hi dorko
after attending a course in "muscle balance" (www.kineticcontrol.com), I
have a different access to postural assessment as the one I learned at
school and I do examine the posture. the information gathered like this
is important for me, but it is only a part of the whole and probably a
hint, where I should have a closer look.
Shirley Sahrmann herself wrote an interesting book: "Diagnosis and
Treatment of Movement Impairment Syndromes" where she among other things
describes the influence of postures.
doris
Barrett Dorko wrote:
> In the latest issue of The Journal of Orthopedic and Sports Physical
> Therapy Shirley Sahrmann PT, PhD, FAPTA (Professor of physical therapy,
> cell biology and physiology, associate professor of neurology; director
> of program in movement science, Washington University, St Louis MO)
> contributed a provocative guest editorial entitled "Does Postural
> Assessment Contribute to Patient Care?"
>
> Dr. Sahrmann advocates postural assessment as a prerequisite for care
> and makes a case for this despite an absence of evidence. I think this
> is an important issue and have included a number of quotes from the
> editorial along with my own thoughts. I'm hoping it will generate some
> comments from our community.
>
> Sahrmann begins: "Is the examination of posture just a tradition of
> physical therapy practice or is the information gathered from this
> assessment useful for diagnosis and treatment?
>
> Dorko- I think it's an example of the power of tradition and that this
> is the primary reason for its persistence.
>
> Sahrmann: "What is the evidence that postural impairments contribute to
> pain problems and need to be included in therapists' examinations? The
> simple answer to that question is that there is very little research to
> support a relationship between musculoskeletal pain and "posture". Many
> respected texts and articles by physicians, physical therapists, and
> physical educators have cited the importance of good postural alignment
> to health, but clinical studies have not supported these beliefs. Though
> I am fully aware of the lack of evidence, I cannot imagine treating any
> patient without assessing posture or, more precisely, alignment...Studies
> of posture have focused on a narrow definition. Posture or carriage of
> the body should be considered differently than the alignment of one
> segment in relation to an immediately adjacent segment."
>
> Dorko- I treat patients without doing a postural assessment all the time
> so imagining it is not necessary for me. Without any evidence for a
> connection between postural alignment and health I can't see any reason
> to "believe" in it. Shifting the focus from an overall or regional
> impression of posture to a description of segmental alignment seems to
> be Dr. Sahrmann's response to an absence of evidence for the traditional
> view.
>
> As Dr. Sahrmann continues: "Probably more important than overall posture
> in the sagittal plane is the relative alignment of one or two segments
> in multiple planes. For example the degree of lumbar curvature can vary
> a great deal, but one vertebra cannot change its sagittal position with
> another vertebra by more than a couple of millimeters before
> contributing to pain from spondylolisthesis."
>
> Dorko- I'm not aware that the system this sensitive. I don't think it is.
>
> Sahrmann goes on: "Studies have not addressed whether some postures are
> more likely to result in intersegmental changes such as
> spondylolisthesis than other postures...Defining subgroups of extreme
> postures is a necessary step in the consideration of alignment as a
> contributor to mechanical pain problems...Alignment is only one of
> multiple factors contributing to the development of mechanical pain...The
> individual who is overweight with a ponderous abdomen who stands all day
> may be at greater risk of developing back pain than an individual who is
> slender with the same alignment who also stands for prolonged periods. I
> believe most clinicians who use postural alignment as a guide to their
> diagnosis and treatment have consciously or subconsciously defined for
> themselves the degree of deviation, the context, and the modifiers that
> when combined reach a level of perceived clinical significance." And
> "Studies suggesting that posture was not correlated to muscle strength
> also raised doubts about the value of alignment impairments because of
> the lack of valid information about muscle function."
>
> Dorko- No doubt. There is no evidence that correcting postural deviation
> leads to pain relief in the research literature or that these deviations
> lead to pain in the first place. Still, Dr Sahrmann concludes, "In my
> judgment, the current preponderance of negative studies about the
> relationship between posture and pain are more reflective of the types
> of questions that have been asked and the analysis that has been used
> than of the lack of a relationship. Assessment of alignment impairments
> has to be an important step in designing an appropriate treatment
> program for correcting mechanical impairment. We need to pursue the
> studies that will enable us to define the relationships among specific
> alignment impairments, altered movement patterns, contributing muscle
> adaptations, patient modifiers and mechanical pain problems."
>
> Dorko- It seems to me that this effort to come up with research to
> justify traditional practices is uncalled for, not that anybody has
> asked my opinion.
>
> I'm wondering what the list thinks.
>
> Barrett L. Dorko, P.T.
> <http://barrettdorko.com>
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