By: Robert Irvin, D.O.

Table of Contents

1. Introduction
   1. The problem of posture and pain.
   2. Reinterpretation of previous studies in light of three forms of causality.
   3. Contrasting the biologic standard of "normality" vs. the mechanical standard of "optimal" or "ideal" as therapeutic standards for posture and pain.
   4. Determination of the ideal reference for measuring the pelvic level: the sacral base vs. the relative heights of the femoral heads.
   5. Pancorporeal and strong effects of postural optimization on chronic pain.
   6. Lack of ready explanation for the effect of optimized posture on chronic pain: a need for a new principle.

2. Principles of medical science
   1. Aristotle's concept of true scientific knowledge.
   2. Ten principles of science: 6 accepted, 2 recovered, and 2 posited.
          1.  cosmologic;
          2.  correspondence; and
          3.  physis;
      Archetypes of Principles
      0. parsimony;
      1. identity;
      2. relativity;
      3. natural proportionality of neighboring extents (recovered);
         1. canons of proportionality of life forms;
         2. Kepler's 3 Laws of Planetary Motion: "Harmony of the Spheres"; and
         3. Newton's Law of Gravitation;
      4. four preferred points of view (posited);
      5. five standards for emphasis (posited); and of
      6. six operatives of transformation (recovered) from cause to effect.
   3. How a principle bears causally on the physical world.

3. Three contextual causalities of human posture.
   1. Mechanical: the three primary mechanical actions of gait:
      1. transformation of viscosity of the N.M.S. at heel strike;
      2. recoil, both spring and elastic; and
      3. pendulum oscillation.
   2. Vibratory: The three morphogenic properties of the standing wave of the human being in terms of:
      1. longitudinal span and component regions of the body as fundamental and harmonic frequencies;
      2. anatomic curves as amplitudes of wave forms; and
      3. anatomic planes as axes of vibratory distribution.
   3. Gravitational: the three primary boundary conditions of posture.
      1. extrinsic;
         1. gravitation;
         2. attitude of the extrinsic base of support (ground); and
         3. resistance of path for gait;
      2. intrinsic;
         1. conscious;
            1. awareness;
            2. intent; and
            3. will;
         2. reflexic;
            1. sympathetics;
            2. parasympathetics; and
            3. postural control system; and
         3. geometric
            1. feet and ankles;
            2. sacral base; and the
            3. skull
      3. auxiliary (acquired) boundary: somatic dysfunction;
         1. articular asymmetry;
         2. restriction of physiologic motion;
            1. disuse;
            2. misuse; and
            3. overuse; and
         3. altered sensitivity;
            1. numbness;
            2. tenderness; and
            3. pain.

4. A procedure for the optimization of posture.
   1. Indications and contraindications for this procedure.
   2. Recording the course of treatment.
   3. Physical examination and manual manipulation to reduce specific restrictions.
      1. the foot region: extensibility of the 1st metatarsal-phalangeal joint;
      2. the hip region: circumduction;
      3. the hamstrings;
      4. the gluteals and the piriformis;
      5. the lumbosacral region;
      6. the flanks;
      7. the upper extremity;
         1. wrist;
         2. shoulder;
         3. the rhomboids;
      8. the thoracic region;
      9. the cervical region;
      10. the cranial region;
          1. vertex to maxilla;
          2. frontal to occipital;
          3. bi-temporal;
      11. the lumbar roll: impulse mobilization.
      12. thoracic mobilization by impulse.
      13. mobilization of the cervical spine.
   4. Therapeutic postures to reduce the bulk of tissue restriction.
   5. The formulation of, accommodation to, and incremental augmentation of foot orthotics.
      1. Indications for foot orthotics.
      2. Collection of foot imprints for crafting of the orthotics, and the initial period of accommodation.
      3. Biweekly examination and prescription for incremental augmentation of the foot orthotics towards optimal.
      4. Solutions for occasional difficulty with accommodation to foot orthotics.
   6. Postural radiography and a procedure for optimization of the pelvic attitude.
      1. Indications for postural radiography of the lumbopelvis.
      2. Technique for radiography.
      3. Preparation for measurement of radiographs.
      4. Measurement and leveling of the sacral base while standing, viewed in the coronal plane, by the use of a heel lift.
      5. Measurement and leveling of the attitude of the sacral base while seated, viewed in the coronal plane, by the use of an ischial lift.
      6. Measurement and correction of pelvic torsion about the vertical axis, viewed in the coronal plane, by the use of orthotics.
      7. Measurement and correction of the sacral angle and the sacral load in the sagittal plane by the use of foot orthotics, heel lift, and therapeutic postures.
   7. Criteria for completion of this procedure and dismissal instructions.
   8. Case study of an excessive rate of heel lifting.

5. Mercantile considerations.

6. Summary.