Techniques

Coming from the Polar Vortex, it was a refreshing respite to be in sunny Arizona for the first Myokinematic Restoration course of 2019. We were fortunate enough to have a very diverse class of attendees ranging from chiropractors, to strength coaches, to physical therapists working in various settings, to certified athletic trainers working with professional athletes.

Myokinematic Restoration is a fantastic course to kick-start one's PRI journey. This was the rare introductory course where over half of the attendees had been to previous PRI courses. This provided us a unique opportunity to delve into other material that we wouldn't otherwise be able to cover. We had excellent questions and excellent lab time as a result.

Lab Demonstration of PRI Testing, Myokinematic Restoration, Chandler, AZ

One of the topics that we were able to cover in this course that previous attendees appreciated was the Hruska Abduction Lift Test. This test is taught in depth in Pelvis Restoration as well, but for those who had attended Myokin previously, this was a new topic for them. Additionally, it provided the newcomers a chance to be able to appreciate how PRI integrates the gait cycle and breathing into treatment from beginning to end. We were also able to briefly touch on other topics, such as PEC management and rib cage IR, because of the previous experience of many of the attendees. However, we were also able to stay very on point and keep the course on track for those who were attending for the first time.

Dan Houglum demonstrating the Hruska Abduction Lift Test, Myokinematic Restoration Course

My thanks to Jim Wittekind, PT, PRC, for his help during lab and insightful discussion. The staff from 360 Physical Therapy, Becky Fox, Jennifer Peters, Krystina Leal, Caleb Walls, and Jason Roe, were perfect hosts. My thanks to Nathan Whitney, Ginsie Huntley, Liz Cash, Chris Burke, and Garrett Chin for their questions and discussion.

Lab Demonstration, Myokinematic Restoration course, Chandler, AZ

At the end of the day, we all need to be a little more like Bruce Wayne, and less like Batman. And we need to use our "good boy band" of muscles, instead of the "bad boy band" that the L AIC often puts us into. As a result of our conversation around normal mechanics vs. compensatory mechanics relative to the L AIC pattern, we were able to delve into how these analogies applied to our assessments and treatment approach. We were able to spend a lot of time on muscle activity as well as how to apply the Hruska Abduction and Adduction Lift tests into assessment and PRI non-manual activity selection.

Hruska Abduction Lift Test, Myokinematic Restoration Tweet

We were blessed with a great group of movement professionals, and I was fortunate to be able to help them either continue or start their PRI journey. Thanks for a great weekend!

Posted February 14, 2019 at 5:29PM
Categories: Courses Techniques Science

What a great way to start off teaching my first course of my 2019 schedule at my own clinic here in Southern Pines! Nothing like sleeping in your own bed and walking your dogs at lunch time! I had the help of Sarah Ratti PTA, PRC! Sarah was a member of the 2018 PRC class and I was lucky enough to get to know her in December and have her help during lab!

Sarah Ratti and Jennifer Poulin at the Pelvis Restoration Course

 I was so excited to teach Pelvis Restoration following attending Ron's Non-manual technique workshop last weekend in Lincoln, NE. I learned so much and it certainly help energize my teaching and deeper understanding of the Non-manual techniques! I was able to really help my course attendees with choosing techniques and following a frontal plane progress as it relates to the Pelvis.

Jennifer Poulin Instructing a PRI Non Manual Technique

Every time I teach this course, I learn more and grow not only as a faculty member, but also as a clinician. I am hopeful my course attendees would feel the same. My class was interdisciplinary! We had PT's, PTAs, massage therapist, kinesiologist, strength and conditioning coaches, Yoga Instructors and massage therapists! It was a 50/50 split of newbies and experienced PRI clinicians. Maude and Brenda were my Pure Newbies, meaning they really didn't know what PRI was all about. But they left excited that they had been exposed to the science and couldn't wait to integrate what they learned into their current practice. I was happy to have Malynda Kerksick in my class. Malynda was a former patient of mine and now a PRI enthusiast!

I have had the pleasure of watching her grow as a Yoga instructor and her questions were much appreciated. She also did a great job photographing moments throughout the weekend. She gets photo cred for capturing my pure joy while teaching this weekend. I am so proud to be a part of the growth of Postural Restoration. We get asked all the time which course should I take next? What is the best first course to take? I made sure to emphasize the true nature of feed-forward neurology. You treat a pelvis, you influence the thorax, neck, head and big toe! I hope to see these faces again in a future PRI course! The #PRINation is now stronger than ever before!

