Postural Restoration

[Randy Dixon]

So what has been accomplished here? It seems to me that everyone is going away with the belief that they are still right, the other side is still wrong and no one has gone away with an appreciation for the perspective of the other. After 5 pages, two weeks, and over 3000 views that doesn't look productive to me.

Believing you are right in a debate, or just a discussion, is the default. Although some of us enjoy arguing both sides of an issue, but generally you argue for what you believe to be true. I see no arrogance in that, if I believed that is all that is happening I would see no cause for people to percieve arrogance. To be clear, most of the questionining I observed in this latest thread and in most others is of that sort, but I also definitely find some comments that verge on being insulting. For those that argue that this is a fair forum, I suggest that you take your arguments to another forum, one that is less accepting of your ideas, such as EIM, (besides Jason) and see if you feel they have given you and your ideas a fair representation. I would guess you will leave feeling they have been dismissive, close minded and arrogant. I am sure they will make the same arguments as to their fairness as those above.

Although I am sensitive to issues of fairness and justice, my job is not to be Miss Manners. I find it very strange to find myself playing that role. I play it here because of the dissonance between the stated purpose of many here and the behavior. You want to get the word out, but then take every action to make sure that others are not wont to listen.

It reminds me of a time I went to the beach with a friend of mine from Brazil. A good looking young woman who wore a bikini to the beach which might be considered modest in Sao Paulo, but was just short of scandalous here. Five minutes after hitting the beach she turned to me and said "I hate everyone staring. Why are they staring?" To everyone who heard the question it was obvious.

Unlike there, here I am perfectly willing to share my ideas about the cause. To her I said, of course, "I have no idea"

[Bas Asselbergs]

After all of this, Randy, I have learned that it is very unlikely that I will consider taking a Postural Restoration Course, that my life in inquiry will go on as always: I look at lots, ask lots and discard more than I find worthwhile assimilating. That's how it goes with much information coming our way these days. I sort and sift. This one thread made me ask questions of PR people, while re-focusing my attention on my own practice - can I answer my own questions from my perspective? Helpful thread.

But has it changed anyone's mind about what they are doing? No. Is that really necessary in order to be a "successful" or "productive" thread? I don't think so.
I believe that any mutual prodding or poking at theories, principles or practices has a beneficial effect - it engages the mind, delves to deeper levels; or, sometimes, one finds that a promising beginning ends up being a dud. Happens. C'est la vie.

[Jon Newman]

Hi Randy,

Not surprisingly I disagree that this has not been productive but I think it has to do with our ideas of productivity. It would seem that you think persuading "the other side" (which I think is actually an over-generalization) in the fewest post with the fewest views is an indication of something productive. I see the large number of views as an being an indicator of people thinking. Surely some of them find it titillating but I'm not sure I can help that. The rest are, as Bas states, sorting and sifting. And the large number of posts are an expression of some passion. For a profession that I'm afraid is dying of apathy, I can't think of much that is more productive than this.

I post on EIM. Sometimes they answer, sometimes they don't. I have my thoughts on why some posts go unanswered but those thoughts don't include that I think they're arrogant or dismissive.

On getting the word out: I'm less interested in getting the word out than figuring out what the word is.

[Diane]

Miss Manners, the fact that you are drawn here and are uncomfortable somehow is interesting, an indication that perhaps your own thinking/questioning is changing/wanting to change in spite of your discomfort. I completely second Jon's idea on what is and isn't productive. Happy reading and posting. Or unhappy reading and posting, as the case may be.

[Randy Dixon]

As I've said before, the same handful of people that keep batting versions of the same ideas around here are happy the way things are. I think this is pretty obvious. It is only when I read questions about why things aren't different, why other people aren't interested that I get confused about what people wish the purpose of these forums to be.

What do I consider productive? The sharing of ideas, evalutating what is likely and what isn't, and pondering with others what possibilities that presents. To give an example I will use the same example I used earlier. The RehabEdge thread with John Child's. For dozens of posts it was one of the most interesting and informative threads on that site in my opinion. He explained his studies and his rational for it, he fielded questions and admitted gaps in his knowledge and entertained ideas about other possible explanations. Then the questions turned for those of inquiry and skepticism to those of confrontation. From "what do you think about..." or "Did you consider" to "and what proof do you have.." and "you are mistaken if..". From that point on, in my view, nothing constructive was said or written. However, prior to that point several things about the neurology of mobilization were referred to, in fact, I wouldn't be surprised if the following study was influenced, at least in a small part, by the early exchange:

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_DocSum

Slump stretching in the management of non-radicular low back pain: A pilot clinical trial.

