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  • Barrett Dorko
    replied
    Randy,

    You're a vet?

    Not all instinctive movement has the same purpose and my point has always been that by restricting certain movements in favor of control we have thrown the baby out with the bath water. A little understanding on the part of the therapy community would go a long way toward appropriate reinterpretation of muscular activity, leaving some room for spontaneous expression that may look odd but has its place. I know that sitting for prolonged periods isn't what we are meant to do but today that's how some of us feed our families. I'm suggesting we prepare our bodies for this task by doing something other than sitting up straighter.

    I have some doubt about your observation of any dog acting physically in an inappropriate way unless you can back that up with some research. Cindy Engel's Wild Health is the best resource I know of regarding animal behavior and what we might learn from it. In there she makes the point that domestication robs any animal of certain instinctive expression that would ordinarily help them in certain ways. I presume this means pain relief as well.

    Instead of moving as we actually want to humans ask experts for choreography. We emulate ballerinas and not improvisational dancers. It is a fact that the latter have found freedom and the former hurt all the time. Obviously Hruska favors choreography and I don't. So shoot me.

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  • Randy Dixon
    replied
    I think you are making huge jumps. It seems likely to me that the idea is that instinctive movement can be overidden by conscious action and once maladaptive behavior has begun that there can be a cascade effect. It isn't instinctive to behave the way we do, we sit at desks for hours at a time, we don't move, we get injured and we fear certain movements. It could be purely social constraints on certain movements that restrict resolution of the problems caused by this behavior, but I see it in dogs all the time. I've seen many dogs hurt their leg and then continue to limp when there is no apparent reason to, even when their paw is anaesthesized. If they overeat or don't get exercise they show it in their movements, we see many similar dysfunctions in dogs and horses that we see in people. They aren't sucking in their tummies and worrying about their hair but the dysfunctions still manifest themselves. However, if you move the dogs leg through the normal ROM and get them putting weight on it, they soon quit limping.

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  • Barrett Dorko
    replied
    If it's possible to get into Hruska's mind (and his absence here makes that guessing game a necessity though I suppose I could take his course and pay for his thoughts), I would say that he sees the patient's brain, especially the more primitive portions, as easily moved toward maladaption.

    Despite the fact that it chooses to use the body/muscles in painful, ineffective and inefficient ways it persists until the higher centers can be taught to inhibit certain patterns of use. Remember, I'm being forced to guess here.

    Such a view, if correct, makes you wonder how we ever survived as a species. There is a good deal of evidence however that beyond survival the human tendency to socialize has contributed massively to certain modern day maladies that our ancestors easily avoided by choosing behaviors that came naturally to them. They didn't opt for appearance over instinctive reaction, they didn't hold in their stomachs and repeatedly exercise certain muscle groups, they didn't worry constantly about their hair. They didn't inhibit the messages sent from their nonconscious brain to their muscles, they expressed them. So does my beagle, Buckeye. If Ron Hruska can find the time to read this I'd recommend Illness and Culture in the Postmodern Age by Morris as a wonderful resource for all of this.

    In short, when it comes to instinctive activity I come down on its side. I don't ask my patients to inhibit what they truly want to do and I don't ask the isometric manifestation of that (which simply precedes its isotonic activity) to just go away or relax. When my friends want to talk I don't tell them what to say either.

    It seems that postural restoration according to Ron Hruska begins with a distinct mistrust of instinctive behavior and works carefully to first inhibit it, having judged it as maladaptive, and then follows with choreographed activity that he has decided is "ideal."

    But then again, I'm just guessing.
    Last edited by Barrett Dorko; 22-07-2006, 02:59 PM.

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  • Raulan2
    replied
    Jon- I guess the question I ask myself is where on the road am I or are we as a profession. I think it would be fair to say that at PRI we have proposed ways of assessing these mechanics, and are in the process of validating these concepts. We have developed these concept based on as much research as we have available. I really don't consider the manifestations of these patterns as static. Just the opposite, I want to gain an understading of what is happening dynamically. The way we describe that is the activication (muscle recruitment) of polyarticular chains, or more likely the inability of the nervous system to inhibit chains due to learned patterns that have become pathomechanical in nature. I tell everyone of my patients that they likely come to my clinic presuming that I want to strengthen, or activate muscle, but it is the opposite, I want assist them in inhibiting muscle, so that they can let the body function how it wants.

