Mythbusters: The Egoscue Method of Health Through Motionby Josh Leeger

KIN 7333334/21/10

Introduction/Literature ReviewThe loop composed of the nervous system, muscular system, and efferent/afferent feedback/forward systems, is a dynamic system of communication and control within the human body. The disruption of the normal behavior of any one of these subset sys-tems necessarily results in abnormal behavior in the remaining two systems (Page, et al., 2010).

Muscular dysfunctions (including length/tension dysfunctions, nervous system/recruit-ment disorders, or over-/under-use syndromes) can have serious negative effects on an individual’s ability to function normally, and on their short- and long-term health.

Specifically, disorders within the nervous system can lead to disordered or dysfunctional firing (rate, timing, or selection) of the muscular system, which can lead to involuntary movements (twitches), seizures, or paralysis. These, in turn, lead to poor muscular de-velopment. (For a discussion of nervous system disorders and their effect on the mus-cular system (or joint neuro-muscular disorders), see Pobre, et al., 2010).

Dysfunction of the muscular system, either in length-tension relationship or even muscle “knots” (ischemic conditions), can be caused by injury or over-/under-use, and will in turn lead to disruptions in nervous system health (either due to decay of the nervous system due to lack of muscular tension or hypertonicity, or restriction of nervous im-pulse due to lack of normal range of movement).

Similarly, afferent/efferent disorders, or reflex-disorders, lead to nervous system decay, which leads to atrophy and eventual decay or calcification of the muscles being inner-vated.

Various methods have been developed throughout human history to address imbal-ances within this larger dynamic system (the “loop”). Within diagnosis and treatment of neuromusculoskeletal dysfunction there have historically been two approaches - one which addresses dysfunction from a structural standpoint (approaching the disorder at the site of the disorder itself), and another which addresses dysfunction from a systemic standpoint (attempting to observe the entire body and interactions of various systems that may be lending to the dysfunction). Within the systemic approach there appears to be a spectrum or continuum of approaches to dysfunction within this system, that ranges from the purely mental to the purely physical.1 (Page & Frank, 2002).

Approaches that attempt to address dysfunction within the loop purely from the nervous system are categorized under the label “somatic psychology.” These therapies usually use only “higher-order” nervous system functions (thoughts, feelings, emotions, etc.), to seek to address an individual’s psychological or mental troubles through a mentally-me-diated “awareness” of their physical body, or to address physical maladies via mental

1 While it is beyond the scope of this paper, it seems apparent and worth noting that the many therapeutic approaches to resolving dysfunction within this loop that do not address all levels or nodes of this loop will have limited results at best.

resolution. These methods have been variously used by Sigmund Freud, Pierre Janet, and Wilhelm Reich, among other psychologists (Young, 2006).

Methods that simultaneously approach dysfunction from all three levels can be grouped within a category called “somatic therapies” - a phrase which implies an approach via the collective physiology of the individual - their physical structure/function, mental/psy-chological constructs, and spiritual/emotional belief systems. This last involves the “higher-order” nervous system functions that are the main pathway to resolving dysfunc-tion in the “purely mental” group mentioned above. Among those methods are the Feldenkrais method of somatic education (1949), the Alexander technique (created in the 1890’s), and Hanna Somatics (est. 1976). Some of these techniques (such as Hanna Somatics) also attempt to use the efferent/afferent feedback/forward system.

In the final group, postural disturbances are approached primarily (if not exclusively) via the manipulation of the body itself. Included in these therapeutic approaches are other somatic therapies, as well as many therapies known as “bodywork.” Traditional West-ern “physical therapy” would also be considered in this group. This last group specifi-cally leaves out higher-order nervous-system processing (thoughts or feelings) in its therapeutic process. While some of these therapies may make use of afferent/efferent or reflex pathways, not all do (at least not explicitly). Many of these methods involve only physical manipulation of the musculoskeletal system either by the practitioner, by the patient themselves (as voluntary movement), or both. Within this group are included physical therapy, occupational therapy, various bodywork methods (including the Swedish system of massage, Rolfing, etc.), and the method in question in this paper - the Egoscue Method (EM).

All of these methodologies share the common belief in the existence of the loop system, and most share the idea that conscious control of one aspect of the system (usually higher-order nervous, or muscular subsets, or both) can lead to therapeutic change in the others.

Physiological Background InformationThere are a few concepts that should be covered before going any further in the paper, regarding human (regular, and) muscle physiology as it pertains to the subject.

Tonic/Phasic, Intrinsic/Extrinsic MusculatureThe first concept is of muscular categorization based on muscles’ roles in postural stabi-lization.

Tonic/PhasicThe tonic/phasic distinction arises from an hypothesized phylogenetic order of develop-ment of the skeletal muscles. The tonic muscles are the flexor group, and the phasic muscles are the extensor group.2 (Page and Frank, 2002). The names “tonic” and

2 The tonic/phasic distinction, and/or the anti-gravity(postural)/movement distinction, is somewhat of a misnomer. Since human beings are rarely standing in precisely the same position for any significant pe-

“phasic” come from the response of the muscle (groups) to depolarization. Tonic mus-cles respond/contract slowly and with sustained contraction and delayed relaxation, where phasic groups contract quickly, and intermittently (Cochrane, 1972).

