Our approach

Logo

pic1 The human body has a perfect dynamic design for movement. This bio-mechanical relationship between the torso and its extremities is symbiotic and is propelled by muscular chains. The attachments of most muscular chains are located in the torso, woven within the diaphragm. Therefore, major muscular chains are functionally influenced by the action of breathing. The dynamic nature of the torso’s position facilitates the reciprocal movement of the body and its balance.

Our logo represents the human body’s torso without the extremities. What remains is a structure, shaped like an egg. The ideal shape of the torso depends on the position of the bones, function of the muscles, the ability to exchange the gases of respiration, and the proper movement of the body’s fluids. Our egg is divided into four quadrants; the top two represent the chest cavity and the bottom two represent the abdominal cavity. These cavities are separated by the diaphragm. Think of the diaphragm as having two hemispheres both physiologically and functionally. On the right side, the diaphragm is better developed and thicker, and is in a better position for inhalation. The left side is thinner, more linear, structurally more concave, and therefore functionally prone to adaptations. Both halves of the diaphragm assist in the movement of the fluids and gases in the body and provide a fulcrum which creates leverage for muscular work. When the body is in the compensated state, the diaphragm becomes a force of postural control.

The white in the logo represents the portion of the body cavity that has to be recruited; meaning the muscle action of this cavity must be engaged to expel the body’s gases during exhalation. The purple represents the portion of the body cavity
that has to be inhibited, meaning these muscles have to be relaxed and the gases have to be inhaled. This alternating reciprocal action is a natural way to propel our body and is the reason for its function.

A structural axis exists from the left shoulder to the right hip. This axis passes through the heart, stomach, and liver and is powerful because it is involuntary. Its positional relationship to the diaphragm guarantees the function of inhalation, and therefore survival in times of emergency. When the heart-stomach-liver axis is overused, during daily activities, it will dominate our life by changing the body’s posture therefore affecting its function and balance.

A functional axis exists from the right shoulder to the left hip. This axis passes through the right lung, stomach, and spleen. It is also powerful because it is asymmetrically balancing the function of the structural axis.

This logo’s functional message both dictate and clarify our approach to treatment at the Comprehensive Physical Therapy. We strive daily to restore an alternating reciprocal action between the structural and functional axis’s to obtain optimal body balance in all daily activities.

Application of PRI

pic2The Comprehensive Physical Therapy and its Application of the Postural Restoration Concepts.

The therapists at the Comprehensive Physical Therapy have specialized training beyond the required state certification from the prestigious Postural Restoration Institute (PRI) founded by Ron Hruska posturalrestoration.com. There are four major concepts around which the philosophy of PRI was developed and that drive our work leading to understanding the balance of our body and the relationship between all of its systems.

Concept 1 Symmetry vs. Asymmetry

In our world today, symmetry is valued as beauty. We adjust the images of models and movie stars to be more symmetrical, always striving for the “perfect face or body”! As children we are taught that we are symmetrical beings with two eyes, two ears, etc. In reality, our lack of symmetry is significant when considering physical therapy. How are we asymmetrical?

Body function is driven from asymmetrical brain centers and asymmetrically aligned inner organs. This enables us to move reciprocally instead of freezing, like robots. We then realize all daily activities are asymmetrically driven and this influences our habitual patterns which can be either functional or non-functional.

Concept 2 Position = Power

Human function depends on the relationship of the positions of the body complexes. Three complexes exist. Understanding their interaction will help us better comprehend our everyday movement. See the chart below and click on video links (Under construction) to visualize their mechanical action.

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When a new patient arrives, we consider the whole body and its function, and then the parts of that whole are taken into consideration. When the three complexes are in perfect harmony, they sit one on top of the other, resulting in a balanced system. However, if one is shifted out of position, we lose power. Internal forces are created (muscle stress, increased respiratory pressure, etc.) and strong external fixations are produced (vestibular, and visual fixations in space, etc.) to obtain a new balance.

Just as the rotating gears of a fine Swiss timepiece affect each other’s performance, our body systems affect each other in their daily function and create the body’s position in space. Imagine each of the three complexes of our body as a major gear with serrated edges.

Gears move in relationship to each other. Visualize three gears in action, as one gear moves clockwise, the next moves counterclockwise, and the third moves clockwise again. Our body’s complexes move in relationship to each other, and no matter what complex moves the other two respond accordingly. Even the simplest body movement becomes complicated. Our watch exists in one or two planes, but our bodies have nearly infinite positions of movement. We can no longer think about body movement as linear, but rather as a 3D wave. This has to be reflected in exercises and other therapeutic techniques.

