Sunday, February 28, 2010

Understanding Egoscue Method Therapy (Synopsis)


The Egoscue Method recognizes that fundamental anatomical, physiological and biomechanical principles govern the human musculoskeletal system. With only very rare exceptions, each person is born with certain core design characteristics that serve as a strong, resilient and efficient operational platform. By using a blueprint of this extraordinary platform as a guide, the goal of the Method is to eliminate disparities that can occur when injuries or negative lifestyle conditions affect the way the musculoskeletal system actually moves as opposed to its underlying structural parameters. By restoring muscular balance, skeletal alignment and the harmonious interplay of internal systems, the body takes a quantum leap in healing power, stamina and physical capability. The Egoscue Method is not a form of treatment that chases after short term, symptomatic relief. Rather, symptoms provide a common sense starting point, a working frame of reference based on each individual’s unique combination of strengths and limitations. Our primary objective applies to everyone we seek to help—to eliminate musculoskeletal system disparities and the resulting postural dysfunctions that interfere with pain-free living.

A key part of the “blueprint” we refer to is familiar to all health professionals—it is known as the standing normal anatomical position. Without being overly technical the hip, knee and ankle joints are aligned vertically in paired stacks, each of which is subdivided by three horizontal parallel planes that extend through the joint pairs, creating what amounts to a partial dynamic load-bearing grid. The grid’s structure is completed by the shoulder joints which are in a functional interactive relationship with the major joints below instead of being aligned vertically like the others, although they too (the shoulders) operate individually and as a pair on a fourth parallel horizontal plane.Topped by the head, placed over the S-curved central spine that links the hips and shoulders, the grid allows upright posture and bipedal motion capable of a great range of movement. In addition, there is only temporary incidental rotation in the pelvis, legs, knees and ankles. (Think of rotation this way: Looking straight down on your upright body from above, draw a imaginary clock face with your head in the center facing twelve o’clock. In design position a straight line runs from hip joint to hip joint starting at nine o’clock and extending through the other hip joint, exiting at three o’clock. In such a configuration, there is no rotation, but if the lines depart from nine and three, say ten and four, rotation is present as the hips move off the design plane. This analogy works for the other load-bearing joints and the big leg bones. It is not unusual to find left-to-right pelvis rotation and right-to-left shoulder rotation.) The body is intended to rotate by twisting and turning, ascending and descending, in reaction to variations in the terrain and other temporary situations and then return to vertical alignment. When it remains stuck in rotation the integrity of the structure can be compromised

As you probably have concluded by now, the load-bearing grid we have just described means that vertical and horizontal alignment is all-important to both the musculoskeletal system’s structural integrity, smooth functioning and full, pain-free capability.

An individual whose body deviates from this design must do so for a reason. That reason is, (in cases that do not reflect past injuries), a muscular imbalance in strength and/or flexibility. An individual’s standing, static posture provides essential information to our therapists in predicting what the body will do as it moves. These predictions can be confirmed and often reinforced by observing the patient’s gait, the way he or she strides forward, turns and executes other routine maneuvers. In the process, changes in muscle tension/length may be detected, along with atrophy of underutilized muscles or damage to over-used muscles that results when one group of muscles is repeatedly substituted for another that is more appropriate to the task. Such postural anomalies, we describe them in general as “dysfunctions,” directly impact joint mechanics.

As well as being a highly integrated structure, the body has a tremendous capacity for self-healing. To effectively facilitate that healing, we must first remove the noxious stimulus that has disrupted normal function. This is a major premise of The Egoscue Method.

An individual who has experienced either some sort of trauma or who has had surgery or both is not beyond benefit from The Egoscue Method. This individual has had some external dysfunction placed upon their existing dysfunction. The combinations of the layers of dysfunction can seriously impede the healing process. Cases in which surgery is performed to accommodate a chronic symptom will have the same outcome as therapy performed with the same goal. It will not impact the cause of the symptom and therefore the symptom will return. Traditional rehabilitation following trauma or surgery following trauma is often much slower than expected and both patient and doctor are unhappy with the recovery. This is because although the trauma created the symptom, or accelerated its appearance, the body’s structural/mechanical dysfunction will not allow it to heal optimally.

The noxious stimulus is never removed. Even if a person has been physically altered due to surgery or trauma, the rest of the body is not relieved of its responsibility to execute its function. A body that lacks one of its components (i.e. meniscus, fused vertebrae), now more than ever needs the rest of the body to function as efficiently as possible to minimize the deficiency imposed upon it.

We must then return to our “blueprint”. The individual is visually evaluated with the aid of a plumb line and background grid. The therapist who is highly trained to recognize structural and mechanical deviations of the body as a whole and does so without the use of diagnostic machines or specific manual muscle tests. Based on the patient’s self reported history and the therapist’s observations, a series of functional demand exercises are developed. These exercises are designed to address the muscular imbalances and dysfunction leading to this individual’s structural deviations.

