Method Wall

System of rehabilitation conceived by a French Kinesitherapist, Francoise Wall (1909-1991). With the eyes of many professionals, this method revolutionized rehabilitation and brought a new vision of human mechanics. Decades after its appearance, it still makes debate and its detractors are numerous.

Historical context

It is advisable to replace the scientific work of Francoise Mézières in the medical context of the time.

Fruit of the Second world war and the epidemic of Poliomyelitis which followed it, rehabilitation is being born in 1945. The optics of this original kinesitherapy is dictated by the recovery of the muscular force of the severely wounded persons and of paralyzed. But, in the years which follow, this therapeutic option is transformed into doctrinaire approach. The pains, the dysfonctions are allotted to a hypothetical lack of force, the deformations are caused by an improbable inaptitude to resist harmful gravity. The common direction holds scientific place of demonstration and the postulate is made dogma. The treatments only consist in reinforcing. Divergences between the various schools confining itself at points of detail, alternatives around the unceasingly revisited topic of the musculation and the profit of force. Francoise Mézières makes her studies at the French School of Orthopedy and Massage of the street Cujas in Paris, under the direction of Boris Dolto. She obtains her diploma of state the day before the evacuation of Paris in front of the projection of the German troops. She learns the techniques there from the time, in particular the “corrective gymnastics”, founded exclusively on the muscular reinforcement The shortly after the war, the school of the street Cujas finds its trace and asks him to come to teach. In spring 1947, whereas it has just finished the drafting of an opuscule, a kind of compilation of the remedial gymnastics of the time, it does what it will call thereafter its “princeps observation”.

Princeps observation

" When a sumptuous morning of spring 1947, we saw entering our cabinet a patient presenting superb a " cyphose" , we were well far from us to doubt that our profession and the fate of legion of patients was going to be changed. It was about a subject longiligne, very large and thin. A corset of leather and iron had caused, not enraiement awaited progress, definitely inexorable, of sound badly, but of the bruises on the hips and around the shoulders, and still seven vertebrae were with sharp as well as the lower angle of the scapulas. But the patient did not complain any and it came because it could not raise the arms any more nor to work. We tested, naturally, the exercises of " rectification " and the work of dorsal in order to strengthening the " bungee cords " back, but the stiffness was such as nothing was not possible. Extending then our patient with ground, in décubitus dorsal, we pressed on the shoulders and we saw, with our amazement, to occur an enormous lumbar lordosis whereas, examined upright, the patient absolutely only one dorsal kyphosis presented. To avoid adding an evil to that which existed already, we rocked the basin behind by bringing the knees on the abdomen and, with our new stupor, we saw the lumbar hyperlordose thus unobtrusive referring to the nape of the neck, the head reversing ourselves behind without it being possible to bring back the chin close to the neck.

the door on the truth was, in front of us, large open but us remeltings of us there to engage and, doubting our eyes, we renewed several times the experiment and, finally, in front of a colleague.

… Our princeps observation was so unexpected, the noted facts if surprising for a Petri expert of orthodoxe theories, if admiring towards its Masters whom it held, up to that point, for erudite truths, that it did not want any to believe his eyes. But the insolente truth was so obvious that he sought then, hopelessly, to see there an exception which would have confirmed the sacro-holy rule. It was necessary to be resigned to the sacrilege and to reconsider the bases of orthodoxy. Remained to release the laws of this absolutely ignored physiology, to discover the mechanisms of them. Then the pangs of the apostasy the delights of the heresy succeeded. It is indeed an unutterable joy of checking at every moment, and in thousand ways, cogency of a theory, such that she luminously explains the causes of all the dysmorphisms and on what undoubtedly curative" can be built a technique; .

In the years which follow, it checks that its princeps observation has scientific value, i.e. it inevitably reproduces under the same conditions of experimentation. In 1949, it publishes “Revolution in orthopedic gymnastics”, an article founder which receives a mitigated reception, not to say frankly hostile, on behalf of the French medical world. It leaves the street Cujas and settles as a liberal to put his principles into practice and to continue its research. It is only well later, in 1984, qu' it will state the 6 laws which explain the phenomena observed at the time of the princeps observation of 1947. It works out a method which, although stammering, is already in its eyes, more effective than the traditional techniques than it taught itself before little time. For want of anything better, it gives its own name to its incipient method.

Scientific contents

Fundamental laws

First law : The many posterior muscles behave like a single muscle.

Second law : The muscles of the chains are too strong and too courts.