This tonic/phasic distinction should apply directly to the relative structure or architecture of the muscle, but in Janda’s model this is not the case. Rather, the tonic/phasic dis-tinction refers to general patterns of activation tendency in systemic dysfunction. We find muscles of every architecture and fiber-type dominance in each category, which ne-cessitates another distinction - the intrinsic/extrinsic distinction.

Intrinsic/ExtrinsicIntrinsic musculature is that which is closer to the skeletal structure of the body (the deep musculature). The extrinsic musculature is, conversely, closer to the surface of the body (more superficial).

The human skeletal system is uniquely evolved for upright, bipedal locomotion. In the history of the human species, as our primary evolutionary distinction, this posture as been the primary posture for homo sapiens. Since smaller muscles closer to the joint generate greater leverage on the bones to which they’re attached, they are more appro-priate for maintaining posture in the upright, bipedal stance. Further, since these mus-cles need to combat gravity for extended durations, it seems appropriate that they would be largely slow-twitch fibers, slow to fatigue and capable of maintaining standing posture for extended periods of time.

Progression of Fiber Type within a MuscleWe know that most muscles follow a progression of fiber type, regardless of their overall fiber-type dominance, having a higher concentration of fast-twitch fibers in the superfi-cial portion of the muscle to a higher concentration of slow-twitch fibers in the deep por-tions of the muscle (Lieber, pg. 41).

Combined, the above facts support the notion that the more intrinsic muscles perform more of an “anti-gravity” role than the more superficial, extrinsic musculature.

The adaptation response of these muscles follows a regular pattern, with the tonic (usu. extensor) group tending to shorten and tighten, and the flexor group tending to lengthen and weaken, or become inhibited (Page & Frank, 2002).

The architecture of the human body, with predominantly flexor musculature located on the front of the body, and extensor musculature on the back of the body, is also relevant here. The standing human body constantly fights against the downward pull of gravity. The extensor musculature, in light of this, is extremely important. Further, it is slow-twitch the anti-gravity extensor musculature that atrophies fastest, shifting to fast-fa-tiguable fibers (Fitts, et al., 2001, pg. 3207; Dudley-Javoroski & Shields, 2008, pg. 283).

riod of time, the entire musculoskeletal system is active in maintaining a dynamic shifting process that we label as a static “posture.”

The pull of gravity on the body, and the tendency of the musculature to behave in a pre-dictable fashion as mentioned above, results in a series of musculoskeletal imbalance syndromes that were first described by Vladimir Janda as the Upper Crossed, Lower Crossed, and Layer syndromes. (Page & Frank, 2002).

In modern U.S. society, most people spend a majority of their time in a seated position, specifically, in Western-style chairs. Unfortunately, this position precisely mimics, and therefore, over time, exacerbates, the natural tendency for tonic musculature to shorten and become tight, and for the phasic muscle to lengthen and become inhibited.

The danger of this situation is that muscle fiber type can potentially change from one type to another, making therapeutic rehabilitation even more difficult (Pette, 2001).

Concepts from Muscle PhysiologySome of the physiological principles that are used in a method such as Egoscue to ef-fect musculoskeletal change are:• Muscle physiological behavior or properties:• Contracture - the chronic neurological “holding” of muscles in a shortened

state.• Spasticity - inability to control muscular contractions linearly, usually due to

velocity of contraction. (Alter 2004, pp. 29-30).• Strength imbalances

• Principles of static stretching:• “Stretch reflexes” generally (Nashner, 1976).• Golgi tendon reflex - senses and can limit speed of muscular contraction. (Al-

ter 2004, pp. 75-79).• Spindle cell reflex - senses and can limit speed of muscular elongation. (Alter

2004, pp. 75-79).• Traction - traction increases space within joints and changes the afferent/ef-

ferent information coming from the joint. It also provides GTO changes to the neuromuscular system. Pain can result from the ischemia or inflammation as-sociated with compressed nerve roots or branches at a joint. Ischemic pain is covered below. Eventually, disruption of the flow of blood to the joint and the flow of normal neurological activity through the nerve, can lead to nerve and muscle degeneration, which in turn lead to abnormal use, and eventual bone/joint degeneration. Traction can be an appropriate means to alleviate these issues. (Krause, et al., 2000).

• Principles of dynamic stretching:• Reciprocal inhibition - the inhibition of antagonist muscles when agonist mus-

cles contract, in order to allow full contraction of the agonist.• Larger system-based reflex patterns and feedback/forward loops (reflex action

covered below):• Pandiculation - the act of yawning/stretching apparent in many if not most

mammals (Bertolucci & Kozassa, 2010).

