To the list:
I recently returned from the Combined Sections Meeting of the American
Physical Therapy Association in Boston. I understand there were about 5000
of us there, making it perhaps the largest such gathering in our
association's history.
I heard several people comment that the listservs devoted to clinical
issues were very quiet after a couple years of fairly intense activity and
that they missed the discussion. I agree. In an effort to revive some of
the exchanges I used to see, I thought I'd introduce a subject that has
caught my attention recently and seems intimately connected to my own
rather eccentric practice. In addition to this, the subject matter is dear
to the traditional practice of physical therapy, postural correction.
If the convention in Boston is any indication of current practice,
relieving pain via alterations in posture remains a favorite strategy of
many therapists. I heard lectures suggesting that strengthening and/or
stretching was the best way to achieve the desired alignment of the bony
structures or, failing that, persistent exhortation to "straighten up." To
my knowledge strength and posture are unrelated, and I don't personally
have any faith in instruction's enduring effect. This does not mean that I
don't want my patients erect, I do. It's just that I think the path toward
the desired position cannot be achieved efficiently or effectively with the
methods traditionally used by our profession.
Here I'm suggesting we consider the possibility that corrective maneuvering
leading toward improved posture would naturally emerge given the
opportunity. In "Wild Health," a new book by biologist Cindy Engle
(Houghton Mifflin 2002), the author details what is now known about the
ways animals in the wild maintain their health through instinctive
behaviors. These are intricate, brilliant behaviors that include both
dietary manipulation for illness and movement in response to physical
threat or its residual physiologic consequences. The instinctive movement
described should be of particular interest to physical therapists that feel
there is a correlation between chronic pain and past events that no longer
require healing, repair or continuous sympathetic response.
More can be said about the specific nature of this movement, but first I'm
wondering about the profession's view of movement that isn't choreographed
by another, movement that emerges effortlessly and without volition, in
short, movement designed to relieve pain. If you were to twist another's
finger and then let go this is precisely what you'd expect to see. There's
no reason to believe that this activity is confined to the finger and the
idea of instinctive correction might be expanded to include other body
parts. It sounds like physical therapy to me, and I would like to see a
discussion about what sort of management this might require. Postural
correction might be a lot easier to achieve if instinct drove it, and
that's what I think I've been watching for many years.
Any ideas, clinical experience with this or methods of management designed
around this notion are of interest to me, and I hope to many others faced
with the task of postural correction each day.
Barrett L. Dorko, P.T.
<http://barrettdorko.com>
Also <http://rehabedge.com>
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