Following the Golden rules of PRI............A Must to succeed ! ! !

 I recently saw a patient who has had chronic left foot pain. Has tried traditional PT, orthotics(the hard, rigid ones that I hate), a steroid injection, everything he knew or was told in the traditional model. Had seen him few years ago for other issues ( successfully for a couple issues),  but knew even at the time that I was not quite finished as he was still not  always maintaining neutral alignment ( and always making his own modifications of the PRI exercises). Sure enough, he was back again with a " new " problem. Was I surprised ? Not, really. Just not too happy we did not prevent this " new " compensation from occurring. Upon evaluating him, I said to him, " You know what I'm going to say and where I am going to start working, right ? At the pelvis and the rib cage of course, because the evaluation tells me that you are not in the correct position, i.e. not symmetrical." His comment was, " I'll do whatever you say, because I've tried everything else they told me and its not better, which is why I'm here"  At the second visit, a week later after we worked his L hip and got his rib cage moving correctly, he was still a little skeptical and asked," We ARE doing this for my L foot pain, right ? " I assured him we were, just to be patient.   Well, 3 weeks and 3 visits later,  he reports that he is feeling the correct muscles in his hip working and his foot is indeed better. But, I am still not happy, because he comes in and the tests prove he is not yet neutral. Digging in further, trying to see what we were possibly missing, guess what we find is most likely getting in our way ? He was doing the exercises we had given him ( without his own modifications, for a change ! ), but along with these was also doing a lot of other " stretches" that were getting him out of position again and negating the effects of what we were trying to achieve. These so called "stretches" were something we PRI therapists never have our patients do, but are done regularly in the traditional training world. There was that missing link, which is why we were taking 2 steps forward and 1 back. My student spent the next half hour laying down some " Golden Rules " of PRI, drilling in the "Do's and Don'ts" and we hope to see faster progress from now on. Now guess what, we plan to have a hand out of the "Golden Rules " and give it to our patients on their first day, to help them on their road to success. Lesson learnt !

POSTURAL RESTORATION: A ROAD LESS TRAVELLED: Part I

" Two roads diverged in a wood, and I -
   I took the one less travelled by,
And that has made all the difference." 
                                   ROBERT FROST
I recently came across this quote while reading Stephen Covey's " The Eighth Habit" and it made me reflect about the path I took back in 2002 when I started my journey with Postural Restoration. Looking back, at the past 10 years, I do not regret that I took up a path that diverged from the traditional world of physical therapy. It has indeed made all the difference in the way I practice and preach. What is so different with this path, you may ask ?  Well, the most important difference for me has been just looking at the human body in a totally different way, because it is indeed different on the left than it is on the right. Says who ?  Well, seeing is believing, don't just take my word  for it. I  see it everyday, thanks to the teachings of Ron Hruska, PT and founder of the Postural Restoration Institute.  Ron, and his team were the first to show me this difference and the need to recognize and address this difference in order to effectively treat any musculo-skeletal issue. Had I not known to look for this asymmetry, I would still be asking my patients to do hamstring stretches or back extensions and chin tucks, just to name a few. I would still be strengthening the same muscles on both sides of the body instead of  isolating and integrating muscles. I would not  have been able to help a sixty some year old yoga practitioner (that had been treated by multiple disciplines, including traditional physical therapy and steroid injections), finally get rid of her hip pain in just a few visits and be able to hike pain free across the country. And there are more examples I will share with you in the second half of this blog. But for now, just know that travelling down a different road, one less travelled by has sure been a great experience !
 

SIT UP STRAIGHT ................OR NOT ?

We have all heard that we must have good posture to avoid aches and pains. What exactly does that mean ? Most people equate good posture to sitting up straight. Well, thats what your mother or grandmother told you or rather always nagged you to do. But in the postural restoration world, we tell our patients that is is okay to slouch a little. Yes, you heard it right, " slouch" . Now, don't get me wrong, that does not mean that you slump right over. It just means that you keep your mid and lower back relaxed, keep the rib cage down and not elevated. When we try to sit up too straight, we arch our lower backs too much, push the ribs up and out, elevating the ribcage and upper chest, tensing up the muscles in the back of the neck and lower back. This creates unwanted muscle tone and shortening and tightening of the muscles in the back and the neck, which can in turn lead to pain. One of the most common problem area we see in patients with complaints of back or neck pain is a stiffness in the mid back area or an inability to bend at the mid spine along with an inability to keep the rib cage in the correct position ( rotated down). One way we check for this is by having the person bend forward and try to touch their toes keeping the knees straight, and check to see if they are able to round the mid back area ( and not keep it straight). We also look if they are able to expand the upper/mid back area when they inhale instead of extending/straightening the spine in this area. We see some amazing results and frequently instant relief of pain when we try to get this area of the back to move like it should and get the ribcage in the correct position. I recently had a teen patient who had chronic neck pain ( for over 2 years) while she was trying to do what she thought was the "right thing to do" by sitting up straight, but had persistent pain until she followed my advice and yes, "slouched" a little and was able to be free of pain much to her surprise ! Again folks, its all about, you guessed it, "Position" and by that I mean the "Correct position".

FROM HEAD TO TOE, REALLY........