Concept 3 Polyarticular chains

The brain and nervous system control all of our voluntary and involuntary functions. Communication between the nervous system and body movement is via polyarticular chains. Muscular chains are found on each side of the body and consist of the same muscles. These polyarticular chains both influence and are influenced by the diaphragm. We need these paired chains to recruit reciprocally (from side to side) for sitting, standing, and walking, etc. For each daily activity to occur, one chain of a pair has to support us, while the other moves us. Without this paired relationship, motion will not be functional and balance will be lost.

Concept 4 Breathing

Breath includes physiological and functional aspects that can be understood at many levels. Our focus is the functional aspect of breathing, how it influences the reciprocal action of the polyarticular chains, and the subsequent body movement. Breathing as a primary respiratory mechanism divides the muscles of the body into inhalatory and exhalatory functions.

What happens in the inhalatory phase? The ribcage expands and ribs move further apart and up; the diaphragm is lowered because the lungs are filled with gas. This will stimulate the muscular chains of the flexors, abductors, and external rotators, which are the muscles that propel our body.
What happens in the exhalatory phase? The ribcage relaxes and ribs come closer together; the diaphragm is heightened because the lung’s gases are expelled. This will stimulate the muscular chains of the extensors, adductors, and internal rotators, which are the muscles that hold our body upright against gravity.

The shape of the diaphragm is important, but equally important is the height of its walls in relation to the rib cage. This dictates the action of the polyarticular chains and the function of the body. The diaphragm is made of two hemispheres, each consisting of many layers of muscle fibers that work together or independently.

The two diaphragmatic hemispheres and the polyarticular muscular chains move reciprocally. This movement creates a perpetual motion of the body, its functions, and how we perform our daily activities.
Let’s apply this science to physical therapy. Every patient seen in physical therapy has developed compensations in their primary respiratory mechanism. Ideally, the function of muscular chains is reciprocally equal on both sides. When imbalanced, either a person’s inhalatory or exhalatory body pattern is more active.

Example: When we do a daily activity - i.e.; tooth brushing - we use positional body patterns. If you are brushing right-handed, you most likely will be standing on the right leg and your right shoulder will be lower than the left one. When the activity is done, if you are able to shift to the left side and drop your left shoulder down, then you are fine. People who remain in the “tooth brushing” position through most of the day, right shoulder lower, and weight over the right lower extremity, have developed compensation. They remain in an inhalatory pattern on the left and exhalatory pattern on the right. They will carry this positional body pattern throughout all daily activities and most likely will develop pain.

Balance

Balance impairment is one of the most frequent reasons for seeking medical help in the United States! To treat the imbalance of any system (i.e., muscular, ligamentous, visual, digestive, respiratory, etc.) it is imperative to understand the above concepts. However, during this process we must keep a broad appreciation of equilibrium of all systems to be successful in applying treatment and to do no harm.
Unlike the tandem movement of a rabbit or kangaroo, humans use arms and legs reciprocally. Our ideal functional gait is to move arms and legs with a relaxed opposing motion.

As we walk, we are constantly losing and regaining our balance. The movement of extremities, with each step, takes us out of balance, and like a tightrope walker we regain equilibrium with the help of the same extremities moving in the opposite directions.

Balance is the most complex function of our system. It is influenced by our sight, inner ear, and body awareness in relation to the surroundings. These three factors are thought to be the major source of the body’s balance.

Factors less commonly associated with balance are inner gases and fluid pressure, hormonal secretion, bite position and function, atmospheric pressure and visual perceiving of the space. In more technical terms, ocular-vestibular reflex and kinesthetic awareness create the body’s response to gravity. These determine our vertical position in space.

Incorrect balance causes instability within the body and ultimately stress and wear on the joints, soft tissues, and inner organs making us prone to injuries and disease.

Think of when you watch TV and see animals hunting on the savannah. Predators look for weakness and changes in gait pattern of their prey. They know it is easier to outrun an unbalanced animal and overtake them in the hunt. Skewed balance causes the prey to have a compromised respiratory function, which decreases the amount of oxygen to the brain and muscles, further diminishing the prey’s ability to flee. The game is over.

There is no difference with people. If, how we hold our body in space with reference to the horizon is compromised, our vision, inner ear and proprioceptive awareness have to compensate, and we start to lose balance.

Proprioception is a kinesthetic feeling of knowing where you are in space. If you alter it, you start to overuse your muscles. Tension is built up, resulting in the wear and tear of body conditions, general weaknesses, or pseudo neuropathy, etc.

