Courses

If patient can’t maintain re-positioning…

Breathing

  • Are they diaphragmatically breathing?
  • Quality of respiration?
  • Symmetry of respiration?
  • Decreased diaphragmatic motion, increased descent of pelvic floor, altered breathing patterns associated with pelvic pain.
  • Diaphragmatic and TA muscle activity reduced with hypercapnea.
  • Pelvic floor depression associated with breath holding/Valsalva maneuver.

Abdominals

  • Can they isolate IO / TA?
  • Symmetrical or Asymmetical?

Abdominals

  • Palpate approximately 2 cm medial and inferior to ASIS.
  • Slowly & gently draw in your abdominals away from your fingers.
  • Sub maximal contraction.
  • Change positions (supine, side lying).
  • Monitor for substitutions.
  • Is IO / TA activity sustained with breathing?

Abdominals

  • Can they maintain IO / TA contraction with upright static & dynamic control?

Walking Seated Ball Pregnancy Squat

Pelvic Floor

  • Can they isolate their pelvic floor muscles?
  • Can they actively contract and relax the pelvic floor?
  • Do they feel an up & in contraction?
  • Are they substituting (glute squeeze, breath holding, adductor squeeze, bearing down)?
  • Is there symmetry?
  • Is there appropriate motor planning?
  • Voluntary contraction of the abdominal muscles stimulates pelvic floor contraction.
  • TA and IO recruited during all pelvic floor muscle contractions.
  • Relaxed abdominals resulted in only 25% of maximum pelvic floor contraction.
  • Women with stress incontinence have increased OE activity (increased OE increases IAP).
  • Back pain more common in women with incontinence , increased probability of LBP if have symptoms of incontinence.
  • Pelvic floor muscles are part of preprogrammed response to postural adjustment.
  • Decreased pelvic floor strength, endurance and thickness noted in women with incontinence.
  • Increased pelvic floor activity with postural perturbations noted with women with incontinence.
  • Pelvic floor tonic activity at rest, with cough automatic phasic response, in women incontinence unsustained tonic pattern with asymmetrical recruitment.
  • Timing deficit of muscle recruitment lost with women with incontinence.
  • Higher resting tone of pelvic floor with dysfunction, need to teach down training.
  • High resting tone does not always mean a strong pelvic floor.
  • The pelvic floor needs to relearn how to function within a neutral pelvis.
  • Feel the pelvic floor contract and relax.
  • Reported cure rate of pelvic for urinary incontinence ranges between 44-69%.
  • 30% of contractions are performed incorrectly; 50% of contraction are strong enough to increase urethral pressure.
  • Pelvic floor muscle activity alone does not predict UI, activity related to UI needs to be considered.
  • Isolated contraction of pelvic floor produces greatest displacement of pelvic floor.

Hypermobility - But Still Have Symptoms

  • Is there global hypermobility?
  • There is a high correlation of pelvic dysfunction with a reduction in tissue collegan concentration.

Abdominal Binder

Referral

  • Has there been trauma?  Consider referral early on if patient not progressing appropriately.
  • Patient can reposition but they still have symptoms- are they able to relax their pelvic floor?
  • Is there psyco-social issues?

Referral To

  • If symptoms have not subsided consider referral to OB GYN/Urologists/Primary MD
  • PT with pelvic floor specific training (biofeedback, internal evaluation, condition specific integration)
  • Podiatry (correlation of foot flexibility and SUI)
  • Dentist
  • Neuro - Optometrist
Posted April 6, 2009 at 7:16PM
Categories: Courses

Karen Jiran, MPT, PRC was the instructor last weekend for our one day clinical course called Postural Restoration.  For those of you unaware of what this course is, this course is an individualized, one day class, that covers concepts requested by the attendees.  In short, the entire day is spent reviewing concepts taught in one of our two day courses.  This course happened to be organized by PRI but we often schedule the courses on request.  Here is some feedback from the attendees:

“Great course, Karen did an excellent job!  I would recommend this class to everyone.  It was a fun, dynamic learning experience!”

“Excellent course, please offer more of them!  It’s nice to have a small class size to have practice time!”

“Very, very good!  The case studies and small group discussion made the problem solving effective!”

“It’s nice to have a source to get questions answered.”

If you are interested in having a one day clinical course at your office, please contact us! This is a great opportunity for more advanced, hands on clinical application for you and your colleagues!