• Cross-patterning - the larger, dynamic aspect of neuromuscular activation patterning that occurs when four-legged animals ambulate, including nocicep-tive and proprioceptive systems. (Zehr, 1998; Dietz, 2002)

• Undefined large neuromusculoskeletal system response to manipulation of the fascial or other soft tissue networks that effectively unites the entire sys-tem (Bertolucci & Kozassa, 2010).

• Ischemic Feedback Loop• When tissues are injured or damaged, blood supply that would otherwise

clear metabolic waste and repair damaged tissues may be shunted from the damaged area. Metabolic wastes continue to build around the site of dam-age, further decreasing the functional ability of the tissue, further decreasing blood flow to the site of damage. This process is called ischemia.

Other principles, such as motor-learning principles, may have some effect, though they do not seem to be as applicable to the Egoscue method due to the static nature of the e-cises, and will be discussed at the end of the paper.

Reflex ActionThe second concept is that of the various muscular reflexes in the human body. Before going into specific reflex actions in the human body, it should be noted that a very sim-ple “reflex” pattern exists simply in fighting gravity. The primary role of maintaining standing posture and the ability to ambulate of the extensor muscle group also pulls against the flexor musculature of the body (that is, the extensors “fight” two adversaries - gravity and flexors). As we will see in the section below, Psycho-Somatic Connection, this becomes extremely important in the psycho-emotional or “motivational” aspects of therapeutic treatment, and of good posture generally.

The Psycho-Somatic ConnectionReflex motor actions are directly linked to certain specific environmental cues, and to mental/psychological (which are, at base, physiological) states. For instance, the startle reflex remains present in human beings throughout life unless it is trained out of them. Similarly, the fetal-reflex remains present in most human beings throughout the lifespan.

What is significant about this is the physiological states these postural positionings gen-erate. Tendency to fall into a fetal position for instance - whether because of use/dis-use, length/tension, or other factors - not only limits range of motion of the individual, but elicits the physiological system-state associated with the fetal position. That is, indi-viduals who are chronically positioned in a flexed or flexor-dominant position will tend to have decreased immune response, decreased sociability, and decreased levels of func-tional endorphins.

This connection, between mechanical position, and physiological “state,” is the basis for “somatic” therapies as described in the first section of this paper.

History of topic/development of idea The Egoscue Method (EM) of “postural therapy” was developed by its creator Pete Egoscue, during his effort to rehabilitate himself from injuries sustained during his ser-vice in the Marine Corps. He received his bachelor’s degree in Political Science from Utah State University. All sources available say that a combination of his experiences in athletics in college and his analysis of biomechanics and anatomy textbooks in his search for healing were the source for the creation of his method.

No direct information is available on the precise history of the Method the first clinic in San Diego is reported to have opened in 1971, though the Egoscue website claims that his first clients were in 1978.

To date, Egoscue has produced five books, is the main voice of a nationally-syndicated radio program that has over 12 million listeners. His company has 24 clinics around the world, and a website that offers online/distance-based therapy, DVD’s, and other equip-ment related to the Method.

Methods/resources Pete used to create EM may have included any number of biome-chanics and muscle physiology textbooks.

The EM ApproachThe method as it stands today approaches the body as a system of stacked joints that are optimally aligned at 90-degree angles to one another. The image on their website shows this “ideal stacking”:

Image from Egoscue.com

As mentioned above, EM approaches treatment of musculoskeletal dysfunction from the conscious control of the musculoskeletal system by the patient themselves. The foun-dation of the Egoscue system is this biomechanical understanding of the static body as designed to function optimally when the joints are aligned “at 90-degree angles” to one another. Any discrepancy from this optimal alignment is said to affect the entire system negatively.

The Method attempts to resolve the malalignment (according to the “90-degree model”) of the joints through various exercises, called “Egoscue exercises,” or “e-cises.” These e-cises are designed to create adjustments to the muscular system, and thereby the skeletal system.

Within a typical Egoscue session, the standing subject, preferably wearing clothing that reveals the positions of the eight joints described above, is photographed from the front, rear, and each side. These photographs are either put into a proprietary software pro-gram created by Egoscue, or analyzed by sight by the therapist. The software/therapist looks for discrepancies in vertical and horizontal alignment across joints, as well as “pat-terns” of distortion throughout the body-framework. From this, e-cises are chosen and put into a “menu” for the subject, who performs those e-cises both under the guidance of the therapist, and on their own at home.

It is these e-cises that we will address in this paper, to attempt to determine what physi-ological mechanisms are being used to achieve the results claimed by the practitioners and (successfully-treated) clients of EM.

Literature review No research literature addressing EM specifically is available, though there is a good amount of literature on other “somatic” methods - particularly Alexander and Feldenkrais techniques. For that reason, we will address EM from the standpoint of its assumptions and possible mechanisms, drawing on generally understood principles of human physi-ology to explain the effects of EM on subjects undergoing treatment.

