Knee Pain

How do we approach knee pain, based on a Postural Restoration understanding of the knee?
We are talking here about a gradual development of knee pain that now demands your attention, not an identifiable sport injury or accident. Your knee hurts when you walk, squat, climb stairs, run, whatever.

In addition to examining the knee for joint or muscle injury, we are very interested in finding out why there are abnormal stresses causing pain at the knee, which may have led to injury. Abnormal stress is often the result of poor alignment of the knee joint bones and muscles, and of an inefficient, poorly balanced movement pattern. We assess the low back, the pelvis, hips and feet, for position and for appropriate muscle activity.

When the cause of pain is injury, inflammation, pain and weakness must be addressed and corrected. However, even in cases of injury, it is important to include correction of postural alignment in the treatment plan in order to minimize stress to the joint, to promote more rapid healing, and to ensure healthy movement patterns for the future.

advance Physical Therapy

Michael is a science teacher and has a very inquisitive mind. The other day he wondered why there is a ‘d’ missing in our name. We should be ‘Advanced Physical Therapy’. He has been coming for a while and readily admits that we really are  advanced in comparison to other places, on a higher level of understanding and treatment. So why not call us ‘advanced’ ?

Well, yes. But…  We intend to advance physical therapy. However, as in any practice the more you advance the more you see what still needs advancing. Even though our physical therapy is advanced, it is not finished,  it needs a lot more advancing. And that is what we intend to do:                              Advance Physical Therapy

Running Shoe recommendations 2010

Every year the Postural Restoration Institute compiles a list of good running shoes. Here is the latest:

Copyright 2010 © Postural Restoration Institute™
RUNNING SHOES
PRI Recommendations: (in alphabetical order)
1. ASICS 2150 (S-M)
2. ASICS Cumulus (S-M)
3. ASICS Evolution (S-M-L)
4. ASICS Foundation (M-L)
5. BROOKS Defyance (S-M)
6. BROOKS Dyad (M)
7. BROOKS Glycerine (S-M)
8. NEW BALANCE 850 (M-L)
9. SAUCONY Echelon (M-L)
10. SAUCONY Stabil (L)
Underline = neutral shoe considerations for orthotics
Italics = light lateral calcaneal give
Qualities of a good shoe:
1. Solid heel counter
2. Excellent calcaneal support (no lateral heel give)
3. Patient can feel arches of shoe
Sign of a good shoe:
PRI tests are negative (pick a few):
Adduction drop, SLR and HGIR (frontal, sagittal, &
transverse planes)

If you are a runner and have questions, ask Jean, one of our Physical Therapists who  is  trained in Postural Restoration.

Top Ten Recommendations for Runners

These Recommendations are reproduced from the website of the Postural Restoration Institute to celebrate springtime

Lori Thomsen, PT, PRC

Hruska Clinic – Restorative Physical Therapy Services

1. Keep your hamstrings strong, especially on the left. (4 & 5)

2. Avoid overstretching your hamstrings (90o straight leg raise at the hip with the

knee straight). Have the ability to stand and bend over and slightly touch toes

(palms to the floor is too much).

3. Occasionally walk slowly up the stairs backwards to keep your glutes

symmetrical. (1 & 4)

4. Properly stretch your Achilles tendon, your toes, and your low back.

a. Heel to floor in the squat position (8)

b. Ankle stretch with shoes on and knees bent (7)

c. Pull great toe up

5. Concentrate on striding out with your right leg and left arm when running. (6)

6. Try to find and feel your right arch when running to assist with shifting to the

left. (4)

7. Perform Standing Resisted Wall Reach to stretch your back, latissimus, and

pectoral musculature. (3 &

8. Stand and shift your body weight over your left leg regularly, keeping weight

shifted through you heel. (4)

9. Keep your left lower abdominals “alive” by performing sidelying activity. (2)

10. Wear correct footwear. Wear shoes that support your heels and that have good

arch supports. Avoid wearing flip flops, sandals and wearing shoes that are

untied during the running season.

Copyright © 2007 Postural Restoration Institute™

New Introductory Postural Restoration Class Starting on April 26th

New Introductory Postural Restoration Class starts on Monday, April 26th at 6 pm to 7 pm. This is an 8 week series, beginning and ending with an objective assessment. It is taught by Susan Henning, PT, PRC.  Space is limited to at the most 8 people. It costs $120. Please call 932 7266 to register.

Stroke Recovery Treatment

Scoliosis

Scoliosis is a case in point. It is so complicated, involving the pelvis, back, ribcage, breathing, etc, that it can serve as a  test for a good bio-mechanical understanding of the body.

