Anita Furbush, PT

...physical therapy that matters.

Anita has been practicing as a licensed physical therapist since 1990.  Her work centers around The Postural Restoration Institute's unique exercise program designed to restore posture, alleviate pain, and promote efficient, relaxed movement.  In 2016, Anita became the first Postural Restoration Certified physical therapist in NH. Below are articles that Anita wrote that were published in her local paper that explain more about this approach.


Neutrality

What it means to be physically fit varies among individuals.  For some it is being able to get to the mailbox and for others it is running a marathon.   What they have in common is their desire to be able to do their activity without harming themselves and with efficiency - using the least amount of energy.     The key to achieving this is centered around what posture or position the person’s body is in while they are doing the activity.  Helping people improve their posture is something I’ve learned while being a physical therapist for over 20 years and working with a wide range of individuals with injuries ranging from minor inconveniences to life-changing catastrophes.


In my opinion, the most important aspect of being physically fit is not strength, but posture.  When people hear the word posture, they tend to arch their back and "sit up tall" in a military fashion.  They are relieved when I tell them that doing that is not "good" posture.  Good posture is a relaxed position and uses very little energy.  It centers around having your trunk in a neutral position.  The dictionary describes being neutral as not being engaged on either side.  For your body, it means that you are not being pulled in one direction or the other, but you can move freely in both directions.  For example, your spine would be able to bend forward as well as backwards. 


Why does it matter that your body is in neutral?  When your body is aligned so that it can move freely in both directions, then the muscles designed to work with the body in this neutral state are positioned in a way that makes movement efficient.  Not only does your body use the least amount of energy, but it makes the right muscles want to work! Furthermore, neutrality positions them so that they can work.  In this position they are neither too tight nor too loose, but in the right place to do the job they were made to do. 


On the other hand, if your body is positioned so that the right muscles are struggling to do the work you are asking them to do, then the overworked muscles start looking for help.  They are not particular in their search and will pull in any other muscles just to get the job done.  This muscle compensation creates inefficient movement patterns that can ultimately lead to injury and further compensation.

So how do you know if your body is positioned in neutral?  That is a more difficult question to answer.  There are tests some physical therapist use on different parts of the body to ensure that the body is placed in a neutral position.  Short of that, pain and recurrent injury are indicators that things are not well.  Trust your instincts as most people know when they are not moving properly.


 

Body Symmetry

Last month I talked about the concept of being neutral.  Neutrality is present when your body can move freely in both directions and muscles work in an efficient and effective manner.  Neutrality helps you to avoid injury and save energy.  Another concept that is crucial in understanding how people move and the posture they use is the concept of asymmetry.


 Although we have arms and legs on both the left and right sides of the body, the body is not symmetrical.   The asymmetrical placement of our organs determines to a large degree how the body moves.


The position of the diaphragm is key for proper movement to occur.  Your diaphragm sits in your rib cage and is attached around the bottom of your ribs and on the front of your spine.  A healthy diaphragm domes up into your abdominal cavity much like a kick ball that has been cut in half.  When the diaphragm muscle contracts during inhalation, the dome flattens and air is pulled into your lungs.  The dome aspect of the diaphragm is essential for its proper use.


The placement of internal organs effects how well the diaphragm is domed.  On the right your liver which weighs roughly 3 to 4 pounds holds the right side of your diaphragm in a domed position.  The small spleen and the heart on the left do not assist in left diaphragm doming.  Breathing is easier on the right because of the diaphragms domed position.


The domed right diaphragm also places the right abdominals in a position to work, whereas the lack of doming on the left makes it harder to activate the left abdominals.  Now that should get your attention!  Our culture has an obsession with abdominals and for a good reason.   Abdominals play a leading role in the search for good posture and core control.

 

Postural Restoration trained therapists pay special attention to positioning the left diaphragm to encourage left abdominal activation.  Positioning the left diaphragm correctly will do more to encourage left abdominal activation than any abdominal strengthening program.  Working with patients on proper breathing strategies and positioning them so that their left diaphragm can dome in sitting, standing and lying down are all simple ways to balance this normal human asymmetry and encourage left abdominal use.


Another effect of the right diaphragm position and improved right abdominal performance is that human beings have a tendency to be right-leg dominant – whether they are right-handed or not.  Having an exercise program that understands the need to develop left leg proficiency is essential to achieving as much symmetry as possible.


Understanding human asymmetries can help you exercise in a way that encourages a relaxed human posture and proper movement strategies.


Should you stretch your hamstrings?

The hamstrings are one of the most misunderstood muscles of the body.  Most athletes know where their hamstrings are because they are highlighted in popular exercise programs.  However, their unique role in helping the pelvis rest in a neutral position is not widely known.


The hamstrings are the big muscles on the back of the upper leg.  They come down from the bone you sit on, the one you feel if you squirm on a hard chair, and attach to the lower leg below the knee.    To really appreciate the unique placement of the hamstrings, you have to understand the bowl-like structure they attach to, the pelvis.


