May 26, 2018

The HUB: Therapist tunes up patients’ posture

Williston practice provides Cornerstone of restorative therapy

Nov. 17, 2011

By Adam White

Observer correspondent

Cornerstone Physical Therapy’s Holly Spence, standing, demonstrates how a ‘90-90 Hip Lift’ and common balloon can be implemented to help a subject achieve neutrality between the diaphragm and abdominal muscles. As one of only 61 physical therapists in the country certified in postural restoration, Spence helps patients eliminate unwanted muscle tension that can lead to back pain, restless sleep and event joint degeneration. (Observer photo by Adam White)

Physical therapist Holly Spence sees the world differently than most people. She looks at a body — human or even equine, thanks to her passion for horseback riding — and sees factors like alignment, balance and neutrality at work.

Unfortunately for many people, the lines she sees are not straight and the biomechanical forces are working against one another; resulting in symptoms like chronic back, hip or knee pain, restless sleep and event joint degeneration. And as one of only 61 physical therapists in the country certified in postural restoration (as of 2011), Spence sees an opportunity to put her specialized training to work.

“I often see people suffering and think about how much more I could have helped if I had seen them sooner,” said Spence, who operates Cornerstone Physical Therapy in Williston’s Blair Park. “But even with older people — who have certain habitual patterns ingrained from so much repetition — we can help them. It might take a little longer, but the changes that can be made are amazing.”

Spence first began studying the discipline at the Postural Restoration Institute in Lincoln, Neb., in the late 1990s. She was attracted by the fact that it was neuromuscular based — drawing on areas she was already trained in — but also focused on more than just one specific body system or part.

“Once I took my first course in this area, I realized it was working on the whole body to help people get out of pain that might only be affecting one area,” she said. “Everything is connected, and a lot of our programs work on … the whole body. That’s where this approach is more advanced.”

Janie Ebmeier, director of business development and credentialing at PRI, said the Institute has grown from offering 15 courses — all taught by founder Ron Hruska — in the year 2000 to offering 50 this year, and has expanded beyond the nation’s borders to such faraway places at Poland.

“I think part of the appeal of our approach is that it’s more integrative, whereas most physical therapy is more specialized” Ebmeier said. “You’re not just going to treat a knee-pain patient; you’re going to be able to treat any patient who walks through the door.”


Neutrality is an important concept in postural restoration. One of the therapy’s primary goals is to eliminate unwanted muscle tension, which can lead directly to stiffness and pain, particularly in older patients. To a clinician like Spence, neutrality equates to putting a patient’s body posture into a position in which a targeted set of muscles is disengaged, to relieve that tension.

This is accomplished partially through a sort of linear analysis – gauging whether a subject’s pelvis is aligned over his or her femur when standing, for example, as well as exercises involving oppositional muscles that may be affected by habitual movement or even respiratory patterns. Spence cited the diaphragm and abdominal muscles as an example of the latter, using a position called the “90-90 Hip Lift” to demonstrate how a subject’s breathing can be affected.

“You can’t breathe properly with your diaphragm if your abdominals are weak,” Spence said. “And if you have poor breathing, that’s going to affect restorative sleep.”

While most people may only envision posture as a consideration when sitting, standing or walking, Spence said body position when sleeping can also play a significant role in quality of rest — which can then have a domino effect in terms of other symptoms.

“When your body’s joints are not in a neutral position at night, you can’t properly rest,” Spence said. “I get feedback from patients all the time about how much better they sleep after (therapy).”


Postural restoration is literally a head-to-toe philosophy; Spence said she often works with an entire interdisciplinary team to ensure that everything from the set of a patient’s jaw to his or her choice of footwear is promoting proper alignment to help achieve neutrality.

“We even work with an orthodontist, to make sure someone’s bite is neutral,” she said. “And it is amazing, the support you get from shoes and the position they put your body in. Usually, by someone’s second visit we are looking at footwear.”

Spence likened the body-to-feet connection to an automobile’s relationship to its tires.

“We ‘tune people up’ all the time,” she said. “It’s just like when your car is out of alignment. If you don’t straighten it out, you’re going to keep wearing out your tires.”

While postural restoration has helped many senior citizens reverse the effects of muscle tension and misalignment, it has also been of benefit to younger, more active people. Ebmeier said PRI will begin offering a credentialing program to athletic trainers and strength and conditioning specialists early next year, and Cornerstone already has competitive athletes taking advantage of its services.

According to a testimonial on the facility’s website, competitive runner Erika Nestor of Burlington ran her fastest half-marathon ever after being treated by Spence and company.

“I feel like a new runner,” Nestor wrote. “I didn’t realize how tight I was before, particularly in the upper body. After our sessions, my whole body moves differently and more easily. It feels as if my spine is lubricated and can now move freely. My running has improved and I find I’m running faster and more easily.”

Spence estimates that upward of 70 percent of her clientele are over age 40, and many of them have been suffering with back, hip or knee pain for extended periods of time. She said the implementation of preventative therapy — before postural problems lead to pain — could make a major difference for many people who are unknowingly setting themselves up for “golden years” marred by creaky joints and stiff muscles.

“I believe that there needs to be a shift,” she said. “If we could start working with people earlier in their lives, we could prevent a lot of issues in the future for them.”

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