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Postural Restoration

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  • While in Orlando a few weeks ago I met a therapist at the McKenzie Institute booth. She was very cordial and filled me in on Robin's current schedule. He no longer flies to teach anywhere but there's a meeting of his students in New Zealand soon that they all seem to be looking forward to. It's titled "The Evidence Mounts." I have the feeling that they're referring exclusively to the evidence they like but I might be wrong.

    I would love to have some his instructors join us here as Raulan has so that we can get some answers to the questions that rise inevitably from an essay like Gifford's. I know I've personally invited a few here, including the woman in Orlando. So far, nothin'.

    If science is about asking the hard questions of another's theory and then getting an answer, well, this would be just about the only place on the web for therapists to do so.

    Why do the McKenzieites so carefully stay away?
    Barrett L. Dorko


    • Bas & Jason,

      The following link will Describe all of the assessments for assessing temporal position. Although we are still in the process of of studies for validity/ reliability. Please read this page. The theoretical explanation for each test is described. Please let me know what you find that does not make sense with respect to anatomy or physiology.


      • Horizontal Upper Extremity Abduction
        Patient lies in supine with knees flexed to flatten the lumbar spine. Passively take the patient’s arm into horizontal abduction while securing the shoulder joint with one hand and maintaining forearm supination with the other hand.
        A positive test is indicated by limited horizontal abduction of one extremity when compared to the other. Less than 30° is considered limited.
        This reads awfully like an upper limb neural tension test to me.

        Roulan, it is interesting to these descriptions, and thank you for bringing them here for us to look at. I can't help but note the lack of concern for the peripheral nervous system threading through all the body parts however, and no doubt contributing a lot to the organism "behavior" observed in lack of range, etc. Do you think this omission will ever be addressed by/in this system?
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        • Hi Raulan.
          Thanks for posting the link.

          I see a lot of subjective assessments of joint position or movement in the descriptions, and this is really the issue we're talking about.
          I can cite a lot of study evidence that evaluates the reliability of these sorts of assessments - not just for spinal position, but things like leg length, ilac crest height, etc - which seem a very valid comparison to the techniques described on this page. The problem is the poor reliability intra and inter examiner for these measures. I take it from this page that the reliability data simply do not yet exist for these measures. That's OK, as long as there's a plausible theory that we're working from. I haven't really seen that on the site.

          Validity is a whole separate issue, and might be best approached by asking if the assymetric findings that PRI therapists look for are found in asymptomatic people. In other words, could you tell someone in pain from someone without pain from the findings? Since you admitted in your post on July 13th that many people with assymetry don't have pain, then that is what I mean by surrendering the validity argument.

          Nothing on the site is inconsistent with anatomy, it's the physiological explanation that's flawed.

          Do you see what I mean?
          Thanks for your ongoing participation and response, I appreciate your effort and patience.

          Jason Silvernail DPT, DSc, FAAOMPT
          Board-Certified in Orthopedic Physical Therapy
          Fellowship-Trained in Orthopedic Manual Therapy

          Certified Strength and Conditioning Specialist

          The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.


          • Diane, the horizontal abduction test determines the resting position of the scapula on the rib cage, and therefore determines the position of the rib cage. The position of the rib cage can determine how the periphery function. So instead of just understanding neural tension. I want to understand the underpinnings of what is leading to that tension. In my mind this is not an omission, rather an understanding that truly takes into consideration the neuro-musculoskelatal system. If the horizontal abd test is indicating neural tension how better to reduce that than to restore rib cage position, and kinematics to allow proper peripheral limb movement and reduce neural tension.

            Jason, When I stated that some people have symptoms and some don't, There obiously is a threshold that leads to pain. I understand your argument that testing position cannot predict who wil have pain. What objective assessment do you use? Is it valid and reliable? I am open to new ideas!

            Barrett, Your comment about "invented terms" disturbed me. From you essays you refer to William Carpenter coining the phrase Ideomotor Movement. Did he not invent this term. When one comes to an understanding of somenthing that has never been described, the you are inventing a term. Mr. Hruska has Invented the descriptions of polyarticular chains, that are different than Meisier', and others. If you are the first to do so I consider that science. Then that term/theory can be challenged, and researched. Why do you have a problem with that?


