Postural Restoration

Postural restoration is a posture based integrative treatment approach to physical medicine. It includes the science of postural adaptations, the influence of the respiratory system and polyarticular chains of muscle, and asymmetrical patterns. Treatment aims to maximize neutrality in the body through manual and non-manual exercise techniques designed to reposition, retrain, and restore these asymmetrical patterned positions.[1] It is used by some physical therapy and athletic trainers.[2] There is little quality evidence on its usefulness in any health condition.

Effectiveness

There is little high quality evidence on its effectiveness. Postural restoration has been looked at in people with sciatica and low back pain,[3] anterior knee pain,[2] temporomandibular disorders (TMD)[4] and orofacial pain.[5]

Mechanism

The Zone of Apposition (ZOA) is a term for the area of the diaphragm that directly opposes the rib cage.[6] The diaphragm's mechanical action and respiratory advantage depends on its relationship and anatomical arrangement with the rib cage.[7][8] Respiratory function, proper diaphragmatic breathing and acquiring a zone of apposition are common principles utilized with Postural Restoration.[1][4]

Evidence base

Hruska 1997, reviewed the influence of faulty breathing patterns and overactive cervical musculature on normal resting position of the mandible and cervical cranial alignment. Clinical recommendations were offered regarding the importance of balancing the respiratory system through diaphragmatic breathing, along with strengthening the internal oblique and gluteal muscles when treating orofacial pain and TMD.[5]

Hruska 2002, discussed temporomandibular dysfunction (TMD) and its relationship to thoracopelvic position. In addition to discussing proper respiratory mechanics and rib positioning, Postural Restoration non-manual technique recommendations were provided to improve abdominal oblique strength with concomitant latissimus dorsi and pectoralis major stretching.[4]

Boyle et al. 2010, authored a journal article discussing the clinical use of a Postural Restoration non-manual technique (90-90 Hip Lift with Balloon). They review effectiveness of a balloon blowing exercise (BBE) technique to restore the zone of apposition and spinal position, allowing the diaphragm to optimally perform its respiratory and postural roles.[6]

History

Physical therapist Ron Hruska developed the science of Postural Restoration in the early 1990s as a result of his clinical experience and dedication to the study of the asymmetrical human body. In 1999, he founded the Postural Restoration Institute, located in Lincoln, Nebraska, as a way to educate healthcare professionals across the world in postural restoration.[1][2]

References

  1. 1 2 3 Spence, Holly (April 2008). "Case study report: postural restoration: an effective physical therapy approach to patient treatment". Techniques in Regional Anesthesia and Pain Management 12 (2): 102–104. doi:10.1053/j.trap.2008.01.003.
  2. 1 2 3 Boyle, Kyndall, L. (2006). Ethnography of the Postural Restoration Subculture: a Posture Based Approach to Patient/Client Management. Nova Southeastern University.
  3. ↑ Asghar Norasteh, Ali (2012). Low Back Pain. pp. 293–332. ISBN 978-953-51-0599-2.
  4. 1 2 3 Hruska, Ronald J. (June 2002). "Management of Pelvic-Thoracic Influences on Temporomandibular Dysfunction". Orthopaedic Physical Therapy Clinics of North America 11 (2): 263–284.
  5. 1 2 Hruska, Ronald J. (April 1997). "Influences of dysfunctional respiratory mechanics on orofacial pain". Dental Clinics of North America 41 (2): 211–227. PMID 9142480.
  6. 1 2 Boyle, Kyndall L.; Olinick, Josh. Lewis, Cynthia. (September 2010). "The Value of Blowing up a Balloon". North American Journal of Sports Physical Therapy 5 (3): 179–188. PMC 2971640. PMID 21589673. Cite uses deprecated parameter |coauthors= (help)
  7. ↑ Goldman, M.; Mead J. (1973). "Mechanical interaction between the diaphragm and the rib cage". Journal of Applied Physiology 35 (2).
  8. ↑ Mead, J. (1979). "Functional significance of the area of apposition of diaphragm to rib cage". The American Review of Respiratory Disease 11 (31).
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