Is it necessary to say this? I mean, where else?

[Raulan2]

Diane- I agree that muscles only do what they are told. Having said that, Isn't it fair to look at muscle function as a manifestation of the nervous system. And allow that to be a way of understanding patterns of neurological functioning. I dont see a problem with talking about muscle function, tone, length, leverage, position, inhibition, if we are all on the same page of understanding that all of this is driven, and reflects the nervous system. I don't want to do that to the exlcusion of understanding neurobiology. Which is an area that I am still learning, I know I am behind the curve in that area in comparison to most members here.

When I evaluate a patient I have serveral areas that I want to understand. I look at musculoskeletal system for position, knowing that the only reason they are in this position is because the ectoderm directed the mesoderm, (and with the case of respiration) affected the endodermic system. I want to understand why the ectoderm has developed a pattern of directing muscle, and function that is creating pathology of connective, or muscular tissue etc.
I want to assist the patient in patterns of movement that will avoid pathology.

An example. A patient with right sciatic pain. This patient demonstrates a fowardly oriented hemipelvis on left side, with hypertonic left illiacus, and psoas, left glute max, right add. mag. Long, weak, hyperotonic left hamstring, right QL very hypertonic. This pelvic position creates a state of left AFER ( acetabular-femoral external rotation), and right AFIR (acetabular-femoral internal roatation). This state of AFIR on the right leads to deep hip external rotators being on long tight, and overused state, and compression of the sciatic nerve with the obturator internus. This situation was developed by this patient through funtion, driven by the ectoderm. I don't deny that simple touch could relieve this symptom, but how does that change the established neuro pattern. With PRI concepts I would assist the patient in retraining neuromusclar patterns to inhibit the above mentioned muscle groups (chains) to avoid pathology. If that happens did this not really come from a change in the ectoderm? If you tell me muscles are only bungee cords controlled by the ectoderm, but I concentrate on the end result (changing the timing, firing rate, inhibition) of those mesoderm tissues, and succeed in releiveing the symptom. Then I have been modulation the ectoderm.
I understand that the epidermis is embryonically tied with the nervous system. But why is touch the only way to moderate that system? Can't it be done by asking the ectoderm to change the communication to the muscles through function?
Thank you for your patience, I am learning a lot, I am not the best writer, and I hope to convey my message clearly. I will be blunt and tell the group I don't break this down to the level you do. In my clinical experience I have gained a tremendous amount of awe for the nervous system, and I have come to trust and respect it. I have found success in working with it and viewing it through its interaction with the mesoderm, but always knowing that it is th ingition, timing system, and inhibitory to an engine (muscle) that would do nothing without it.

[Diane]

I agree that muscle function is a manifestation of the nervous system, I'd even go so far as to say that muscles are just puppet strings for the nervous system. All I'm saying is.. why focus on strings? Why not find out what sort of difficulty the puppeteer is having?

Usually there is some simple issue, (e.g. tenderness, neural tension) somewhere in the tissue that will easily neuromodulate and voila, muscle function (output) is suddenly all straightened out along with decrease or elimination of that other output, pain. I guess getting the ectoderm to change output to the mesoderm without any sort of diagnostic or therapeutic hands-on contact can be accomplished by some individuals.. I never had much luck doing that in 35 years, which is why I switched over to what I do now.

As long as you are aware of it (the NS, or ectoderm), are working with it and not against it, it may well be cooperating with whatever it is you do, even if you aren't putting it uppermost in your mind or trying to work out a better theory for why your system works.. however, I think taking the time to learn to put nervous system considerations ahead of muscle considerations would lead to a whole lot of future generations of people who learn from you/others who teach your system not ending up confused or lost up a conceptual blind alley.

[Jason Silvernail]

Raulan-

I appreciate your effort to explain the fact that you feel muscles are driven by the nervous system, and that in order to change muscle function, you must approach the nervous system. I don't think anyone would disagree with that.

I am intrigued by your complex sciatica example. I hate to keep coming back to this topic of assessments, but I don't feel you've addressed it just yet. I do know you have your hands full with the questions, so I'll wait my turn.
You mention in great detail the slight misalignments of joints that are causing alterations in muscle functioning that "compress" the sciatic nerve. I am still interested in your assessment of the reliability and more importantly, validity of this assessment. Given the already-mentioned copious research demonstrating the poor reliability/validity of other static posture and position assessments, how can you be at all certain that the patient has these supposed misalignments and supposed poor muscle function?
How can you tell if a muscle is hypertonic vs hypotonic? How can you tell if someone has a forward hemipelvis (whatever that means)? Etc, etc.

Can you address at least in ballpark terms what you feel the reliability is for these judgments? And, the validity in terms of whether or not these supposed findings are present in someone who is asymptomatic or if these findings can discriminate between those in pain and those not in pain? Since you admitted earlier that the type of asymmetry in function or position that you're looking for and treating is present in those without pain, I'm guessing you've already surrendered the validity argument. While that does make the reliability issue moot, I'd still be interested in your response.

It seems you are trying awfully hard to explain in intricate detail why things we have no reason to believe we can actually find exist and how they explicitly cause the patient's symptoms. It's just quite a bit of a reach, and it seems as if, in opposition to Occam's razor, you are trying to explain a phenomenon in the most complicated and implausible terms, rather than the other way around. This is what we mean by "cart before the horse".

Thanks.

Jason.

[Raulan2]

Barrett-

When I treat a hairdresser with pain I work to get them to create a system with a greater adaptive potential and more accurate knowledge of what efficient functioning is known to be.

Do you mean that you help them gain a knowledge of how to correct a compensatory pattern of functioning neurologically?

[Barrett Dorko]

No, I never attend to what people call "compensatory patterns."

I pay attention to the resting posture of the hips and the autonomic state.