Third law : Any located action, as well elongation as shortening, causes instantaneously the shortening of the whole of the system.

Fourth law : Any opposition to this shortening causes latéro-inflections instantaneously and of rotations of the rachis and the members.

Fifth law : The rotation of the members due to the hypertonicity of the chains is always carried out in inside.

Sixth law Any elongation, untwisting, pain, any effort implies instantaneously respiratory blocking in inspiration.

Explanation of the fundamental laws

The analytical one with the integral one

Medicine and kinesitherapy compare the spinal column to a mast of ship with its stays, represented by the muscles. According to this model: if the mast is not square, the stays should be retightened. It is the conceptual base of the traditional remedial gymnastics that Mézières regards as doctrines. For it, this model is erroneous. It invites to regard the individual as crushed by his own force, its own stays, too short. Although many, the muscles of the back of the body (stays) behave like a single muscle, tightened cranium until the end of the toes and the fingers. For it, the model of the headstock on which is founded all modern kinesitherapy is unsuited. On a headstock, one can make move a member independently or another, without effect on the remainder of the body. It is not what one notes on the human body. It is the model of the headstock which the first law beats in breach. Wall replaces it by the model of the puppet in whom a system of strings connects the members between them and also with the trunk. The second law indicates that the aforementioned string is far from being too weak or slackened. It is too short and too strong. And thus, it is not possible to mobilize a segment without the whole of the system being implied. It is the appearance of the concept of intégralité1. One cannot claim any more to look after a part without taking the whole in consideration. The third law expresses the judgment of the analytical, expensive principle with kinesitherapy. Wall sees there only one ridiculous attempt at saucissonnage body.

Hypothetical weakness with the true shortening

The fourth law proposes an explanation for the three-dimensional deformations like famous the idiopathic Scoliose. It would be due, not with a weakness of the muscles rachidian érecteurs (which for it do not exist!), but with a shortening of the muscles which underlie the spinal column, boring it of this fact to the manner of a spiral staircase. As for the fifth law, it integrates the members into the general process of deformation. The sixth law stresses the importance of breathing during the meetings of rehabilitation.

Corrolaires

Statics, the way in which one is held, is a semi-automatic function: one can intervene by the will, but only while one thinks of it. As soon as one thinks of another thing, in fact the habitus takes again the top, which is managed by “unconscious” zones of the brain. Kinesitherapy postulates that at the conclusion of an effective conditioning, the fold of the salutary effort would be taken and corrected statics. Wall is categorical: we do not have muscles able to untwist us, us détasser, us délordoser and a fortiori to grow us. By the will, we can only transitorily move the deformations. As of the stop of the effort, they return to their place of predilection. Stronger still. For this iconoclast, it is ridiculous to try to educate to be better held: there is no muscle to do it. “One is held as our muscles put to us”, says it. The only thing to be made, the only relevant step consists in trying to reduce the tension in the “muscular stays” because it is their tension, and not gravity, which deforms us and makes us suffer. This cannot be done all alone. Education, the awakening and the injunctions parental are not of any effect. Only a well led rehabilitation can, gradually, have a favorable effect on statics, without same as the subject is not obliged to think of it of the daily newspaper.

Deformation and normal form

To speak about deformation, like the fact Wall, implies de facto the postulate of the existence of a normal form. The shortly after Shoah, this concept is not politically correct, it is shocking. The physical therapy describes irreversible “morphotypes”: the longilignes, the brévilignes, etc With each one of these typologies, it allots a preferential sporting discipline: race and jump for the longilignes, haltérophilie for the brévilignes.

Wall fraudulently registered and it acts there of an basic element, basic of its message. She writes “ If the circular wheels are made, it is that does not go when they are square ”. And to describe a perfect human form, a virtual model which it calls paragon. She makes the difference between morphological perfection, essentially absolute, which goes hand in hand with an optimal function; and the subjective beauty, relative and variable of a person to the other, culture to another.

" the pretty one is the enemy of beautiful the " Fernand Leger

This polyathlète of dream which it describes would be possible if there were not the systematic shortening of the muscular chains. We all would be “beautiful and perfect”.

