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Posture wars
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Posture wars - October 14, 2003 10:46:00 AM
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mcap56
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From: New York, NY
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The posture wars continue..... I have contended for some time that PTs over-evaluate posture and that the relationship between posture and pain can be overvalued. Keep in mind that I am not talking about dynamic working postures or extreme postural faults. More the patient that comes in with accentuated lordosis and low back pain. Why bother to try and change it?
Central to my arguement was the belief that you can't really change a lot of these postures with exercise. However, a recent study in the PT journal has given me pause. It does seem like they altered posture and passive tissue tension in the test subjects. The study was well done. I don't know if there were radiographic changes....I am not sure there would be. However, they did have an effect in bringing more extreme postures closer to neutral.
The question remains whether these postures are related to pain and dysfunction. And there were very small numbers in each group. However, it is a nice addition to the debate and something worth considering. Anyone else see it?
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Re: Posture wars - October 14, 2003 12:32:00 PM
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Barrett
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From: Cuyahoga Falls, Ohio
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I saw it and similarly wondered about why such a fuss was being made about something never demonstrated to be a common contributor to painful function.
Should we be surprised that training alters use? Is there any indication that this alteration endures?
This isn't too far from the "Emperor's Clothes" thread elsewhere on this site.
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Re: Posture wars - October 14, 2003 1:21:00 PM
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mcap56
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Barrett:
I agree....the larger question still remains......are these postures related to pain. Don't see much evidence for that. And....I don't know if the postural changes would endure.
However, perhaps my pants would fit a little better [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]
An interesting study nonetheless.......
Mcap
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Re: Posture wars - October 14, 2003 7:27:00 PM
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coloradojulie
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I also saw the study....and I am for the posture side of this war. There may be not conclusive evidence for (from quantitative research standpoint)...but is there evidence against these structures being pain sensitive and effective by increased tension?
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Re: Posture wars - October 14, 2003 7:34:00 PM
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PTupdate.com
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From: Pittsburgh, PA USA
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I think that in some instances, posture can be related to pain, and perhaps prevent natural healing. Not always, but in some cases. Some examples:
Sitting somewhat slouched results in reduced cervical ROM, with more joint compression at end range. For someone with cervical DJD, and perhaps neural impingement, reaching this endpoint at 45 degrees rotation (which may occur many times through the day via driving etc.) over and over can lead to pain and irritation.
The shoulder musculature, especially the rotator cuff, can become quite weakened and compromised in slouched positions. Try this on yourself. Sit slouched, place your arm at 90 degrees of flexion or abduction, and try to resist someone pushing it down. Re-test while sitting up straight, and you will see quite a difference. Most weight trainer's will tell you they see the difference in ability to military press when sitting upright with support. How will slouched posture affect the laborer using his shoulders throughout the day? Is this analogous to driving around with your front end out of alignment and only 10lbs of air in the tires?
Also, look at the guy in the movie theater who sits slouched. Through the movie he fidgets, fidgets and fidgets. The guy who sits up straight often will not move through the movie.
Just some observations that I have seen over the years that make me question the posture theory with regards to different problems. I remember Barrett once talking about how unnatural and forceful we may tend to be when striving for perfect posture (whatever that means), and that alone may create a problem for the patient.
John Duffy, PT OCS [URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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Re: Posture wars - October 15, 2003 3:45:00 AM
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Barrett
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Of course the structures are pain sensitive. Such a question shows how most therapists miss the point.
When stressed mechanically it is the neural tissue that responds first and the brain's reaction is to contract the muscles that produce correction. Given full expression that corrective manuever can be analgesic simply because it leads to a restoration of normal nutrition to the nerve and a subsequent reduction in its sensitivity. Instead of promoting this corrective movement therapists just tell patients not to do whatever it is that seems to hurt. This is typically the admonition to "sit up straight."
I think we can do better than that.
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Re: Posture wars - October 15, 2003 4:06:00 AM
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gary s
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John,
As long as we're doing hypotheticals, perhaps the sloucher's posture is the one that gives the most comfort (temporarily) based on his/her own tolerance for mechanical deformation of neural tissue. The fidgeting is the unconcious attempt to reduce neural tension. Erect sitting would probably cause more discomfort.