Pelvis Restoration Course, Non Manual Technique Demonstration

Pelvis Restoration Lab Demonstration

Posted February 13, 2019 at 5:33PM
Categories: Courses Techniques Science

A few days before this course, I was reviewing the material and made a remark to Jen Platt on how much “good” stuff is in this course, that I forget about from year to year. It is so enjoyable to have an opportunity to discuss the reasoning one might use before selecting a position to place a client or patient in, before selecting a non-manual technique. What went into the thought processing regarding reference centers and concepts and why is it important to select an appropriate primary reference for desirable “referent” behavioral outcomes? 

Ron Hruska demonstrating a Non-manual Technique with Neil Rampe

Results are based on preparation. Preparing the patient on what to be mindful of, sense, possibly expect, experience, etc. are all more important than making sure they are doing the technique “correctly”. Processing information can be difficult if individual centers of tactility are not explored first. Words matter, word placement matters, word meaning matters, word correlates matter, word integration matters and word synchrony matters. 

Ron Hruska Non Manual Techniques Workshop

This course allows me to review this communication process, inhibitory intensity and neurologic effort for those who have unique limitations but very similar outcome needs, relating to pattern development around asymmetrical design. Over twenty different non-manual techniques, many of which were selected by the attendees, were reviewed, torn apart, discussed, re-designed and then re-designed again, to recognize reliability of approach and validity of use. It is personal for me. And therefore, an opportunity for those who share their transparencies to reap “good” stuff.

Ron Hruska Non-Manual Technique

Posted February 12, 2019 at 5:10PM
Categories: Courses Techniques Science

Santa Barbara is one of California's beautiful towns and would be considered one of our seaside gems. Prevail Conditioning and Performance Center was the location of Postural Respiration this past weekend. Owner and operator, Peter Blumert, provided a superior training facility for this weekend which followed his hosting Myokinematic Restoration last November. This weekend was a first for PRI! We introduced our latest revision of Postural Respiration. This course is packed with new material including a new test for posterior mediastinum inhibition called the posterior mediastinum reach test. There have been new documents added to support PRI concepts with loads of references for this course. In addition, case studies have been added and were a big hit with our students!

This was a course loaded with professionals in not only physical therapy, athletic training and sports performance but included an osteopath as well. Postural Respiration really describes how the diaphragm affects every system in the body. This course connects pelvis position to the ribcage and illustrates that breathing can be viewed as the gait cycle allowing ribcages to actually walk! That seems like such a far-fetched concept to those new to PRI on day one of the course and seems like such a bold statement. By the end of the weekend, every student could see that breathing is walking and the diaphragm and ribcage position and posture is key to tri-planer, dynamic, balanced gait.

We also had a chance to introduce the effects of the diaphragm and the ribcage to the cervical spine and jaw as well. The connection with Postural Respiration and the neck and jaw was experienced by a student when testing HGIR, or internal rotation of a Humerus in a glenoid fossa. She experienced jaw pain during HGIR testing and learned there was a connection of the Omohyoid with shoulder blade, neck and jaw. This was reinforced when the manual technique to release her subclavius muscle was demonstrated. Not only did this technique make her tests neutral but her jaw pain was gone. She also understood that with any manual technique, a non-manual technique and progression via treatment guidelines will be needed. Needless to say she was enthusiastic about continuing her PRI journey! Thank you to Aimee Miyazawa, ATC, PRT for being a seasoned veteran of PRI and a wonderful lab assistant. Thanks again to Peter Blumert for hosting this course as he welcomes Pelvis Restoration later this year.

Posted January 24, 2019 at 9:00PM

Earlier this month, we hosted our first Non-Manual Techniques Workshop with 42 attendees from across the US, and several different countries gathered in Lincoln to learn more about the intricacies and details of the PRI Non-Manual Techniques developed by Ron Hruska. The first 5 hours or so, Ron spent time discussing key concepts related to positioning, reference centers, and the organization of the Non-Manual Techniques programs. This then allowed us to then dive into several techniques (approximately 15) in great detail, and get Ron's input on set up, performance, cueing, modification, types of patients the technique is good for, and more. For each technique, Ron had an attendee demonstrate, while he provided tips on performance and modification. The workshop was a huge success and based on the feedback from the attendees, it is something we plan to host twice next year in Lincoln. We have had several requests others wanting to host this workshop, however due to nature of how the workshop is organized and run, the set up at the Institute is best, where I can assist Ron in pulling up techniques onto the screens as needed. Another fun thing about this workshop, is other than the first 5 hours, no two workshops will be the same! We thoroughly enjoyed the first go around, and look forward to next year!

