Postural Restoration

[BB]

Hi Olly,
Again, thanks so much for participating here. I think some of us were getting scared that you weren't coming back and the discussion would cease.

Since I'm here, I'll kick it off, especially since my road travelled is probably similar to others.

My approach, in treatment of those in pain, is to consider the nervous system. Since pain is an output, and not an input, I find it important to consider why this output has come to be. Why is the body under the impression that it is being threatened, and is therefore attempting to use pain to bring about resolution. Then, I hope to unravel what needs to happen to bring about this resolution.

It will be easier to describe the influences of my technique than to describe them, because in approaching the patient in the above manner, I don't use a toolbox, but rather a framework. I'm sure you understand.
The big influences for me were first Sahrmann, after which I used very tissue stress based explanations, similar to yours above so far. Next up was Butler and Shacklock with Neurodynamics. At this point I began to see that pain cannot be explained in terms of tissue stress. As Lorimer Moseley said, "nociception is not necessary nor sufficient to cause pain." So, an incorporation of the physiology of pain, and the nature of the nervous system was incorporated. Lastly, has been the influence of modern neuroscience. The work of Patrick Wall, Joseph LeDoux, Damasio, and others helps to paint a picture of how pain is very context driven, with tissue stress being just one of many, many facets of that context.

As Jon said, your technique likely brings about results, no doubt. I think where we are concerned is with differences in explaning why your approach brings about the results that it does. It is not a lack of understanding, nor a lack of eagerness to learn that is in our tone (In fact, I think that if you read through some of the threads you'll see that an eagerness to learn and foster learning is one of the many strengths of this site). Instead it is a tone that doesn't trust that a mechanical or tissue stress based explanation will hold weight throughout a pain physiology perspective.

Critiques here can no doubt become harsh, but all we are looking for is an equally strong defense. Not defensiveness, but defense of theory.

Thanks again for posting!
Cory

[Jason Silvernail]

Olly-
I think you're right, in that this is a tough crowd.

Here's my thought on this: those on this board are used to having long debates, here and elsewhere, with many in the therapeutic community who are not aware of what we consider to be (and have references to prove are) basic facts of neuroscience and pain physiology.

The practitioners we have encountered and debated think only in "biomechanical" terms, equating pain to various aspects of strength, posture, or flexibility. Of course, the reference list proving these things are false is quite long, but for whatever reason these myths persist in the therapeutic community.

While we remain mystified why this persists, we are doing our part to help reduce this continued misinformation through contact with students and other practitioners.

When a new practitioner enters to debate these issues, while the process may seem new and fun to them, it is actually a rather "same-old, same-old" process for us, and I suppose our patience and tolerance for those without this knowledge is growing thin. Of course, these myths have been passed down from instructors and CEU courses, so it's difficult to be frustrated at individuals, just the process by which it happens.

So, the dripping irony and cloud of smug that seems to hang is directed at the process of misinformation and the myths, not individuals who are so indoctrinated.

In other words, nothing personal.

I'm not sure if that helps or not, but there it is.

Jason.

[Jon Newman]

Hello Olly,

I do think this site is for furthering knowledge by communicating with others although not without criticism. Without that, knowledge will likely be elusive. Those who have asked questions have a "true interest" in pain physiology and have trouble accepting the premise of postural restoration or are trying to understand what the premise is in the first place. My questions and concerns are legitimate and I'm dissapointed that you see that as otherwise. I won't try to defend some of my comical quips, they are what they are.

[Cory]

PRI and asymmetry

Hi all. I am also a PRI certified therapist. I am fairly new to the use of the message board and don't get time to check often but I will jump in as I can.
I have to give props to Olly for diving in and hope I can assist in the discussion.

There seems to be an underlying debate about the issue of asymmetry. PRI does not say that we are not, or should not be asymmetrical. On the contrary it has actually looked at the most common pattern of asymmetry that appears in almost all individuals and describes what one should expect to find. The issue of how much asymmetry is more likely the issue. When a person begins to become so patterned that they can no longer move or shift out of an asymmetrical position that they begin to develop other compensatory strategies for movement. This patterning can be a result of asymmetrical muscle strength and flexibility, articular changes, neurological changes such as visual midline shifts, etc.

