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  • CT Postural Restoration

    Two days ago I wrote something about The Postural Restoration Institute in the "Five Questions" thread and now I feel that this deserves it's own place in our discussion of pain and its management. Specifically I wrote, "Obsessed as I am with theory and practice and, well, science, I found the web site for the Postural Restoration Institute and the name of its main guy, Ron Hruska.

    Now that we have it, those viewing this thread can easily contact them about the issues of posture and clinical practice that occupy so much of our time. Perhaps after reading the "science" portion of the web site some questions regarding what is proposed and concluded there might pop into your head. Boy, I know I sure have some! (ha,ha)

    It would probably be best if I didn't make this request for more information myself. I seem to have become some sort of "participant repellent," for lack of a better term. I contend it has something to do with my hair.

    So, anybody interested in inviting Mr. Hruska over here?"

    I spent a portion of the morning reading through the Postural Restoration Institute’s web site and find myself both confused and fascinated.

    Last week’s student was not the first therapist I’ve come across who seemed to have been sold on the theory and principles of practice Ron Hruska promotes but for the life of me I cannot generate any personal enthusiasm for what I’ve read there. Consider this from the “science” section of the site:

    “Individuals experiencing symptoms at the knee, hip, groin, sacral-iliac joint, back, top of shoulder, between the shoulder blades, neck, face, or TMJ, will demonstrate inability to fully adduct, extend or flex their legs, on one or both sides of their body. They usually have difficulty in rotating their trunk to one or both directions and are not able to fully expand one or both sides of their apical chest wall upon deep inhalation. Cervical rotation, mandibular patterns of movement, shoulder flexion, horizontal abduction and internal rotation limitations, on one or both sides will also compliment [sic] the above findings. Postural asymmetry will be very noticeable, with one shoulder lower than the other, and continual shift of their body directed to one side through their hips.”

    Aside from the misspelling of “complement” this is written well enough I suppose, and I understand what he’s saying, but I’m left with two impressions:

    1)Who doesn’t display most of what he says to the extent that the word “usually” would apply? I've got most of this; why don't I hurt? As has been pointed out on this site in other threads, asymmetry is the norm, not the problem.

    2)Just how exactly does this therapist justify his conclusions about function and consequent methods of practice? Is it pure empiricism? Is there evidence (and I mean good evidence) to support this? Why isn’t the verifying literature cited along with the conclusions? If it’s only available at his courses, why should I have to pay for such a thing?

    I presume that these courses are increasingly popular and my fascination with this revolves around our therapeutic community’s willingness to unhesitatingly accept what is proposed there. Is it the word “posture” that draws them? Is the teacher especially charismatic?

    Let’s get Ron over here and talk about this. I'd also like to see the student who objected to my problems with Hruska's theory join in.
    Barrett L. Dorko

  • #2
    I checked out the site.. some nice artwork there.

    This has nothing to do with the debate on this thread, but I was struck by the resemblance between Ron Hruska and my favorite Canadian comedian. Could they have come from the same part of the human gene pool?

    About the overall concept, it seems like many others, trying to work backwards from what is "seen" into some sort of management plan, seems quite Sahrmann-esque that way; overall, like trying to put the egg back into the shell, or the gas back into the hose. In general, I think these approaches all look at the body through the wrong end of a telescope, and don't take in the whole view; they magnify some things, obliterate others, focus on the stuff that's "wrong", don't look at why the body might behave as it does.
    Diane
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    "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

    “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

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    • #3
      Barrett,

      That could be a very interesting discussion I think. I'd be glad to invite him, sometime in the next few days to a week (after I read his web page) but I'm only a CMT so...I don't know if he would take me seriously.

      You know, it does keep occurring to me that the average person having opinions that differ from the general consensus of this mesage board (not to mention those who know less than the average poster here) might feel a little intimidated to post here, as they would feel outnumbered. I'd guess it's the same on other e-groups or boards too. The lack of overlap and intercommunication leaves something to be desired at times. It would be super if Mr. Hruska would post here! And he would be considered, at least by me, a brave soul too

      Dana
      Last edited by stregapez; 28-05-2006, 09:48 PM.

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      • #4
        If I do write him I will make sure to correct any typos first

        Also, I didn't mean to indicate above that I have any bias one way or the other

        Dana

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        • #5
          I think you're right. It would be better for a fellow PT to invite him.

          I am unconcerned about the "numbers" of therapists here who might question another about their theory or who might disagree with their answers. This isn't a tea party, and no one proposing some method of patient management should be hesitant to discuss what they do and why just because they might be offered information they don't care for.

          Mr. Hruska has had many students and his site has a page full of testimonials from those who think he's done some amazing work. They are welcome to join in.
          Barrett L. Dorko

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          • #6
            Ok, good call.

            I suppose I wouldn't mind it being a wee little bit like a tea party though (I find tea parties are good for your autonomic state)

            Dana
            Last edited by stregapez; 29-05-2006, 04:37 PM.

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            • #7
              Diane’s comment about “working backwards from what is seen in order to create a management program” is precisely the issue addressed in an essay I wrote a few years ago. See The Alien View.