Paper outline In this section we will outline the approach to the analysis of EM that will be taken, in or-der to understand its use of physiological mechanisms in a rational manner.

First, we will address the concept of the “optimal alignment” model that is the corner-stone of the Egoscue approach, as outlined above. Next, we will examine three typical e-cises from the perspective of muscle physiology, specifically attempting to determine the physiological mechanisms that are being applied to achieve the desired outcome.

Secondly, we will attempt to understand the use of the method in a broad (system/body-wide) sense, and determine possible changes and their potential duration based on what is known about muscle and human physiology.

Finally, we will attempt to explicate the underlying principles being used by EM, and to understand those principles generally. Recommendations will be made for the applica-tion of these principles across “movement disciplines,” as opposed to those strictly situ-ated within the EM framework.

1. Physiological mechanisms The Biomechanical “Optimal Alignment” Model of EMAs stated above, EM proposes that the skeletal system of the human body is optimally maintained in situation where each of the major joints (ankle, knee, hip, and shoulder) stack directly vertically above, and at “90-degree angles” to one another, and with sym-metry across sides. The standard lateral postural model is also used in EM, where a plumb-line runs directly behind the ear, through the center of the shoulder, through the center of the hip, along the mid-front of the knee joint, and just ahead of the anterior malleolus of the ankle. This alignment is said to provide the most effortless support against gravity, and represent a situation in which muscles length-tension is balanced from front to back and from on side to another.

While the postural model used by EM may apply generally, there are many situations in which it is not applicable. An individual may present with postural differences from the given model based on many factors, including skeletal disorders, nervous system disor-ders, or muscular disorders. Further, posture will vary across morphologies. Given those specific differences, however, it is generally accepted that the postural model out-lined by EM is optimal, and reflects a situation in which several things are occurring:

• The length/tension relationship of the musculature is optimal from anterior to pos-terior and from side to side

• The ability of the nervous system to function is not impaired by limited spacing in the vertebral column or restricted tension within particular muscles, and

• The ability of the musculature to function properly in action is potentially maxi-mized due to correct length-tension relationships.

Further, it has been shown that length-tension relationships do influence the posture of the body, and that change in length-tension can result in change within the skeletal sys-tem.

We can conclude, then, that the EM approach to recognizing postural dysfunction through structural abnormalities, and applying a muscular length-tension corrective ac-tion, is at least somewhat appropriate and supported by science.

Egoscue E-cises OverviewFrom a review of the Egoscue literature, there are essentially two types or categories of e-cises. Each category attempts to change muscle length-tension relationships and thereby skeletal posture/structure in slightly different ways, and will therefore be dealt with individually. The two types/categories of e-cises are:

1. Passive/Traction - in which the e-cises are entirely passive in nature. All of these e-cises involve the subject lying supine on the ground, with no muscular force being exerted, and involve some sort of “traction” being exerted, by gravity, onto the subject.

2. Active - consisting of movements in which the subject is consciously and actively controlling their movement. These e-cises occur in many different bodily orienta-tion, and usually involve intentional passivity of certain muscle groups during in-tentional activity of other muscle groups.

We will address three e-cises in this paper, which are as follows:1. “Progressive supine groin.” In this e-cise, the subject lies supine on their back,

with their non-tractioned leg supported under the calf, with the knee and hip bent at 90-degree angles. The tractioned leg rests with the knee straight and the heel on another block or object that is roughly the same height as the other calf (Egoscue produces a “multi-position tower” to make this progression easier).

← Image from: http://www.sandiegomassage.org/healthInfo-massage-dayspa-sandiego/posture-sandiegomassagedayspa.htm

←2. “Elbow curls.” This e-cise involves the subject standing with their heels and back

against a wall (as much as possible). They then position their knuckles at their temples, thumbs pointing down toward the ground, while keeping their shoulders depressed. The movement for this e-cise is to simultaneously bring both elbows together in front of the face, and then to adduct the humeri again to the starting position.

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← Image from: http://subdude-site.com/WebPages_Local/RefInfo/StretchExerciseEtc/Egoscue/Standing_Egoscue.htm

←3. “Downward dog.” Similar to the yoga movement by the same name, the down-

ward dog starts in a prone four-point stance, with the subject positioned on their hands and knees. The subject then presses up and back, straightening the legs, and attempting to place the heels on the ground.

←

← Image from: http://subdude-site.com/WebPages_Local/RefInfo/StretchExerciseEtc/Egoscue/Main_Egoscue.htm

Progressive Supine Groin (PSG)Outcome:The aim of the PSG e-cise is to allow the musculature surrounding the hip to relax, let-ting the acetabulum of the femur re-seat in the socket of the pelvis. The reasoning be-hind this, or the perceived need for this e-cise is from the tendency for most people in modern America to have externally rotated femurs due to a combination of short/tight external rotators of the hip (PGOGOQ), and dysfunctionally-anteriorly tilted pelvises.