Cleland JA, Childs JD, Palmer JA, Eberhart S.

That exchange to me is productive. Inviting someone to share their ideas that you know you are almost certain to reject, simply for the purpose of rejecting them when presented, is not.

Certainly there is a time and place for confronting ideas and adversarial presentations, that is in neutral forums, in refereed peer review journals, and in formal debates, but not in a forum stacked with detractors and few if any supportes, not when one side is well prepared and has "prior warning" and the other side does not.

[Randy Dixon]

Diane,

The psychological aspects of my being here aren't that complicated. At it's best this forum presents "The sharing of ideas, evalutating what is likely and what isn't, and pondering with others what possibilities that presents" It is when a person with an idea that many members are hostile to presents itself that I see the negative traits emerge. Despite the claims of objectivity and impersonal analysis, what I often see is an emotional reaction that carries over to the person presenting the idea as well as the idea itself.

[Barrett Dorko]

Randy says: "I wouldn't be surprised if the following study was influenced, at least in a small part, by the early exchange..."

It makes more sense to me to assume that it was the later exchange that influenced the study.

Skepticism is by nature confrontational, as is any scientific inquiry. Again, you seem put off by what you perceive as impoliteness, and that's just too bad. Emotional responses haven't come from the people you're having trouble with but from those with whom we express disagreement. Telling us that we are badly behaved isn't progressing this discussion at all.

[Diane]

I thought this was interesting; it was included in a website link that talked about kinetics and kinematics, of all things. Which was likely a personal quirk of the website designer, but an interesting coincidence, I thought.
Karma.

Note the reference to skillful as opposed to nonskillful action:

The Law of Karma

In Buddhist teaching, the law of karma, says only this: `for every event that occurs, there will follow another event whose existence was caused by the first, and this second event will be pleasant or unpleasant according as its cause was skillful or unskillful.' A skillful event is one that is not accompanied by craving, resistance or delusions; an unskillful event is one that is accompanied by any one of those things. (Events are not skillful in themselves, but are so called only in virtue of the mental events that occur with them.)

There's that personal perception thing again, cropping up all the time, making it so hard to get a fix on what is truly and forever absolutely "right" or "wrong"... always in between perceived self and perceived other. In much the same way skin/ectoderm (whether of self or of other) is always a confounding factor/conduit of nervous system connectedness in manual therapy; one should never discount effects it has on treatment efforts. One is deluded who thinks one is having an effect purely and isolatedly on some deeper mesoderm level. One who negates skin is (knowingly or unknowingly) deluding others who are trying to learn manual therapy, and contributing to mass delusion.

Therefore, the law of Karma teaches that responsibility for unskillful actions is born by the person who commits them.

Let's take an example of a sequence of events. An unpleasant sensation occurs. A thought arises that the source of the unpleasantness was a person. (This thought is a delusion; any decisions based upon it will therefore be unskillful.) A thought arises that some past sensations of unpleasantness issued from this same person. (This thought is a further delusion.) This is followed by a willful decision to speak words that will produce an unpleasant sensation in that which is perceived as a person. (This decision is an act of hostility. Of all the events described so far, only this is called a karma.) Words are carefully chosen in the hopes that when heard they will cause pain. The words are pronounced aloud. (This is the execution of the decision to be hostile. It may also be classed as a kind of karma, although technically it is an after-karma.) There is a visual sensation of a furrowed brow and downturned mouth. The thought arises that the other person's face is frowning. The thought arises that the other person's feelings were hurt. There is a fleeting joyful feeling of success in knowing that one has scored a damaging verbal blow. Eventually (perhaps much later) there is an unpleasant sensation of regret, perhaps taking the form of a sensation of fear that the perceived enemy may retaliate, or perhaps taking the form of remorse on having acted impetuously, like an immature child, and hping that no one will remember this childish action. (This regret or fear is the unpleasant ripening of the karma, the unskillful decision to inflict pain through words.)

If there are no persons at all, then there is no self and no other. There is no distinction between pain of which there is direct sensual awareness (which is conventionally called one's own pain) and pain that is known through inference (conventionally called another person's pain). Whether pain is known directly or indirectly, there is either an urge to quell it or an urge to cultivate it. Whether joy is known directly or indirectly, there is either an urge to nourish it or to quell it. In the conventional language of speaking of events personally, the urge to quell all pain and to nourish all joy is known as being ethical or skillful or (if you like) good. The urge to nourish pain and quell joy is known as being unskillful, unethical or bad.