            • Diane, the horizontal abduction test determines the resting position of the scapula on the rib cage, and therefore determines the position of the rib cage.
              Hello Raulan,

              It would seem that there could be a few things that could contribute to this. How was it determined that the resting position of the scapula reflects the position of the ribcage? As I was reading this I couldn't help but think of Barrett's "defense or defect" argument Asking Why. So, how did the ribcage become defective or malpositioned? Could the position of the ribcage be in defense of sensitive neural tissue? How did the neural tissue become sensitive?

              Really looking at this there could be many factors, how is it possible to know which? I am not sure if it is even possible to know which given the ubiquitous nature of the human body, but trying to arrive at a simple explanation that makes sense appeals to me.

              Christopher Bryhan MPT

              "You are more likely to learn something by finding surprises in your own behavior then by hearing surprising facts about people in general"
              Daniel Kahneman - Thinking Fast and Slow


              • Raulan-

                Thanks for responding so quickly!

                Well, I use various orthopedic tests in looking for musculoskeletal pathology, I think you'll find Josh Cleland's book "Orthopedic Clinical Examination" gives a good summary about validity/reliability of those tests. I use the ones supported by the best evidence. However, many of my patients appear to have pain as a result of mechanical tension in their nervous system, and for this group, there are few tests that are terribly helpful. Some data have been published about upper and lower limb neural 'tension' testing. Since I don't use these examinations to drive my treatment of patients with this particular essential diagnosis, then I think the reliability/validity of the tests are less important. I think Barrett's essay "The End of Evaluation" on his site covers this well.
                I'd be happy to discuss any aspect of my practice elsewhere, and be open to your criticism, but I'll let this thread stay about PRI and it's concepts.

                Interesting that you bring up the idea of a threshold for pain, I couldn't agree more, I have heard this concept described as "adaptive potential". How can this be measured, and knowing the issues with reliability and validity we brought up earlier, how does aiming treatment at these findings address pain relief?

                Jason Silvernail DPT, DSc, FAAOMPT
                Board-Certified in Orthopedic Physical Therapy
                Fellowship-Trained in Orthopedic Manual Therapy

                Certified Strength and Conditioning Specialist

                The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.


                • Carpenter came up with a single term over 150 years ago that has stood the test of time and thousands of studies. He did this to make a known phenomenon clearer, not to obfuscate.

                  The plethora of terms often invented by those who propose we see things never before noticed doesn't help. It is the sort of thing done by those who have a preconceived notion of dysfunction and then try to find evidence to bolster their argument. New terms multiply as rapidly as the courses invented to teach them.
                  Barrett L. Dorko


                  • Raulan,

                    Something you might like to think about: how does a scapula and ribcage "know" to present as a defect/defence? They are structures that can only move as directed by the nervous system; they can be seen as 'slaves' or as Diane puts it, 'puppets' on a string. They know nothing about initiating a contraction or a pull this way or that; it is not in their duty statement. They are in the Army, where NCOs do only as they are directed.
                    Therefore treating the rib cage and scapula directly can achieve results; but Army privates can only follow orders from the top brass (the nervous system) - not from us. So unless the top brass is addressed....the solution may not last very long, unless we are lucky and incidentally include the Boss.



                    • I am going to get my water gun out. Mr. Hruska did not have pre-concieved notions. He has many years of experience and through disciplined observation, and dilligent research internationally, he described manifestations of neuro-muscluar patterns, in way that has not been described before. How do you do that without new terminology. You may not agree with our philosophy, but when trying to describe neruo-musculo-skeletal expression and also consider the effect of respiration, sympathetic/parasympathetic, and autonomic nervous system, there werent terms available. I dont think that obfuscates anything, but rather allows for understanding. But the real test will be the test of time. My money is on those terms being around in 150 years.
                      I guess why some people have a hard time being in this forum is they cant tolerate criticism. I will say that to newcomers there is an evident collective arrogance of the group. No offense, but I don't see where this arrogance is derived from. Personally I don't care to engage in "deconstructing " anyone else or their approach. I may know that their theory doesn't work for me, I would rather promote and advance my own theory, but I appreciate that if you can't take a few bumps and bruises then you really aren't meant to be a scientist. My purpose of responding here was to try and legitimatley answer your questions, and hopefully add to the body of knowledge of our profession. I am glad there are others who are trying to shift our profession away from the status-quo that has been so stagnant to true advancement. I would like to challenge Mr. Barrett who is obviously a gifted writer to not limit himself to essays, but to use his talents in peer reviewed journals. I also hoped that I might challenge those in the group with enough interest that they might attend one of our courses. You all seem to be against attending courses. You may not agree with everything, but I hoped you would realize that what PRI is promoting would at least be thought provoking in a unique way, and not another course in how to mob a shoulder. I took a chance on attending Mr. Dorko's course based on one word in the title that referred to the nervous system. Please understand that there are others out there who are considering the nervous system, but we describe from a different perspective. I would like to invite any members here to attend a course and then continue our discourse. Thanks for inviting us here, and I will try to respond as time permits.


