Postural Restoration - Advance Physical Therapy

Introduction to Postural Restoration

Postural Restoration evolved as a study of human biomechanics. This approach to healing is holistic and integrative. Clinically proven and scientifically based, Postural Restoration provides tools to evaluate underlying cause of pain, dysfunction and slow recovery from trauma. Treatment using Postural Restoration therapeutic activities has produced dramatic relief from chronic as well as acute conditions. These therapeutic activities reposition the musculoskeletal system, correct movement imbalance, restore normal tonicity to muscles and strengthen efficient, balanced, functional activity. Postural Restoration empowers you to maintain your optimal health and vitality in daily life and sports, and helps you avoid injury.

Asymmetry

Postural Restoration recognized that humans are, by design, asymmetrical. Asymmetry facilitates our movement. Organ placement contributes to asymmetry. In the lower trunk the large, heavy liver is situated on the right while a smaller, lighter spleen is in a similar location on the left. Our right lung has three lobes, the left has only two, to accommodate the heart in our left upper trunk. The right diaphragm is larger and better positioned for respiration than the left diaphragm. Muscle attachments of the diaphragm to the ribs are thicker on the right. The right and left hemispheres of our brain govern different functions.

The majority of people worldwide are right handed. Our man made environment accommodates, even facilitates, right hand reach activity. The muscles that make up our right dominant movement patterns are used much more frequently and become much stronger than the same muscles of the non-dominant pattern. Even if you are left-handed you must live in a right-handed world.

Consequently, we all have the tendency to stand on our right leg and reach with our right arm. This reaching results in upper trunk rotation to the left. Consider how you open a door, reach for your cup, or brush your teeth. Often, people who are left-handed for fine motor activity use the right hand for power functions such as throwing. This dominant patterning is most useful! We don’t have to pause to consider which hand we will use to open the door. The pattern facilitates automatic activity, making life a bit simpler. Athletes thrive by strengthening powerful asymmetrical patterns. The downside of asymmetry is that our lifestyle – often sedentary and or filled with repetitive motion – reinforces our pattern so much that we can no longer move out of it. We lose the ability to balance our movement for example: to shift into our left hip and reach with the left hand. Although we walk with both legs, our center of gravity stays over the right hip. Although we have two lungs, we rely more heavily on the right. This one sided imbalance in activities that require alternate, reciprocal movement – such as walking, breathing and chewing – often results in abnormal stress, unequal wear and tear, dysfunction and pain.

3 Dimensional

As 3 dimensional beings, we function in 3 planes of motion: front to back – like taking a bow, side to side like climbing a ladder and in rotation as with twisting to see what’s behind us. Most healthy human movements take place in all three planes.

As asymmetric 3 dimensional beings, the spine orients to the right and we stand on the right leg. The upper trunk rotates back to the left in order to face straight ahead. In so doing right side bending occurs bringing the right ribs a bit closer to the right pelvis and the left ribs a bit further way from the left pelvis. In this position the right trunk muscles shorten and tighten, the left stretch and lengthen. The left abdominals thereby lose their optimal ability to anchor the left lower ribs and the left pelvic crest. The left pelvis rolls forward and inward, the left ribcage elevates and flares. In the front to back plane of motion there is excessive tightness of the back and overstretch of the abdominal regions. In the side-to-side plane of motion, structures on the right are generally too close together and structures on the left are generally too far apart. Finally, with these movement planes diminished, we have difficulty moving in a healthy way in the third plane of rotation at all. Each of these movement disorders can lead to unhealthy stress, chronic injury and pain.

Breathing

In this 3 dimensional, asymmetric configuration the respiratory diaphragm (our primary muscle for inhalation) becomes poorly positioned for healthy breathing. Without efficient function of our primary, low energy breathing system, the diaphragm, we rely more heavily on our auxiliary, back up system- especially the helper muscles of the neck to get enough air into our body. Usually reserved for higher oxygen demand – as when we are running a marathon – the neck muscles become overactive, unable to relax. This activity triggers the sympathetic nervous system – our fight or flight, high alert system. In a constant state of stress, we are restless, unable to relax, unable to sleep deeply. I this vulnerable state, it does not take much to push us over the edge – whether physical, environmental, emotional or mental stress.

How Postural Restoration Can Help

The Postural Restoration therapist initiates a process of rehabilitation that begins with repositioning. Repositioning therapeutic activities are carefully constructed exercises to restore neutral alignment to the musculoskeletal system.

Results can be immediate or may take several sessions to achieve. Repositioning exercises incorporate breathing techniques to restore normal, efficient respiration. Repositioning exercises also teach the person how to feel the activation of corrective postural muscles.

Once neutral alignment is achieved, it must be maintained and integrated into the movement patterns we use in daily life activities. A personalized exercise program is designed to progress strengthening from lying to sitting to standing and finally back into upright movement in a more balanced way.

Often, the aches and pains and movement limitations previously experienced were the result of an imbalanced asymmetrical pattern. These pains drop away as more balanced, more efficient and less stressful muscle activity is restored. In some cases, true pathology may have developed, such as joint breakdown, muscle tears and adhesions and ligament strains. These will become evident and appropriate treatment can be more accurately determined and applied.