Posted April 3, 2009 at 7:34PM
Categories: Courses

to our first Interdisciplinary Integration course, you missed out on a fantastic weekend!  Let me give you a quick overview on each day…

Day one which covered Podiatric Integration started out with information covering gait analysis and it’s relevance to PRI related treatment.  It was a great overview of the reciprocal process that takes place as our body moves through the motion of gait and what PRI considerations we should keep in mind as we are treating different phases of gait.  The afternoon carried on with information regarding orthotics and what purpose a PRI orthotic serves in reducing neuromotor pathomechanics provided by Dr. Paul Coffin.  The day couldn’t have ended better than with Ann Ringlein, from the Lincoln Running Company, covering proper shoe wear.  Here are some comments from attendees of day one:

“Excellent clinical application I can use immediately.”

“Fantastic, fascinating guy; we could learn a lot more from him!”

“Excellent information and application for our clinic.”

“The videos and pictures of those walking was so helpful!”

Day two was devoted to Dental Integration provided by Dr. Mike Hoefs.  The entire day was spent by a passionate, enthusiastic dentist talking about the importance of position and maintaining cranial symmetry.  Dr. Hoefs is one of the few dentists in our country treating craniofacial pain and dental discrepancies through gnathic orthopedic positioning.  The highlight of the day was when he took our very own, Lisa Bartels, DPT, PRC, and placed a twin block ALF appliance in her mouth in front of the whole class.  It was incredible to see the postural changes that took place immediately following the application of this appliance!  Here is what others had to say about the day…

“Interesting, informative and very helpful for understanding when and how to refer to an appropriate dentist!”

“This was such an eye opener; I really appreciate all the information given!”

“The demonstrations used during this course were very applicable for use in the clinic.”

“Wow, Dr. Hoefs is the Ron Hruska of dentistry!  He is such an innovator!”

Day three was spent on Vision Vestibular Integration.  The first part of the day covered optokinetic learning taught by Ron Hruska, MPT, PT.  We learned all about vision and its influence on balance and the vestibular system. The morning provided an excellent overview on how to integrate and communicate with optometrists.  Dr. James Nedrow discussed his expertise in neuro-optometry and the treatment of visual midline shift and post traumatic visual dysfunction.  Here is what others had to say:

“I have a better idea of when to request optometry and neuro optometry.”

“Both the morning and the afternoon came together for me and showed me where to look to study and begin tying things together.  The whole day was fascinating!”

“This course opened my eyes to the importance of treating the entire system.”

“Wow, this course definitely helped clarify the relationship of the vision-vestibular system and posture.  Ron and Dr. Nedrow did a great job of presenting this information and demonstrating the importance of interdisciplinary integration.”

And finally, day four!  Pelvic Floor Dysfunction was the topic of this day given by Heather Engelbert, PT, PRC and Lori Thomsen, PT, PRC.  What an incredible day covering the importance of establishing a positioned pelvic floor, before addressing pelvic floor dysfunction.  Not only was pelvic asymmetry discussed but also covered was the importance of the respiratory system and its influences on the pelvic floor!  The afternoon was spent on treatment techniques for pelvic floor dysfunction and we were given several new activities to use with our patients.  Here is what other attendees had to say about it…

“Great explanation of the Left AIC pattern and how it affects pelvic floor dysfunction.  I loved the “egg”, pelvic floor and diaphragm diagrams; it helped me to understand position of the pelvic floor and the pelvic diaphragm.”

“The clinical application with treatment strategy and reasoning behind these strategies was one of the best discussions I have ever heard!”

“This was a wonderful way of improving my understanding of how to fit the pelvic floor in the PRI picture.”

“This course exceeded my expectations; I now know what is going on at the bottom of the egg and what to do about it!”

Interdisciplinary Integration

Posted April 1, 2009 at 7:42PM
Categories: Courses

Abdominal Discord

  • Abdominal weakness- dorsal stabilizers become tight and static, exhalation becomes passive and rate of inhalation increases.
  • Belly breathing associated with increased lordosis.
  • Unilateral or bilateral rib flare.
  • Rotation dysfunction increases with internal oblique weakness on side toward which the body is rotated, external obliques weakness on opposite side.
  • Strains sacral iliac ligaments.

Common Compensatory Pattern

1.  Pope, R. The common compensatory pattern: it’s origin and relationship to the postural model.  AAOJ 14(4):19-40.
2.  Zink G, Lawson W. An osteopathic structural examination and functional interpretation of the soma. Osteopathic Annals, 1979 Dec 7(12):433-440.

Posted March 29, 2009 at 7:07PM
Categories: Courses

PRI Gait Analysis of the Accelerated “Asymmetrical” American

1.  The left foot goes through a toe-out gait pattern at early push-off compared to the right.  Secondary to poor abductor co-contraction of adductors and anterior gluteus medius.

2.  The right lower extremity externally rotates more overall than the left.  During swing because of overactive iliacus and during stance because of innominate orientation of legs and trunk to the right.