A few testimonials from course attendees:

"I learned better ways of cuing patients (tactile/haptic) and more focus on reference centers to maximize patient ability to improve/progress more effectively and quickly."

"Awesome tools to progress or regress routine all within the same exercise!"

"Excellent!! Must do after 3 primary courses."

Posted June 25, 2018 at 5:08PM
Categories: Courses Techniques

We are excited to offer our Manual and Non-Manual Technique Programs directly on our website as Digital Downloads. If you have already purchased the CD's or DVD in the past, there is no difference in content between these and the digital download version, and the process to save these programs to your desktop is the same. But, with ever-changing technology of computers and laptops (many of which no longer come with a CD/DVD drive), the digital download offers a more convenient way to purchase these products. Each of our three primary courses; Myokinematic Restoration, Postural Respiration, and Pelvis Restoration have a corresponding Non-Manual Techniques program. The Manual Techniques program includes nearly two hours of video including demonstration, instruction and explanation of each manual technique provided by Ron Hruska, which compliments the Postural Respiration course.

If you are Interested in learning more about these products, they can be found on our website HERE!

Posted June 21, 2018 at 8:31PM

We recently were made aware of four journal articles that use PRI techniques to study the effects that they have on lumbopelvic pain, knee osteoarthritis pain, illiotibial band tightness and chronic low back pain. We are excited to see the growth in research for techniques that PRI Therapists have been using clinically for years. All of the articles below are available free of charge.

To view all of the articles click here.

    Posted March 2, 2018 at 5:34PM

    Our right triceps become very challenged if we can not sufficiently engage our left internal obliques and transverse abdominals during active late left lower extremity ‘push-off’ and concomitant active late right upper extremity ‘push-back’ (shoulder extension). Our bodies lose their ability to become centered over the left when our left abdominals, left hamstrings and right triceps disengage as a functional group. A few weeks ago Sy Abe-Hiraishi, a PRI faculty member, asked me about a non-manual technique called the ‘Supine Weighted Tricep Curl’ and the reasoning behind the two methods of instruction. I absolutely loved the question, the dialogue and the timing, since I will be presenting information on group function afferentation at this year’s Spring Symposium. Please read her summary and the response that is presented from a question that was initially asked by a course attendee that attended one of her courses in Japan. So awesome!   

    Gratefully, Ron

    アメリカの皆さんこんにちは!

    Hello everyone!

    日本講習担当、PRI講師の阿部さゆりです。昨年の12月に日本で初めてポスチュラル講習の開催をすることができたのですが、その際に参加者さんから出た質問とその答えを今日はここで共有したいと思っています。ロンが日本語と英語の両方でアップして!というので、両方でお届けしますですよ。

    This is me, Sy writing this blog post – those of you who do not know me, I am one of the two PRI faculty members that are designated to teach courses in Japan. We hosted our very first Postural Respiration courses in Japan in December, and this interesting question came up from a participant. Today I am hoping to share the question and answer with y’all…(in case you cannot tell, I currently live in Texas). Ron specifically requested that I post this both in Japanese and English, so here it is – hope y’all enjoy!

    ポスチュラル講習では左のハムストリングを使って骨盤を起こすように、右のトライセップスを使って右肩甲骨を起こすことがいかに重要か、という話をしますよね。その流れで講習中スーパイン・ウェイテッド・トライセップス・カールズの解説と実技ラボをおこなったのですが、このエクササイズにはやり方が二通り(ポジションA vs B)あり、「このエクササイズのポジションの違いは何?どういう状況の場合、どちらを選ぶのが正解なの?」という質問が日本人参加者さんから出たのです。

    In Postural, we learn to use the Right Triceps to “get the scapular up” just like we learn use our Left Hamstring to “get the pelvis up” in the Myokin course.  One of the exercises we demonstrated and practiced in our Postural courses in Japan was “Supine Weighted Triceps Curls,” and that’s when this question was brought up – “I see, in the manual, that this exercise can be performed in two different positions – the original (Position A) and the alternate (Position B). What is the difference and what are some of the reasons we should pick one over the other?”