    I think that some level of hypoxia triggers a mechanical change is respiratory mechanics, I cant answer if that is systemic or not. Great research question.
    Last edited by Raulan2; 22-07-2006, 07:25 AM.

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  • Jon Newman
    replied
    I think there are ranges of "normal" or "optimal" position, shape, etc, and that is determined by evolution, and not by me just defining that way.
    I agree that there are ranges but unless we understand what is "normal" or more importantly the range that represents pain then assessing mechanics is of little value. Neither normal nor painful ranges of movement are likely to be established unless there is a reliable manner of measuring them in the first place. Many of the questions being asked of the PRI group center on this dilemma. Additionally, I think there is also an issue in that there seems to be a presumption that the mechanics you are assessing (reliable or otherwise) are static and don't change unless you move the person or tell them exactly how they need to move and I think that is unlikely to be the case.

    Your comments about O2 demands make me wonder if it is your contention that there is a systemic hypoxic condition that precedes the compensatory use of scalenes, elevation of the ribs, etc.

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  • BB
    replied
    Raulan,
    Glad to see you back and to see the discussion rolling again.

    My questions:

    Do you treat every suboptimal position that you see?
    Once you determine that a suboptimal position is present, how do you test your hypothesis that the suboptimal position is related to the problem?

    Thanks
    Cory

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  • Raulan2
    replied
    Diane, Thank you for your response, I was just giving an example to help you understand how I think clinically, I know it is not that simple, but by assessing multiplte factors, it gives me some objective way to put the pieces together. You may be right, we may not have considered how much we were affecting the ectoderm, we are trying to allow the kinematic function to restore itself, this includes many systems in the body, and we do aknowledge the nervous system as the key system.

    Jon I want to answer your question, but I am baffled. Whether this amazing body came about by evolution or intelligent design, there are in my understanding optimal and sub-optimal lengths, shapes, orientation, position, of tissues. If the diaphragm is in a sub-optimal position, the ectoderm can tell it to function, but if it physically is in a sub-optimal position and cannot function with efficiency , then the nervous system has to find other muscle to meet O2 demands. You may consider this the bodies freedom of adaptatin. And it may be. At some point this can cross the threshold and lead to what I call pathomecahnical funtioning. i.e. overuse of the scalenes for inhalation, elevation of the upper ribs, compression of brachial plexus, thoracic outlet syndrome. I think there are ranges of "normal" or "optimal" position, shape, etc, and that is determined by evolution, and not by me just defining that way. I am just trying to find a meanigful way to describe it. So I think this is an area that we disagree on.

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  • Jon Newman
    replied
    Raulan, most of my patients come complaining of pain and that is what I half expected as an answer when I asked the question. The focus on proper kinematics or proper dome configuration or proper alignment makes me wonder "proper for what?" Do we really have so few degrees of freedom available to us?

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  • Diane
    replied
    OK, I'll bite. I agree to a certain extent that looking at how the muscular system is behaving is a measure of sorts, of how the brain is behaving. But you can't measure brain function with a goniometer. If only it were that simple Raulan.
    If pain is soley a neurobiolgic occurance, secondary to tissue deformation, What is the cause of the deformation?
    Instead I'd ask,
    How many deformations do we need before pain becomes the output? The original deformation might have come from a ding, a habit, a position, a repetitive use, a way of sitting, in short anything at all. It may have registered consciously or may have registered outside of conscious awareness. The brain did its best to keep the mesoderm from threatening the O2 supply of its peripheral nerves, but like a ball of yarn that gets tangled, pulling it tighter doesn't really undo the knot. Lengthening out the musculature eccentrically may help a lot, but it seems that the brain needs reminders on how to do that on occasion. E.g, ideomotor movement, etc.

