Postural Restoration

[stregapez]

Barrett, I may have misunderstood you, but beginning with the reference to the Goodfellas movie and the Joe Pesci character (being offended and angry because he thought he was being treated "like a clown") I saw the same thing Randy did (I think). You seemed to me to be offended, and seemd to be retaliating verbally. I didn't view Olly's wording as at all offensive in context (ie when he sad he "got a kick" out of the thread.) Why? Mostly because in your very first post here you said "ha ha," literally, as regards how your view of PRI....And it was obvious you found it laughable. So isn't it understandable, as well as predictable, that people from PRI might, unless they were absolute "saints" respond in kind?

Olly, I tried to frame my questions in a way that would both acknowledge your description of what you view as a pathological postural condition, and bridge it to some of the questions that had been previously asked by other posters (I was trying to "humor" both sides , with the hope of getting some actual interaction going)

I agree some of the comments here have been contentious (in a bad way; ie maybe even a little hostile) and i think it's kind of unfortunate. However, I think about 2/3 to 3/4 of the comments and questions have been quite fair, if somewhat contentious in a good way (ie challenging, yet not impolite) and i still hope you and/or Cory (welcome Cory!) will try to overlook the personality issues, and address the questions. Like the other posters here, I don't feel they have been answered. Since the brain, partly via the rest of the nervous system, is the only part of the body that can feel pain, I also find it essential that things be explained in terms of the nervous system. I think once you began to do that here, there would, in turn, be more responses and then you would be able to perhaps better challenge the seeming disagreements. Many of the disagreements might remain for most here, but the issues would be more clearly defined.

I can understand everyone's annoyance at not having questions answered, but at the same time I think a little pateince would have helped (though I could be wrong)

Olly, I am a massage therapist. I mostly do Swedish relaxation massage, with some gentle rocking and passive stretching and passive ROM mixed in. I get some very good and immediate results with both physical and mental tension/unease, and pain (and it seems even with both long-term pain and stress at times). I'm not sure how it works exactly, though I think I have a partial understanding , and have attempted to address that issue in some old theads. I don't pretend to be a scientist (especially not at this point) but I am trying to learn and to be open-minded. I'm would surmise some posters here don't think what I do has all that much value, yet I continue to read (and post) here as I feel I may have some things to learn from the people here (who I think are pretty well-versed in modern pain theory and research)

Dana

[EricM]

Being one here who has met Barrett personally a number of times, I had been thinking of how he had been restraining himself. We are who we are and no one here should feel like they have to apologize for just being themselves. When you read closely, none of what may seem like personal attacks are in fact that way at all. Olly is a complete stranger to me and I’m sure a really great guy (girl?). What are questioned are ideas and that should not be taken personally.

I really don’t think anyone here doesn’t get what PRI is all about. It’s quite straightforward and since we were all ‘raised’ within a biomechanical, ‘mesodermal’ philosophy we can all see how it is just another twist on the same old stuff. Just enough mystery is left on the web page to draw a person in, that’s marketing for you. Therapists are desperate to cling to anything that might help them treat those painful problems that just never seem to get better. No one here is denying that PRI probably helps some people. So does massage, manipulation, MFR, and even ultrasound for that matter. All for the same problem, and that’s the problem. When multiple modalities can each work for exactly the same problem by claiming to have an effect on different tissues and systems, can any of them be correct? How confident would you be infront of a tribunal defending your theory to a higher authority? When you account for the nervous system a logical defendable theory for recovery presents itself. When you finally understand how the nervous system is really functions in pain states, biomechanics, strength, posture etc become largely irrelevant in your reasoning. When we talk with our patients and our colleagues about why what we are doing works, we have to look beyond traditional explanations because they simply are not defendable. For most, this is not an easy step to take. It takes a great deal of courage to deconstruct what you have always held to be true. Everyone posting on this site would give the shirt off their back to help with this process, for free, for anyone willing to take that step. But you have to be prepared to face the hard questions.

As for myself, I am 32 years old, with 3 years of practice behind me and am glad to have discovered the people here as early in my career as I did.

eric

[Barrett Dorko]

Dana,

To your credit, the first five words of your last post are certainly correct. After that...well, when I said "Ha, Ha" I was referring to my own rather obsessive tendency to question things - not the things I am questioning. I don't find anything laughable about Hruska's theory. Disturbing yes, comic no.

Olly made it perfectly clear that he was amused at all the speculation regarding this theory and practice. I didn't say so at the time but I find a comment like that patronizing. I figured I'd let Joe Pesci say it for me. By now you might have figured out that I think some screenwriters are far more clever than I am. So shoot me.