3.  The right heel lifts early at mid-stance compared to the left and at push-off.  Secondary to longer interval of right weight acceptance and trunk glide and longer shorter swing and ‘stride’ with left leg.

4.  The femurs significantly internally rotate at push-off.  At late mid stance and trunk glide phases innominates are forwardly rotated too much contributing to FA IR orientation or position.  Especially seen in hyperextended individuals. 

5.  There appears to be a higher ‘active’ mid foot arch on the right at mid stance.  Secondary to overactive, shortened strong right adductor influence on foot and ankle.

6.  No sufficient resupination of the left foot occurs after midstance to stabilize or “lock” the tarsus in the sagittal plane and allow for efficient propulsion.  Contributed by weak right acetabular femoral external rotational strength.

7.  The right 1st metatarsal is not secure in plantar-flexion against the ground during forefoot loading.  Contributed by C.O.G. over-distributed to the right and overactive left TFL during swing. 

8.  The right 1st MTP joint does not dorsiflex freely for forward gait progression without compensatory dorsiflexion from smaller toes and shifting of COG to the right.  Secondary to forefoot and possibly rearfoot varus and overactive posterior gluteus medius and iliacus. 

9.  The right arm does not move forward upon right toe-off.  Secondary to poor left lateral abdominal integration and overactive right thoracic abductors reinforcing right arm adduction. 

10.  The left shoulder does not drop upon left toe-off.  Contributed by weak left gluteus medius and left lateral abdominals at late mid stance or trunk glide. 

Posted March 26, 2009 at 7:10PM
Categories: Courses

Our first annual Interdisciplinary Integration course is fast approaching!  The course is scheduled to begin next week, Thursday March 26th, and conclude on Sunday March 29th.  Between now and the start of the course we will be busy here at PRI placing thefinal touches on the course material.  If you have already registered for this course, we look forward to seeing you!  If you are not registered and are interested in attending, please contact us

Posted March 16, 2009 at 7:12PM
Categories: Courses

Please join us March 28th for Postural Restoration - A One Day Clinical Course.  If you have taken Myokinematic Restoration or Postural Respiration and would like to spend a day learning how to clinically apply the PRI knowledge you have gained, this is the course for you!  Registration deadline is this Friday, March 13th.  Please contact us if you would like to register!

Posted March 10, 2009 at 7:14PM
Categories: Courses

I am so excited about the upcoming four day Interdisciplinary Integration course.  Heather Engelbert and I, will be talking about Pelvic Floor Dysfunction.  Position is key for these muscles to work as they were intended for organ support and sphincter control.  We have the asymmetrical pelvis broken down into left and right with relationships of the “adductor, hamstring and glute max” of the pelvic floor.  Exciting stuff! We have developed a hierarchy of treatment with PRI principles and new exercises to show you!  We will also discuss when it’s appropriate to refer to a pelvic floor specialist for an internal exam and integration with other health care professionals.  We hope to see you there!

Posted March 2, 2009 at 8:22PM
Categories: Courses

Day Four...What’s new in the PRI curricular future? The pelvic floor- like never discussed before. Heather Engelbert, PT, PRC and Lori Thomsen, PT, PRC will bring you up to date on the importance of establishing a well-positioned pelvic floor, before addressing pelvic floor dysfunction. Ironically, the timing of my pregnancy fit perfectly with our need for a PRI model for this course so you’ll be seeing me in many of the ‘new’ PRI pelvic floor non-manual techniques. Applying a PRI myokinetic format to the pelvic floor anatomy is exciting in itself, but to integrate these concepts with the respiratory system is even more rewarding. What an uplifting way to end the four days!

Posted February 23, 2009 at 5:58PM
Categories: Courses

Day Three...how about going back to school to learn about vision and its influence on patterned balance and the vestibular system? Ron Hruska will start off by giving an overview on how working with optometrists has helped him establish timely, good neuro-mechanical postural change, complimenting Postural Restoration Institute goals of improving reciprocal balance and function. A didactic day of functional optokinetic learning. Learn about associated vision and vestibular patterns of people who rely on back and neck extension, and their right extremities. Dr. James Nedrow’s discussion about neuro-optometry in the treatment of visual midline shift and post traumatic visual dysfunction will enlighten any professional who treats patients with dizziness, headaches and perceptual issues. Both Dr. Nedrow and Ron are members of NORA, the Neuro-Optometric Rehabilitation Association, and see eye-to-eye on the need for increased vision-vestibular integration in the future of orthopedic, neurologic, pediatric and geriatric treatment programs. What an ‘eye-opening’ day!

Posted February 22, 2009 at 5:59PM
Categories: Courses
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