These compensations can cause further patterns of asymmetry in other regions of the body, or can lead to pathological localized adaptation or damage to the tissues and structures in response to the excess strain or load.

Using a framework that relies on recognizing these patterns, the degree of asymmetry, the ability to move and function within the pattern as well as out of it, we can more effectively aim our treatment at bringing the asymmetry back under control, not completely be rid of it.

Looking at posture and position is a lot more than "attending to a plumb line", and I feel needs to be addressed. One can not assess and treat a shoulder pathology (impingement for example) without also looking at the resting position of the shoulder complex and the postural patterns that direct that position. Those patterns include the position of the the ribcage, breathing dynanics, position of the trunk on the pelvis, the pelvis on the lower extremities, and so on.

Thanks for the very stimulating discussion.
Cory

[Barrett Dorko]

Olly says, "So far not one of you has asked a qustion in a manner that belies true interest..."

This is quite simply untrue. Well, it might be true if you define "true interest" as "a readily pliable belief that the body exists as anyone else chooses to describe it - no evidence required."

I've spent an entire career trying to get people intersted in my own ideas and had little or no success. The fact that so many here are questioning you so readily certainly implies an interest. Is it the word "true" that changes your definition of this?

Olly, when you say you find me "comical" I have to assume you see humor in what I've said. Is it wrong for me to assume otherwise? When you don't mention that you find things funny and I can see nothing funny (to me) going on, I can reasonably assume that your mirth in dimishing. If so, maybe you shouldn't use the phrases "get a kick out of" or "comical" when replying.

This will help to avoid confusion.

Now, back to those answers we've been waiting for.

[nari]

Olly,

I'm surprised that you think we are not interested in learning more (see your quote); I thought asking questions was one way of learning about another's approach or thoughts.....apparently that is not the case.

Can you clarify what you mean by a lack of interest?

I can't go past what is written above by Jason. Bas and others, as what I think clinical work is about, and should be about.

Nari

[Diane]

Hi Olly, Cory (#2) (BB is also "Cory"),

Thanks for sticking with the discussion so far.

This whole site exists because none of us are especially interested in what I call "empire building". Instead, we have this weird idea that it's good to exercise our synapses together and individually, understand nervous system processes and promote that. We don't exist to construct yet another system based on misbehaving mesoderm, how it looks, how to make it look different/better, how to poke it or pop it hoping that will take care of pain problems. Nor do we exist to promote other systems based on these pretexts. So you can't sell us your course, or expect us to let you promote it here freely; so if that's your real intent, sorry.

Collectively we would like to see the profession move away from "mesodermal thinking", which completely
1. obliterates/makes invisible any understanding of the actual mechanisms that underly human behavior, response to treatment, physiology, movement, and pain;
2. provides the world with a plethora of guru driven treatment "systems" and/or "techniques" that all tend to contradict one another and make a few people (the most persuasive ones) rich, at the expense of the many (those who forever remain confused about which "tool" to use for what type of mesoderm they think they should try to fix).

We can't see how your system differs in any remarkable way that would persuade us to leave this set of understandings/convictions we've attained, back onto the merry go round of "this works, so buy it and try it."

It sounds like your founder saw things a certain way, and thought, yeah, this is THE way, and starting selling it. Sounds like you guys bought it, and that now you are salesmen for it. We know the role.. and have successfully avoided it, so here we are and here you are and here we all are, together talking.

Several posts ago I quoted a long list of statements made as fact by Olly, then asked "So I'd be interested in having all of the above translated into "neuro", if possible.."

I was told I was getting an answer, but instead got assumptions based on structure instead of answers based on neural function or dysfunction. I was even told it was going to be made as simple as possible for me.. well, I want to let you know just in passing, that frankly, I prefer complex. There's nothing about nervous system function that is simplifiable without skipping over it completely, which is what happened, for not a word was spoke about nervous system anything.

To answer the question about how I work; I'm a sole practitioner in a cash-based practice doing manual therapy, getting "instant results" quite frequently, by focusing on neural entrapments and helping the patient's brain unload them itself, the Diane way. Posture improves by itself I guess, much of the time, not always.. really I don't care about that as much as I care about how patients perceive being in a body, if it's more comfortable/useful for them post than it was pre. I've been a PT for 35 years.

Maybe we are a tough crowd, I don't know.. Maybe there are some less grizzled PTs out there you can sell your system to; I stopped buying. Finally.

