The Shift from Segmental Rehabilitation to Brain Based Postural Correction
What system controls and coordinates all other systems of the body? The neurologic system. What system provides the physical framework for all other systems of the body to resist gravity and function within our environment? The Posture System. These intricate systems work together to control and coordinate all experiences and actions throughout our lives.
Postural Neurology is defined as the network of neural impulses to support proper functional alignment of the Posture System. The purpose of Postural Neurology is to develop plasticity of proper structural alignment through brain based treatment protocols.
Why implement Postural Neurology into your practice? Quite simply, every musculoskeletal problem is at some level a neurologic problem. Neurology dictates movement, structure, and the function of your Posture System, overseeing and refining every single movement that you do on a daily basis.
It is an outdated system of healthcare to look at one part of the body, the site of injury or pain, and make assumptions about that person’s health and ability to function. Identifying the area of injured tissue, then creating a rehabilitation plan around that injury is less than adequate. The new system is all about function and whole posture patterns.
The shift has happened from segmental rehabilitation to Brain Based Postural Correction.
If the patient says “I hurt here,” or you test a weak muscle “here.” It does not mean that the problem lives “here.” This is simply information telling us that there is pain or dysfunction that is being expressed in that end organ. There is absolutely no indication that the problem is in that tissue. The noxious stimulus being interpreted by the brain is nothing more than a sensory input. The weak muscular output is nothing more than an insufficient motor plan.
This is the difference between segmental and brain based thinking. Segmental healthcare professionals do not see beyond the “hurt” or “weak” segment, oblivious to compensation patterns that are dampening function in the rest of the body. Compartmentalized thinking is not adequate for a system as dynamically developed and as functionally managed as the human body. It simply won’t cut it.
This guide introduces you to the Neurology of the Posture System, so you can understand the functional output of the brain and how it contributes to upright postural design.
Motor Cortex: The primary motor cortex is located in the frontal lobe of the brain. The frontal lobe is the center of human development including executive decision-making, language, and problem-solving.
Located within the Motor cortex is the Motor Homonculus. The Motor Homonculus is a map of motor output for each part of your human anatomy. Within this map, the amount of cortex devoted to any given body region is proportional to how richly innervated that region is, not to the body region’s physical size. Areas of the body with greater or more complex sensory or motor connections are represented as larger in the homunculus such as the hands, lips, and the face.
The primary motor cortex receives signals from the pre-motor cortex to make a movement. The primary motor cortex then sends the information to make that movement from the cortex down the spinal cord to the skeletal muscle of that body region.
Motor movement occurs contralaterally, meaning that your left motor cortex controls movement on the right side of your body. Your right motor cortex controls movement on the left side of your body. Every action occurs in this fashion, in response to a descending signal from the brain to the body.
Why is the Motor Cortex important to Posture? The motor cortex controls motor function. The Posture System is never actually “static,” we are dynamic beings who are always in motion. The motor cortex is constantly making small movements (even minute movements) necessary to prevent falling over, and to interact within our environment. Optimal dynamic posture begins in the motor cortex and is regulated by the cerebellum.
How can I check for weakness of the Motor Cortex? You can check for weakness of motor output by performing muscle tests. If a muscle on the left side is weak, this is information to do further muscle tests to confirm for weakness of the right motor cortex.
Sensory Cortex: The somatosensory cortex of the parietal lobe is the center for sensation. This is where you perceive your world and how you process all of the tactile and proprioceptive information received from your external environment.
Just as the motor cortex is a map whose arrangement gives preference to the highly innervated parts of the body, so does the sensory homunculus. The sensory homunculus is the primary mechanism of cortical processing for sensory information originating at body surfaces and other tissues.
Why is the Sensory Cortex important to Posture? The sensory cortex is very important for posture because the sensory cortex lights up with activation from novel stimuli such as proprioceptive signals and mechanoreceptor feedback from complex movements. Lack of movement is the worst thing for your sensory cortex. In fact, with lack of stimulation to an area of the sensory cortex, the sensory map “blurs” together with less representation of that body part in the brain.
For example, when patients present an injured knee and they have worn a brace that limits their range of motion. This limited motor output of the knee results in less tactile and proprioceptive feedback from the knee, the brain then thinks that the knee is “less important” and blurring of the cortical representation of the hip and ankle will begin to occur over the knee.
Less awareness of our body leads to poor activation and neglect of that area. To keep your patients healthy, keep them moving and activating all joints of the body.