 Do you remember the nursery rhyme you learned in elementary school," The foot bone's  connected to the leg bone........? " Well, in the PRI world,we mean it, literally . A foot problem can lead to a problem somewhere higher up in the chain and viceversa. So, when we look at someone with say neck pain, we are interested in not only looking at how they move their neck, but just as interested in how they walk, what is happening at the foot, are they able to breathe properly , can they move air in and out of the chest wall effectively, is their bite even, and much more. Believe it or not, we also look at the eyes! Often, we can tell by just looking at the person walking, standing or sitting as to what could be causing the problem.  We will not give you a generic set of stretching exercises just for the neck to stretch and/or strengthen it, more than likely I can probably guarantee that we will never have you do those. Instead, we would make sure that  you can expand your mid back, relax your lower back,and  get air in and out of the chest wall without using the neck. We will make sure your pelvis is in the right position so you can do all of the above. You will more than likely blow up  a balloon to help chest wall mobility and get the diaphragm in the correct position, so you can get air in and out of the chest wall  without having to use your neck. You will be surprised at how at how being able to expand the mid back can help you turn your neck with increased ease and reduced pain.

Can I go back to the gym ?

  When can I go back to the gym ?  Is it OK to do bar squats or lift weights overhead ? Can I stretch my hamstrings ? These are questions I get from my patients that I generally dread and am a little hesitant to answer right away. Why ?  For one thing, I can almost always be certain that they would be doing this with their muscles in the wrong " Position". As a Postural Restoration trained  physical therapist, I focus on making sure that muscles are in the right position before progressing with a rehab program or any training program for that matter. If any muscle is not in the right position, it will never be able to be as strong and effective as when it would be if it was in the right position. ( Please refer to Torin's blog-"The importance of being in the right position" on hruskaclinic.com.). When this happens, other muscles will compensate to do the movement which puts you at risk for injury. Now don't get me wrong, that does not mean that you can never go back to a gym program; you can but only after you are in the right
"Position". How can you do that ? By going through a Repositioning program that your Postural restoration trained/certified physical therapist can show you. Once repositioned, and able to maintain that correct alignment with the proper muscles firing along with turning off certain muscles that have a tendency to be overused, you can go back to a gym or training program ( or for that matter, running or any sport) with  a few tips ( do's and dont's) from your therapist. We'll talk more in the next few blogs about some common exercises and training routines that can cause more harm than good in the wrong run. In the meantime, try to find help from a PRI therapist to get in the right "Position".
Sangini Rane , PT PRC
sangini@yahoo.com
Apex Physical Therapy & Wellness Center
Apex, NC

Recognizing asymmetry, a key concept in the postural restoration world: Part 2

So, now you know that the human body is inherently asymmetrical.  We never use our body the same way on the right as we do on the left, and this functional asymmetry creates torque in the body, which in turn creates unnecessary muscle tension, alters breathing and can negatively affect the entire nervous system as well. We can get " locked " into certain, often predictable patterns, developing compensatory movement strategies. For example, we tend to stand on our right leg more than on our left, with our left shoulder higher than the right; we generally have more tightness in the right side of our rib cage and neck, along with a forward pelvis on the left.
Postural Restoration practitioners recognize this asymmetry and look at the right side of the body differently than they look on the left. Right shoulder pain is evaluated and treated differently than the left.  Regardless of where symptoms are located, the goal is to reposition the pelvis, rib cage and cranium to reduce this torque and restore more symmetrical movement between the right and left sides of the body. Patients are often surprised at how restoring proper position in one part of the body can affect a seemingly unrelated part. Often, chronic problems that have not responded to traditional treatments respond very quickly to this approach of treatment.

Recognizing asymmetry, a key concept in the Postural Restoration world : Part 1

Look around you, you can see it. The human body is not symmetrical, and never will be. I did not learn that in school, but I see it everywhere now. (Even my kids see it now or so they say, probably because they are tired of me pointing it out where ever we go.) More people with left shoulders higher than the right,  right side of the torso looking "crunched" and left side elongated. Left ribcage flaring out more than the right, people standing more on their right leg, with their upper body trying to turn left. Right arm swinging a lot less than the left, the right leg toeing out more than the left.  I could probably go on, but you get the picture.
 Why does this happen ? You may say because we are right handed or right side dominant. Yes, that does play a role, but how/where does this begin ?  Ever considered internal organ asymmetry ? Well, we have a huge liver on the right, three lobes of the lung on the right vs two on the left. A right diaphragm that is anatomically larger ( both the leaflet as well as the attachment to the spine). The result ? Our weight is distributed more to the right, so our spine and pelvis are oriented to the right. Out torso tries to counter rotate back to the left (so we walk facing straight) , in the process creating a left rib flare and a higher left shoulder. Starting to see it now ? Just look around you, or look in the mirror. We'll continue in part 2 in a few days.

Postural Restoration, an interesting journey................

Here's wishing everyone a Happy New Year and welcome to the first blog post of 2012 ! In these pages, I would like to invite you to explore the world of postural restoration, an innovative treatment approach that addresses the primary cause of postural movement dysfunction.
For me, this has certainly been an exciting journey, one that began in 2002 and remains just as exciting and interesting as it did it back then. I had been practicing traditional physical therapy for about 18 years and although was getting fairly good outcomes with my patients with what I did at the time, there was this nagging feeling that I was missing something. Why did some patients whose primary complaint had been resolved, return with a recurrence of the same or a new seemingly (?) unrelated problem a few years down the road ? Why was it that certain problems/injuries seemed more common on one side of the body than the other ? And then, I met Ron Hruska, PT founder of the Postural Restoration Institute in Lincoln, Nebraska and it totally changed the way I practiced. In the next few days, you will see just how and why.