The exercises emphasize the deeper muscles of the axial skeleton and pelvis as well as the more superficial muscles. They require no special equipment and are designed to strengthen the body functionally. Our primary source of resistance is the person’s body weight and the force of gravity. The Egoscue Method’s therapists do not administer “hands on” therapy. The patient is instructed in a series of personalized exercises and then is expected to continue them on their own at home. Modifications are readily made whenever necessary. The home program prevents the patient from developing a dependency on someone else while pursuing their own well being. Instead, they assume responsibility for their own health. This is another major premise of The Egoscue Method.

The exercises alone are not the sole determining factor in improving structural/mechanical function. There are three primary components:

  1. The application of specific exercises to a given individual’s dysfunction. We have a catalog of over 400 different exercises. Only those exercises that apply to that individual will be of benefit.
  2. The sequencing of the exercises within a given routine is critical. Each therapy session has a given objective. That objective can only be reached through a properly designed menu. The exercises must be sequenced such that one exercise prepares the body for the next and that a successive exercise does not negate a prior exercise.
  3. The exercises are performed for an average of seven days. At this point we re-evaluate the patient and redesign the routine accordingly. Often the exercises are of low demand and as the neuromuscular efficiency improves, the exercises become less effective. Therefore, the body must be put under an increased or varied demand to adjust to the changes that has occurred as a result of the prior routine. This provides the means to continued progress. Patients on the average are seen once a week for eight weeks.

The Egoscue Method has had enormous success in helping people overcome their physical ailments. It is a technique that is attractive to many people because it is a common sense approach to the human body. The individual can see and feel the physical changes that take place as a result of their efforts. Associated with that is an increased feeling of confidence that accompanies the improved health that he or she is responsible for. A major concern of health care today is that of reduced costs and prevention. Therapy requires no special equipment or dependency on anyone other than you. Because we do not treat the symptom, but instead look to restore optimum function to the body, the implications toward prevention are obvious and very serious.

Saturday, February 13, 2010

Scoliosis, back pain, exercise, surgery and Egoscue

Scoliosis is defined as an abnormal curvature of the spine when viewed from the front or back. It typically looks like this:

The Mayo Clinic states: “Doctors don’t know what causes the most common type of scoliosis…” but they do know that it most often occurs during a growth spurt. Scoliosis can cause lung, heart and back problems including arthritis and degeneration. The Mayo Clinic says typical treatments are braces and surgery and states “physical therapy exercises can’t stop scoliosis.” WebMD states “there is no evidence that corrective exercises, electrical stimulation, or chiropractic manipulation are effective treatments for scoliosis.”

But is that really true?

Can exercise or more specifically posture correction exercises effect scoliosis?

You tell me. Here is a woman’s photo of normal relaxed standing before Egoscue:

Here is the same woman 1 1/2 hours later after Egoscue:

What do you think?

Do you think Egoscue exercises can affect scoliosis?

Do you think Egoscue might be able to stop the progression of scoliosis?

Do you think it could start reversing scoliosis?

Now let’s explore why. First thing to remember is bones don’t move bones. Muscles move bones. We all know this. Most treatments for scoliosis focus on the bones, but we all know the bones are only doing what the muscles are telling them to do. Fix the muscle imbalances and the bones will follow. Another way to look at it is: form follows function. Restore the function to the muscles and the form of the bones and joints changes. This is what Egoscue focuses on.

Another important thing to remember is the spine doesn’t function all on it’s own. So treatments focused on the spine alone will not create long term change. Why is this? Well the spine is balanced on top of the pelvis and the spine is reacting to what the shoulder blades are doing. Take a look at the first image in this post. Notice how they pointed out the uneven shoulders and hips? That’s key. Those imbalances have to be addressed in order for the spine to change position and stay in a better position. Now look at the “before” photos earlier in this post. Notice again the uneven shoulders and hips?

The Egoscue routine of exercises we designed for our example here was basically going after the imbalanced hip and shoulder position and letting the spine react to that. And quite a reaction we got! Now in order for her posture to maintain this new beautiful position she must continue to do her Egoscue menu of e-cises on a daily basis to change her muscle memory. When she does this, long term change is not only possible, it has to happen.

When thinking about scoliosis, there are several key points to remember:

  1. Bones do what muscles tell them to do.
  2. The body functions as a unit.
  3. Scoliosis, or the curve of the spine, is reacting to the hips and shoulders.
  4. Specific exercises designed for an individuals unique imbalances will create positive change.
  5. It’s never to late.
Matt Whitehead
Egoscue Portland