THE PARAGON " But, if measurements and calculations are tiresome and sources of errors, we have all average quite simple and natural, we have all of the eyes and also the innate direction of the beauty (although the absurd modes distort the taste). In the same way the ear distinguishes the right notes and the false notes, in the same way the eye must recognize the healthy form and the dysmorphism. And one easily checks by examining the patient that: of face, the clavicles, the shoulders, the nipples, brachiothoracic spaces must be symmetrical and of the same level; side contours of the thorax must be rectilinear and diverge since the iliaques peaks to the fold from the armpit; Back, the nape of the neck must be long and full (and not to show two vertical projections separating three gutters). In addition to the symmetry of the shoulders, hips and scapulas, those should not show any relief and the lower beam of the trapezoid must appear (at a nonfat subject) until the dorsal twelfth; In position of front inflection, the hanging head, the backbone must be in total and regular convexity and the balance of the knees to be located on the heads astragaliennes (and not to move back behind of the heels); Of profile, the point of the nipple must be the most advanced point, below which the former contour of the thorax and the abdomen must be rectilinear to the pubis. The contour of the back must be visible, the arm separating 1/3 from the thorax behind and 2/3 ahead. Lower extremities, examined of face, feet being joined together heel at the end of the first toe (station which must always be easy); must touch itself: top of the thighs, knees, calves and malleoli internal; those must be higher than the external malleoli. The axis of the leg must pass by the medium of the knee, the medium of the line intermalléolaire and the second toe. The foot must widen heel at the end of the toes which must diverge and extend on the ground. The side edges of the foot must be rectilinear, the intern notched by the internal vault which must be visible. "

This paragon becomes the guide and the objective of all its method: if the deformations are at the origin of our pains, only a method able to restore normal morphology takes really the problem with its source, thinks it. If the deformation evolves/moves spontaneously, and all the life during, towards aggravation, it is that it is not immutable, fixed. And thus it is possible, on the condition of using the good tools, to bring back the patient “polydéformé” towards the polyathlète. And this, even if that takes years, even if the perfection concerned is never reached. The ugliness is never “normal” and it is never too late. The “typologies” described by traditional kinesitherapy (and many its former students) are, for Francoise Mézières, only deformations frequently met, indexed. They are accepted, wrongly, like normals, because they are believed innate (what is inaccurate). Typologies are the antithesis even message of Wall. According to it, adhesion with this commonplace would condemn the therapeutists to a perpetual rustinage. In addition, the subliminal connotations which result from this are, obviously much more noxious than the concept of paragon. It is dismayed to see some of its pupils venturing in the systematization of doubtful correspondences between “morphological typologies” and certain psychic characteristics? It closes its door to them.

Pathogenic postulate

She explains the deformations and the dysfonctions by the perpetual shortening of units which she calls “muscular Chaînes”. She defines the muscular chains as being whole of muscles polyarticulaires (which span several articulations), of the same directions and whose insertions are recovered with the manner of the tiles on a roof. It describes 4 muscular chains: the posterior chain (of the back of the cranium jusq' to the ends of the toes), the antéro-interior chain (inside the belly: diaphragm and psoas), the chain brachiale (of the former face of the shoulder until the end of the fingers) and the former chain of the neck (3 muscles on the former face of the cervical vertebrae). In permanent retraction, these chains oblige the body to twist in the three plans of space, thus moving away it from its normal form. These deformations, in S `worsening generate pains and disfonctionnements. This working hypothesis changes traditional kinesitherapy radically: It is not any more question of weakness, but of shortening. The morphotypes are only deformations due to the retraction of the chains. Their stretching is supposed to restore normal morphology and, by there, to restore the function and to remove the pains.

Therapeutic technique

In order to cure the shortening of the chains, Mézières proposes a whole of postures carried out on a specific breathing. The postures are active. Even if the therapeutist takes part, it does nothing but help, to guide the work of the patient. It is the eye and the hand. It is essential.

Hunting for the compensations

The principle of the postures: Wall names it “ eccentric isometric contraction ”. It consists in positioning the chain aimed in most stretched possible position, to request its contraction without authorizing the shortening. The chain contracts, tries to bring closer its insertions, does not arrive there and thus, lengthens. This principle is not without recalling that of Mitchell to the United States at the beginning of the XX° century. This work, uncomfortable, causes defense reactions that Mézières calls “compensations”. The therapeutist must neutralize them. Wall guarantees the short cut which consists in summarizing its method as “ a long hunting for the compensations ”.

It does not have there bad breathing, it has only constrained breathings there

A specific breathing, rising from the 6° law, accompanies this work. It is based over expiratory time. It is free (without brake and thus quiet), regular and deep. One cannot say that it is especially abdominal or thoracic, because it is adapted to each patient. With the eyes of Wall, it is impossible to rehabilitate an incorrect breathing without changing the mechanical parameters them: “ a breathing is not rehabilitated, it releases ”.

