Courses

The ENT Institute just north of Atlanta was the location of the latest Cervical Revolution presented to a curious, question asking and enthusiastic group of PT’s, athletic training, fitness and soft tissue professionals.
One major emphasis of Cervical Revolution is on the brainstem specifically nerve and CSF flow at that highly neurologic articulation located at Atlas and the occipital bone.  When a neck is unable to maintain neutrality and oscillating function, especially at the craniocervical articulation or the occipital atlanto joints, a wide range of symptoms are likely to occur.  These symptoms can include hypotonia affected by the fusimotor system, neuralgia, inflammation, tinnitus, dizziness and hypertonia especially with stiffness of cervical musculature and headaches.


This is a short list of symptoms that can also mimic Chiari-like symptoms that can include all of the above with sleep apnea and sleep disorders.   One goal of this course is to identify and restore normal spinal coupling of the cervical region through testing and non-manual techniques for proper tri-planer function of the neck, cranium and occlusal system.  In this course, the neck is the primary driver of cranial strain patterns that can appear in a non-pathological or pathological presentation.  The cervical spine has a direct relationship with osteopathic descriptions of cranial position including temporal bone influence on the jaw.  The occlusal system also has a strong influence of not only the cranium and neck but the entire body. This is known as the stomatognathic system, and it has a significant influence on the entire axial skeleton.


The staff at The ENT Institute was so excited about attending this course since they see so many patients with the symptoms previously mentioned and can see the application of PRI into their daily practice.  It is always a pleasure for a faculty member to have so many intelligent questions and see so many “ah-ha” moments from students eager to learn a detailed, and at times, challenging to assimilate course! 

 
Thank you very much to the staff at The ENT Institute including Allison, Jennifer, Niah, Miscelle, and Ann.  Thank you to Tassie for driving up from Warner Robbins, Mary Beth for all the great questions, Andy for your continuing journey, Danielle, Meghan, Roberta for your energy and last but not least, Kaitlin, for participating so well during lab.     

Posted March 14, 2024 at 4:38PM
Categories: Courses

They say the third time is a charm! I think we’ve been planning to take the “old Peds course” and now the new, remastered “Human Evolution” course to Alpine PT in Seattle WA three times, and in October, we finally did it, barring surgery and COVID! From my perspective, it was well worth the wait. Christopher Murhpy, Jeremiah Ferguson, Eli Zygmuntowicz, and Eva Bilo were the most gracious hosts and hostess. It was so great to have met you after hearing so many good things about you and your clinic.

We took a journey through the development of a human, highlighting critical sensory motor milestones, reviewed the literature supporting why these human developmental principles are important and connected it all with a description and application of 7 specific developmental processes. With over 100 videos of clinicial application through the lifespan, we were “in the clinic” with 8 patient cases for all of Day #2, from 15 months old to 70 years old.

We had an important conversation about the overwhelming benefits of crawling on hands and knees, and how important this skill is to painfree, grounded, postural development and walking as we age. This skill (at any age, really) brings sensory attention to all of our bases of support (right and left, front and back), helps to use and to integrate primitive tonic neck reflexes, provides a sense of upper extremity self-referencing on the maturation of cephalic-caudal independence, allows us to feel a grounded sense of gravtiy in a primitive form of forward locomotor movement, AND to explore our worlds from a new visual persepctive for cognitive processing!  And that’s only one of the 10 milestones we recognized.

A couple of the attendees came up to me and said, “As you were talking, I was writing patients names down because this course applies to so many of them”. We might not be crawling for locomotion as adults, but as we are cleaning out a bottom cabinet, gardening on hands and knees, pushing a grocery cart in the grocery store, rolling over in bed, lowering ourselves to play with our pets or children, or walking upstairs (or downstairs backwards – WHAT?), we are using the skills that were hopefully laid down in the developmental years. If these skills were not wired developmentally, or if an injury or insult changed that developmental fortification, there’s a good chance one might be pursuing PT, which is why your patients might be in your clinic. This course was created to help us all better understand these cross-referenced connections for better patient outcomes.

I hope to see you in one of 2 live stream offerings in January or September of 2024, or maybe I’ll get to shake your hand in person in Malvern PA in April. Thanks again to the fine folks at Alpine PT, and to everyone who attended, nodded, questioned, and participated. Your presence was enriching to me and to the group’s learning. I appreciate you all!

