The PMRF is a dynamic relay station located in the brainstem at the pontomedullary junction where pons meets the medulla. It is considered the epicenter for postural control (Image 1.). The PMRF houses eight cranial nerves that carry out vital motor and sensory functions including eye-ear coordination that aids in head righting reflexes and balanced gait. When functioning properly, the PMRF inhibits cervicothoracic flexion, which, in turn, effectively resists gravitational exposure. Those clients with PMRF disorders may present with an Upper Cross Syndrome pattern, i.e., forward jutted chin, internally rotated arms, protracted shoulder girdle, and t-spine hyperkyphosis. Each day these bodies battle gravity and in the absence of experienced manual, movement and brain-based therapy, usually end up on the losing end.

Hours sitting staring at screens, lack of exercise, and poor body biomechanics all contribute to the symptom of poor posture, and may lead to other conditions such as lack of focus, visual disturbances, depression, poor balance, protective muscle guarding and more. When performing a postural assessment as part of a client’s intake exam, I’m not only looking at tissue issues, but more importantly, what the nervous system is doing with this information. For example, I may include proprioceptive challenges such as one-legged standing to assess for vestibular (balance) dysfunction, gaze stabilization exercises for visual disturbances or the Romberg (sway) Test for cerebellar weakness. Sensory impulses originating in the neck and ankles are particularly important. Proprioceptive input from the neck indicate the direction in which the head is turned and cues from the ankles indicate the body’s movement or sway relative to the ground.

As sensory integration takes place through good bodywork and corrective proprioceptive exercises, the brain stem transmits impulses to the muscles that control movements of the eyes, head and neck, trunk, and legs, thus allowing a person to both maintain balance and have clear vision while moving. Of course, there are multiple neurological systems that contribute to optimal posture. Our goal is synergistic integration of these systems to normalize and restore flexor/extensor synergy and postural stabilization during dynamic movement.