Postural Restoration techniques create a more balanced/less stressed physical foundation for life activities, sports activities and for rehabilitation following trauma or surgery. These techniques empower you to self maintain your optimum function and to enjoy an active life.

Learn More from the Body Sense Podcast

Part 1: Posture

Part 2: Breathing

Part 3: Asymmetry

Part 4: Neutrality

Testimonial

Reese’s Scoliosis Journey

— Reese's Mom, Charlotte, NC

Reese started having shoulder pain in April 2018. As her mom, who has been an occupational therapist/certified hand therapist for almost 20 years, I was sure it was due to her playing tennis many hours a day for many years. I assumed her rotator cuff was inflamed and that she would need a break from tennis, as well as therapy to rehab her back. After 3 months of rest and therapy with no improvement, I knew something else must be happening.

In June of 2018, Reese was seen for her well visit and her pediatrician suggested we x-ray her back due to some unevenness observed when she bent over. I remember sneaking a peak as she was getting her x-ray a week later and my heart sank. There it was, clear as day. Scoliosis. The visible curve was large enough that my mind was racing as we walked back to the car. How could this curve be this big without me noticing it? How did I not attribute that to being a possible cause of her chronic shoulder pain?

Immediately I started googling and diving into Orthopedic and Physical Therapy Journals, using my own credentials to gain access. All that research pointed me to two conservative treatment options with promising results: Schroth Physical Therapy and Rigo Cheneau bracing. There was hope.

In Charlotte at that time there were no Physical Therapists certified in Schroth PT. The closest was Advance Physical Therapy in Chapel Hill, NC (www.advance-physicaltherapy.com) and I made an appointment with Lisa Mangino PT, DPT, PCS,C/NDT,PRC, SBC-2. Reese and I spent 3 days in June of 2018 learning Schroth and PRI (Postural Restoration Institute) exercises. It was a lot to take in. Four months prior Reese was playing competitive tennis pain free, and she was ranked 15 th in the nation for her age group. Now we were doing breathing exercises and discussing the need for full time scoliosis bracing. I wondered how my daughter could play a sport at such a high level with Scoliosis?

When Reese arrived for her first appointment with Lisa, she was in chronic shoulder pain and had not picked up a racket since April. When we left Lisa three days later, Reese was reporting it no longer hurt to put her hair up or wash her hair in the shower. We texted her coach on the way home, and he suggested we meet the next morning to see if she can play. She has been playing tennis pain free ever since.

The next part of the equation was to schedule an appointment with Luke Stikeleather, the Chief Orthotist and founder of National Scoliosis Center (www.nationalscoliosiscenter.com). The former president of SOSORT (Society on Scoliosis Orthopedic and Rehabilitation Treatment), Luke has been specializing in scoliosis and making the Rigo Cheneau brace for almost 30 years. I knew I was lucky enough to have him within driving distance. The experience was welcoming and positive. He allows the kids to have input on so much of the process, even offering different patterns for their brace. I suggested to Reese the pink heart print, but she settled in on what I am calling the “tattoo graffiti” print. I am hoping this is not a foreshadow into her future tattoos!

Luke emphasized that compliance with wearing the brace, in conjunction with Schroth Physical Therapy, would give her the best chance of stopping curve progression and maximizing the potential for the curve to permanently reduce. He suggested wearing the brace for 18-22 hours a day. Reese was 11 years old, Risser 0 (skeletally immature with a lot of growth left) with curves of 25/25. Her potential for curve progression was high, nearly 100%, with no intervention. Due to the lightness of this brace Reese weaned into it the first week and built up to full time wear within a few weeks. Today, she reports it no longer feels like she is even wearing a brace. She has no issues wearing it for 20 hours a day, removing it only for tennis and showering (and an occasional pool day). We talk about this brace not being forever, just a moment in time to prevent surgery.

I knew I had to bring Schroth PT to Charlotte. Brittany Hunt is the Director of PT at UBYLEE Healthcare Group (www.ubylee.com) where we both work. Brittany agreed this was a program we needed to bring to Charlotte. In December of 2018 Brittany become certified in Schroth PT as a C1 therapist. A year later she was certified as a C2 Schroth PT, and she has been helping many kids in our area prevent further progression of their curves. She has been working with Reese for over a year and a half now and is a major part of her success.

Reese was diagnosed at 4’11” and has been on this protocol for 2 years. She is now 5’6” with curves of 20/15. Seven inches of growth with only improvements! I remember back to the day she was first diagnosed and how my heart sank, for a multitude of reasons. Many healthcare professionals will say Scoliosis is a “wait and see” diagnosis. Their approach is to simply wait to see if surgery will be necessary. That is not always the case. We used a “try and see” approach, and Reese’s results have been amazing. Her journey with Scoliosis is not over, maybe it never will be. I know for today her body is healthier, stronger and pain free. I know this is a result of the Schroth PT, Postural Restoration Institute Methodology and her Rigo Cheneau brace.