Reverse Posturing Theory

image If you missed out on last week’s post on “The best postural stretch?” you missed a pretty good discussion and exchange of ideas.  During the discussion, I had one of those “Ah-ha!” moments that we all have at times!  While I was typing the term “reverse posturing” just came out and I have been thinking about it ever since.

I know this itself is no scientific breakthrough and probably not the first you have heard of the term, but I thought to myself, how many repetitive stress injuries can we prevent if we got to the real root of the problem – poor posture during our every day activities.  Then I thought – how many times have we as clinicians evaluated someone and just worked on their clinical findings and not the source of their problem?  I am willing to bet we all have and will continue to do so at times.

I stated it in the previous post and I will do so again, but I really do not think we can make a significant change in someone’s posture that has been accumulating from years of adaptation to everyday activities.  But I bet we can change their postural habits and work with the body to reduce the stress and strain associated with these postural adaptations.

Below is what I would consider key ingredients to my “reverse posturing” theory.  Again, I stress that this isn’t completely a unique thought, but rather a combination of several thoughts from people like Janda, Sarhmann, Chaitow, Myers, Travell, Simons, Butler, and many more.  I think that you will get better results from combining theories rather than just sticking to one, sort of like taking the key points from each and blending together.  Each below is equally important and neglecting any of them will not allow any true progress.  This is why we see so many people with recurrent pathologies:

  • Positional relief positions – positional release techniques similar to the yoga cobra position we previously discussed.  I am starting to think that this is a big issue that we can work on and see some significant results.
  • Lengthening of shortened muscles
  • Release of postural trigger points
  • Inhibition of overactive muscle groups
  • Activation of inhibited muscle groups
  • Strengthening of synergistic force couples
  • Normalization of proper joint biomechanics and arthrokinematics of the joint and other joints within the “chain reaction.”
  • Patient education and maintenance strategies

More to come on this as I am brainstorming a bunch about this, but I want to hear your thoughts – what else???   Let’s keep rolling on this thought process!

20 replies
  1. Preston Collins SPT
    Preston Collins SPT says:

    Mike,
    I too have been thinking about this idea of reverse posturing since seeing it in your last post. Being a current PT student, we have been taught a lot of Sahrmann's models and lines of thought regarding what to address from a physical exam and intervention standpoint (including muscle length, firing activity, effects on posture, etc). I think that you are exactly right that these are the things we should be focusing on with patients. We just spoke the other day in class about how the TrAbd can be very difficult for patients to "feel" and activate through exercises. However, because the Multifidus is innervated through the same routes as the TrAbd, by activating one, you can also activate the other as a result. This will not cause any strengthening, persay, but rather get the muscle turned back on and ready to work – in this case for stabilization. This is just one example showing how the model above can be implemented with patients. I think you're on to something here and its comforting to know that what I am learning in school may actually have a practical purpose! 🙂

  2. Preston Collins SPT
    Preston Collins SPT says:

    Mike,
    I also wanted to ask, which of these do you focus on most when dealing with high-level athletes? Is there an underlying common denominator almost always seen? In addition, why do you feel this is the case?

  3. Noah Zacharko DPT
    Noah Zacharko DPT says:

    Mike-
    I think you are spot on with this thought process. The ability to reverse the postures that eventually lead to our patients pathologies is the true root of the problem. Your 8 points that you listed are essentially what we do to address various impairments and pathologies on a daily basis. I have thought for years that the best approach is a combined approach from many different theories to achieve the same desired result and your 8 points are the "bones of the skeleton" for how we achieve that. I would add joint manipulation to the Normalization point as it is largely under utilized by PT's and goes a long way to changing joint mechanics and reducing reflexive soft tissue tone.
    I enjoy reading your posts, keep them coming!

  4. Phil Page PhD PT ATC
    Phil Page PhD PT ATC says:

    Mike, you know my one-word answer….BRUEGGER. The Bruegger exercise does all those things, plus there's a lower extremity component…. Liebenson's 2nd edition has an entire chapter devoted to Bruegger. I hosted a Bruegger workshop here a few years ago with a certified trainer from Germany; pretty amazing stuff

    • nikita
      nikita says:

      hey! im a PT student, and im planning to do a project on BRUEGGER’S exercise and its effect on trunk flexion. im looking for literature for the same can you help me finding something? what do you think the effect on trunk flexion would be? will it increase? please help me find information on BRUEGGER’S 🙂 awaiting your response.

  5. Mario Nucci
    Mario Nucci says:

    Med school student- First of all, I love your site and your blog. Could you elaborate on patient education and maintenance strategies? Would lifestyle and ergonomics be included in this?

  6. Anonymous
    Anonymous says:

    Phil,

    None of the Brugger practitioners were effective with the athletic population in Cologne or Munich. Can you share any evidence of success with German athletes from 1970-2010?

  7. Chris Johnson PT
    Chris Johnson PT says:

    Mike,

    Just wanted to say that you have a gift for getting like minded people to come together in our field. WIth regards to reverse posturing theory and the best pect minor stretch…why not kill two birds with one stone…have people stand in anatomical position for 30-60 seconds periodically throughout the day. No need to go so extreme with the Cobra position though it probably does a great job of resolving iliopsoas tightness though I'd hope the person doesn't have a spondy. With anatomical position, have patients start from the ground up. First make sure that the feet are about shoulder width apart such that if each foot were on a body weight scale that it would register the same weight. Next, gently tighten/cinch the abdominal region. From there slide the scapula around the costal cage and rotate the upper extremities so the palms are facing forward and the arms are parallel with the trunk. Finally, perform gentle cervical retraction. This exercise is such a game changer!

    "Simplicity is the ultimate sophistication."

    "Things should be made as simple as possible but not one but simpler"

  8. Anonymous
    Anonymous says:

    Mike,
    Have you checked out the Postural Restoration Institute? I think you will find the information compatible with your thought process.
    posturalrestoration.com

  9. Kyle True, D.C. M.S.
    Kyle True, D.C. M.S. says:

    The easy answer to all of this is Bruegger exercise. This does all of what you are trying to accomplish in this post. Liebenson does a tremendous and detailed job explaining this in his text.

  10. Mike Reinold
    Mike Reinold says:

    I agree with Bruegger, but I think there is more to explore… There is more to it to explore and develop. I'm still working on this in my head and hope to get some morw information available. PRI is close too, but neither get it 100% they way I am thinking of it, something is still missing…

  11. Erik Knuth
    Erik Knuth says:

    I was working with similar thoughts and came along the concept of “Reverse Adaptation”. Knowing that postural distortions are propagated by habitual movement patterns and familial
    conditioning. “Reverse Adaptation” looks at behavior and Somatic intelligence (Voluntary) vs.Reflexive, with isolation sequences (ROM) and integrative sequences (ROM) to re-pattern postural distortions and support a healthy kinetic chain…one with out rusty links. Just a thought…

  12. Pat Stanziano
    Pat Stanziano says:

    Sometimes I joke with my clients that my physio schooling should have been just 1 lesson: Learn what movements and positions people are always doing as part of life, then ask them to do the opposite.

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