Both cathégories operations

Wall distinguishes two types of operations: - those which correct from the start a given dysmorphism - those which worsen from the start a given dysmorphism It privileges this second category which it declares “very effective”. If the first time of a worsening posture consists with péjorer a deformation, it goes without saying that, in the second time, the things must return in the order. One touches finger the responsibility for the therapeutist and one includes/understands the requirement of competence of this woman for his pupils.

Treatment

The meetings long (roughly 1 hour), individual (it is of course impossible for a therapeutist to manage several meetings at the same time) and are manufactured (no equipment is used). They are practiced by expert experts who, in the spirit of Wall, have an exclusive practice. The rate/rhythm of the meetings (one per week) can surprise, especially when it is known that no work at the house is required.

Criticisms

As for the concepts

One reproaches Mézières for easily generalizing an observation with the whole of the species. Thus of its princeps observation: what it did it observe in 1947, could be transposed to the unit of the mankind, in all the cases of figure? Wall functions with the intuition. Some say that such was its genius. Others, affirm that it was its weakness. It is true that this procedure is not compatible with the scientific step and the medical research for which “the force of the proof” makes law. Its assumption as for the pain is beaten in breach by certain observations. Example: if the pain is caused by a deformation, how to explain why, for the lumbago, it forever be possible to correlate the lombalgic pain with any body deformation. Its explanation as for the results obtained is disputed: she claims that if the patients are better it is that their muscular chains were stretched. But of many scientists are registered out of forgery. They show that it is impossible to stretch muscles on the alive one. The feeling of tension during the stretchings is due only to the setting in tension of the fascias (fabric of envelope of the muscles, very richly innervé). If results there is (they were never objectified in a scientific way), they would be thus due to another thing that with the improbable muscular stretching.

As for the transmission

Teaching indigence

If one agrees to credit Mézières with an exceptional gift of observation, if one readily describes it as visionary, it is obvious that the organization and pedagogy could have been managed better. Because of absence of control of knowledge and diploma, there are practically as many comprehensions different from its message than it had pupils. Consequently, what of astonishing that this expansion of parallel schools where côtoient the best and the worst. The deficit of writings does not arrange anything and, the years passing, the message seems to know major distortions (meetings of group, musculation, work of the inspiration, training of the good posture, work on table). For the patient, as for the prescriber, it becomes difficult to make the share of the things and to know if such therapeutist who says “mezierist” is or is not in the line line of the teaching of the missing Master. So that many are those which explain why the only person to have ever made Wall is… Wall itself.

Sectarian operation

It is also made objection to Mézières of sound will have of guru and the sectarian character of its teaching. Even if it has asceticism very, its method however does not have anything mystic or esoteric: simply a relevant manner to consider human mechanics. It is however exact that, during a few years, it was necessary to be sponsored to claim to follow its teaching. In the same way, it is not niable that, during a time, it made sign with the trainees an engagement to practice his method other than very other. This behavior which can shock was not, for it, which an attempt despaired to preserve its work, to protect the patients against dilettantism and the mercantil spirit that it exécrait and which besieged it. It is while wanting to avoid Charybde which it precipitated in Scylla. She condemned all the parallel schools due to drifts, which towards the traditional kinesitherapy, which towards cheap psychology or of the techniques which had the wheel in motion like osteopathy. Notwithstanding, some associations and dispensaries still claim “mind Mézières methodical”.

The particular case of the Postural Rebuilding

Founded in 1992, the Postural Reconstruction is the only one with being taught at the University. At its beginnings, this school the most accurately had as an ambition of retransmettre possible teaching of Wall. But quickly, the interdisciplinarity of the academic world opened new horizons while obliging with a scientific rigor which did not have course in the entourage of Francoise Mézières. So that, 15 years after, the external observer does not distinguish, in the Postural Rebuilding, than the vestiges of original work. Derives or evolution? It remains that the reconstructeurs are kinesitherapists sorted on the shutter who compel themselves, after a three years course, examinations and a report of university, with revalider annually their diploma. These examinations of recertification are the ticket of entry to be able to integrate the International College of the Experts of Postural Rebuilding and to be reproduced on the directory of the approved experts. This step avant-gardist, single in the medical landscape, reflects the respect for the patients and testifies to the difficulty of a complex and delicate method.

Readings

Wall wrote only three opuscules and some articles. They all are exhausted and its sole legatee did not make them republish. Only the work of Michael Nisand recalls her life and its work:

References

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