Posts by Robert George

Chiropractor

In the middle of the hustling pace of mid-town Manhattan off of Madison Ave. is a health oasis called "Mocean" and is the location of last week's Cervical Revolution. The facility is as modern and up-to-date of any I have ever seen and it was a pleasure to work with a wide range of professionals from physical therapy, chiropractic and strength and conditioning movement specialists.


Cervical Revolution is the course that is the gateway from the primary courses, especially Postural Respiration, to the cranium. Through the anterior neck flows airway, blood flow, food, sound and especially translational movement of the jaw and rotation of the cranium. There is lymph flow, CSF flow, nerve flow including autonomics, motor control and somatic sense inside the spinal column as well as outside of it. The ability to turn a neck is essential for upright human evolution and existence, and when rotational transverse plane is lost, a functional "de-evolution" results.


Since Cervical Revolution is a secondary course, having a primary course foundation is critical especially when the dominant pattern and position of the cervical spine and cranium is essentially "right stance".  In the primary courses it is much easier to see patterns and position in the pelvis and rib cage that dictates sacrum and sternum position. In this course, since it is harder to see obvious movement in the cranium or the position of cranial bones like the sphenoid and temporal bones via vectors of stress over time driven by atlas underneath an occipital bone, the basic concepts of atlas/occipital patterns and position were described in detail repetitively to provide a basic and sound foundation. Once  this  sound foundation of atlas under occipital bone, driving sphenoid position and temporal bone rhythm, directing mandible position is established, cranial torsion as a patho-mechanical presentation can be introduced with testing and treatment.


This course is also a gateway into the occlusal system and how position of jaw and bite influence not only the cranium and neck but the entire "stomatognathic" system as well. Atlas and occiput are the main neuro-articulation that are defined as the position of those two bones drives not only cranium and jaw but has an effect on the entire system.

This group of students was really sharp and had some of the best questions that helped inform and teach the entire group. There was plenty of time for lab and demonstration and the basics of this course were reinforced over the entire weekend.


Big shout out to Joe Giangrasso for being my tour guide and subway guru. Not only that, but it was Joe, Mike Zhao, Liz Cash who enthusiastically promoted the course and showed up with their "A" game of attention and participation. Thank you to Emily for coming out from Texas, Alex from Chicago but most especially Lenny from London and Wing Ho from Hong Kong! Wing Ho flew in the day before, flying coach, for 15 hours! Huge shout out to Aleena for being our lab assistant. She is a fire ball of energy and PRI knowledge and is a pleasure to know and have as support staff for any course. Thank you especially to Josh Park for hosting PRI at Mocean!

Posted October 31, 2023 at 6:19PM
Categories: Courses

Just north of the San Fernando Valley and Los Angeles is the town of Valencia and is the location of the Henry Mayo Fitness Center. This is a world class facility with a combination of fitness training available to the public and rehabilitation provided by physical therapists as well. Postural Respiration was hosted there last weekend to a sold out group of physical therapists, chiropractors, athletic trainers, strength and conditioning personal, yoga and pilates instructors and a massage therapy student who has also been a personal trainer for years and has been adding PRI to his toolbelt.


From a faculty member's perspective, this was an ideal environment and an ideal group of individuals that came together with interest and energy. More than half of the students were new to PRI and many more new to Postural Respiration. For several students, Postural Respiration was their third and final primary course and was an integration that connected PRI "dots" starting with the diaphragm and delivery of air pressure sense into a thorax. This critical component of exploring asymmetries with air pressure differences into the thorax, driving spinal position and ultimately posture as a result of dynamic respiration made for exciting discoveries of understanding form and function of the thoracic diaphragm and entire skeletal system.


One of the most important learning objectives is how to apply what seems to be an overwhelming amount of information into assessment and treatment of patients and clients. This past weekend there were a couple examples of students who were subjects of PRI exam and treatment. One was straight forward and became "neutral" almost immediately. The other student, or patient example, was more complex and required focused attention on the page 50 guidelines with some tests remaining positive even with the best efforts of the instructor and excellent lab assistants. This individual had a history of ballet and lots of aerobic exercise over the years as well as recent lasik eye surgery. She was also a Superior T-4 patient and a great example of patho-mechanical respiration. One patient example in class was relatively easy, the other required more persistence and follow up care. This is the beauty of having an example of complexity and that PRI has pathways to take a patient further into discovery as this individual will have follow-up care with a PRI practitioner. The good news is this person slept better than they have in some time following PRI manual and non-manual techniques and is thrilled to continue their journey into learning more about themselves and applying PRI to their practice.