This may sometimes be due to a combination of tight/short iliopsoas group, tight/short rectus femoris, and tight/short quadratus lumborum, and therefore, inhibited abdominals and gluteals. This pattern is what Janda referred to as the “lower crossed” pattern.

Method:In the PSG e-cise, the tractioned leg hangs by the heel from an object. When the mus-culature around the hip “releases” (said to be signaled by a flattening of the lumbar spine against the ground), the subject lowers their foot by approximately five inches and repeats the process. Going through six iterations of this process (moving the foot from an elevated position to a position level with the rest of the body) can take upwards of one to two hours per leg.

Physiology:What is actually happening when the muscle “releases?”

The musculature surrounding the hip joint is put in a position of light traction. The mus-culature is left completely relaxed. Under continued tension/stretch from the traction ef-fect, the golgi tendon organs (GTO’s) and muscle spindle cells begin to signal tension changes to the central nervous system. At this point, two things may happen. The CNS may effectively become “overloaded” with the “white-noise” of these impulses, and pro-gressively decrease nervous stimulation to those muscles, causing the muscles to relax. Also, either in addition to or as a separate effect, the extrinsic (and often, in cases of dysfunction, supporting “phasic”) musculature may become exhausted and experience temporary contractile failure. This may effectively “reset” the CNS recruitment pattern in which instance tonic musculature engages and resumes its proper (primary) role in joint stability in standing posture.

Simultaneously, basic stretching of the soft tissues is occurring, perhaps signaling the “pandiculation” reflex mentioned above, effectively reuniting the body as a single opera-tional unit, and integrating the modified musculature into the larger whole-body pattern-ing.

Validity:Traction is an extremely well-documented treatment methodology for many types of dysfunction, though results and methodologies used are mixed. The above description relies on qualities of muscle architecture to explain possible results obtained from this e-cise. However, extensive research would have to be performed to verify any of the above actions.

Possible Negative Effects:There may negative be afferent/efferent, and/or soft-tissue effects after a 60-minute du-ration of deformation. That is, proprioceptive input may be significantly altered following this e-cise. Stretching of the tendons (GTO’s), and muscle bellies (spindle cells), as well as ligamentous stretching may occur, resulting in altered proprioceptive feedback.

Elbow Curls (EC)Outcome:The outcome of the EC e-cise is to increase mobility of the scapulae and thoracic spine of the subject, as separate from mobility in other areas. That is, the e-cise is designed to attempt to remove the possibility of compensatory movements when attempting to perform movements involving the thoracic spine and scapulae (essentially, and upper-limb movement).

Method:The EC e-cise appears to be a relatively simple movement of the body. When it is in-structed by an Egoscue therapist, however, things become more complicated.

Within the form described above, the subject is also instructed to keep their thorax/rib cage in a neutral position, to prevent compensation for scapular immobility by the lower thoracic or lumbar spine. The subject is instructed to position their feet in such a way

that the outside border of the foot is perpendicular to the vertical line of gravity. This feels, for most people, like a somewhat “pigeon toed” position.

The subject is instructed to contract their quadriceps musculature, and relax their ab-dominals. They may be instructed to press into the floor with the medial border of their feet. Finally, they are instructed to keep their shoulders depressed, and their thumbs turned as far downward/forward as possible while keeping their wrists straight.

Physiology:The accessory contractions mentioned above appear to create a chain of inhibition throughout the extensor musculature, of which the rhomboid and trapezius groups are a part.

The positioning of the hands at the temples with thumbs pointing down rotates the ra-dius and ulna, making it difficult for the subject to internally/medially rotate the humerus. This effectively locks the humerus into a neutral or somewhat externally-rotated posi-tion.

This rotation can only be achieved through the co-activation of the “rotator cuff” muscu-lature along with accompanying inhibition of pectoralis and SCM.

The subject is instructed to keep their head in a neutral (“chin tucked”) position, activat-ing the cervical flexors and inhibiting the cervical extensors. They are also told to keep their scapulae depressed, which activates lower trapezius and serratus anterior muscu-lature.

It is interesting to note here, that this pattern of activation/inhibition directly counters that described by Janda’s model for Upper Crossed syndrome.

Image from Page & Frank, 2002

When the subject adducts their humeri, the upper-thoracic musculature is put under an active-isolated stretch, assisted by the contraction of the pectoralis musculature (which inhibits the the extensors). When the arms are abducted back to the starting position, the opposite happens.

Validity:In effect, this e-cise would seem to be an effective way to “loosen up” the musculature of the shoulder girdle, particularly, in a physiologically preferred (or a “good-posture-neutral”) position.

Possible Negative Effects:It is hard to determine any potential negative effects of this e-cise. Subjects with ex-treme dysfunction of the musculature of the shoulder girdle may not be able to perform this e-cise, simply due to the range of motion required to perform it. Another e-cise is most likely recommended in those cases.