Posted November 30, 2023 at 9:41PM
Categories: Courses

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

Flying from sea level North Carolina to mile high Colorado was indeed a great way to experience pressure changes. It gave me an opportunity to discuss, firsthand, what our craniums should constantly be doing to resolve these changes, which are cyclically occurring (perhaps to a smaller extent) inside of our heads (and bodies) every moment of every day. And I could not have had a better group of people to discuss this with than those that attended last weekend’s “Cranial Resolution” course held at ProActive PT in Fort Collins, Colorado.

 

The Cranial course indeed has a lot of didactic material, but right from the start clinical application of this material was being discussed. And I can’t tell you how thrilled I was to get, early on on day one, questions that reflected how people who had never previously taken this course (which was the majority of people that were in attendance) were clearly conceptualizing this complex information in a clinical manner. Like when Tracy asked, “Well then wouldn’t it be helpful to block the right nostril when doing some of the PRI techniques?” What was so cool about these sorts of questions is that they showed people were starting to understand WHY we might want to do things . . . before ever being algorithmically introduced to a ball of cotton or a funny hat.

 

To me, understanding why PRI works is at the root of the Cranial Course. It brings concepts and people back down to basics, literally down . . . as in sitting on the floor down, to take their either “too loose” (disassociated) or “too tight” (overly regulated) legs out of the equation so they can feel how their cranium and thorax SHOULD integrate (alternate and diverge).  The two avatars that volunteered to illustrate these two different ANS integration responses could not have been more perfect, or more appreciated. Addison not only visibly gained nearly 40 deg of SLR, but also admitted that at the end of his demonstration he was, “for the first time,” able to comfortably tolerate long sitting. And Karen was finally able to find and feel her hamstrings (even if it was “only a 25% sense,” she now at least had something to start ergotropically PUSHING the floor with). And we were able to get Craig, our well balanced, “neutral” model, to quickly illustrate the role that lateralized multisensory input plays in influencing our ANS responses. Sorry Craig.   

This trip to Fort Collins was my first venture into Colorado, so of course I had to make the most of it. Jennifer, a wellness coach who has become a staunch PRI ambassador, was going to be attending so the two of us arranged to fly out several days early to be able to do some hiking. We loved the trails along the Poudre Valley (Hewlett Gulch and Grey Rock) and went up the well-traveled Horsetooth trail to the falls just outside of town. All spectacular, especially since the sun was out, the temps were perfect, and the Aspen’s were at their peak yellow. I’m starting to like this traveling to teach gig!  

Most importantly though, I want to extend a deep, heartfelt thanks to both the institute and the incredible hosts at ProActive (Brian, Tracy, Craig, and Addison), along with all of those that traveled (Jennifer, Chris, Karen, Lisa, Derya, Rachel and David) to be a part of this weekend of learning. Absolutely everyone brought something to the mix (even quiet Chris, learning about how you have worked with an ENT and Nutritional Flow was thought provoking). It was all such a great experience. I can't wait until the next time I get to teach this material, which will be on a live stream from Nebraska.

Posted October 24, 2023 at 7:17PM
Categories: Courses

"October 14th and the skies were gray, a rainy day in Reading, PA that was perfect to perturb some paradigms around the power of a pattern. We mined the pattern’s positional influence setting the stage for the task at hand and ending our day with a repositioning plan.

Day two dawned appropriately repositioned, the sun shining down elevating our condition. An earnest query session kicked off the day and made this instructor excited by the interplay.  

Focused and engaged, we delved into the test designed to guide our retraining the best. With the Hruska Adduction Lift Test leading the way, we endeavored to find and to feel the myo-ingredients that would progress the scores so we can all own our floors."

A big thank you to everyone who joined me this past weekend and did such an impressive job of focusing and working to apply and experience the material, and most importantly, asking questions that facilitated a clearer and deeper appreciation of the content. I would encourage all of you to embrace the uncertainty and discomfort that invariably accompanies new paradigm’s and know that this is a sure sign of growth.  

A big thank you to Frank Mallon, DPT, PRC for driving up from Philly both days to assist in lab and adding to our discussions, his presence was such a boon to our group!
Thank you to Alliance Fitness Center and Collin McGee for hosting and making sure we had what was needed for the success of our weekend.

Posted October 20, 2023 at 6:54PM
Categories: Courses

It was a wonderful two days teaching Pelvis Restoration from "home." at the Postural Restoration Institute. Thank you, RJ, for your amazing tech skills and assisting with setting up. Hayley you were a fabulous lab assistant, and I appreciated your insight and clinical experience and tips you shared with the class.

The course attendees were fabulous. I loved their eagerness to learn and think outside the box with the science of PRI. Fifty percent of the class were attending their first course. I remember attending my first PRI class and how overwhelming it was to learn about patterns, asymmetry, and the power of respiration. Once I started seeing the results in the clinic and seeing the patterns, I didn't look back only forward in the PRI journey. I hope this is the same for all of you.