Many thanks to Rie Takakura, P.T., PRC for coming out from Hawaii to be one of our lab assistants. Her energy and knowledge was so much appreciated. My friend Locatelli Rao, P.T., PRC made my job easier as well as he provided his expert clinical knowledge of PRI and clinical application of PRI to this weekend. His ability to describe and "coach" technique is a gift to all in attendance. And last and most importantly, thank you Thomas "TJ" Di Prima, P.T., DPT, OCS, ATC for arranging and promoting PRI in this facility. His goal is to introduce PRI into his community at the Henry Mayo Fitness Center and we are all grateful for his support and look forward to returning in 2024. Thank you all, students, lab assistants and the staff at the "Center" for the privilege of presenting Postural Respiration.

Posted October 4, 2023 at 9:14PM
Categories: Courses Science

Last weekend, August 5-6, at Hidef Physical Therapy in Bellevue, WA, I had the pleasure of teaching Postural Respiration to a wide range of professionals that included a chiropractic student, physical therapists, LMT's, strength and conditioning professionals and an osteopathic physician that wanted to learn more about respiration, neurology and biomechanics.


Every PRI course that is presented is always different in terms of questions asked and what is discovered during demonstration and lab.  For example, often after re-positioning a pelvis on Day 1 with non-manual techniques, the student  will become immediately neutral to the "oohs and awes" of the course attendees.  The PRI magic seems almost easy and effortless with a technique that targets inhibition of the L AIC.
Since this course is an integrated approach to the treatment of patterned thoraco-abdominal pathomechanics, it is also likely that the PRI magic is not apparent on day 1 as the student being demonstrated on may not get neutral with any non-manual technique on Day 1 or even into the morning of Day 2.

 
This is where the process of following the guidelines on page 50 in the course manual come to life.  What if your best efforts with non-manual techniques don't seem to be making a difference clinically?  The roadmap then takes the whole group of students through a journey of applying manual techniques to create first a ZOA, then right apical chest wall expansion.  If after doing the right apical expansion or superior T-4 manual technique does not result if all of your tests turning negative, or you have limited cervical axial rotation to the left and especially a positive left apical expansion test, then you have a definitive Superior T-4 pathomechanical respiratory process.


In every course there is someone that is Superior T-4.  In this course the students that were the demonstratees were all Superior T-4.  Much to the instructor's relief they all became neutral after a subclavius  release and infraclavicular pump!  The most gratifying part is to walk the class through a process that they need to practice and apply clinically,  especially for the more complex cases that present to their offices.  Accessory muscle overuse, the over-reliance of end range lateralization, the inability to reciprocate and alternate side to side and especially being aware of delivery of airflow pressure sense into a chest wall for the purpose of neuro-respiratory, physiological and biomechanical variability is the heart and soul of this course.


Thank you to my most professional lab assistant Paige McNerthney, PT for all of your help this weekend and to all of the students who brought their "A" game of attention, focus and energy.  Thanks to Hidef for hosting Postural Respiration.

View Full Photo Album HERE!

Posted August 9, 2023 at 8:05PM
Categories: Courses Clinicians Science

Postural Respiration was presented at the Postural Restoration Institute May 28-29 to a large zoom audience of students as well as live participants. It is always a pleasure to have students from around the world in different time zones staying up late or getting up early to participate in this flagship primary course. There were students from Australia, Europe and coast to coast from North America and a large percentage of students were first time attendees to a PRI course, and for the majority of students, first time to Postural Respiration.


Delivery of air pressure sense and its effect on pelvis, ribcage and diaphragm shape, form and function are central themes that are returned to over and over in this course as it relates to neurology and ultimately biomechanics.
I taught Postural Respiration two weeks before in Chandler, AZ and there were similarities in terms of lab and demo with one student in each course presenting with almost exactly the same exam findings and same treatment guidelines as defined in this course for Superior T-4.


Often this patho-mechanical compensation can seem daunting to identify and treat, however, in both courses with both attendees, following the course guidelines with a detailed and repetitive description of both non-compensatory respiration and contrasting with patho-mechanical respiration made this difference very clear. Both students remained positive in their PRI testing on day one even after non-manual and manual AIC treatment regimens.  Then, on day two following Page 50 guidelines to determine if these individuals were in fact presenting with Superior T-4, a subclavius release with infra-clavicular pump was performed and all tests became negative with both cases.  No pressure, but the instructor is always relived when this occurs!