                      • Raulan,

                        You attended my course because of one word in the title? You didn't look carefully at the writing here and on my site as was encouraged in the course brochure? It seems that I get most of my students in the same way; seemingly disinterested in doing the work necessary to avoid attending a course taught by anybody with an idea or scheme. That is a recipe for disaster in continuing ed and I suspect it's happened countless times.

                        Our interest in deconstructing theory here may be unique in the profession, and that is a tragedy, I think. Your claim that we are arrogant is simply untrue and belies a tendency to attack the messenger that I've seen elsewhere on this board in the past. NO ONE has said a thing about the person who has advanced the theory proposed, and any personal characterization of those questioning theory is inappropriate.
                        Last edited by Barrett Dorko; 18-07-2006, 01:37 AM.
                        Barrett L. Dorko


                        • It took me quite a while before I critically questioned someone or tried to defend myself publicly . While there is a learning curve, one I'm still on and will likely be on for some time, I think calling this process arrogant (and actively avoiding it) is tantamount to aiding and abetting the dumbing down of our profession. Actively engaging in this type of dialogue does not prevent someone from pursuing their own ideas and in fact it is the only way to side step errors in thinking before you build a kingdom on a quagmire.
                          "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris


                          • Thanks to Raulan for sticking around so long. It actually took quite a while before acknowledging his recruitment efforts

                            I find the assertion that the people on this board are adverse to courses quite laughable. Probably the most well-educated group that I've come across in some time. Forgive us for being discerning about where and how we choose to learn. I'm quite sure few here will be signing up without some more answers to the questions posed. Again, thanks for you work on this so far.

                            BTW, I think Barrett's writing gifts would be wasted in peer-reviewed journals.

                            Nick Matheson, PT
                            Strengthen Your Health


                            • I did not contend that anyone person here was arrogant, but rather the collective group conveys an I'm right, you're wrong connotation in their communications in this thread and others. I have stuck around this long because I understand that this process is important to advancement of the profession. I guess I am asking this group to be as introspective with the same level of criticism as they of others. Repeated posts directed my direction regarding invalid and unreliable assessments could easily be asked to you. Maybe this is more appropriate in another thread, but I think this group has scientifically based theory and yet lacks some of the same validity and reliability they point out in others.
                              Nick- Mr. Dorko teaches continuing education courses, so do I. In revealing that I would encourage attendance to a course is that I feel that there is valuable information that is unique compared to the average level of courses out there. I detect that you think my motives are purely monetary. Is Mr. Dorko the only one allowed to be altruistic in his motives for teaching?
                              Last edited by Raulan2; 18-07-2006, 07:17 AM.


                              • Jon- Barrett said something important in an earlier post. That a theory or concept will stand the test of time. Theories, or treatment philosophies, will stand on their own merits, or more importantly fade away to inobscurity based on the lack of science. In my opinion, the best way to advance the collective knowledge is to advance your theory through research, and improved success with patient treatment. The more success you have in a science based philosophy it will elevate this above poorly scientifically based theory and treatments based on "traditions of the past". Have you considered that when you spend so much time trying to deconstruct a theory that you unintentionally give more validity to that school of thought that it deserves? Scientific evidence will be all the deconstruction you need. I wish that at PRI we had completed more of our research, we are actively engaged in this, and a large portion of our proceeds from our courses is set up to ensure that research can continue. I know that some out there make a considerable income through their cont. ed courses, If you could see the car I drive you would understand that if this were my motive, then I neeed to reconsider my career path. I look forward to the discussions we will have in 2-3 years. I really think that many of the concepts here are shared in both of our concepts. I do feel like we have some common ground, and some areas where we are further apart.