Learning about the pelvic inlet and pelvic outlet with four quadrants each is a lot to learn for position, muscle facilitation or inhibition. I assure you the clinic will be your best lab as you gain insight and knowledge as this information will resonate as you see it with your patients.

Thank you for spending two days with PRI. I was so grateful and humbled to spend it with such amazing clinicians.

Posted October 17, 2023 at 6:16PM
Categories: Courses

Fort Collins, CO: The wide expanses of meadows and trails, fresh mountain air, and the Rocky Mountains – merely a stone’s throw away – provide an irresistible playground for movement. Did you know that movement starts at the thorax? The thorax is the first and foremost body region to assess and treat in our patients-clients, regardless of symptoms. The most recent rendition of Postural Respiration, hosted by Rebound Sports and Physical Therapy, explored why this is true. The group included a large cohort of physical therapists joined by two PT students, an athletic trainer, PTA, occupational therapist, chiropractor, and pulmonologist.

Postural Respiration includes in-depth discussions on the form and function of the left and right hemi-diaphragm, reflected in:
-    inefficient breathing strategies, such as belly and neck breathing and breath holding.
-    inefficient walking patterns, such as lack of arm swing, leaning to one side, early heel rise, and waddling.
-    forward head posture, straight spines, and rib flares.

Like the other two primary courses, Postural Respiration offers an algorithm to guide the clinician and provide the when, how, and why of treatment progression.  We spent significant lab time performing and interpreting tests and practicing non-manual and manual techniques to achieve a level of competence come Monday morning, with its real-world patients. Comments from the class after the techniques: “I feel more grounded.” “My movement is more fluid.” “My neck tension is gone.”

Thank you to those who elevated the learning experience for all by willing to be models for assessments and treatments: Sarah Awe, PTA; Tyler Fosdick, DPT; Daryl Hobbs, DC; Ambrey Holliday, MSPT; Annyce Mayer, MD; Michele Munsil, DPT; Alexandra Nachtman, DPT; Tara Rorvig, ATC; and Marisa Vargas, DPT.

Thank you to the staff at Rebound Sports and Physical Therapy, for all of the work you put in to host this course: Sarah Awe; Emily Clark, MSPT; Tyler Fosdick; Jason Grissom, DPT; Ambrey Holliday; Crissy Ott, MSPT; Brad Ott, MSPT; Elyse Prescott, DPT; Kevin Rhodes, OTR, CHT; Amber Schwarting, DPT; and Karen Stillahn, DPT, PRC. Karen, your insights and expertise during lab was invaluable and so appreciated!   

Finally, thank you to Craig, Abby, and Daisy Depperschmidt for your warm hospitality. I thoroughly enjoyed hanging out with the three of you and sharing stories over breakfast and dinner.  You made me feel so welcome!

Posted October 10, 2023 at 6:35PM
Categories: Courses Science

What a great weekend we had last weekend in Tualatin. 26 clinicians from around the region and country came together to experience a class on relationships and shifting.

The Portland and Tualatin area has a special place in my heart as it landed near the end destination when I biked across the country in 2006. The summer of 2006 was a summer of relationships and shifting life experiences, so I was really looking forward to returning to the area for fall of 2023. Ever since being assigned this course in Tualatin I have been excited for the weekend.

Well, the group that attended in Tualatin did not disappoint and really lived up to and exceeded my expectations!

I was able to rekindle my relationship with fellow 2012 PRC grad Emily Iverson who is well known in the PRI community. It was such a treat to have Emily's knowledge, experience, kindness, and overall passion for PRI felt throughout the weekend. Her assistance and presence was greatly appreciated!

Micah was a superb host at Active Edge Physical Therapy. It was a bonus for us that his relationship with his anterior hip capsule and iliolumbar ligament was still intact, providing an excellent example of a non-pathological compensatory left AIC patient.

Sarah was a gift for us as a perfect Avatar for a pathological compensatory left AIC patient. She appreciated the importance of shifting into her left hip with appropriate ligamentous muscle. Malcolm, Sarah's partner in life and business, was gracious in being the narrator for the course. Their relationship was felt as they shifted their mindset to PRI lenses in order to enhance relationships with their patients in their community.

Melissa and Mike celebrated their one year anniversary of marriage on day 2 of the class, learning the importance of shifting for a level 5 while "shifting" off plantar flexors. Their relationship will grow with their PRI journey!