The overuse of accessory muscles of respiration became very clear to all attendees in both classes knowing that scalenes, for instance, need to act more like initiators of the first rib to signal rostal to caudal sequential rib elevation and not become primary rib lifters attempting to direct and deliver air inappropriately  into a right chest wall. Superior T-4 became very clear as to just one more step in the treatment guidelines for effective and balanced delivery of airflow pressure sense. This allows then alternating and reciprocal function into the entire physiological, neurological and biomechanical systems.


All in all it was a wonderful course especially the time and attention all of the students provided and "spot-on" questions that were asked. Thanks to all of our students especially on zoom from  different continents and time zones.  And the course was facilitated so well by RJ Hruska as he makes the process go so easy for students and instructors!

Posted June 2, 2023 at 3:16PM
Categories: Courses Science

Postural Respiration was presented April 15-16, 2023 at Spooner Physical Therapy in Chandler, AZ to an enthusiastic mix of PT's, Chiropractors, OT's and fitness professionals. There were students from Alaska, California and Idaho that made the trip to AZ. Dr. Victor Elmurr, D.C. was the motivating force in contacting the staff at Spooner several months ago and facilitated the return of PRI to the Phoenix area.


Among the new attendees to PRI, most of the students were new to Postural Respiration and their purpose was to understand and integrate delivery of airflow into the thorax with their knowledge of pelvis, lumbar spine and femur myokinematics. The response from them, and understanding that this course is the flagship of PRI, was that this course completes a picture of diaphragmatic function and how it affects not only delivery of air pressure sense into the thorax but the position, posture and movement of the entire axial skeleton.  


Since posture is not a static concept often thought of in a normal sense, the dynamic, tri-planer function of air flow pressure and sense allowing alternation, reciprocation and variability were all defined and experienced by every student.


As with every Postural Respiration course, Superior T-4 is the patho-mechanical portion of the weekend that is explored in detail on day two.  Rhythmic airflow and it's physiologic effects are discussed on day one in terms of dynamic airflow considerations.  Next, the importance of the first rib, especially on the right, is discussed in this context of rhythmic airflow and the first rib being an "initiator" of rostal to caudal rib movement.  With overuse of accessory muscles like the scalenes, the first rib will be lifted out of "sync" with the ribs below leading to patho-mechanical respiration as described in this course.


One of the students was used as a "demo" on the first day of the course for PRI exam, NMT and then a left ZOA manual technique. The inability to adduct a femur along with positive BC testing after NMT and manual techniques on the first day lead into day two of the course to explore if this individual was a Superior T-4. With definitive testing and after following the treatment guidelines on page 50 in the course manual, his Superior T-4 was discovered, treated and resolved for everyone to experience the progression to resolve patho-mechanical respiration considerations.


This course was such a pleasure to teach and thank you to the staff at Spooner especially Jessica who got there early and stayed late to lock and clean up. Thank you also to Carly, Sarah and the rest of the Spooner crew and thank you Ben for allowing us to share PRI with your clinic and the community. 

Posted April 20, 2023 at 8:21PM
Categories: Courses

The first Cervical Revolution course of 2023 was presented at the Postural Restoration Institute to an international group of students. Attendees present were from all around the globe including China, Japan, Singapore, Canada, England, Ireland, Germany and Bulgaria as well as from every part of the U.S.A.  Professions included physical therapists, chiropractors, strength and conditioning professionals, an osteopath and a medical doctor to learn PRI concepts of the cervical, cranial and occlusal system.

Cervical Revolution is the introduction to the PRI concept of "top down" while acknowledging that "bottom up" is always at play since humans need to manage upright posture, gravity and gas! One of the biggest topics is that if you lose the floor then a new ground up into the cervical spine, cranium and even jaw will occur. When this over reliance on the neck occurs, cranial torsion or pathology is almost certain. This course unlocks the path into the cranium and a deeper dive into neurology which is then presented in tertiary PRI courses.

During the weekend, PRI examination of the cervical spine was then integrated with repositioning techniques that addressed position of the cervical spine, occiput, sphenoid and temporal bones all at the same time. This is part of the magic of this course in understanding how to integrate many parts to restore alternation of the whole with oscillation of atlas and occipital bones, freedom of a sphenoid, wobble of temporal bones and jaws that can freely swing or truse! Louise Kelley, PT assisted me greatly in this endeavor with lab exam, PRI techniques and answering tough questions from curious students.