    With your example of diaphragm treatment, it sounds to me like you're pulling skin in certain ways and letting the motor output take the mesoderm in a different direction, giving the brain a differential as Cory would put it. Maybe you've been treating ectoderm all along and not considering it as important?

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  • christophb
    replied
    Supertraining: only $373.99 on Amazon... ouch

    If there is tissue deformation, obviously there is some improper movement/function that is leading to this deformation.
    Maybe, but for the sake of discussion, where does this originate, what is the origin of this improper movement/function. I think what Barrett what eluding to was that is is difficult to attribute causation to a particular pattern of function or dysfunction due to the large number of variables that could possibly be present. Does the pattern change with context, environment, etc. Also, I think a big question is, what is sufficient deformation to cause the sensation/perception of pain.

    I would guess there are people with improper movement and function without pain and go throughout their life happy and asymptomatic, with improper thoracic/ribcage positioning. Is it the posture thats the problem or is it the inability to accomodate? What I want to know is, does PRI modulate the nervous system to change it's communication to the mesoderm, or does it force the mesoderm to change and then have the nervous system accommodate to that change? I think Diane would say it is impossible to treat mesoderm without going through the ectoderm.

    Chris


    I have to admit I may be beating a dead horse with these questions, but asking these questions helps to organize my thoughts, or see how disorganized they are... thanks
    Last edited by christophb; 22-07-2006, 12:31 AM.

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  • Raulan2
    replied
    Nick- there are several techniques, But I will describe a common technique. The patient is in a supine hooklying position, THe operator sits at the head of the patient with right hand under the patient on the most prominent upper lumbar/thoracic vertebrae. The left hand is on the sternum. Upon exhalation the operator guides the sternum down/distally and towards the left as he is guiding the vertebrae superiorly/proximally, the operator then holds this postion during the inhalation phase. This allows for a zone of apposition, and allows the patient to restore proper kinematics during the inhalation phase.

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  • Raulan2
    replied
    Here is a question I have to the group. If pain is soley a neurobiolgic occurance, secondary to tissue deformation, What is the cause of the deformation? I believe Diane posted in another thread that it is difficult to assess the ectoderm. Why are you opposed to evaluating the ectoderm as it is manifested through the mesoderm? I personally feel that a goniometer is a neurologic instrument of measure, By understanding joint/muscluar postion, you are getting an understanding of how the ectoderm is functioning, and what patterns are dominant. Is it possible that you can understand tissue deformation by patterns of function, and excessive assymetry? If there is tissue deformation, obviously there is some improper movment/function that is leading to this deformation.
    Jon- do patients come to you complaining of a lack of ideomotor movement, or do that they realize their inability for non-volitional movement and seek your help? I think we are all seeing the same type of patients, most want relief from pain. ALthough I work with athletes who are seeking performance enhancement.

    For the sake of understanding on my part, I agree that pain is neurobilogic and for the most part is due to mechanical deformation. Does the tissue care how that deformation is removed? Is it impossible for volitional movement to remove that nerual tension?

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  • Nick
    replied
    Raulan,

    Could you briefly describe how one manually restores the diaphragmatic dome?

    Nick

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  • Barrett Dorko
    replied
    Raulan explains: "...polyarticular chains of muscles (are) grouped based on anatomical relationships, and how they are recruited by the nervous system."

    During prolonged discussions on the original Supertraining listserv the late Mel Siff, a highly renowned exercise physiologist and athletic trainer took great pains to explain that muscular recruitment for any task was subject to change quite unexpectedly from one attempt to the next and that this recruitment often had little if any effect on the adequate completion of the task itself or the efficiency of the performer. His exhaustive knowledge of movement and the physiology/neurology of how it might be optimized with training makes it clear that any notion of a static or predictable pattern of recruitment must be brought into question. I learned a long time ago that disagreeing with Mel was, to put it mildly, problematic - but only because he knew so much.

    His book Supertraining is a classic. I wonder if Ron Hruska is aware of it.

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  • Raulan2
    replied
    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.
    Last edited by Raulan2; 21-07-2006, 11:45 PM.

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