Downward Dog (DD)Outcome:The DD e-cise reflects the larger-scale, or systemic, outlook of EM to the function of the human body. One of the aspects of the therapy mentioned by practitioners and in the Egoscue books is the need for the pelvic and shoulder girdles to obtain and be able to maintain rhythmic interrelated movement under control. This e-cise is designed to cre-ate a simultaneous flexion of the hip with extension of the arms.

Method:Similar to the EC e-cise, there are intricacies to the instruction/execution of the DD e-cise. Specifically, subjects are instructed to attempt to keep their shoulders depressed, their head in a neutral position, to leave their abdominals relaxed, to contract their quadriceps, and to attempt to straighten their legs as much as possible while maintain-ing a neutral lumbar spine.

Physiology:This e-cise utilizes a combination of the stretch reflexes from PSG and reciprocal inhibi-tion from EC. When subjects are instructed to maintain the DD position for an extended period, GTO’s and spindles begin to signal gradual length/tension changes to the CNS, and potentially create overload, causing muscle “release.”

Contraction of the needed muscle groups to hold the position reciprocally inhibits op-posing (dominant/flexor) musculature. In the case of the quadriceps, sustained contrac-tion of this large group eventually results in fatigue, at which point smaller musculature may attempt to maintain the position. These muscles fail in turn (more rapidly), and the subject is potentially left being supported either by deep intrinsics or by ligamentous/ten-donous tissues.

In situations where the subject is instructed to repeatedly perform the DD movement to/from the four-point starting position, the reciprocal inhibition aspect of the movement will be stressed, resulting in stretching of the anterior shoulder girdle musculature, potential mobilization of the thoracic spine, and stretch of the leg flexor groups (hamstrings and calves).

Validity:This e-cise similarly creates mobility and potentially strength increases (given the sub-ject’s level of conditioning and the number of repetitions performed) in the shoulder and pelvic girdles. It additionally creates a motor pattern that synchronizes mobility of the humeri and femurs in their respective joints.

Possible Negative Effects:As with PSG, if held for very extended periods, this e-cise may result in stretching of lig-amentous tissues, or deformation of fascia and spindle/GTO/proprioceptive disruption. If performed in repetitions, negative effects can result, again, from a subject lacking req-uisite mobility or strength to adequately perform or control the movement.

2. Understanding EM in a Systems ApproachIn this section we will attempt briefly to understand the use of the method in a broad (system/body-wide) sense, and determine possible changes and their potential duration based on what is known about muscle and human physiology.

As with many therapeutic approaches, the Egoscue method appears to be very symp-tomatically-driven. In spite of the claim to a system-based approach, most movements

are joint-specific. Because of the complexity of the interactions of the neuromuscu-loskeletal system, seeking to make systems-wide modifications through the adjustment of specific joints is most likely a losing battle.

The principles used in EM, however, may be applied systematically, as shown by pio-neers such as Vladimir Janda, Vaclav Vojta, and Pavel Kolar, a summary of whose work is beyond the scope of this paper.

For the purposes of this section, it should suffice to say that the approach of the EM to the body utilizes specific properties of muscular physiology to achieve muscular relax-ation at certain joints thereby facilitating proper joint mechanics and potentially, proper muscular recruitment/action around the joint.

This author’s perceived lack of a true systems approach is not to detract from EM, which has been effective in reducing pain and neuromusculoskeletal dysfunction of many people throughout the world.

3. Application of Knowledge: Explication of the Princi-ples Behind EM, and the Possible Application of those Principles, GenerallyFinally, we will here attempt to explicate the underlying principles being used by EM, and to understand those principles generally. Recommendations will be made for the application of these principles across “movement disciplines,” as opposed to those strictly situated within the EM framework.

The biomechanical model that EM follows, as stated above, is physiologically sound in principle. The use of physiological principles of muscle as listed above, is also sound.

How can those principles be applied, generally?

While a therapeutic application is significantly different from a “general fitness” applica-tion, we will try to make some recommendations that can be used in a general setting.

First, approaching the body from the perspective of the load bearing joints’ symmetry both the frontal and in the sagittal plane is a good place for many general fitness enthu-siasts to start. If significant differences exist between left and right sides of the body in terms of alignment with regard to the spine, if the spine itself is not vertical/aligned, or if malalignment exists with regard to the load-bearing joints from the side-view, care should be taken by the fitness enthusiast to choose movement patterns, loading pat-terns, and loading parameters, that will help to alleviate those imbalances.

Secondly, the general fitness enthusiast can use the same principles that EM has used - physiological principles of stretching, muscle behavior, and reflex-patterning in order to create more effective fitness programs.

This has been done in a most rudimentary form in “push/pull” weightlifting routines, which utilize the reciprocal inhibition of the secondary muscle group to create a poten-tially greater contraction in that group as it is exercised, immediately following the ago-nist group. Utilization of general physiological principles of muscle in an exercise rou-tine has also been seen in use of the post-action potentiation effect, wherein maximal lifts (1-5RM) are performed immediately following an identical “plyometric” movement (using the stretch-shortening cycle).

