Method

Philippe Souchard

Introduction

Global Postural Re-education (RPG® – Rééducation Posturale Globale) was first introduced in 1980 by the French physiotherapists Philippe Souchard, in his book entitled “Le Champs Clos – Bases de la RPG“.

 

“The most important thing to understand about the RPG® method is that:
The static function is as important as the dynamic function!
It is not more important or less important. It is as important. And depends on an individual’s specific physiological, muscular and neurological features.”

Philippe Souchard

 

Alongside this basic conception of muscle function are 3 fundamental principles, namely:

GlobalityCausality Individuality

Static function

What it is

 

The first cornerstone of the method derives from the fact that it highlights the so-called “static” function of the muscular system. Indeed, much work has been done on the “dynamic” function of muscle, which is generally perceived as the “driver” of movement. Souchard does not call into question the dynamic function of muscle, but asserts that muscles also fulfil an equally important “static” function.

Our muscular system serves to maintain our bodies in space, or in a given posture, or when standing or sitting. It is what maintains our head on our shoulders, our hands on a steering wheel or on a keyboard, etc. In other words, our muscular system fulfils a “static” role or, put another way, it controls and stabilises our bodies in space and against the force of gravity.

The semispinalis capitis and the soleus muscle are two examples of muscles that fulfil a “static” function.

The physiopathological condition that occurs as a result of this “static” function is known as muscle retraction.

 

Studies on the “static” function of muscles have allowed us to gain a better understanding of the pathology of the neuromuscular system that fulfils this function. Muscles that fulfil a static function are permanently contracted, and progressively become shorter. When this happens, the muscle becomes stiff and eventually retraction occurs. At the structural level, this is manifested by a reduction in the number of sarcomeres – the contractile units of muscle – along the length of the muscle.

Due to their static function, spinal muscles tend to shorten over time. The resulting stiffness can occur at different locations, which vary from person to person.

What are the consequences?

 

Muscle retraction leads to morphological deformities, an increase in intra-articular pressure, and changes in joints’ axes of rotation. As the static and dynamic functions of the muscular system are closely linked, changes in the static function will also affect the dynamic function. As such, when muscle retraction occurs, movement and range of motion are restricted and muscle power is lost.

Pain, inflammation, arthrosis, tendinitis, and muscle tears can also occur as a result of muscle retraction.

 

 

The ultimate goal of RPG® is to lengthen muscles that have become retracted due to their static function.

Globality

When a retracted muscle is stretched, it will always try to relieve the tension and seek some way of compensating for it.

As such, when correcting a joint, we place the muscle is a stretched position and obtain an effect on “upstream” and “downstream” joints.

This can be achieved because of the way our musculoskeletal system is organised, i.e., as a series of “neuromuscular coordination chains” in which muscle is only one component which transmits tension forces to upstream and downstream components.

To prevent tension from “leaking” and achieve an effective stretch, tension must be applied globally and progressively. When applying tension, globality can be achieved by correcting compensations as they appear.

 

 

Globality is fundamental in stretching!

The traction (tractive force) exerted on the stiff gastrocnemius muscle is transmitted to the hamstrings, which tilt the pelvis backward. The pelvis acts like a pulley, and the tension induces kyphosis in the lumbar region.

Causality

In response to retracted muscle, or an injury or pain, the entire body reorganises itself to achieve a new state of balance so that it can continue to function. The body compensates and it is just as well! Otherwise, the slightest injury would cause our bodies to grind to a complete halt. Thus, to enable us to continue our activities, our body adapts, and does so without even warning us of the minor retractions that progressively occur as a result of micro-injuries, repeated movements, positions maintained over long periods of time, etc. Until the day we experience pain! When the pathological condition manifests itself, it is a sign that the body can no longer compensate sufficiently.

It is for this reason that the pathological condition is sometimes the delayed and indirect effect of a cause that the patient is unable to explain.

In that case, it is essential to resist the temptation to treat the symptom in isolation but instead to view it in the context of the body as a whole and work backwards from the symptom to identify the cause.

 

With the global approach advocated by the RPG® method the symptom is treated by correcting the muscle retractions that produced it and, in doing so, dealing with the cause.

Individuality

There are schemas which describe the main neuromuscular ensembles. Formerly referred to as “muscular chains“, these are now more often referred to as “Integrated Neuromuscular Coordination Systems” (INCS, or SICoNeM in French). But each individual compensates differently, and has their own way of adapting to entrenched muscle retractions. Accordingly, when treating the pathological condition, it is essential to take its individual nature into account.

 

“Just as no two human beings are alike, so too are no two pathological conditions alike. What you need to treat is the patient, not the pathological condition.”

Philippe Souchard

a. Main posterior INCS (SICoNeM), which fulfils the static erect function.
b. Main anterior INCS (SICoNeM), which fulfils the static suspended function.

Therapeutic indications

RPG® is a gently, progressive and active method which can be used with patients of all ages and conditions.

 

It can be used to treat chronic morphological problems, acute joint conditions, and any pathological condition affecting muscle (tears, tendinitis, etc.).

 

  • Morphological deformities (scoliosis, postural kyphosis, genu valgum, etc.)
  • Joint damage
  • Post-traumatic sequelae
  • Chronic pain (lumbago, cervicalgia … )
  • Disorders arising as a result of repetitive work- or sports-related activities
  • Respiratory disorders
  • Sequelae of spastic neurological conditions

In practice

RGP® sessions always begins with a full and in-depth assessment of the patient. Based on the outcome of the assessment the practitioner will be able to determine the most appropriate stretching postures for the patient, and the correction goals that would need to be taken into account during the treatment.

 

RPG® is then performed using slow, progressive stretching postures.

Assessment

 

The patient begins by describing their symptoms and any pain they may be experiencing, and the circumstances in which these occur.

Next, the practitioner has the patient undress to their underclothes and then observes and analyses their posture to identify muscle retractions, imbalances and other morphological deformities. They also analyse the patient’s medical imaging results, if any are available.

The practitioner then carries out a local palpatory examination, as well as various rebalancing tests corresponding to the desired correction of the postural imbalance in the painful region. This produces tension in the muscular system and reveals the problematic retractions and the ensuing compensations. In this way the practitioner is able to work their way back to the cause of the problem.

Treatment

 

Global Posture Re-education consists in slowly and progressively working through muscle-elongating postures that will stretch the specific muscles responsible for the pathological condition, while at the same time being mindful of the global nature of the neuromotor coordination chains they belong to.

 

The treatment itself begins with an assessment of the patient’s breathing patterns. This is followed by a series of movements to elongate and correct the position of the spine.

Breathing is a fundamental aspect of RPG®. Deep breathing reduces excessive muscle tone as well as stiffness in the muscles involved in inhalation.

 

The practitioner then places the patient in the appropriate posture so they can progressively increase the tension and achieve the elongation where it is needed. To ensure that the tension is exerted globally, compensations are corrected as they appear. When the tensed muscle has reached its most eccentric position, elongation is achieved by contracting the muscle isometrically.

 

The practitioner’s main tools are their hands.

 

Treating joints is also essential: one of the basic manoeuvres used in RPG® is joint decompression or separation.

 

The patient’s cooperation and involvement is essential. They maintain the posture while effecting a series of slight contractions, which enhances the effectiveness of the stretch.

 

The purpose of the stretching postures is to correct morphological deformities and realign joints so that the patient can move as freely as possible. The static function serves the dynamic function!

Good posture: An essential prerequisite for optimal dynamic function!

Example of a posture with coxofemoral angle closure