How can I check for weakness of the Sensory Cortex? You can check for dysfunction of the sensory cortex by performing sensory tests such as light touch, vibration, temperature, painful stimuli, and joint position. If the patient presents with decreased sensory recognition, the contralateral sensory cortex is weak. Meaning, that if the left side of the body cannot detect tactile sensation, this is a weakness of the right sensory cortex.
Cerebellum: The cerebellum works in conjunction with the contralateral motor cortex to coordinate fine movements. The cerebellum is an “inhibitor,” it reduces any extra or unnecessary motor movements to perform the desired action as accurately as possible.
The cerebellum receives input from sensory systems of the spinal cord and from other parts of the brain, and integrates these inputs to fine-tune motor activity, providing feedback to the motor cortex of how movements can be smoother and more precise. When patients have deficits of the cerebellum they have excess movement, such as a tremor or a wide stance because they can’t balance with their feet together. Their equilibrium and ability to perform controlled motor movements is compromised.
Why is the Cerebellum important to Posture? The cerebellum coordinates all movement, to more precisely regulate fine movements. Proper cerebellar output means that the patient can perform their intended movement without recruiting other muscles. They are on target and on point with coordinated functions of the Posture System. Cerebellar deficits on the other hand affect the patient’s posture, they have compromised postural stability and uncoordinated dynamic postures.
How can I check for weakness of the Cerebellum? You can check for cerebellar weakness by performing a Romberg’s test. Have the patient stand with their feet together, close their eyes, and see if they sway to one side. The patient will sway toward the side of cerebellar dysfunction.
Brainstem: The brainstem is the center of postural control. The brainstem is made up of the midbrain, the pons, and the medulla and is the house of the nuclei of 10 of 12 of Cranial Nerves. Each of the cranial nerves provides important sensory and motor functions for the body. Of particular importance to the Posture System are the visual and vestibular nuclei that reside in the brainstem.
The visual system controls your orientation in space, literally how you see the world. Visual fibers descend to the cervical spine controlling head posture. Visual deficits result in forward head posture, lateral head tilt, and head rotation.
The vestibular system controls balance and extension. Flexor dominant posture is weak posture; upright extended posture is healthy and optimal for better function. This system is of utmost importance for upright postural stabilization and balance.
The brainstem also controls involuntary systems of your autonomic nervous system that regulate life-sustaining processes such as breathing, heart rate, sexual function, and digestion. Plus, the brainstem modulates postural tone, and inhibits flexion toward gravity.
Why is the Brainstem important to Posture? This is the primary control center of postural stabilization! The brainstem inhibits flexion, and in conjunction with the vestibular system activates extension. Descending fibers from the cranial nerve nuclei of the eyes control your head posture, and the ability to keep your eyes parallel to the horizon during dynamic movement.
Understanding the brainstem is an important connection for all posture professionals. Your posture depends upon the functional output of the brainstem.
How can I check for weakness of the Brainstem? Checking posture provides valuable insight into the function of the brainstem. Noted flexion of the Posture System or head posture distortion patterns indicates that there is weakness of the brainstem.
The Cranial Nerves also provide valuable insight of the function of the brainstem. Dysfunction of the cranial nerves means that there is ipsilateral weakness of the brainstem.
Spinal Pathways: The spinal chord and its pathways are the communication system to and from the brain and the body. The descending motor pathways stimulate movement and postural control. The ascending sensory pathways carry information of sensation to be processed and “understood” in the brain.
The brain and the body are in constant communication to perform efficient movements, to stabilize without falling, and to detect signals from the environment that require a response. Sensorimotor integration happens in your spine, this is the communication highway of the nervous system.
Why are the Spinal Pathways important to Posture? The pathways are invaluable to your postural design. Pathways from the motor cortex send information to create dynamic movements, and pathways from the brainstem descend to stabilize your postural tone. Ascending pathways from the body to the brain ignite the sensory homunculus for perception, and carry information from the primary sensors of your body for proprioception, vision, hearing, touch, smell, taste, etc.
How can I check for weakness of the Spinal Pathways? There are many different pathways. When you understand the function of that pathway you can design a test for it. For example, the corticospinal tract descends from the motor cortex to the spine to create motor output. Dysfunction of this pathway would present as weakness on muscle tests.
The spinothalamic tract is an ascending tract from the spine to the thalamus that recognizes stimuli associated with pain and temperature. To test this tract you would test sensory integration of hot, cold, and painful stimuli.