Postural Restoration and Sarno Similarities

Hello all,

I think this post is more for the TMS practitioners and/or any medical professional who reads this forum. But this subject could interest anyone.

Let me begin by saying that I am a big believer in Dr. Sarno's work, as both my mother and me used his book successfully to deal with pain syndromes in the past. Hers was "fibromyalgia" and mine was more generalized lower back pain.

I also have dealt with, at one time or another, debilitating plantar fasciitis, repeated SI joint blowouts, neck spasms, rotator cuff tendonitis (from pitching too much when young), and neck pain.

I did IT work for about five years after college and that is when I was in the most pain, between the plantar fasciitis and SI joint problems. I also hated the job and felt like I was wasting my life. I was extremely unhappy, depressed actually, although the pain was definitely part of the depression.

Upon reflection, the worst pain I've experienced also happened to be during the most unhappy parts of my life, so I do believe that my mental and physical states simply reinforced each other.

On the other hand, incorporating certain exercises, called dynamic warmups, improved my body's ability to move considerably, and at that point my plantar fasciitis started to calm down. Improving my hip mobility and improving glute function was what I concentrated on.

Due to this improvement and my ability to finally stand up without pain, I ended up quitting my job, learned to dance (eventually becoming an instructor) and got into personal training.

Fast forward to about four years ago. The only physical issue I still dealt with was repeated episodes of SI joint pain and eventually back spasms that left me with a lateral pelvic tilt. Nothing could rid me of the tilt until I found the Postural Restoration Institute. I took one of their home study courses and quickly found the source of my SI joint problems: an asymmetrical pelvic position.

This is not meant as an advertisement for PRI (although I went through their credentialing process after four years of study and practice). I just think it's worthy of sharing my experiences and how PRI works.

PRI teaches that the human body is inherently asymmetrical, that the left and right side of the body will never work in the exact same way. Most of this goes back to the difference in size between the left and right hemi-diaphragms.

The asymmetry causes us to end up in a typical movement pattern where the left hemi-pelvis is rotated forward compared to the right side. While it seems that we all have a normal amount of acceptable asymmetry, when that asymmetry gets to pronounced, we lose the ability to move through three planes of motion at the pelvis, rib-cage, and sometimes neck without compensation. Essentially, we get "stuck" in one pattern that we can't break out of.

This is where the similarities with Dr. Sarno's work comes in (in my view).

Just like Dr. Sarno, PRI is adamant that they don't treat pain. They dispel the notion that there is something physically wrong with the patient (in the absence of acute injury)

They restore the ability to move through three planes of motion without compensation. All this is done via the autonomic nervous system. In the typical pattern (left pelvis rotated forward, left ribs elevated, increased curve in the lower back) you are living in a state of "fight or flight". You are sympathetically driven.

PRI enables you to reposition a pelvis and ribcage to achieve a more "neutral" resting position by turning off an overactive chain of muscles, and thus breaks you out of this sympathetically driven neuromuscular pattern.

At first I had difficulty reconciling what I was learning in PRI, the results I achieved with myself and clients who were suffering from various pain ailments, and the success I and thousands of others have had with Sarno's book.

PRI uses orthopedic terms and talks of bones and muscles. Not something that Sarno does. Eventually I understood that PRI only does this because they come out of the physical therapy world. They need to teach their concepts in a way that rehabilitation people can understand and relate to.

But at one particular seminar the instructor said something that gave me my "a-ha" moment.

He said what we are doing in PRI is "de-toning the system".

One way or another, we have to turn off the sympathetic nervous system.

PRI does it through an ostensibly physical intervention, using specific techniques to turn off overactive sympathetically driven chains of muscles that are holding us into a position that we are stuck in (for any PT reading this, we are stuck in the "right stance/left swing" phase of gait, so we are turning off the chain of muscles that hold us into that position).

Buddhism and meditation tone down a system through removing anxiety by letting go (among other methods).

Sarno's methods tone down the system by letting you know that there is nothing structurally wrong with you, and then educates you as to the real issue. This alone releases anxiety.

It seems to me that all methods "interrupt" a pattern, be it a physical movement pattern (PRI), or a stubborn mental pattern (Sarno and Buddhism) that then influences physical movement patterns via tension. Ultimately, I think the physical pattern and the mental patterns simply reinforce each other and make both patterns stronger.

Knowing that these neuromuscular patterns as identified by PRI exist (there is testing that shows the position of the pelvis, ribcage, and neck) I do often wonder if we could reposition these structures into "neutrality" (being neutral means that these structures are resting in a position that allows true tri-planar movement without compensation) through purely mental processes.

After all, it is an overactive chain of muscles that hold us in these positions, and the mind mediates all this. The system is tense. Re-positioning a pelvis and ribcage gets us out of a neurologically overactive movement pattern. It gets us unstuck.

I think of it like a circuit breaker: it breaks us out of the fight or flight response and facilitates a more parasympathetic bodily state.

Again, I've had success with both methods, and I think that both PRI and Sarno essentially strive to do the same thing: detone an overly sympathetic nervous system. Or, at least they both identify the source of the pain, an overactive sympathetic nervous system.

So in my experience pain can result for physical reasons, due to being at the end range of motion in a movement pattern we can't get out of, which would result in impingement type pain. But obviously pain can happen for reasons that Sarno would identify as traditional TMS.

Either way, de-toning the system, shutting off overactive chains of muscle, is still the key.

I actually think the methods compliment each other since they are both attempting to influence the autonomic nervous system. Perhaps those type of people who can't let go of the idea that something is physically wrong with them would respond better to some type of PRI inspired physical intervention because it "fits" their preconceived notions of some sort.

And perhaps people whose PRI tests are all negative (which indicates true tri-planar movement without compensation is occurring; you have thus de-toned the system) yet still feel pain can benefit from Sarno's methods.

If you are interested in the Postural Restoration Institute, they have a website. You can look them up and see what they do and see if it makes sense to you. Perhaps understanding their methods could be another tool to help you rid your clients of pain, which is what we are all really after.

I am grateful to both Dr. Sarno and PRI for helping me get my life back after so many years of pain.

Neal

 

This is interesting. There are other mindbody interventions that work through the body, like Somatic Experiencing and TRE. All with the same outcomes. Thanks for sharing.

 

Thanks for sharing this story. As a PT i'm familiar with the concepts you identify. I think that a lot of people respond well to a more "somatic" approach for restoration of the parasympathetic nervous system...and some don't. A lot of people I work with respond very well to exercise for pain. It's especially helpful if one isn't ready to work with a TMS approach. There are ways of moving naturally and easing tension that can create a relaxed posture and mindset, like what you describe.

At the end of the day, those of us who follow the TMS approach know that this type of pain is caused by an overactive "low brain" (amygdala, fight or flight response), increased sympathetic nervous system output, etc. Reprogramming your brain to unlearn the pain activates the prefrontal cortex and turns down the amygdala and sympathetic response. I could definitely see various methods contributing to this. I think for a lot of people though, it's hard to hold both the TMS approach and a somatic approach in mind at the same time...they can be a bit contradictory. I don't subscribe to the belief that there is a "right" way to move, as I have many patients who have suffered strokes, brain injuries, and other things that move very unconventionally and don't have pain, they move as they are able to and it works for them. Posture comes in many forms as well.

I'm glad this approach worked for you though! It just shows that different approaches work for different folks, i'll keep this in mind. Good physical health and being pain free ultimately is the result of good mental health, which can be achieved through a variety of methods