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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.