Myokinematics is the study of muscle as it relates to movement. It is a class on relationships and shifting. Relationships of muscles, relationships of your left and right halves of your body, relationships between swing and stance phase of gait, and perhaps most importantly, relationships between people. It is a class on shifting perspectives and shifting well to the left and to the right.

I truly felt I connected with and started a relationship with everyone in the class. The weekend was such a fun experience that lived up to my 12 month anticipation of being there. Thanks to all of you that attended for making it such a great experience! I look forward to crossing paths once again in the future and relating our shifting life experiences.

Posted October 9, 2023 at 4:47PM
Categories: Courses Science

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

I had the great pleasure of teaching Myokinematic Restoration this past weekend in Jupiter, Florida. It was such a gift to be able to travel to Florida and spend time with this fantastic group of clinicians, coaches, massage therapists, Yoga and Pilates instructors, and even an engineer (shout out to Hugh!)

The class participants were so fun and engaging that it truly felt like I was on vacation hanging out with 33 of my best friends. The quality food and evening beach walks also helped with that feeling. Except for Amy Brown, PRC and rock star lab assistant, this was everyone's first Myokinematic Restoration class. I learned from everyone in class and really had a great time getting to know them.

Ashley helped us think critically on how we can integrate PRI thinking within the gym and strength world. Megan was a gift from above and our main "Avatar" for the weekend, being a perfect example of a patho-compensatory L AIC individual that we can all learn from. Ed and Ingrid brightened both days by sitting front and center with their beautiful smiling faces and excellent questions.

Greg reminded us that everyone wins with a PRI lens, even when we are in a competitive market in the therapy world. Jarrod will be applying his PRI knowledge to the military world (and has a sweet truck!).

Heather brought in an Equestrian bias and dropped horse knowledge on us revealing that 90% of equestrian riders bias their horse one way thanks to the rider's inherent asymmetries. Her friend, Darren brought his majestic deep voice to narrate non-manual techniques as well as reading positional and compensatory influences of the left AIC pattern on muscle of the lumbo-pelvic-femoral region.

Frank and Kenneth helped us understand a tight posterior capsule and how it may limit the Hruska Adduction lift scores, while Leroy and Logan helped us appreciate how important a posterior capsule is for shoulder function with the Chicago Cubs.

Barbara was a gift from the "pelvic floor" specialist world. Barbara - you are much too young to consider retirement, our profession needs you! Her colleagues Laura and Chelsea helped us understand the single blinded randomized controlled trial in the back of the manual. Chelsea plans to do a presentation on Myokinematic Restoration while implementing page 46 for her company's case care algorithm standard of practice. Stephanie's bright, smiling face joined Chelsea and Laura up front to help us realize the importance of a Myokinematic Restoration program during and after pregnancy (congrats, Stephanie!).

Jennah (with an "h"!) was a joy to have in class with her brilliant questions and insights. Get after those hamstrings, Jennah! Her friend Messiah was a pro at the techniques, as long as he shut off those "northern glutes"! Seth was our PT student representative. Love having DPT students in class, they provide such fresh insight and questions!

Jen and Mickey represented Arise well with fantastic questions from the back. They helped us understand the danger of compensation and how if we don't always test in a predictable way, that still gives us valuable data.

Kristina helped us appreciate hyper-mobile individuals and how important it is that we get them on a PRI program so as not to over stress ligaments - in the pelvic, hip, or knee. Brad helped us realize the importance of our hips in our movement patterns, whether they are original or enhanced hips.

Dwight, Jennifer, and Dawn were the Dream Team in the middle of the room. Dwight, thanks for the tuna and restaurant recommendations. He was a good reminder that PTs can make good restaurant owners! Dawn helped us understand a bilateral AIC pattern, potentially influenced by a famous body building background. Jennifer was kind enough to spend her birthday with us on Sunday. Hope I didn't make it too boring for you, Jennifer!

Robert, former professor and lecturer, helped us understand an over-active right adductor and provided thought provoking and critical questions for the class. Darrell brought excellent insight and questions from a manual therapist point of view.

Matthew and Andres proved to be enjoyable company for lunch. Matthew, fantastic questions, good luck on the potential move to COLORAD! Andres, thanks for being such a great non-manual technique demonstrator and making the drive across the state. Let me know when you are in Colorado again and we'll get up a 14er!

Big thanks to Amy for assisting in lab and providing valuable clinical insights. Special thanks to David for being an excellent host. Perfect amount of coffee, snacks, and La Croix! All-in-all, I felt like I gained 33 new friends from this past weekend. It was such a pleasure and joy to be with you all. 

Posted September 26, 2023 at 6:52PM
Categories: Courses Science
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