[Diane]

Me again... this just arrived in my mailbox from Ian, who has perpetual problems with his ISP in Scotland. He has asked me to post it here.

Postural reply ……….

Its possible to assume that people on the board are in a group or in some way know each other or support a technique based ethos . Nothing could be further from the truth . I don’t ‘know’ anyone here and have little interest in branded techniques to solve the confusion which is ongoing pain .
My opinion is that groups headed by charismatic figures are almost religious rather than neutral questioning systems of enquiry .
To navigate human suffering and ongoing pain, science may provide many answers especially modern neuroscience which many here are interested in .
However, there are changes happening ……We now know that the brain is the organ of pain and many influences determine the sensitivity of a persons body .
Tissue ischeamia is a typical source of pain in modern western countries due to a low grade threat response engendered by a very different society than we have evolved to live in . In order to influence people rather than idealised images of a stationery body in a clinical environment models based on onion rings (biopsychsoical framework) helps to see the wood for the trees . There is an increased acceptance of integrating issues outwith traditional orthopaedic thinking . Importantly people like Hadler in the U.S have repeatedly broadcast what drives people to therapy and treatment and it is not what we would like to think . It is suffering and coping which determine for many the tolerance to discomfort and I think Physiotherapy is overcomplicating this issue dramatically.
What we need to become more interested in is eliminating threat responses and promoting self reliance wherever possible . There is an explosion of interest in placebo mechanisms which we constantly skirt round in the search for the technique which may prove more successful than the last one we paid to learn!
For me the framework needs to integrate stress biology and basic brain processes of pain . This is the academic bit but I see a real role for personal development and understanding of input /output processes when interacting with others (see the explosion of research into mirror neurons).This is where the effect of touch, education and the understanding of the ‘art’ of therapy comes in –motivation ,humour and the immeasurable aspects of care .
I think its good to have a movement practice oneself in order to understand the effect of movement on ones own matrix . Many of the postural ‘corrections’ and ideomotor principles although explained using esoteric language have bee understood first hand by practitioners of chi kung and mediation for a lot longer than therapists have been in business and they cost nothing!
So all in all Physiotherapy developed to meet the needs of wartime combatants based on orthopaedics and biomechanics is evolving . I think there is a need to integrate basic neuroscience with well proven psychosocial data in order to eliminate the myriad of competing tissue based constructs . Basically I ‘believe ‘ an awareness of mediation and mindful movement would assist most benign pain states that I commonly see as for the most part it’s a glitch in the matrix rather than any gross peripheral problem that is largely being influenced ?
However the biggest factor is seeing the individual in front of you for who they are --an individual and for this I see a need to provide very simple treatments with a an awareness of the complexity of the patient .This complexity ranges from understanding common issues with fear avoidance /the effect of social and personal isolation / the effect of misperception of effort which may need motor awareness training ,the effect of a persons language on their brain output (narratives affect brain construction) and the basic reasoning of adaptive and maladaptive sensitivity …….There is not a brand to teach you this its ‘my’ integrated approach utilising information by Hadler ,Wadell, Damasio, Gifford ,Dan Dennett ,Patrick Wall and Jon Kabat Zinn!
What happens commonly is to define yourself by the technique one follows and as we know very few in physiotherapy have got much to offer when isolated …….its the understanding that is more important I feel!

ian

[nari]

Ian and Diane said it all better than I could.

Inspiring courses that seem to have the 'a-ha' factor are endemic. We all attend courses which more or less, fill gaps in knowledge.
Some tend to make more gaps, so we go to more to fill them...and so on.
Eventually we end up with a plethora of methods and then start looking at subgrouping patients in order to slot in the dozen or so methods. Some patients don't fit the grouping and subgrouping, so more courses to establish predictive values, grouping analyses, normative values, proving Fred's courses are invalid and Joe's courses great.......
We always hope someone else in our profession will show the way.

Wrong.

It's up to us to work it out as best as we can from grass roots/basic physiology concepts, the opinions of gurus and do lots of tossing out of 'methods' which do not sit well with basic knowledge.

I think on this site, we do that, without any worshipping of gurus. They can be useful, or add to confusion.

Nobody ever said it was easy, but at least it is honest.