What Eric says is perfectly true and justifiable and when Olly offered that quote about someone "thinking their learning is finished" I have to wonder who he thinks he's referring to. Certainly not the regular posters on this BB.

I'm searching the old memory banks for another movie line in reference to that one, and I'll let you know.

[stregapez]

Barrett,

I don't know what to say. For one thing I think communication via the internet is more likely to be misunderstood than in person. It's quite possible Olliver and some other people thought thought the same thing as me... Also, ironically, to be honest, a bunch of times in posts I've thought you were being quite patronizing (in this thread and elsewhere) and overly-defensive in a personal way. That doesn't mean i don't find most of your posts intelligent (and also very interesting), but not infrequently they make me want to cry or go run for some Tums And sometimes I think you are sabatoging your own desires to get more people to participate here. The Pesci thing, to me, just seemd so confrontatonal , and melodramatic, especially directed at someone you don't know. If had had been a joke it would have been funny ...now shoot me, or edit me.

Anyways, enough of that here, unless people really want to talk about comunication (if so that should proly be a different thread)

I still hope very much the PRIers come back and that a real conversation concerning their theories and practices (and yours) emerges.

Dana

[stregapez]

Eric,

I don't disbelieve you, the point is that apparently the average person doesn't have enough information to disbelieve the posture-focussed people either, even trained PTs. Like I said, I'm on the fence, though I tend to agree with you more. If people here wanted a real converation to happen, I just think it would be better to start with Beginner's Mind sort of thing (or at least pretend you are) rather than start off attacking the PRI theories before they've even explained how they work in nervous-system terms. But maybe i am wrong

Dana

[Barrett Dorko]

This BB obviously isn't for beginners. We all treat patients here and I presume some relevant schooling would precede that job. What we have here is the skeptical mind. This requires a provisional approach to claims and is by no means an "attack" of any sort. Skepticism continuously "applies the methods of science to navigate the treacherous straits between 'no nothing' skepticism and 'anything goes' credulity." (From Skeptic magazine) The "beginner's mind" closely resembles the latter.

Dana, If you feel I've said something patronizing provide a quote, don't just accuse me of this. I'm not going to bother trying to find what you consider "over-sensitivity" on my part. I'm guessing you can't read my mind so you wouldn't actually know about this.

It has been quite a while since Olly was asked to describe his work using some neurology. This is a reasonable request, to say the least. But his last response included this: Before I start to answer your questions again, I would like to know what you all do, what approaches do you use and just in case I am not familier with your approaches I would appreciate a short synopsis of what you do and why.

I'm guessing we haven't completed our assignment yet.

[Jon Newman]

Fair enough. The vast majority of my approach to pain management can be (over)simplified to the use of education/communication and to the promotion AROM of a certain quality. If the patient is insufficiently strong but has excellent pain management, I use resistance training. If they are insufficiently flexible but have excellent pain management I use stretching. Often times I find that once they are able to self manage their pain they are uninterested in the latter two aspect of therapy described above but I provide it as needed and desired. I'm quite sure you're sufficiently familiar with the above procedures such that I don't need to do a synopsis. If I'm wrong, please start a new thread and I'd be happy to participate in answering questions to the best of my ability.

[EricM]

Ditto that Jon. I guess I would add that a fairly large contention of mine is honesty in my interactions with my patients. Perhaps I'm overly sensitive here but I like to do my best to explain things in terms of what is most probably happening. To me that implies using the language of neurophysiology. If I happen to do something that looks like PRI I would try to explain it in these terms. It's my opinion that we do our patients and our profession(s) a diservice to do otherwise. I cringe at the thought of being a propagator of faulty memes.

eric

[Diane]

I cringe at the thought of being a propagator of faulty memes.

Me too.
At the risk of this thread careering toward going off topic, I'd like to point out that it is an individual responsibility in our lovely postmodern age to be careful of one's memes, as each of us exists as a locus of information, like it or not. Each of us has to be our own "higher authority."

Some of us, formerly in oppressed roles, embrace the job, happy to at last have the chance to take it on; others bemoan the loss of conventional conservative structure that kept everyone in a heirarchy (with white men at the top just under the construct called "God"); and most don't even know and/ or couldn't care less.

Please note, just because there aren't any "higher authorities" doesn't mean the job of higher authority is up for grabs by would-be gurus; none of us can afford to support them anymore. It means that you have to be careful what to trust, cultivate skepticism as was suggested above.

