Looking at the Forest and the Tree: How will Postural Restoration be incorporated into my Physical Therapy?

By Matthew Harwood, PT, DPT, OCS

Postural Restoration trained therapists implement tests which assess for asymmetries in posture and muscular strength. These asymmetries can lead to overuse of certain muscle groups over others and patterning of movement. For example, right shoulder pain may result from the right ribcage being restricted during inhalation; this positions the scapula to rest forward on the ribcage. Thus, when the person goes to raise their arm, it will be limited.
Is it the forest or the tree? Postural Restoration gives our physical therapists a global picture (the forest) of the individual we are working treating. It helps us to identify how the interactions of one part of the body can influence another part of the body. In the example above, the tree was the shoulder pain and the forest included the ribcage and scapula. Other global influences we look at involve the position of the pelvis, feet, and spine. We identify the resting length of the abdominals and other muscles that attach from the legs and thighs onto the pelvis and spine. We look at movement patterns which may contribute to the development of local (tree) issues. A thorough physical therapy evaluation including medical screening and differential diagnosis testing helps us to identify underlying impairments, functional limitations and appropriateness for physical therapy services.

Postural Restoration

I love my mother. I have learned, and continue to learn, more from her than from any other source in my life. One of her favorite expressions, now at 80, is that “if you can change your mind, you can change your life”.

As an established orthopaedic therapist, my practice and mind were pretty well fixed on rehabilitating bones, joints and muscles in various states of disrepair. Things were going along just fine, then I took a course in Postural Restoration. Now, I have to change my mind. I’ve come to realize that I’m not just an orthopedic therapist, but I must be a neurologic (brain) therapist as well.

Bones, joints and muscles are nothing without the powerhouse of the brain that tells them when they are too tight, too long, too loose or too close together. If I don’t teach my patients what it feels like to be in balance, to know where their body is in space, they will never stop being on my orthopaedic caseload. This year a knee, next year a shoulder and so on…… But, if I can teach my patients to know when they are in “balance”, to change their mind about what feels “normal”, they will be able to manage and prevent the common chain of bone, joint and muscle problems that come from years of faulty habits and patterns of imbalance.

If I can help you “change your mind”, to get better and stay better, you can thank my mother.

Jean

Running Injuries: Injury Prevention Check-List

Running Injuries: Injury Prevention Check-List

Before an airplane leaves the airport for its next destination, the pilot, ground crew and mechanics run through a check-list to identify how the plane is functioning and if there is any reason the plane should not take off. Running, whether for training for a goal race or as a form of general exercise, can be approached the same way.
Below is a check-list which you can complete that helps you organize your running program, identify areas that could lead to potential injury and help you identify characteristics about an injury before it gets worse. Questions 1-12 are helpful in organizing your running program, 13-16 can be used when an injury is starting; take this information with you if you need to seek medical care for a running related issue. It will assist in getting right to your issue and getting you back running!

If you have questions about one of the questions or about injury prevention let me know. I check the blog regularly.

Injury Prevention Check–List
1. What are your running goals?
2. How long have you been working to achieve this goal?
3. How many miles do you run per week?
____ days/______ week
4. How much time do you spend with non-running training/cross training?
5. Have you had a musculoskeletal exam to identify functional fitness?
Yes / No
6. What is your running schedule?
_____days/ _____ week
7. Do you maintain a running log?
Yes / No
8. Are you following a specific running and cross-training program?
Yes / No
9. What type of surface have you been running on?
(Road, trail, grass, rubber track)
10. Do you know your foot type? High/Average/Low Arch
Yes / No
11. How old are your running shoes:
Years/months
12. Do your shoes show an observable wear pattern on them? Look at your older shoes if you have a new pair.
Yes/ No
13. Are you currently running with an injury?
Yes/ No
14. Where is your injury?
(Foot,ankle,knee, hip,etc.)
15. When do you experience the pain or discomfort? (During the run, after running, on days you are not
running)
16. Has there been a recent change in running program? Intensity/ Duration/ Frequency

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™

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