  

For over a year, Louise Kelley, DPT, has been training with me to teach Cervical Revolution. This past weekend was her last training course as she will be "flying solo" in May to teach this course on her own. During this time working with Louise I have been so impressed by her knowledge and dedication to the science of PRI. Over the weekend and over the past year I have watched her grow into becoming a stellar faculty member especially in her understanding of PRI principles as well as describing and breaking down techniques to restore alternating cervical and whole structure alternating function. I will miss spending time with Louise and she will be a brilliant Cervical Revolution teacher! 

Posted March 9, 2023 at 4:32PM
Categories: Courses Techniques Science

Divergent Physical Therapy and Wellness in Wellesley,MA just out of Boston proper was the location for Cervical Revolution on Oct. 22-23, 2022.  Cervical Revolution is the introduction to "top-down" PRI concepts of neurology especially autonomics and how the cervical spine at the atlas and occiput directs the cranium and ultimately occlusion. Since this is a complex system, there is also a connection on how occlusion and the cranium can also direct the entire body and all of it's postural and physiologic systems especially when the sphenoid becomes "fixed" and oriented while the rest of the axial skeleton compensates when in a pathologic state. The A/O runs the show until over-referencing with occlusal and cranial consequences drive pathomechanics.

 


What a great group and facility. Wellesley is a beautiful town and was surrounded by forested neighborhoods turning fall colors. Divergent is a state-of-the-art therapy and training center and lends itself to a perfect environment for learning.

This course was unique in that we had 7 PRC/PRT's that made for high level clinical discussions. There were students that were local from the east
coast as well as SoCal, Honolulu and even Alabama. Shout out to Alan, Cody and Paige for the long travels and especially Cody from Honolulu and a 10 hour flight. Neil Hallinan, PRT came up from  'Jersey and always has his expertise and knowledge that adds to the discussion. Thank you to Mike, Connor, Garrett and Cameron for providing their facility to all of us. Big thanks to Louise Kelley, DPT, PRC who brings energy, needed details and technique application to the course. And last but not least, thank you Karen Taylor-Soiles, PT, MA, PRC for providing a warm home, wonderful food and a seasoned provider's insight to the weekend. Louise and I are grateful to you and all in attendance.

Posted November 1, 2022 at 9:02PM
Categories: Courses Clinicians Science

Cervical Revolution came back to Lincoln this past weekend with a large zoom audience spanning internationally from Asia to North America to Europe. I had the pleasure of teaching to a live audience as well as having the added assistance of Louise Kelley, PT to help breakdown PRI concepts including  the finer parts of technique for de-rotation of the Right TMCC as it relates to not only the cervical spine but the entire system as well. In attendance was an impressive interdisciplinary group including movement specialists, strength and conditioning professionals, massage and soft tissue professionals, chiropractors, physical therapists, an osteopath, two dentists and one RN who is also a CSCS wanting to expand his horizons!


This is a course about the cervical spine and the need for revolvement that maintains alternation side to side, brainstem oscillation, temporal bone "wobble" and a jaw that can freely move side to side to keep a neck and nervous system in balance of an asymmetrical human that can stand erect and move fully and freely. Atlas and occipital bones make up a highly neurologic articulation with a brainstem and autonomics that are intimately connected to this highly reflexive region. This course is the gateway to the cranium and the introduction to top down as well as bottom up concepts of PRI. The cervical, cranial and occlusal systems are all integrated in this course and an impressive demonstration for all, especially the dentists, was provided with a simple mouth guard that Ron made for Louise the day before the course started. I demonstrated this stomatognathic example with Louise by first testing her cervical spine with a mouth guard that gave her right molar contact and reinforced her RTMCC pattern resulting in positive tests of her cervical spine. Another mouth guard was then utilized that dis-occluded her right molar contact while giving her left molar contact sense and all of her tests became negative immediately. This demonstrated the neurologic effect of a simple mandibular appliance on not only the cervical spine but the entire neuro-respiratory-biomechanical system.

Needless to say, this was communicated to me by a student as 'mind blowing' and brought an experiential example of the power of this course. Thank you to RJ for expert facilitation of this course over the weekend, Louise Kelley for being such a great lab assistant and team mate and Ron Hruska for spending Friday before the course reviewing advanced PRI concepts. Most of all, thanks for all of the students in attendance especially from international locations that stayed up really late or got up really early and for all of the diverse professions that contributed their advanced thought and experience to the enrichment of this weekend.

Posted September 13, 2022 at 8:12PM

After a three year Covid 19 hiatus, PRI was back at Lindebergs Academy in Munich, Germany to present Postural Respiration and Cervical Revolution in July of this year.  I had the privilege to teach both courses in Munich and it was the highlight of my career filled with many highlights as a faculty member for PRI. 