The pelvis is actually three bones that form a ring.  The sacrum is the part of the pelvis that is a continuation of your spine.  Coming out from the sacrum on either side are two bones called the ilia which come together in the front about 5 inches below the belly button.  The healthy position for this pelvic bowl is to be dropped down in the front a little.  This anterior tilt of the pelvis can become excessive and place the lower back in a forward position putting stress on the joints of the spine.  This can lead to a disc problem and a condition called spinal stenosis.  Excessive anterior tilt of the pelvis also puts strain on the hips, knees, and ankles.  Because of the asymmetry of our bodies, the left pelvis tends to be positioned in more of an anterior tilt then the right if no trauma has occurred.  An excessive posterior tilt rarely happens and won’t be discussed here.


An excessive anterior pelvic tilt is clearly something to be concerned about.  That is where the hamstrings come to the rescue.  They are attached to the pelvis in a way that encourages a neutral pelvic position.   However, if the hamstrings are too long they will not be able to perform in this way.   The problem is that if you have an excessive anterior tilt, the hamstrings feel like they are short and need stretching, leading the person to stretch more, making the anterior tilt worse and making them feel like they have tighter hamstrings, and so on.


Some physical therapists, like myself, can test you to see if your pelvis is neutral and if stretching your hamstrings is necessary.  Hamstring strengthening exercises with the pelvis in a neutral position or tilted back are recommended, with careful attention to maintaining a stable pelvis (no cheating).


The pelvic position is crucial for a stable and relaxed posture and the hamstrings play an important role in achieving a neutral pelvis.  Find out if you should be strengthening or stretching your hamstrings – ask your physical therapist.


Low Back Pain

The complexity of the human body becomes more apparent to me the more I learn about how it works.  Each complex part of the body (the neck, shoulder, foot, or finger) depends on each other part to function optimally.  A recent patient of mine will help illustrate this.


A gentleman came to see me with complaints of low back pain.  He kept pointing to his right low back and telling me that is where it hurt.  But, when I was evaluating him, his right shoulder position was drawing my attention.  His scapula was in a forward position and his right shoulder was held back further than his left shoulder.  


Not surprisingly, he said he had experienced right rotator cuff problems in the past.

If you want to feel the effects of this posture, stand up and bring your right shoulder back and drop it down a little bit.  Most people feel their left lower ribs elevate.  Your body is like a seesaw and if the right shoulder is down and back, then the left lower ribs are up.  If the left lower ribs are up, then the left diaphragm is flattened and the left abdominal muscles have difficulty engaging.  Stay with me as we take this one step further.  If the left abdominal muscles are compromised, then the right low back muscles try to help balance out the body and right low back tightness results and pain can occur.


I taught him how to position himself when he was sitting to help dome the left diaphragm so he could encourage left abdominal muscles while he was driving or watching television.  I taught him exercises that encouraged hamstring muscles, the left hip adductor muscle and right glut muscles to balance his pelvis. All that was good and helped, but the real breakthrough was when we were able to address the poor air flow into the right upper chest area.  As the right upper ribs opened, the left lower ribs were able to drop down, allowing for left diaphragmatic breathing, encouraging left abdominal muscle use and letting his right low back go on vacation.  He told me that during his healing, whenever he began to feel his right low back pain, he would stop what he was doing and position himself to bring air up into his right upper chest, and after a few deep breaths his low back pain would go away. 

Knowing how the body functions as a whole and using that knowledge to bring healing to an injured area can make all the difference in the outcome of rehabilitation efforts.


Squatting

When I evaluate someone to help them improve their postural alignment or reduce pain, one of the first things I am concerned with is whether their body can flex.  Flexion is the movement available if a person bends forward without allowing any side motion.


One of the first tests I do with a person is the standing reach test.  With legs straight and feet hip distance apart and facing forward, I ask the person to reach their hands toward their toes.  They need to be able to do this with a rounded back.  You know the way a cat looks when they round their back up and stretch?  That is a rounded back.  If your back can’t round, and you can still touch the floor, then you may want to look at my past article about excessive hamstring flexibility.


If a person is unable to touch the floor in the standing reach test with a rounded back, then I rarely give stretching exercises to gain flexibility, but rather exercises designed by the Postural Restoration Institute to turn the back muscles off and allow the back to relax and the spine to bend forward.  The muscles best suited for this job are the hamstrings (on the back of the thigh) and the adductors (on the middle thigh or groin area).  Because of the asymmetry of the body as discussed in previous articles, the left hamstring and left adductor are the ones most needed to promote trunk flexion.


Until the person can perform the standing reach test with their back rounded and touching their toes, I really can’t progress to the more challenging areas of movement because they require trunk flexion.  Without trunk flexion a person’s abdominals are not positioned optimally and therefore core control is compromised.  This puts the person at risk for injury.

 

Another test used to see how well a person can flex their body is the functional squat.  A functional squat is a squat performed with a rounded back and heels firmly on the floor with feet facing forward and legs hip distance apart.  In the full functional squat the person can rest comfortably with their buttocks at their heels.  They need to be able to breathe in this position without falling over.  Very few Americans can do this well, however, in most developing countries everyone, including the elderly, can squat because they spend much of their day in a squat position.   They can breathe comfortably in this position because their rib cage is able to expand in all directions. 


In summary, it is all about breathing once again!  What I am really looking at with these tests is whether the person can breathe in a folded or flexed position.  If they can, then the diaphragm is in a healthy, domed position and they are breathing using their diaphragm, a must for good postural alignment and proper movement patterns.