Finally, lessons for the general fitness enthusiast can be taken from EM’s movement se-lection and repetition/duration scheme. As far as movement selection, the general fit-ness enthusiast should take care to select the “most bang for the buck” movements. Also, loading should emphasize an inside-out approach to the development of strength, building endurance-strength of the tonic stabilization system first, and explosive- or maximal-strength of the phasic “movement” system second.

Personal critique/perspective of the Egoscue MethodI have a few things to say about EM in this section, that will fall into three general cate-gories. First, my personal experience with EM, and the benefits I’ve seen it have on myself and on others. Second, the limitations of EM due to the perception of fitness in the modern fitness world. And finally, limitations of EM due to a lack of integration of EM principles into complete, continuous movement patterns.

Personal ExperienceDuring the throwing season (for Scottish Highland Games) last year I exacerbated an existing hip discrepancy that was almost completely resolved with EM. I did perform the e-cises mentioned in this paper, along with many others. I’m also very good friends with an Egoscue therapist, and have spoken with him and many of his clients in depth about the EM treatment, and seen very positive and sometimes dramatic results in other peo-ple who have undergone the therapy.

Perceptions of FitnessFitness is perceived as something “extra” that people do, and typically referred to and regarded in terms of the “externalities” of the activity - either aesthetically, or in atten-tional focus.

That is, most folks see exercise as “working out,” an extrinsically-motivated activity, me-diated by societal or peer pressures. The attentional focus of most general fitness en-thusiasts is either on the aesthetic results (a “hot body” or “washboard abs”) or on some externally-based standards of exertion (“I really killed myself in the gym today...great workout” - see Crossfit).

This type of extrinsically-motivated approach leads to burnout and failure, as the exer-ciser has no internal “anchor” for their activity. Worse still, the exerciser gains nothing in knowledge of the workings of their own body, or in the sort of self-responsibility that that type of knowledge can engender.

The Movement Dilemma Before we begin to answer this question, it is important to note that most (if not the large majority of) people seeking EM therapy are in at least some if not a significant amount of pain from neuromusculoskeletal dysfunction. That is, many of these individuals are not in a state to engage in full-fledged physical activity. They would be considered peo-ple better suited for structured physical therapy, or post-physical therapy type activities. Therefore, this particular section only applies to EM subjects who either begin at or have progressed to a stage in their therapy that would allow full-range and full-body movement, or to the general fitness population.

While EM does recommend that subjects progress to newer e-cises, and that more functional subjects also practice physical activity in “the Patch” (an obstacle course composed of tree-trunk-fences that the participants can jump over, crawl on, etc.), the fact that subjects are already paying for therapy and spending (sometimes significant) amounts of time in EM therapy brings up the question of whether or not the effects of EM can’t be found through other methods that might also involve more movement, metabolic demand, or physical exertion.

Given the one movement above, and its prevalent use in Yoga, Yoga might be a good place to start. However, Yoga, it seems, frequently falls into the same dilemma, offering perhaps a little too much movement (focused on “flexibility”) and not enough static/iso-metric control.

Can the principles of EM be used to create movement patterns that will have the same effects and at the same time appeal to the whole-body reflex neuromotor patterning that seems to be the real basis of long-lasting change?

The cross-patterning associated with walking or crawling not only provides structural movement-pattern lessons (by, for instance, emphasizing the “serape effect” - Logan & McKinney, 1982). These type of large-scale patterns in the neuromuscular system are the last to form, but appear to be the most resistant to change once a compensatory pattern has taken hold. Not only that, but these patterns seem to involve cross-pattern “reflexes” (or at least, cross-pattern nervous stimulation of contralateral limbs (see Zehr, 2004, and Dietz, .

This leads to the question of how the changes that occur during e-cises integrate into the individual’s larger motor programs - that is, the things they do day in and day out? Dr. Michael P. Leahy developed what he calls the “Law of Repetitive Motion” or “Cumu-lative Trauma Disorder” (Leahy, 1995). This “law” is written as “I = NF/AR,” or, the In-sult or injury to the tissues = the Number of repetitions times the Force, divided by the Amplitude of each repetition times the amount of Rest between repetitions. In other words, people’s neuromusculoskeletal health derives from the activities they engage in the majority of the time, and not from the thirty minutes to an hour that they may spend exercising every other day.

For e-cises, in order to introduce an amount of strain that will counter the sum total of the movement of the rest of that person’s day, their time would either have to equal that of their other movement, or the force that they withstood during the corrective move-ments would have to be significantly large.

This presents a possible addition to the section above, in that it may be that well-chosen heavy (high-force) weightlifting movements that counteract the individual’s dysfunctions could have as great or perhaps a great effect on their neuromuscularskeletal health than a well-chosen e-cise menu.

How can the lessons from the success of EM with certain subjects can be taken into a framework that also integrates the nervous system (higher- and lower-order)?