Students representing diverse disciplines and professions from all over Europe were in attendance.  Germany was well represented as well as Austria, Norway, Ireland, Britain, Australia and even a student who rode a bus for 10 hours from Slovenia!  Shout out to Naja for making that long trip on a bus.  There was even a physical therapist, Paula, who came in from Australia.  Francesca came all the way from Norway and Maria and Julia came in from Vienna and another small town in Austria!  I can’t forget Rob, and no one else will either, from Dublin!  And Beth made it from America on the F1 circuit in Europe!

The interdisciplinary approach of PRI principles spans many specialties and professions and in these courses we had physical therapists, athletic trainers, pilates instructors, personal trainers, kinesiologists, a speech therapist and two M.D.’s that integrate PRI into their practice models.

As a faculty member I was so impressed with the curiosity, energy, warmth and enthusiasm not only from the students but the staff at Lindebergs Academy as well.  Regina was so gracious and helpful with facilitating these two courses providing set up of tables in the course room and great food.  Also, Regina lent me her bicycle so I could ride all over Munich to really get a sense of this magnificent city.  Lindebergs is a state-of-the-art facility and to have the support of Regina and the entire Lindebergs crew is a faculty member’s dream.

Daniel Muller is a PRI veteran and has been vital in our presence at the Academy, Germany and Europe at large.  He was instrumental in making sure these courses were successful and that student and instructor needs were fulfilled beyond expectation.  Daniel also took me around Munich and provided friendship for a stranger in a foreign land for which I am eternally grateful. 

Our lab assistant was the incomparable Kazu Nishimura.  Anyone who can speak two languages impresses me but Japanese, German and English?  The quality of Kazu’s help was another layer of support and enhancement that added to the most positive experience of these two courses and helped enrich the learning experience for everyone in attendance.  He rode a bus for six hours from Berlin!

Munich has been the PRI hub of Europe and once again interest, energy and enthusiasm is growing for more courses.  As a result Pelvis Restoration with Lori Thomsen will be taught next May and then in July  Dan Houglum will teach both Myokinematic Restoration and Impingement and Instability.   The Interest in those three courses was a resounding “we can hardly wait” for PRI to come back.  And as an Institute, we can hardly wait to go back to Munich and continue to build PRI Nation internationally.   Thanks to Ron, Jen, RJ and Hannah for your hard work to help make this trip professionally and  personally satisfying for me.  At the end of teaching I took 10 days to explore and hike the Austrian Alps and the Dolomites of the Italian Alps.  Every moment was quintessential and an irreplaceable lifetime experience to explore and discover a new land, different cultures and spending time in beautiful cities, small towns and hiking in achingly beautiful mountains alone and with friends that live in Europe. 

 

Posted August 29, 2022 at 3:31PM
Categories: Courses Science

Huntington Beach was the location of the California Chiropractic Association’s (CalChiro) annual sports symposium on May 21-22. There were a wide range of topics including shoulder diagnosis to sports psychology to treating Marfan’s patients and then on to several approaches of functional movement specialties for rehabilitation and sport performance in a chiropractic practice.


I had the privilege of representing the Postural Restoration Institute and the topic presented was on the “The Two Roles of the Diaphragm in Chiropractic, Rehabilitation and Sport Performance”. This topic with lecture and lab had an enthusiastic response and many of the attendees that had taken a PRI course before were “fired up” to learn more. Those who had never heard of PRI or were unfamiliar with our approach were very curious to learn more especially regarding the thoracic diaphragm, breathing in sport performance and pelvic floor dysfunction.


This was the first time PRI was represented along with DNS and SFMA in the same venue at a chiropractic symposium. I got to know Michael Rintala, D.C. who teaches for DNS and Greg Rose, D.C. who developed the SFMA and it was a pleasure to get to know these two highly dedicated and competent practitioners on a personal and professional level.

 
I was more than thrilled to represent PRI to progressive chiropractors open to having an integrated practice approach. It was also a thrill to have Drs. Rintal and Rose in attendance to share more of what PRI can offer regardless of one’s practice approach. I enjoyed learning more about DNS and refreshing my knowledge of the SFMA. In addition, this weekend was a treat for me to see my colleagues and friends Drs. Richard Cheung and Jeff Tucker who were both, in part, responsible for my journey into PRI certification and ultimately into becoming a faculty member. I will always be grateful for their support.


And last, this past weekend was the 10th anniversary of taking my first PRI course, Postural Respiration, and what a meaningful journey it has been!       

Posted June 29, 2022 at 8:36PM
Categories: Science
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