Gary
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Re: Posture wars - October 15, 2003 7:07:00 PM
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PTupdate.com
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It may depend on the person. I am sitting here reading through all these threads, quite slouched, and I hurt. When I sit here nice and erect, I can do it for hours with minimal problem.
Is there a psycho-social component to posture and pain? I am sure. The tall girl in school who slouches so she doesn't stand above her class mates, etc. How many times have we seen the meek, shy akward kid in the clinic who sits like there is no spine inside of him, with all kinds of aches/pains. Do we see the same type of complaints in the confident athlete, with excellent "posture" and a ton of self confidence? I know I don't.
Also, there is the biomechanical considerations. Who reading this post has the same shoulder/cervical/jaw ROM when slouched as they do sitting erect?
Duffy
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Re: Posture wars - October 16, 2003 3:51:00 AM
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Barrett
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Some people are born shy, awkward and without the enormous egos common to successful athletes. There is no evidence that they suffer from chronic pain and none of these attributes would cause pain in any case.
I think your description reveals more about your attitude toward certain personalities and body types than anything else.
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Re: Posture wars - October 16, 2003 8:07:00 PM
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coloradojulie
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From: colorado usa
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Barrett you are a gem! I love the fact that you think we are all idiots...really it makes me smile and LOL.
Above I believe you included me in the genre of PTs who miss the point. I appreciate this assessment. Your neuro leanings are absolutely beyond me, and those points I might miss all day long. However, as a lesser evolved PT I still give credit to length tension relationship of muscles and the pain generating capacity of these tissues.
My question above was somewhat rhetorical...if you throw lack of proof at us in one direction, I merely am throwing back at you in another.
PTs practice different "religions", if you will. You have firm belief in yours, I in mine. Like any religious debate, we will find much to disagree with. I would like to think that points presented with mutual respect versus frank dismissal would be more conducive to information sharing.
Rather than scoff at the infantiles, why not enlighten us? You obviously have more clinical experience than most here...myself included, and it seems you have judged many as "unworthy" or their points of view as ones you care not to ingest or respond to (my wording)...I understand I am one of these backward thinking therapists...
Explain, if you will, from your "religious" standpoint, why you think postural changes (and sitting up straight is not what we are talking about) both statically, dynamically and functionally are not relevant? I start to wonder what treatment you are actually using in your clinic. I imagine your treatments being you talking your patients out of pain... "that doesn't hurt"! says Barrett.
I am genuinely interested in your rationale. If the nervous system is the corrective factor...what would you actually do for your patient...?
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Re: Posture wars - October 17, 2003 3:53:00 AM
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Barrett
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Telling someone they’ve missed your point and calling them an idiot may be the same thing where you live but here in Ohio we don’t see it that way. I disagree with others at times, and at times I don’t. I never, never call anybody names.
At the center of clinical science is a patient in pain. Because of this, therapists should work as hard as they can to understand the nature of the problem and devise a method of management that is sensible and can be defended using the latest peer reviewed literature. If the work done the past twenty years by Breig, Sunderland, Elvey, Gifford, Shacklock and others is “beyond” you that’s a pity but that fact makes modern neurobiology no less relevant to our patient’s complaint and to our approach as therapists. It was always my understanding that our methods of management should begin with a defensible theory and, like all theories, it would evolve as new discoveries brought the deep model of function closer to the truth. Strength/tension relationships, pain/strength relationships and posture/pain relationships have been questioned, refuted and shown to be woefully inadequate in the literature for years. Still, therapists hang on to them like grim death, not unlike a religious zealot, as you point out. I have nothing against religion or belief, but both depend upon persistent faith in the absence of evidence or in the face of evidence to the contrary. I distinguish between going to work and going to church, so your question about my “religion” won’t be addressed here.
As to what I think and do, well, I have written of that to the point of irritation in the minds of a few people I know. In hundreds of essays on the web and countless posts to listservs and bulletin boards my philosophy of care and specific suggestions about manual technique has been articulated. Your conclusion that I just tell my patients they don’t hurt says more about your reading habits and bias than anything else. I have a few former students here that would probably agree that I do a good deal more than talk.