                               Position A                                                               Position B

    What a great question! This got Ron super-excited because no one in the U.S. ever asked this question to him, and Ron and I had a great conversation about it over lunch the other day. So let me first share the short version of the answer – “You should always try Position A first. If it does not work, try Position B as this should be the “mechanically advantaged” version of the same exercise.”

    最初に答えを書いてしまうと、どんな患者相手にもまず試すはポジションAです。このポジションでは、歩行時に左足で身体を前に押し出して、右手を前・上方に振り切った状態(=右立脚中期)からエクササイズが始まるんだ、とイメージするとわかりやすいかも知れません。ここからPropel (前進)するために次にすべきは右腕を振り下ろし、後方に振り切ることですよね。同時に左腕も前に振り上げれば、体幹の右回旋・骨盤の左回旋と一緒に右足のpush-offが起こり、左前方への体重移行が可能になります。

    平たく言えば、トライセップス・カールズはこの右腕の「振り下ろし始め」を練習するエクササイズなのです。エクササイズ開始時のポジションでは右肘と右肩は共に屈曲位にあり、上腕三頭筋をisolate(隔離)するのに最適と言えます。肘と肩、両関節で伸長位に置かれたこの筋肉を、肘伸展を通じて収縮させることで「腕の振り始め」に真っ先に上腕三頭筋にスイッチを入れる感覚を体得できた人は、そのあとの「右腕の後方振り切り」はモーメンタムと広背筋らの協力を得て比較的楽に、自然とおこなえるんだということに気が付くかもしれません。

    And here’s the longer-version of the answer. Everything we do can be applied into various phases of the gait – so please picture yourself being in the right mid-stance. Your L AIC pushed you over to the right, you are feeling the right heel and the right mid-foot, and you just finished swinging your right arm all the way forward. Now look at Position A – both right shoulder and elbow are flexed – doesn’t it look awfully similar? If you are thinking this position is mimicking the I-just-finished-swinging-my-right-arm-forward phase, you are absolutely right!

    Now think what needs to happen next. You will need to begin swinging your right arm towards the back as you start to prepare yourself for the push-off phase, and eventually to shift your body weight to the left. The initiation of the right arm swing is essential because, without this, your right arm won’t be pulled all the way back, your right trunk won’t be pulled back, and the right trunk rotation won’t occur. Combined with L AF IR, the back-swing of the right arm is the key for the upper and lower body integration as shown in the picture below.

     (89) Left Stance Interrupted Swing

    **改めて言及しますが、右の腕を後ろに引く、ということはロンがどの講習でも何度も繰り返し強調する、超超超超超重要事項です。右の腕を後方に振り切るということは右の体幹を後ろに引く、つまりは体幹が右に回旋するということでもあります(例: 下の写真参照)。体幹の右回旋は骨盤の左回旋(L AF IR)と対になるべきPRI介入には欠かせない要素です。ロン曰く、「左スタンス時(下写真)に荷重されていなければならない肢がふたつある。なんだかわかるかい?左足と、右腕だよ!」。歩行時に腕を荷重だなんて、その表現の仕方がまたロンらしいですけれど、つまるところ彼は空間把握や自我確立を導く神経的道具として、この状況では左足右腕が真価を発揮しているべきだと言いたいのです。

    And hence the beauty of this exercise. Triceps curls in this position (Position A) is a great way for us to practice the initiation of the right arm swing. In this position, the triceps are elongated through the combination of shoulder flexion and elbow flexion and can be effectively isolated isolate.

    しかし、このポジションで陥りやすいワナは「非常に矢状面に特化したエクササイズであり、上腕の屈曲には腰椎の伸展も伴いやすい」という点です。PRIの基本は適切なポジションで適切な筋肉を使う練習をするところですよね、ですから、患者さんがもしこのエクササイズで呼気(state of exhalation)のポジション、つまり胸郭の屈曲を保てなければ次はAlternate Position(代わりとなるポジション)であるポジションBを試すべきです。

    However, here’s a pitfall of “Position A.” Because performing triceps curls in this position promotes sagittal movements, some patients just cannot help but extend their back. Those individuals weren’t quite ready to truly isolate the triceps and may need to take a step back – and try the alternate position, Position B.