[stregapez]

Barrett,

Ok, I apologize for making vague allusions like that, but I didn't want to take the thread off track and cite examples . By the way, I also didn't mean to imply I thought it was the totality of your personality (and I am also fully aware one's personality is unlikely to be fully expressed on a message board anyway) . I'm about to shoot you a pm to explain part of what i meant

Jon,

I would be interested hearing more about what you mean by pain managment by education, but I don't know if that's something you want to elaborate on here, or if it' maybe something that should be obvious to me from other threads.

Whats' AROM, by the way?

Dana

[Diane]

Dana,
AROM= active range of motion

[stregapez]

Thanks Diane, I'd have gotten it except for the A

Dana

[Bas Asselbergs]

On June 9, I wrote:
"Olly, my first reaction to that question was: "Since when is it up to me to prove a negative?" The question is rife with assumptions: "uneven" - measured how exactly? "Inefficiently" - measured how exactly? "Asymmetrically" - measured how exactly? I am saying I do understand the train of thought and the seemingly logical process here, but it is not exactly a process that stands up to Occam's razor, is it?"

Clear questions - no answers yet.
With regards to learning - why in the world do people think we are here on the site? Mutual admiration? I have much more interesting things to do with my time than that.

When I see claims of effectiveness of a treatment approach based on the detection of dysfunctional "asymmetry" with what seems like a plethora of biomechanical minutae, I want some clear idea on what it really is based.
To satisfy the need to know who you are talking to, Olly: I am an old PT who has taken Sahrman, Upledger, some of Barnes' courses, Greenman (DO), Kuchera (DO), Maitland, Kaltenborn, even Jimmy Cyriax, David Butler and Vladimir Janda's courses in my many years as a PT on the "hunt" for more. I have taken acupuncture and sports physiotherapy, and manipulation (orthopaedic) specialisation in the Canadian system, have learned an awful lot from the internet (Barrett, Diane, Jon, Ian, Jason, Bernhard etc etc), ......and do much gentle manual therapy, and I am always involved in patient education - whether verbally or non-verbally.

Now, did that make my questions look any different?

[ollyhall]

PRI neuro

Hope you all had a good weekend,

OK so you want to know more about PRI and it's neuro effects. Posture and alignment are not just working on muscles and bones, but on every system in the body. It determines the room we have for our abdominal viscera, it effects circulation, it determines the environment around our nerves.

Working hard to breathe due to a twisted diaphragm is going to increase the sympathetic action of our nervous system.
Due to pelvic floor tone we are at increased risk of piriformis syndrome.
Due to accessory muscle of respiration activity we are at increased risk of TOS.
Due to a rotated sphenoid bone the jugular foramen becomes more closed on one side which will affect the Vagus, Spinal Accessory and glossopharyngeal nerves (let me know if you need a recap on the function of these nerves).
Spheniod position will affect vascular flow to the cranium, thermo regulation and hormone balance.
Torsion of the cranium is also going to affect the position of and space for the brain.
Alignment is also going to have an impact on the neural foramina of the spine.

The nice thing about PRI is that these problems are all treated simultaneously, not in isolation. PRI will affect all systems of the body.

Olly Hall, PT, PRC

[Diane]

Hi Olly,
Thanks for coming back in with your additional neuro reasoning added! I see you know some stuff about neural tunnel compression, one of my favorite topics. Also about breathing and autonomics.. More please, these are things I'm reviewing and learning deeper layers of just now.. how does pain as a predominating symptom fit into all this?

As I'm writing this and reviewing earlier posts, I am typing with my right hand, my weight on my left butt cheek, right leg slightly abducted and outwardly rotated compared to the other, my trunk sidebent slightly to the right, and rotated to the left, definitely flared out more on the left lower cage, head tilted left and rotated right... too much info, I know.. but I'll proceed.. after a long time of doing this I get up and do about 5 minutes of ameboid- like streaming ideomotor movement, or less, and it all undoes. Instant results..

So, my understanding so far is that your system is about helping people become aware of their need for developing "zones of apposition," learning exercises that will help them line themselves up (in a mirror?)

To aquire this position on a plinth is relatively easy and the challenge is to coordinate opposition muscles throughout the body to maintain this balanced state even when standing and indeed with all levels of activity.

Is the goal then, indeed cosmetic? i.e. is it a system that appeals most to the sport crowd or the body building crowd, the fashion model or movie star crowd, the people who need to look good for a living?

I think most of us here are interested in function and reducing pain for a living, and tend to attract patients/clientele who have problems more with how they feel things are "working" physically or with pain levels, than how they look. Not that the two (posture and pain) aren't often "associated".. just that they aren't cause and effect..

Thank you again for your continuing participation.