I only know of two approaches that try to get to the causes of scoliosis, the Schroth Method and Postural Restoration. All other attempts deal  with the symptoms of scoliosis and they don’t need a thorough understanding of it.

Katharina Schroth suffered from scoliosis herself and she developed an exercise program based on her intuitive understanding of what helped. The Schroth Clinic in Germany, since the middle of the last century, has been very successful, even with older people with significant curves.

Postural Restoration provides a bio-mechanical understanding of the causes of scoliosis and the very precise exercises  are based on that understanding. The exercises help diminish the curvature, particularly among young adults or teenagers. The main difficulty is to get teenagers to do these exercises religiously on a daily basis.

The younger the people and the less pronounced the curve, the easier it is to re-balance the body and get rid of the curve. However, young teenagers are the hardest to motivate.

One of  our therapists, Susan Henning, is hoping for or dreaming of a regular screening  at schools for scoliosis, because the imbalances and the suffering that follows for a whole lifetime, could be avoided.

Lymphedema: what it is and what if it stays untreated

Lymphedema, which is also spelled lymphoedema, is abnormal swelling of the tissues, due to the presence of excess protein-rich fluid known as lymph. This swelling occurs when the lymphatic system malfunctions or is damaged and lymphatic fluid cannot drain as quickly as it is produced. It affects an estimated 100 million men, women, and children around the world, including at least 3 million Americans. Lymphedema of the arm occurs often as a result of treatment for breast cancer. Breast cancer is only one of the many causes of lymphedema. It most commonly occurs in the extremities (arms or legs); however, it can also affect the trunk, breast, abdomen, neck, head, and or genitals.

The fluid that causes the swelling of lymphedema is protein-rich and this makes the tissues easily susceptible to infections. Each infection damages lymphatic structures and places the area more at risk for developing lymphedema. Once the lymphatic systems malfunctions or lymphatic structures are damaged and lymphedema has developed it can be treated but not cured. Early treatments can usually effectively control the swelling. Without treatment, the lymphedema symptoms become progressively more serious. Left untreated, lymphedema is much more serious than the inconvenience of a swollen limb. It is a progressive condition in which frequent infections cause serious pain and may require hospitalization. Skin changes, like benign papillomas may develop. Eventually, lymphedema can lead to the loss of mobility and total disability. In rare occasions malignant skin cancer develops, like lymph-angiosarcoma (Stewart-Treves-Syndrome.)

Alma Vinjé-Harrewijn PT CLT-LANA

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Why all this fuss about Postural Restoration?

In 20 or 30, maybe 50 years Physical Therapy will be Postural Restoration. The more traditional techniques will not disappear, but they will have to adapt to the basic insights of Postural Restoration.

I can say this easily because I am not a physical therapist and certainly not a Postural Restorationist. I don’t know all the details of Postural Restoration. However, it is clear that Postural Restoration provides us with a paradigm shift in the short history of Physical Therapy. It is not just another technique that will be added to the many other techniques. Postural Restoration is a revolution.

The basic insight is as simple as Newton’s apple falling from a tree: We are asymmetrical beings by nature and it is good that we are asymmetrical because we probably could not move well at all if we were symmetric. We are reaching out with the right arm or  leg because it is easier and more powerful. We are made that way.

We see the application of it for instance in sports. To give one example: In all track and field activities we always run around the field in the same direction, opposite clockwise. There is no culture and no individual that prefers to run the opposite way. It is because we are faster this way. The reason is our basic asymmetry.

There are many other examples. The point, however, is that based on the insight into our fundamental asymmetry and on a sound understanding of bio-mechanics, the founder, Ron Hruska, developed what we call now Postural Restoration, a growing canon of hundreds of exercises.

The exercises can be used to either enhance performance in movement or sports, to avoid injuries or to correct painful imbalances like back pain, neck pain, hip pain, knee pain and so on. A couple of sport teams have been using the exercises successfully, as do a couple of physical therapists.

Unfortunately, there are limitations. The exercises are so precise and difficult that they are not easy to learn. It is an effort.For physical therapists also, Postural Restoration is not easy to learn and challenging intellectually. To slap on a hot-pack and use the ultrasound machine is a lot easier for both the therapist and the patient. Much easier also to do the same exercises first twice to the left, then twice to the right as it is done almost everywhere, ignoring our basic asymmetry. It is easier, but it does not always help.

Once the exercises are understood, which may take a couple of sessions, progress should be immediate.