The loss of balance might be from a head injury (caused by a simple bump, concussion, surgery, etc.) resulting in a vision shift. There may be a misfiring of the vestibular system due to changes in the pressure of the inner ear or overly stretched ligaments, etc. When the body has a balance problem, the brain’s first thought is not, “let’s go to the gym and exercise.” Rather, the brain wants the body to be upright, so that the eyes provide accurate information to the brain, thus increasing survival chances. Our culture has a “suck it up” and “stand up straight” attitude, and we hope for the best. This is our culture’s understanding of how to improve balance. This “bull-like” approach is very destructive. What is needed is education, positive attitude, and motivation to change the body’s position and permanently get rid of symptoms. Without such change, chronic pain and compensations will develop. If, the balance problem continues over time, irreversible pathologies might develop, leading to more serious consequences.

1. How are we asymmetrical?
We have one stomach, liver, spleen, heart, etc., and our intestines are positioned asymmetrically. Our brain is wired differently between the hemispheres and therefore functions as two brains. The lymphatic system drains most cellular waste to the left side of the body and back to the circulatory system. Our lungs are positioned and structured asymmetrically to make room for the heart; there are three lobes of the right lung and two lobes of the left lung.

2. Habitual patterns
A habit is something that the brain does automatically; movement repeated more than three times may become a habitual pattern.

3. Position
Interrelationship of the complexes of a person’s body, in space, to obtain balance.

4. Physiological breath
Cellular respiration and diaphragmatic breathing

5. Functional breath
How the body’s gases affect the polyarticular chains and body’s movement

6. Reciprocal shift
Movement between the sides of the body in different directions.

4 R’s of Dynamic Posture

pic3The 4 R’s of Quality Physical Therapy Treatment

Once a person needs physical therapy, accurate and specific exercises must be chosen to achieve an effective restorative result for each patient. Those exercises must be applied sequentially based on the initial and subsequent assessments. A universal process is employed to “restore a balanced posture.” This process includes four distinct stages, repositioning 7, recruiting 8, retraining 9, and restoration 10.

Repositioning and recruiting exercises differ from commonly used physical therapy techniques of stretching and strengthening. Repositioning and recruiting exercises directly engage a particular muscle(s) to obtain neutrality of the system for its best restoration. Clinical experience shows that if strength is restored first, system power is lost and we reinforce the wrong position of the muscle(s) or joint(s) that brought us for treatment in the first place. Repositioning and recruiting exercises are engineered to correct how each muscle is held and performs. Think of these exercises as correcting the brain signals to position each muscle or muscular chains. Once posture is restored, as you do your daily activities muscle strength and joint alignment will return. This is an important paradigm shift for most patients, just like the creation of a digital watch was a change in thinking for the makers of the geared watch.

Retraining, mechanical understanding of the body’s position is important, but the habits we develop are more significant. When the brain is asked to send a message repeatedly to perform a movement, it reinforces the use of that action and ultimately becomes a habit. All actions while awake or asleep become a part of the pattern. This creates a “living function” that can support the best use of our physiology or become a habit that strains our bodies.

By definition, “A habit is something that the brain does automatically.” Habits are the brain’s shorthand, a coded set of instructions that let us move in our three dimensional world without having to think about how we do physical therapy terms, you created habits in your movement patterns to compensate for lost position and developed weaknesses in your muscles. These may include, a limp, holding one shoulder higher/lower, always standing on one leg, always stepping forward with one foot, chewing on one side, looking through one field of vision, etc.

In physical therapy terms, you created habits in your movement patterns to compensate for lost position and developed weaknesses in your muscles. These may include, a limp, holding one shoulder higher/lower, always standing on one leg, always stepping forward with one foot, chewing on one side, looking through one field of vision, etc.

The Repositioning, Recruitment and Retraining exercises you will be asked to do are not always physically difficult and do not require strength like weight lifting. The challenge asked of you is to change the mental and physical patterns (habits) of how you do the simplest tasks. We all know that change is not easy.

Restoration, the Comprehensive Physical Therapy strives to transform our habits from negative to positive. The patient and therapist must work together to restore alternating reciprocal movement to obtain a balanced dynamic posture 11.

7. Repositioning exercises
With assistance of the respiratory system, neutrality is obtained by the central bone(s) (sphenoid, sternum, and sacrum) of any complex to allow the system’s function to be restored.

8. Recruiting exercises
Stabilization of body or joint position requires that we turn on specific muscle(s) on in a sequential planned process from head to toe, or the reverse, depending on dysfunction.

9. Retraining exercises
The exercises used to influence habits, allowing for better function and comfort of movement throughout daily activities.

10. Restoration
Achieving optimal function (homeostasis) of the body as a whole through the processes of repositioning, recruiting, and retraining exercises.

11. Dynamic postures
Posture is a reflection of the “position” of many systems that are regulated, determined, and created through limited functional patterns. These patterns reflect our ability and inability to breathe, rotate, and rest, symmetrically with the left and right hemispheres of our axial structure. - Ron Hruska Jr., MPA, PT www.posturalrestoration.com