Being fully ethical is said to be impossible for those who make a distinction between self and other and show preference for the perceived self over the perceived other, for such perceptions inhibit being fully responsive. Being fully ethical is possible only for those who realize that all persons are empty, that is, devoid of personhood.

Once in awhile I read things like this and marvel at how these ideas were arrived at just by sitting and pondering, long before the existance of mirror neurons was known; furthermore, now it is known that multicellular creatures including us are colonies of cells that were once bacteria, who faced evolutionary selection pressures by living together and helping each other. Now it is known that a sense of self is a convenient mental projection that evolution selected for, made by nonconscious processes in the brain and synaptic patterns that finally wire up by age 20 or thereabouts. Now it is known that atoms are made up of mostly space, i.e. that we are made of mostly space, that the ratio of stuff to space in an atom is roughly equivalent to that of a speck of dust lying on the floor in a large stadium. Sort of makes sense to be the space and not the stuff.
I suppose that the kinetics/kinematics aspects of all this may have entertained the website author although he offered no real comment, just provided the link.

[Raulan2]

WOW! was that comment misunderstood. Too bad I was Gone for a few days. I have been missing all of the fun. I simply answered the question that keeps being asked by the members here. In short, "why don't people stay here when challenged?" If you look at the sarcastic comments in posts 12-27 then you realize what I was referring to was not the point-counterpoint of science in later posts, but the tone of the comment. I was just offering my impression.

Jon. I hadn't realized that I had a "Ploy", Sounds sinnester! In my abscence I have been communicating with my dasterdly collegues in an attempt to elevate that "ploy" to the level of a "plot", or maybe even the dreaded "conspiracy". Why the level of paranoia? Go ahead open the blinds, relax, let some light in.

I was invited here to answer your questions, I feel I have done so honestly and to the best of my ability. In my opinion the only significant flaw at the PRI website was posting photos of the faculty. I consider myself a humble endomorphic therapist who is just trying to be a great clinician by the end of my career. Oh, I am rather Jolly.

I guess my comment was fodder for those interested in debating the debate.

Randy, Thanks for your comments, I thought it was Jon's goal (post 201), to try and prevent innacurate schools of thought from driving subsequent behavior?
I think the forum is in ways productive. I have gone and done a fair amount of research so that I can try and understand where this group is coming from. Could that help me in my clinical practice, sure. Could that help add to the knowledge base at PRI, sure.

I have several questions for the group that will be addressed in a new thread. Let me summarize why so many therapist are finding PRI concepts helpful. We have "borrowed" concepts put forth from others as mentioned in other posts. They have been cited accordingly on our site and in our literature. Does that mean we accept ever part of their conept? No, if it is not supported in the literature. If you take the supprted work of others that concentrate on different systems of the body and can organize it in a way that gives new understanding of how those systems are intergrated, this may require proposing new ways of describing neurological patterns of functioning. Which terminology do you use if trying to merge these schools of thought in a meanigful way and to include all systems. It may require new terms so as to not obfuscate the meaning. Isn't this advancement of science? This is not just repackaging ideas, but advancing the understanding process. I think Jon, Jason, did not take the time to really look at the cited references to understand the physilogy of what we are proposing. Is there still research to be done? Sure, is that not the scientific process? The value of the PRI approach is we are trying to understand function of the neuromusclular system, on the mesoderm. I agree that the PT community has been looking at the mesoderm, and ignoring or giving lip service to the ectoderm. But the comments of this group seem to convey that the endoderm is insignificant and a nuisance. Our goal is to look at all systems and how they interact by describing patterns of funtion, this allows us to not just look at "pain", but understand patterns of pathology, and how to enable performance enhacement.

[Diane]

Well, glad your virtual skin is thick enough, Raulan, to continue the debate.:thumbs_up

we are trying to understand function of the neuromusclular system, on the mesoderm. I agree that the PT community has been looking at the mesoderm, and ignoring or giving lip service to the ectoderm

So... you agree that the PRI approach is just reinforcing the same old memes? The second half of your statement sounds like a bit of a shift over into some another non PRI perspective..

When you find out what endoderm might have to do with anything that could possibly have anything to do with manual treatment, please let us know. I'm also a bit of an endomorph.

[Barrett Dorko]

Raulan says: "Why the level of paranoia? Go ahead open the blinds, relax, let some light in."

As with the "arrogant"comment (which has not been justified, by the way) I reject this characterization as blinded paranoids.

Think you could perhaps stop doing that?

I'd love to hear something more from the colleagues you've been consulting with.