[Diane]

Jason wrote,

You mention in great detail the slight misalignments of joints that are causing alterations in muscle functioning that "compress" the sciatic nerve.

To that I would add one little word.. allegedly causing alterations.

[BB]

Hi Raulan,
Thanks so much for participating here.

I want to understand why the ectoderm has developed a pattern of directing muscle, and function that is creating pathology of connective, or muscular tissue etc.
I want to assist the patient in patterns of movement that will avoid pathology.

This is I think an important part of the distinctions being made. Patterns creating pathology of tissues means tissue stress. It appears that you are basing your rationale upon tissue stress. Tissue stress is not sufficient nor is it necessary for pain (Moseley).

And you may say, well we are looking at the same thing from different perspectives. But the next sentence "assist the patient in patterns to avoid pathology" is problematic, and makes the difference in perspective clear. If you are basing you advice on avoidance of tissue stress, you are often creating an unnecessary fear or avoidance of movement (there is actually a really good discussion from louis gifford on the pps website about this very topic as related to mckensie approach). And since tissue stress is not sufficient nor necessary for pain, avoiding "pathology" does not mean avoiding pain, nor is it necessary to avoid pain.

In other words, tissue stress theory is not a sufficient explanation for why what you do works. You need an explanatory model that is more broad, one that explains pain, one that starts with an n and ends with euroscience.

Cory

[Randy Dixon]

I had a fairly long post in mind composed from earlier when I briefly looked in on this thread, since then though I think an important line has been passed. Raulan stated that he realized that the effect of his treatment was due to changes in the nervous system, that he wasn't actually affecting tissue property. Isn't this the basic understanding that people on this list have been hoping others achieve?

"When I evaluate a patient I have serveral areas that I want to understand. I look at musculoskeletal system for position, knowing that the only reason they are in this position is because the ectoderm directed the mesoderm, (and with the case of respiration) affected the endodermic system. I want to understand why the ectoderm has developed a pattern of directing muscle, and function that is creating pathology of connective, or muscular tissue etc.
I want to assist the patient in patterns of movement that will avoid pathology."-Raulan

I think that if we remove that last sentence he is asking the same question of himself that is being asked of him. Why (and how) does this happen? The last sentence causes some resistance here, because most feel that the individual knows that movement better than the therapist ever can. I think that if the answer of "Why and How does it happen" is understood the rest following that will fall into place.

I think as others have noticed, that using muscle tone,temperature, movement and positioning to assess a condition is a good ectodermal approach as well as a mesodermal approach and that using movement, touching, positioning and breathing can lead to positive nervous modulation. So that no one here is going to be surprised if there are some good results. There is going to be questions about palpating bony structures with issues of accuracy, reliablity and validity but also with the reasoning. If the root of the dysfunction is neurological, then it would make more sense to assess the neurology with the bony parts only incidental to that. Wouldn't it?

From Raulan's questions I have a a question/comment. Raulan asked why some people with similar conditions remain asymptomatic and some don't, Jon replied:

"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."


I don't think this answered the question, it is really just a rewording of the original question, or perhaps just taken one step further. Why do some people have lower tolerances than others? I don't think we know the answer to that one satisfactorily. Why is TMJ pain almost always one-sided? It's the same nervous system.

Anyway, I'm glad that Raulan has thick skin and will stick around long enough to actually make the exchange meaningful.

[nari]

My view on Randy's sentence, which is a highly important one:

People have thresholds and tolerances of pain that vary from one person to another. To me, it depends on whether their systems are OK, subcritical or critical, as to when the incoming messages are interpreted as pain. Someone who is in a subcritical state ( lots of deadwood around, including emotional issues) can tip readily into a critical state if the systems are threatened; once in a critical state, it takes very little indeed to fire the whole system up. (high sensitivity)

But someone in an OK state can almost get away with murder - compressed nerve/s and other exciting things found on MRI that nobody knew about. The system does not go up in flames because it is stable and nonsensitive. Kick it around for a few months and the organism can go from OK to critical fairly rapidly.

Does that make sense?

Nari

[Jon Newman]

Hi Randy,

I agree that my response only took that observation one step closer. But it is one step closer to what PTs ought to be researching more intensely (or at least paying attention to what others are researching) in my opinion. The threshold and tolerances that I'm specifically interested in are perception thresholds, not necessarily whether an AP has been produced. Additionally, I'm interested in the "binding" of inputs in the process of perception. These areas of study are far more helpful in my understanding pain than what's on offer from PRI (and many others) right now. The concepts and approaches being advocated by PRI very well may turn out to be helpful but without including how sphenoid/temporal unevenness and it's correction (for example) affect physiology, it is less interesting to me. This assumes that one can accurately detect and correct these things to begin with.

[Bas Asselbergs]

Raulan, as you may have noticed, I am not arguing effectiveness of PR as a treatment. But I do need to echo myself and Jason in particular with regards to these questions :

"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."

"Regarding "Myokinematic Functional Performance Grading" - have there been any reliability or validity data determined for these findings? "

Thanks.

[Barrett Dorko]

Randy says: "I think that if the answer of "Why and How does it happen" is understood the rest following that will fall into place."

The "how" we might answer adequately if we know the deep model accurately and the "why" we might speculate upon but will never know for sure. These questions too closely approximate the "How did you get to be the way that you are today?" question that is simply impossible to answer, even by the person who got that way. See Ubiquity by Buchanan.

We need to ask: "What are you doing to stay the way you are and what can you do now to get out of this fix?"

[BB]

I found the link to the Gifford discussion I mentioned above. Aches and Pains Online, not pps.

Here is the link to the discussion (sorry, I still don't know how to hyperlink here):
http://www.ppaonline.co.uk/mckenzie.html

cory