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Re: Posture wars - October 17, 2003 4:32:00 AM
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Shill
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Joined: February 13, 2003
From: Madison WI USA
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Colorado,
you hit the nail on the head with this one. I tried to post something regarding the finger pointing without the problem solving yesterday, but had to delete the whole thing because I couldnt put things as eloquently as you did. Thank you...
I agree with you. I agree with some of what Barrett discusses, in regards to some of the things we invent that we feel are significant, BUT, It seems to me as well that Barrett chides without volunteering techniques, approaches, or methods that might be better backed by research than those we may use. Is that not one of the purposes of a site like this? He then verbally goes for the throat (not unlike a certain linebacker, also from Ohio, where they dont call you an idiot, they just dig their fingers into your throat) by claiming that we have attitudes toward body types, miss the point, etc.
Dont be afraid to repeat yourself, Barrett, in regards to some of the specific ways that you practice, and please, not in story form, with references that I dont understand regarding intellectual literature from the renaissance.
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Re: Posture wars - October 17, 2003 10:48:00 AM
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coloradojulie
Posts: 413
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From: colorado usa
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Thanks Shill...don't underestimate your eloquence! I am still laughing!
Barrett...You are correct, you never called us idiots. I merely felt this was inferred by the tone of your posts. I will certainly look into some of the references you posted regarding neurobiology.
As Shill and SJ mentioned, if you could offer some practical insights in regards to this issue in a short paragraph, I am genuinely interested in your approach. I admit that I would be unable to find the time to do extra research to locate your essays.
As I once did a presentation regarding evidence based practice to a hospital I was do an affiliation with about 9 years ago...there is an ungodly amount of literature being published on a daily basis, and if we read one article every day we would fall years behind each day. So it would be appreciated if you could offer a synopsis, direction, something...again I have honest interest in your opinion.
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Re: Posture wars - October 17, 2003 11:09:00 AM
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Barrett
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From: Cuyahoga Falls, Ohio
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You never considered going to my web site?
Thirty years of work and you want a paragraph? No wait, a "short paragraph"?
Something with the title, "How to treat pain" perhaps? Would that help?
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Re: Posture wars - October 17, 2003 11:58:00 AM
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gary s
Posts: 74
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From: wantagh, ny, usa
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Shill, Julie,
Using the football analogy, your're piling on Barrett unecessarily. I think that your somewhat vehement reaction to his words reveals some insecurity on your part. I've taken his course, use his "methods". Barrett "walks his talk". He is not saying that he is more successful than anyone else, but rather, he must do what makes sense to him. A simple search will lead you to his website. Once there you can find a wealth of references and yes, his own writings which will perhaps expand your perspectives.
Gary
[This message has been edited by gary s (edited October 17, 2003).]
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Re: Posture wars - October 17, 2003 12:34:00 PM
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Shill
Posts: 1097
Joined: February 13, 2003
From: Madison WI USA
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"I really like this, and I strive to keep my ideas contained in a few paragraphs that rarely exceed 600 words or so"
Ok, ok, a few paragraphs will do.
Gary, we are asking for information, not psychoanalysis. "he must do what makes sense to him." Me too. Id actually like to hear more about what makes sense to him. Point remains he kicked off (another football analogy) and I returned the ball. I pointed out that he provided his opinion about how other posters have attitudes towards body types, or how most therapists miss the point. How does one not take some offense (albeit not vehemence) when addressed in this way? Reflective introspection aside, we can all learn a few things from each other, if we can stop picking on each other!
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Re: Posture wars - October 17, 2003 6:28:00 PM
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Barrett
Posts: 967
Joined: July 28, 1999
From: Cuyahoga Falls, Ohio
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I'm deeply appreciative of all the advice given on writing style and will certainly take it to heart. Until I manage to figure out how to do this I'd suggest you folks simply ignore my posts and essays. I don't want to tax you in any way.
Can't wait to start writing more scientifically! Thanks again!
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