Conclusion In conclusion, the Egoscue Method appears to be an effective method for resolving neu-romusculoskeletal disorders arising from length/tension imbalances of the musculature. It does this through the use of stretch reflexes and muscle physiology properties, ex-ploited in different postures or movements that affect specific groups of muscles. The changed length-tension relationship of those muscles in turn affects the line of force di-rected to/through the joint, potentially restoring normal function to the joint and allowing for normal nervous impulse generally and to the specific muscles in question.

While the therapy is effective, the nature of the e-cises as static seems to prevent them from being incorporated into or from having a significant effect on the larger motor pro-gram of the subject, which necessitates constant practice of (and modification of the specific choice of) e-cises in order to maintain positioning.

It would be interesting to take the approach used by EM and other therapeutic methods and try to incorporate them into “movement-based” exercises, thereby potentially having lasting effects on the subject’s motor programs and neuromusculoskeletal system.3

Hopefully, this paper has served to take away some of the “mystery” of EM by showing the way it works in terms of well-understood properties of the neuromusculoskeletal sys-tem.

3 This is the stated aim of somatic methods such as Feldenkrais and Alexander technique, though little work has been done to scientifically validate (and refine) those methods or the mechanisms by which they attempt to influence the subject. For one recent example of an attempt at this, see Connors, et al., 2010.

References Alter, M.J. (2004). The Science of Flexibility. Champaign: Human Kinetics.

Cochrane, D.G., Elder, H.Y., Usherwood, P.N.R. (1972). Physiology and ultrastructure of phasic and tonic skeletal muscle fibres in the locust, schistocerca gregaria. Journal of Cell Science, 10, pp. 419-441.

Connors, K.A., Galea, M.P., Said, C.M., Remedios, L.J. (2010). Feldenkrais method balance classes are based on principles of motor learning and postural control retrain-ing: a qualitative research study. Physiotherapy. Currently in press.

Dietz, V. (2002). Proprioception and Locomotion Disorders. Nature Reviews: Neuro-science, 3(10), pp. 781-790.

Dudley-Javoroski, S., & Shields, R.K. (2008). Muscle and bone plasticity after spinal cord injury: Review of adaptations to disuse and to electrical muscle stimulation. Jour-nal of Rehabilitation Research & Development, 45(2), pp. 283-296.

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Egoscue, P. (1992). The Egoscue Method of Health Through Motion. New York: Harper Collins.

Egoscue, P. (1998). Pain Free: A Revolutionary Method for Stopping Chronic Pain. New York: Bantam.

Fitts, R.H., Riley, D.R., Widrick, J.J. (2001). Functional and structural adaptations of skeletal muscle to microgravity. The Journal of Experimental Biology, 204, pp. 3201-3208.

Krause, M., Refshauge, K.M., Dessen, M., & Boland, R. (2000). Lumbar spine traction: evaluation of effects and recommended application for treatment. Manual Therapy, 5(2), pp. 72-81.

Leahy, M.P. (1995). Cumulative Trauma Disorder Defined. http://www.sportdc.com/art/leahy_art.shtml

Lieber, R.L. (2002). Skeletal Muscle Structure, Function, & Plasticity, 2nd ed. New York: Lippincott, Williams & Wilkins.

Logan, G.A., & Mckinney, W.C. (1982). Anatomic Kinesiology. Ann Arbor: University of Michigan Press.

Nashner, I.M. (1976). Adapting Reflexes Controlling the Human Posture. Experimen-tal Brain Research, 26, pp. 59-72.

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Page, P., Frank, C.C., & Lardner, R. (2010). Assessment and Treatment of Muscle Im-balance: The Janda Approach. Champlaign: Human Kinetics.

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Pobre, T., Matthew, J., Weiss, L., Weiss, J.M., Araim, R., Chantasi, K. (2010). Chapter 8: Neurological Disorders (pp. 227-252). IN Oxford American Handbook of Physical Medicine and Rehabilitation. L. Weiss, J. Weiss, & T Pobre, eds. Oxford: Oxford Uni-versity Press.

Young, C. (2006). One hundred and fifty years on: The history, significance and scope of body psychotherapy today. Journal of Body, Movement and Dance in Psychother-apy, 1(1), pp. 17-28.

Zehr, E.P., & Stein, R.B. (1998). What Functions Do Reflexes Serve During Human Locomotion? Progress in Neurobiology, 58, pp. 185-205.

Zehr, E.P., & Duyssens, J. (2004). Regulation of Arm and Leg Movement During Hu-man Locomotion. The Neuroscientist, 10(3), pp. 1-15.

Submission instructions 1. There are two submission requirements: a. Online via iLearn Turnitin link, do not wait until the last day to submit to Turnitin as it can take upwards of 24hrs to get your Originality Report. b. During class on May 4, 2010 2. Submit paper via iLearn, using the Turnitin link, check your originality score. If greater than 15% it is recommended that you edit the content of the paper and resubmit using the Resubmission Turnitin link. 3. Print the Turnitin Originality Report (or write the percentage at the top of your paper) and staple it to the front of your paper to be turned in during class.