[Raulan2]

Barrett, Even my attempts at levity are misunderstood. I guess only original members of the group are allowed that here. I was being facetious.

[christophb]

Not to linger too much on the purpose of soma but I though this was interesting, relevant...

I was listening to the podcast recommended by Jon on Point of inquiry with Thomas Kida and he had this to say about skepticism (Paraphrasing)

"Most people equate skepticism with being a cynic or looking for the fault in everything, which is not what a skeptic is all about. A skeptic just wants to see and evaluate the evidence before they believe it... We need to keep an open mind but need have to have a healthy dose of skepticism; we just can't believe every little thought that comes into our heads. There is a continuum of belief, in the middle we have "I don't know" on the right we have a strong belief and on the left a strong disbelief. We are very credulous creatures, we want to believe things and so very often as soon as we hear any bit of information, we very quickly end up on the right end of the scale with a strong belief in something, what we first have to do is embrace the notion of "I don't know" and start at the mid point of the belief continuum, and then look at the evidence and the plausibility of the claim and as the evidence mounts for or against, we can move along the continuum of either a strong belief or a strong disbelief."

I hope what we are trying to do here is play in the middle ground of "I don't know" and evaluate the evidence (which is hopefully more than anecdotal "well it works" evidence). No one has said it doesn't work or is saying to stop doing PRI.

I think one thing that happens here is that you have a well studied group of individuals that have been keeping themselves up-to date with the latest advances in our profession, pain, neuroscience etc. So there tends to be a bit of a gradient away from the "I don't know" middle ground when things don't make sense given what is currently known about the human organism. There are many things informing our doubt, so when something is being said that contradicts what is known, the spidy senses go off. That's just healthy and well informed skepticism... I think.


Chris

[Jon Newman]

I've asked the following questions so far (in reverse order):

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


Can you describe a bit more narrowly what you mean by "established neuromuscular patterns"?

In actuality I'm left unsure of what the consequent method of practice entails. I get that they do some diaphragmatic breathing (in an ultra fine grained method that also invites critical analysis) but what else goes on in treatment (regardless of how it is explained)? Is there any concordance at this level with other approaches?


What should one expect to find in a painless person and is anything other than these expected finding likely to be painful?


What is the difference between normal localized adaptation and pathological localized tissue adaptation?


Can you expand on the idea of postural patterns directing an end position?


What clinical presentation are you talking about? Maybe I don't understand what it is you are fixing in the first place. Are people coming to you because they note a decreased hip adduction on the left and lack of internal shoulder rotation on the right?


My first question is about this concept of idealized symmetry. Isn't lateralization of function considered normal development?

If these were addressed on the PRI website or their reference literature then you are correct I did not take sufficient time to find the answers to these questions.

I think any attempt to try to limit the asking of legitimate questions is sinister whether you understood what you were doing or not and saying so doesn't make me paranoid whether you were "just joking" or not.

[Raulan2]

Jon- thanks for the questions.
1) I don't know of any research yet on the incidence of temporal uneveness in assymptomatic populations. Many of us will demonstrate mild assymetry. At what point do they cross the threshold into pain? Again, no studies that I am aware of. In my clinical experience though, a patient with painful TMD, has always demonstrated hypo/hyper mobility, or greater than 3-4 mm of difference in lateral trusion.
2) It is our contention that people develop certain neuromuscular patterns, affecting what we term polyarticular chains of muscles. (these are grouped based on anatomical relationships, and how they are recruited by the nervous system). When a person develops these patterns in excessive assymetric ways then muscle imbalance, or adapted neuro recruitment pattern become more and more encoded. We propose that these patterns are responsible for tissue deformation, and pathology.
3. Lets take the limited HGIR example. No the person insn't coming to me for lack of internal rotation of the humeral glenoid. THey may have pain and hypertonic muscles in the right upper scapular/neck region. The assessment test on the website explain how I would assess what the scapula is resting on, i.e. the rib cage. If I determine that the have an internally rotated rib cage on right and externally rotated on left, then the scapula will be resting on that rib cage in a mal-adapted position, and the body will have to develop a pattern of neuromuscular recruitment of the scapular muscle to still perform the funtions tha tthe person is placing on the body, i.e. shoulder elevation etc. with muscles in sub-optimal length/ position. My treatment approach will involve manual, and non-manual techniques. An example of manual techniques Would include restoration of diapghramatic dome, Restoring apical expansion on right side, Re-orienting the sternum and length of the transverse thoracis muscle, all of this is done by moving the rib cage to guide air flow into the desired quadrant.
Jon- I will post again later.