Robert E. Irvin, D.O.
Postural Relief of Common, Chronic Pain

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Synopsis of Method for Postural Relief of Chronic Pain

Postural Relief of Common, Chronic Pain

Notice to Physicians and to the Public of a Marked Advance In Treatment of Chronic Pain of Joints, Muscles, and Nerves That Is Not Due to Disease, Or Is Residual to Trauma.

In the last few years, marked progress has been made in the alleviation of common, chronic pain of the joints, muscles, and nerves where there is no evidence of a disease as cause of this pain. This web site is intended to inform the public and their physicians of this advance, so that those persons who are interested in obtaining or providing relief from chronic pain can proceed. It is recently reported in medical literature that, on the average, better than 70% (and often complete) relief of such pain is reliably and enduringly alleviated by the procedure summarized herein (Fig. 1).1

Figure 1

Figure 1. Graphic effect of optimization of posture on regional incidence of chronic and otherwise idiopathic pain. This population reported chronically recurrent discomfort in 43% of eight regions, pretreatment, and 13% of these regions, post treatment.

Common conditions which typically respond to this treatment include:

  1. osteoarthritis, psoriatic arthritis, rheumatoid arthritis;
  2. chronically (greater than 3 months) herniated intervertebral disc;
  3. carpal tunnel syndrome;
  4. muscle cramps not due to insufficient circulation or side effects from blood pressure medication;
  5. painful condition of the feet from any of the following: plantar fascitis, hammer toes, Morton's neuroma, heel spur, tendonitis, bunion, excessive callus, or ingrown toenails;
  6. numbness or weakness of the arms, hands, fingers, thighs, legs, feet or toes not due to disease, such as diabetes;
  7. degenerative changes of any joint that has not progressed to the point of being "bone on bone"
  8. tension headaches;
  9. temporomandibular joint pain;
  10. spinal stenosis;
  11. failure to recover from previous trauma;2 and
  12. spinal scoliosis of either unknown (idiopathic) cause or of postural origin.3
This procedure is not indicated for treatment of pain due to:
  1. cancer;
  2. infection;
  3. acute (new onset) herniation of an intervertebral disc;
  4. cauda equina syndrome (mechanical entrapment of the lowermost end of the spinal cord, a rare condition);
  5. acute bone fracture;
  6. anterior herniation of an intervertebral disc causing urinary incontinence;
  7. acute (new onset) pain for which other, less involved, treatments might suffice; or
  8. joint degeneration that is so advanced that the joint surfaces are "bone on bone" with no joint space remaining.
This relief is routinely attained by the minimization of the routine stress of posture by the combined use of
  1. foot orthotics to optimize the shape and alignment of the feet and ankles (Fig. 2);

Figure 2

Figure 2. Precise shaping of foot orthotics aimed to optimize the arches of the feet and fully straighten the ankles, rather than simply support the sub-optimal arches, as is the common practice today.

  1. heel lift to level the pelvis (sacral base), measured radiographically (Fig. 3);

Figure 3

Figure 3. Panel A: The delineated attitude of the sacral base (Line segment A) intersects with a vertical line constructed through the apex of each of the femora, both right and left sides (Line segments Brt and Blt). The difference in vertical span of Line segments Brt and Blt equals the mm of unlevelness of the sacral base (Line segment C) with respect to the lateral position of the femoral heads. Panel B: A level sacral base due to the correct thickness of lift beneath heel on the side of the sacral base that previously was low. Note the correspondent and vertical alignment of the lumbar spine.
    Correcting even normal extents of flatness of the arches or angularity of the feet, or unlevelness of the pelvis, is followed by a strong reduction of chronic pain. Thus, most people with chronic pain can be helped, as most people have somewhat flattened arches, some angularity of the ankles, and an average unlevelness of the pelvis of 1/4 inch.
  1. osteopathic manual manipulative treatment to gently reduce tightness and tenderness of tissue due to the prior posture, trauma, or both.

    People who require regular or periodic manual manipulation or medication to relieve chronic or recurrent pain can greatly reduce or eliminate the need for ongoing manipulation or medication by optimization of their posture.

Pain experienced while seated for extended periods is greatly relieved or alleviated by the placement of a pad beneath one buttock, of the thickness necessary to precisely level the pelvis while seated (Fig. 4).

Figure 4

Figure 4. Effect of an ischial lift on unlevelness of the sacral base and lateral angularity of the lumbar spine, before (Panel A) and after (Panel B) the placement of the lift. This method is of especial importance to the computer-active population.

For those with a mild to moderate degree of scoliosis (curvature of the spine), usually without known cause (idiopathic), this procedure (on the average) results in the reduction of about 1/3 of the degrees of spinal curvature.

The integration of this precise postural manipulation with lifts and foot orthotics, combined with manual manipulation to reduce the accumulated restriction, tenderness, numbness or pain yields a non-invasive, safe, and economic method with enduring results that are without peer efficacy in any health care profession, and offers a desperately needed relief to the American public burdened with an annual cost for back pain estimated to be $40 billion, with immeasurable suffering.

This site lists the small but growing number of physicians and orthotists who have trained in their respective portions of this method. If your pain or spinal scoliosis is similar to that of the population described above, print this Notice and show it to your physician, asking that he/she consider taking this training (weekend Course), or to refer you to someone who can provide this service for you.

With kind regard,

Robert E. Irvin, D.O.
Course Director: Postural Relief of Chronic Pain

   1   Irvin RE The origin and relief of common pain. Journal of the Back and Musculoskeletal Rehabilitation 11 (1998) 89-130.

   2   Shell MG, Reinhard DL, Irvin RE, Curtin T. Neuromuscular sequelae of post concussion syndrome and post traumatic headache that result from mild traumatic brain injury: a comprehensive review. In: Lennard T, Brooks D, editors. Physical medicine and rehabilitation: state of the art reviews, motor vehicle accidents. Philadelphia: Hanley and Belfus, 1998:85-97.

   3   Irvin R E 1991 Reduction of lumbar scoliosis by the use of a heel lift to level the sacral base. Journal of the American Osteopathic Association 1: 33-44.

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Last updated on September 24, 2008
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