              It says in part: “If you’re still with me, this is what I’m proposing: Physical therapy procedures for painful problems have rarely contained a reasoning that “traveled in the opposite direction” as is so clearly explained by Wilson. Instead, they commonly employ a “from the outside in” method of thinking that ignores the full reality of painful sensation. Instead of considering the subtle brain chemistries that might contribute to something like central sensitization, they look at the muscular activity evident to palpation and make all kinds of assumptions about its meaning without actually considering the many contributions of the nervous system and its vast chemistry. Therapy without such careful and well informed thought is little more than personal training, and poorly done personal training at that. I think that this is how we’ve arrived where you see us today; clinics where people in pain have their exercises counted for them by somebody other than a PT, and no real time is ever spent in unique and personal caring for individual problems. Protocols developed for generic problems (there is hardly such a thing) for all “typical” patients (no such thing) drive the system.”

              As I recall, my pursuit of this line of reasoning really aggravated a therapist who does a lot of trigger point manipulation. He made it clear that my insistence on an inside-out vision of problems and their solving was downright insulting. Hope that doesn't happen again.

              The attitude of the person whose theory is being questioned, I mean. Not my insistence on defense.
              Barrett L. Dorko

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              • #8
                Nowhere else is this more relevant than in post-surgical protocols; developed as a generic therapy across the board for young and old, for a 'standard' procedure. Admittedly, the protocols are developed in cahoots with the PT (in Australia, anyway) but it is mainly done to keep surgeons on side. It demonstrates that we are there to treat the side-effects of the surgery in the first instance.

                Peripheralists will argue that reducing nociception in the periphery reduces the pain experience; hence the sticking of needles, ultrasound and/or thumbs into various structures. This appears to work for some PTs and patients.

                Barrett, I know you have talked about peripheral stimulation / quasi-nonnociceptive therapy before.

                Can you elaborate again your thoughts on this?

                Nari

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                • #9
                  Nari,

                  I presume you mean a simple distinction between neuromudulation and ideomotor activity. While the former might provide distinct pain relief via the gating mechanism and, perhaps, the blood flow some massage can elicit, the latter addresses the origin of the pain - the mechanical deformation.

                  I always cite the example of a poker player requesting a massage while still playing (a common practice). They hurt, I presume, because they haven't moved in a way that effectively reduces the troublesome mechanical deformation unique to them. Of course, if they do they will quite possibly reveal their thinking. Remember that ideomotion expresses a dominant thought, and that thought leads to movements that reveal our thinking as well as our movement toward a reduction in neural tension - these two things are sides of a common coin. It makes sense to let both out, of course.

                  Hruska doesn't seem to think that instincts such as this play a role in comfort. I doubt he knows about them. He seems to think that some ideal of symmetry or sequential muscular contraction will solve painful problems and lead to enhanced performance. To me, this is a remarkably superficial view of human activity. Its popularity has everything to do with Ramachandran's theory of aesthetics detailed in the "Altering the Ideal" thread found in "Barrett's Forums" here. Until therapists read enough of the latest neurobiology this will never change. There is no possibility that that will ever happen.
                  Barrett L. Dorko

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                  • #10
                    Thanks, Barrett.

                    I thought it may be helpful for fencesitters for you to elaborate a little more on what seems to confuse them. I know your essays go through it all, but your summary above spells it out well. So does Rama..

                    Nari

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                    • #11
                      I've looked carefully through the institute's web site and cannot find any indication there of what a course actually costs. I wrote a couple of days ago requesting this information and will let you know what I hear.

                      The woman from Minneapolis has not yet looked in here, as far as I can tell. As I said, I've not personally asked Mr. Hruska to help us with this discussion.
                      Barrett L. Dorko

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                      • #12
                        Barrett

                        I found under the 'course' tab:

                        (Basic?) course, 15 hours $350

                        Advanced Integration Course $700

                        So for $1050, one can learn to stand tall.


                        Nari

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                        • #13
                          Thanks Nari,

                          I don't know how I missed that. The question remains, how have they drawn the conclusions stated in the "science" section of the site? It appears that in order to become "certified" a good deal of related research (of a sort) and case studies are required, so there must have been something done over the years. I wonder where it's been published?

                          I also remain uncertain just what exactly it is they're treating.
                          Barrett L. Dorko

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                          • #14
                            Disobedient musculature? Nonconforming sarcomeres? Aesthetically displeasing presentation?

                            I'd like to know too.

                            Nari

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                            • #15
                              Late yesterday afternoon I sent the following email to the email address for general information on the PRI web site:

                              I am hoping this email finds its way to Ron Hruska and the other faculty at the institute:


                              Recently a thread was begun on Soma Simple.com regarding the theory and practice promoted by the Postural Restoration Institute. We would appreciate some input from your staff regarding your practice and invite you to take advantage of this opportunity to speak directly to therapists from many countries.


                              Soma Simple's front page: http://www.somasimple.com/


                              Barrett Dorko's Forums, where this thread may be found: http://www.somasimple.com/forums/forumdisplay.php?f=80


                              The thread itself: http://www.somasimple.com/forums/showthread.php?t=2444


                              We look forward to your joining us.

                              Barrett L. Dorko P.T.

                              Nothing in reply yet, but it's early. I'll let you know.

                              In the meantime, anybody else have something to say about this approach? It seems that my troubled student from a week ago hasn't yet arrived here.
                              Barrett L. Dorko

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