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 (occasionally interdisciplinary) aims to maximize neutrality in the body through manual and non-manual exercise techniques designed to reposition, retrain, and restore these asymmetrical patterned positions. Although primarily used in physical therapy, this approach has also become popular among athletic trainers, strength and conditioning coaches, occupational therapists, and other healthcare professionals.

History
Physical therapist Ron Hruska developed the science of Postural Restoration in the early 1990's 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 the science of Postural Restoration. Over 50 Postural Restoration courses are taught across the country and internationally each year.

Effectiveness
The Postural Restoration approach has been proven to successfully manage patients with sciatica and low back pain, asthma, anterior knee pain, thoracic outlet syndrome, temporomandibular disorders (TMD) and orofacial pain.

Sports injury rehabilitation and performance
The Science of Postural Restoration has become more commonly used by athletic medicine professionals working with various populations, including several NCAA Division I men's and women's programs, MLB, PGA and MLS.

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

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.

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.

In 2005, Coughlin et al. discussed a case study involving a 22 year-old male's response to Postural Restoration treatment in successfully managing a diagnosis of asthma and cough for seven years. Treatment involved a Postural Restoration home exercise program to address anterior chest wall tightness, increased lumbar lordosis, and breathing mechanics in attempt to restore his zone of apposition.

Boyle 2007, provides an overview of Postural Restoration, a holistic approach to the management of postural patterns of asymmetry.

Spence 2008, discussed a case study report of a 40 year old female with multiple musculoskeletal pain issues who failed improvement with previous physical therapy and chiropractic intervention, but her pain issues did resolve with physical therapy provided by a Postural Restoration certified (PRC) therapist through treatment involving Postural Restoration manual and non-manual techniques.

Robey et al. 2009, presented a case study of a collegiate football player with bilateral thoracic outlet syndrome whose symptoms were eliminated following prescription of therapeutic exercises developed by the Postural Restoration Institute to optimize respiration and posture through muscle inhibition and activation.

Boyle 2010, reported complete resolution of chronic low back pain and sacroiliac pain in a case study report of a 65 year-old patient following assessment and treatment using the Postural Restoration physical therapy approach. 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.

Tenney et al. 2013, reviewed the effects of hamstring and abdominal muscle activation on a positive Ober's test in individuals with lumbopelvic pain. Their findings show a significant improvement in passive hip-adduction angles and decrease in pain immediately following instruction from a Postural Restoration non-manual technique (90-90 Hip Lift with Balloon or 90-90 Hemibridge with Balloon).