From: McMahon, James
Sent: Tuesday, August 06, 2002 11:45 AM
To: '- for physiotherapists in education and practice'
Subject: RE: A question of posture
I found your comments regarding postural assessment interesting to
the point that I should respond. I was wondering if you could comment
further on Sahrmann's statement, "the relative alignment of one or two
segments in multiple planes". You stated it sounded like "chiropractic
hooey". How can you say that intersegmental relationships/positions have no
influence on symptomatology? I think that traditionally, therapists
utilized the "postural assessment/screen" as a way to collect additional
objective information, however I found that therapists would make great
leaps in correlating their findings with a specific PT diagnosis. Rather,
through the work of Janda and the influences of the osteopaths,
chiropractors, etc, PT's have learned to refine their use of the postural
screen and have begun to recognize the "intersegmental relationships" and
their overall influence on the Pt's condition.
A perfect example would be to look at assessment tools like the vertical
compression test and the lumbar protective mechanism and how improving upon
intersegmental (somatic) dysfunction will often improve the Pt's performance
and tolerance for these tests (which are functionally based examination
tools that assess segmental load sharing and dynamic response to external
force). In addition, from an osteopathic standpoint, certain lesions (Type
I) are often initially recognized through a postural screen. It isn't that
a diagnosis is made based solely upon the visual inspection, but rather it
helps to guide the clinician in identifying underlying pathology (ex. sacral
base dysfunction, LE length discrepancy, myofascial dysfunction, etc)
Therefore, to characterize the postural evaluation as a waste of
time or as not a crucial component of the PT evaluation really can limit
your treatment approach and ultimately influence the chances for a
James H. McMahon MPT, ATC
Fort Howard VA Medical Center
From: Barrett Dorko [mailto:[log in to unmask]]
Sent: Tuesday, August 06, 2002 10:05 AM
To: [log in to unmask]
Subject: Re: A question of posture
At 06:30 AM 8/6/02 -0700, you wrote:
>It seems possible that if posture alignment is associated with
>imbalances which can result in a painful condition. Isn't this the basis
>for osteoarthiritis? Therefore, it makes sense to correct the poor
>biomechanics. I believe I heard Dr. Sahrmann say in a lecture if it hurts
>don't do it. For example, if you're slumped in a chair and your back or
>neck hurts, changing the posture should improve this.
Thanks for responding. I'm not suggesting that corrections of deformity
don't reduce pain, of course they do. But this has never been the point of
the overall postural assessment and the strengthening and stretcing work
proposed to solve problems like spinal pain. Sahrmann seems to finally
recognize this and has abandoned the regional view for one that includes,
in her words, "the relative alignment of one or two segments in multiple
planes." This sounds like chiropractic hooey to me, and in a hundred years
of that practice they've never demonstrated this to be true or relevant.
Are we supposed to start doing that job for them?
If any posture produces pain it will be helped by altering it, of course.
Is that the best we can do? Shouldn't we work to create a system that
tolerates slumping? Mine does.
Barrett L. Dorko, P.T.