    ポジションBでは同じ歩行は歩行でも腕を縦ではなく横に振りながら、水平面で胴体を回旋させながら歩行してるイメージです。右の腕をぶん、と横にスイングし前に持ってきたようなこのポジションでは腰椎の伸展は格段に起こりにくいばかりでなく、体幹の左回旋が促進され、左腹壁の活性化と左後方縦郭の拡張、そして右肩甲骨の安定が起こりやすいのが特徴です。つまり、こちら(ポジションB)のほうが上腕三頭筋を単独で活性化させる(ポジションA)前に、腹壁・胸郭・肩甲骨と腕との統合をまずマスターしなければいけない患者に適したエクササイズなのです。

    So now look at Position B. You also see the same gait phase in Position B, but the arm is swung to the side (on the transverse plane) instead of up to the front (on the sagittal plane). This arm position promotes the trunk rotation to the left, the better left abdominal engagement and the right scapular stabilization on the thorax, which further secures the right triceps. In this position, the patient will be given the mechanical advantage to remain in the state of exhalation (and thus not to extend the back) while activating the right triceps.

    要約すると、「右上腕三頭筋の活性化にトライセップスカールを用いる場合、最初はポジションAで、もし腰椎の伸展がどうしても起こってしまう場合はポジションBでこのエクササイズをおこなう」ということです。こんな話をロンとしていたら、「こんな質問、アメリカでは受けたことないよ!」と非常にうれしがっていました。日本の方の思考力の助けを得ながら、これからも日本での講習でPRIコンセプトをこれでもかというほど切り刻んでいきたいと思います。アメリカの皆さんもこの回答を楽しんでいただければ幸いです。

    Let me summarize it – “When using triceps curls to facilitate the activation of the right triceps, anyone should try Position A first. If the patient extends the back in this position, try the alternate position, Position B for the better abdominal integration.” I hope that this answer helps y’all, PRI families in both Japan and the U.S.!

    追記ですが、ロンに日本のPRI講習で使っているスライドを見せたら「なにこれ!すごいねすごいね、これも一緒にアップしてよね!」と興奮して大騒ぎされてしまったので、私たちが日本ポスチュラル講習で使ったスライドの写真もおまけに付けておきます。アメリカの皆さんにも、PRIを日本語に訳すのがどれだけ大変だったか、これを見れば少しだけわかっていただけますでしょうか?

    P.S. – I showed this (power point slides that we used in Japan) to Ron and he told me I HAVE to post this photo in this blog. I created some visuals and added them to the slide explaining the importance of the right low trap and right triceps…well, I am sure y’all can read the rest ;)  We will continue to strive to teach high-quality, full-of-fun PRI courses in Japan!

    Circle Explanation: That's the cross-sectional view of the R BC-patterned chest....L lungs are more inflated than R, and the sternum tipped to the R. Orange semi-circles in this diagram represent SAs, and the light-blue lines are the lower traps. I use this diagram to explain how "L SA is rounded yet elongated (= challenged)" and "R SA is shortened yet flattened (= also challenged)" - sort of like obturator internus. Also, this diagram may help visualize how low traps are positioned in the transverse plane. For example, R low trap is shortened in the frontal plane (as shown in the image on the left...the back view), yet it is actually elongated in the transverse plane if you are to take a look at the image on the right (light-blue line)...the opposite is true for the L low trap... and therefore, again, both lower traps are challenged in its own way.

    Dave Drummer, PRC, therapist at The Hruska Clinic shows a unqiue way to improve balloon blowing technique for those people who struggle to find the power to get air into the balloon. This technique, that originated at the Hruska Clinic, is taught as a core exercise through the Postural Restoration Institute and has been adapted and utilized to assist in treating anyone from the geriatric population to college athletics and professional sports teams.  Click HERE to see the video.

    Posted February 26, 2016 at 4:54PM
    Categories: Techniques

    Ron had a chance to respond to a recent email question regarding the respiratory mechanics when doing the left Sidelying Respriatory Scissor Slides. As you might have noticed in the handout for this technique, the respiratory mechanics are different for the left and right sidelying positions. CLICK HERE to learn more about this technique!

    Posted February 26, 2015 at 2:51PM
    Categories: Techniques
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