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Postural Restoration

What is Postural Restoration?

Postural Restoration is an advanced treatment approach used at Cornerstone Physical Therapy. It is an approach based largely on the work of Ron Hruska, MPA, PT founder of the Postural Restoration Institute™ in Lincoln, Nebraska. Cornerstone Physical Therapy is proud to be one of only 36 Postural Restoration Certified Centers in the United States.  All of the clinical staff at Cornerstone have advanced training in Postural Restoration and have studied directly under Ron.     We have seen first hand the effect that this type of treatment brings about in our patients, and have adopted its concepts as an integral and essential part of the rehabilitation process.

How  does it work?

An easy way of understanding Postural Restoration is to think a car which has a problem with tire wear on one side. No matter how many times the tire is replaced, it keeps wearing out. The underlying issue in this case is not the tire itself but the alignment of the car’s frame that needs to be addressed. Postural Restoration works in much the same way. Ultimately, by improving a person’s postural symmetry at the pelvis and trunk, the underlying conditions and stresses that lead to joint pain and soft tissue pain are solved.

Postural symmetry is improved by eliminating unwanted muscle tension in the body.  Trauma, stress, habitual movement patterns, respiratory patterns, and right or left handed patterns can all create muscle tension.  When present, there is a contraction or shortening of the muscle. This places abnormal forces on the joints and the soft tissue that supports them (muscle, tendon, cartilage, ligaments, etc). This is observed during a physical therapy examination as a reduction in flexibility, ROM, strength, and poor posture.  As a result, pain may develop at the site of muscle tension or at some distant location as the body attempts to compensate for it.

Postural Restoration techniques are used to eliminate unwanted muscle tension and to achieve neutral posture, full ROM, strength, and flexibility, which ultimately leads to soft tissue healing and pain relief. This is achieved by techniques that activate the muscles in the body that oppose the muscles that are contracting unnecessarily. Activating this antagonistic muscle will shut down the unwanted muscle contraction through reciprocal inhibition. For example, if the quadriceps are overly active, the hamstrings can be used to help them relax because they work in opposition.

What does the treatment consist of?

There are two main categories of treatment that are generally used in Postural Restoration. The first intervention, and the most important for success, is the home exercise program. Your therapist will work with you to create a tailored exercise program which addresses your individual needs.  Functional and integrative exercises are progressed from lying down, to sitting, and then to standing as neutral posture is achieved and maintained. These exercises MUST be done frequently in the beginning (2-4 times per day) as it is necessary for motor re-education to take place. As the pattern of muscle tension is eliminated, the frequency and number of exercises can diminish.

The second approach is manual therapy. This involves the therapist guiding the body into the new positions as you engage the muscles to hold those positions. Most of these techniques work the ribcage/torso to help with realignment. The muscles that are often found to be in a state of tension are accessory muscles of inhalation (breathing in), and the diaphragm. Most of the home exercises and manual therapy techniques incorporate breathing, and specifically exhalation (breathing out) because they work in opposition.

There are generally five common goals with the Postural Restoration approach:

1) Achieve full flexibility and range of motion indicating full muscle length after treatment in the clinic.

2) Return to the clinic with full flexibility and range of motion.

3) Relief of symptoms/pain to promote healing.

4) Increase strength of postural stabilization muscles.

5) A return to all functional activities without symptoms.

Postural discrepancies will lead to muscle and joint stress and ultimately to pain. These pain syndromes can involve the entire body (neck and shoulder pain, low back pain, hip and lower extremity pain, etc. . .). Faulty posture is often the origin of insidious pain and overuse injury, and it can delay healing when there is a traumatic onset of pain. Postural Restoration can help alleviate common pain syndromes and restore function in individuals of all ages.

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