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How one method of physiotherapy is correcting posture and treating back pain
There’s only the sound of an occasional stifled yawn in the studio as we lie flat on our backs, knees apart in a butterfly stretch, slowly lengthening our adductor muscles. We maintain this posture for minutes on end, accompanied by deep breathing, relaxation of the chest and an occasional gentle neck stretch for optimum effect. Any deviation is picked up by our instructor, Muriel André, who doesn’t hesitate to chastise and correct our positions.
This weekly stretching class is designed for athletes and sports enthusiasts – I’m something of an imposter – with the 75-minute sessions encompassing the major muscle groups. Set to music, they start with gentle stretches before focusing on series that stretch tight hamstrings and adductors, quads, shoulders, back and neck, with some abdominal crunches thrown in for good measure. Any yawning is a natural reaction to the relaxation and concentration required.
Everyone appreciates the benefits of these deep stretches, known as Global Active Stretching. Regular attendance at classes helps prevent muscle injury, enabling people to continue their sport longer and with less injury.
Many of us here are patients of Namur-based physiotherapist André. Her stretching classes are an offshoot of Global Postural Reeducation (GPR), a method created in 1980 by French physiotherapist and former engineer Philippe Souchard, who took a revolutionary biomechanical approach to treating musculoskeletal disorders.
André’s clinic specialises in this, and she is a passionate proponent of the method, teaching and organising conferences for professionals and the public, as well as giving evening classes and running her practice. It was her tuition under Souchard that transformed her work as a physiotherapist. The Frenchman identified a neuro-muscular chain of coordination, distinguishing static and dynamic muscle fibres. By strengthening some muscles and stretching others, it was possible to gain flexibility, balance muscle tone and eliminate tension.
“Take the bicep, a static and dynamic muscle that is in permanent contraction to suspend the humerus,” says André. “If it’s permanently contracting, the muscle shortens, which happens when a person excessively works out with weights.” Ignoring the static movement in a muscle is a mistake. “You can’t drive a car with the hand brake on,” she says.
Post-war Scandinavian sporting regimes are at the root of current preconceptions around exercise, she explains. “They recognised the need for exercise as lifestyles became more sedentary, but they were too demanding on the body, leading to a gradual shortening of muscles. Today, we have developed all kinds of sport without considering if a child or adult is morphologically apt for it.”
In addition to too much or too little exercise, injuries and congenital deformations like scoliosis are also responsible for shortening muscle fibres, resulting in pain and reduced movement in joints, vertebrae and ligaments. At André’s clinic, one-hour sessions take a global approach to each person’s individual needs. By the time she sees a patient, “pain is already a consequence of a problem in the muscular chain”.
One of her patients needed no convincing of the method’s benefits. Orthopaedic surgeon Bernard Devyver was already promoting GPR when he fell victim to back pain himself. “It was a good experience,” he says of his treatment. “After a couple of sessions, I was already better.” It also altered his perception. “Back pain may not be serious, but it can seriously poison your life.” Devyver, who has been a spinal disorder specialist for 30 years, now prescribes physio sessions as one of his principle treatments. “Out of twenty patients I see, only two require surgery,” he says. “Many people are lost, they have consulted doctors and physios, taken medication and are still in pain.” Explaining the problem to patients provides relief. “It helps just to know what is happening to them.”
He sees GPR as a coherent method that is complementary to his work, recognising that orthopaedic surgery has evolved and now takes into consideration soft tissue as well as bone. “Before, we treated one part of the spine and ignored the rest.” His one frustration in prescribing GPR physio is the lack of trained therapists in Belgium, especially as he takes care to always specify the patented Souchard method.
For André, the growing recognition of GPR is due to ifs efficacity. “Quite simply, it works,” she says. She would welcome more scientific research into the method to further spread its practice; in the meantime, she believes it’s important for physical education teachers to pay attention to stretching in schools. She also highlights the importance of outdoor play in a child’s physical development, while for adults, she recommends the practice of a variety of sports.
Sit up straight?
With 25% of Belgians between the ages of 15 and 64 suffering from back pain, according to reserach institute Sciensano, there is increasing pressure to end the vicious cycle created by spending much of the day sitting down. The sitting position causes hamstring muscles to retract because of flexed knees. This in turn results in the pelvis tilting backwards, which can cause fused vertebrae discs. Standing up can also become a painful exercise. In order to sit up straighter, many people shift their pelvis and raise their shoulders and chest, which only has the effect of further shortening muscles. This biomechanical imbalance means it then becomes impossible to straighten without the excessive contraction of back muscles.
This article first appeared in The Bulletin autumn/winter 2019