Nari

[Jon Newman]

There seems to be an underlying debate about the issue of asymmetry. PRI does not say that we are not, or should not be asymmetrical. On the contrary it has actually looked at the most common pattern of asymmetry that appears in almost all individuals and describes what one should expect to find.

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

These compensations can cause further patterns of asymmetry in other regions of the body, or can lead to pathological localized adaptation or damage to the tissues and structures in response to the excess strain or load.

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

Using a framework that relies on recognizing these patterns, the degree of asymmetry, the ability to move and function within the pattern as well as out of it, we can more effectively aim our treatment at bringing the asymmetry back under control, not completely be rid of it.

This sounds like getting people to be more aware of how they move.

Looking at posture and position is a lot more than "attending to a plumb line", and I feel needs to be addressed. One can not assess and treat a shoulder pathology (impingement for example) without also looking at the resting position of the shoulder complex

I don't look at the resting position of the shoulder in order to direct my treatment of individuals with impingement syndrome, yet people that come to me with this diagnosis typically improve. I've found that when they attend to qualitative aspect of movement more so than quantitative aspects that they do just fine.

...and the postural patterns that direct that position

I find this interesting. Can you expand on the idea of postural patterns directing an end position?

[Barrett Dorko]

I think I've got it.

Asymmetry isn't important, painful, unusual or pathologic unless it becomes so.

Is that it?

Note: This is not actually meant to be funny but please feel free to laugh. I will make no assumptions regarding your reaction.

[Randy Dixon]

Barrett,

You always invite people to post here, yet when they do so you always seem to take offense at what and how they present it. There is something to be said for genuineness, but it doesn't preclude the possibility of politeness. Olly, and now Cory, has virtually walked into a room full of strangers and presented his ideas. Ideas which everyone else in the room disagree with and which they continually debate among themselves about. This isn't easy, it shouldn't be made harder. If you really wish others to share in this discussion and this forum, rather than the same handful of people engaging in an ideological love fest, then perhaps you could try to be more respectful of the people who take your invitation to post here, even if you remain disdainful of their ideas.

Olly,

I have some sympathy for your approach. I believe that you see the compensation patterns you describe, I see some of them myself. I also think, as do most of the others here, that you probably get good results doing what you do. The problem is that there are why's not being addressed. Why did the polyarticular links, kinetic chains, muscles, whatever make the adaptions they did? Why do they continue and how? How does moving the skeletal and muscle structure resolve these problems, in the course of normal movement they will at some point in time reach the positions you place them in, why don't they remain that way? What is missing in your explanation is that the musculoskeletal system isn't steak and sticks, what controls it is the nervous system. Muscles don't "shorten", joints don't become "tight", they have altered neurological signals. If they were the result of "pathological localized adaptation or damage to the tissues and structures in response to the excess strain or load" you would not see instant or quick results, the tissue would take days or weeks to repair itself.

So if you agree there is a neurological component in what you do perhaps you can explain it in those terms.

If you disagree an explanation of why not would also be helpful.

Also, if it is neurological, is what you are doing the most effective way to address it. I'm not saying it is not.

[Barrett Dorko]

Randy,

You're way off base. After 70 posts on this topic the position of the PRI people can be succinctly stated as I did. Olly's earlier comments regarding his amusement were his own and not mine. I've shown no one any disrespect whatsoever. You've been watching me participate on the BBs for years. What makes you think I'm suddenly interested in being told how to behave?

As with the MFR discussion six months ago, the unanswered questions are piling up. I'm no psychic, but I don't anticipate any change in their status.

[Jon Newman]

Randy I don't see people taking offense to someone coming on to discuss their ideas. I do see offense taken when people refuse to discuss ideas without charging (must attend the course) and I do see people taking opposition to what is being presented.

To a priori treat someone as if they cannot participate in a debate of ideas is disrespectful of that person's abilities in my opinion. Olly and Cory are likely to have enough fortitude to withstand disagreement from others and if not, they may benefit from developing it because this bulletin board is not the only place that might disagree with them and it doesn't appear that the person who originally presented these ideas to them is willing to publicly help them out. I've seen this before and it might represent a more veridical source of disrespect.

[Jon Newman]

An additional thought: My use of "humor" used during the thread likely contributed to Olly getting on the track he did and was unhelpful. Point taken.