Techniques

A few days before I was to present Postural Restoration, I reflected back to the number of times I had taken this course during my 17 year journey in PRI. We were fortunate to have nine movement specialists taking their first PRI course, and with the exception of two attendees, no one else attending the course had attended Postural Respiration previously. Since it was almost everyone's first voyage into this course material, I wanted to really focus on two topics that had escaped me in my previous attendance of this course: what/why/how surrounding Superior T4 Syndrome, and why do the R low trap/tricep and L serratus anterior/low trap hold such high significance in PRI for management of the BC pattern.  

We had lively discussion surrounding human asymmetry and how that asymmetry feeds into patterned respiratory mechanics, as well as the potential detriments of patterned breathing. Once we had the foundational concepts secured, we could move into the prevalence of the R BC pattern and what tests we could use to determine if the R BC pattern was overactive. Using the algorithm found on page 48, we were able to walk through manual and non-manual treatments, as well as spend a lot of time defining why and how Superior T4 Syndrome presents itself, and how to uncover the presence of Superior T4 Syndrome as a pathological, or "phony", respiration strategy.   

Algorithms are used frequently in PRI as a means to learn and improve ones ability to apply PRI concepts, particularly if the learner is new to PRI and the science behind it. Again, using page 48 as a backdrop, we were able to progress through why the R low trap/triceps is a necessary piece of R BC inhibition, but also why the L serratus anterior/low trap are necessary for security after proper management of Superior T4 Syndrome. We were also able to spend time in lab going through several of the non-manual techniques that support the manual techniques presented in this course. Since inhibition is such a huge part of PRI, we were able to focus on several non-manual inhibition techniques surrounding those individual who present with B PEC or B BC findings.

Being able to present this course in the clinic I work in with fellow PRC, Donna Parise-Byrne, was great. It was also rewarding to have fellow PRC, Jill Maida, in attendance as well. My thanks to Gail Trubow, Brock Mitchell, Anne Farkas, and Heather Pappas for their help during labs and asking great questions. We really had many great questions and dialogues over the course of the weekend. Thank you to all who attended the course as we took every precaution possible to ensure everyone felt safe, while still receiving the course content at a level that each individual needed.

Posted September 14, 2021 at 3:36PM
Categories: Courses Techniques Science

For many of us who have taken PRI courses over the years, Lincoln, Nebraska, often becomes a home-away-from-home. This has been particularly true in the last two years with the inception of PRI live-stream courses. It has been such a blessing for PRI to reach so many people via live-stream. In total, we had 78 people attend Impingement and Instability, with 20 of those having attended the course in previous years. However, only 5 individuals had attended the new and upgraded version of I&I before this weekend. Having six people live and in person was such a gift. It was an honor to have 11 PRC's and PRT's in the audience as well.

This course is a clinician's course, and we are able to make a lot of connections and links between several PRI courses in one weekend. Yes, this is a dense course with a lot of great information. The advantage of the live-stream is that all the attendees received the recording of the course for two weeks to listen to the material again. The ironic part of the "new" version of I&I is that a lot of the material is unchanged; the context and neurological links between the floor on the ground and the "floor" under the scapulae are significantly changed. This allows the attendee to further appreciate the "why" and "how" behind non-manual activity application and selection.

   

This course is dripping with neurology and is a gateway for the attendee to attend the PRI Forward Locomotion Movement, Cranial Resolution, Occlusal Cervical Restoration, and the new Voice Box course. We build off the three PRI primary courses to delve into how to apply those basic concepts using a higher level of decision making based on a neurological sensory framework. Hopefully, we were able to provide the attendees with that appreciation and help prepare them for future PRI courses.

My thanks to RJ Hruska for orchestrating the entire weekend. He was very helpful to me, and made my job much easier. We got so many great questions over the weekend, and we were able to answer most, if not all, of them.  And having six people live in the building provided an additional layer of questions and feedback. My thanks to Benjamin Sandman for his help with our calcaneal sensorium demonstration. He said it perfect when he said he was surprised at how much better he could sense the ground under his L calcaneus even after the demonstration was over.  

It was truly and honor to have attendees from 14 countries. It is amazing to think that this technology exists, and I am very thankful that fellow movement specialists were willing to spend time with us, even from the other side of the world. Even though most, if not all, of the 72 of the live-stream attendees were in their homes, it was comfortable for me as well to be in my home-away-from-home and spend some quality I&I time with so many like-minded peers. 

Posted August 26, 2021 at 4:19PM
Categories: Courses Techniques Science

This workshop was a first for Jen Platt and I. Opening the workshop with discussion on corollary consequence, correspondence and compensation allowed us to “look” at the top-down influences of PRI Corollary Movement in each of the 12 secondary and tertiary techniques that Jen chose for us to cover. She did a great job in organizing these techniques, laying them out and selecting techniques that offered the attendee a wide perspective of application. Normally, we do not list testimonials after a course.  (You can find testimonials by courses by going to the ‘Programs and Courses’ site on our website).  However, after reading the feedback that Hannah compiled, I felt it would be helpful for those who may be interested in taking this course in the future, as well as to read what the ‘first-time’ attendees had to say about it.

 “I have already listened to at least 60% of the course material. I cannot tell you how much it helps to have the content available to go over again. This course put so many things together in regard to patterning. There were so many lightbulb moments into why things may fall apart for the patient at home with their exercise program because of the brain influence in regard to patterning. The word sense is so different than finding and feeling. Sensing something different in the body especially when sensing one thing can help the patient sense another area is HUGE in regard to making a program successful. Walking away from this course has had one of the most dramatic effects on putting the whole picture together, especially with the ability to go back and review it again. I hope that you can continue to offer the courses on zoom. I also wonder if any of the other recorded courses that were offered through zoom could ever be available as a take home course. It is nice to have that available as an option. Also wondering if Ron was ever going to put all the 33 corollary exercises together now that we understand the corollaries. I know that the other exercises are from other courses but we never had the corollaries with them. Thank you again for everything you all do!!!!”

“This course will allow me to progress all of my clients over the coming months and was a fantastic guide in sensory integration that I felt was a missing puzzle piece.”

“I have learned it in neuroanatomy but only in an abstract manner - now it becomes more meaningful for my work. Thanks!”

“I've always known the importance of multi sensory "sense", but this took my understanding a step further for sure”

“It feels like this course was a missing puzzle piece in my application. This made it much more straightforward to progress and cue clients”

“1. Greater confidence with technique selection 2. Deeper understanding & appreciation re: critiquing and cueing for a clients understanding of both positional and integrative sense”

“This course material will likely allow me help clients move to a higher level of motor learning much more efficiently and with less cognitive load (corollaries > references) especially in a fitness setting, but obviously also with rehab clients.”

“This is one of the MOST relevant courses offered by PRI to my area of practice in my opinion, moving away from more "attention intensive" movement practices towards integrated sense of corollaries will allow all of my clients, from pro athlete to rehab, to experience and sense the task at hand rather than trying to juggle a more cueing intensive task.”

“Thank you again for supporting the growth of PRI nation. We love you and this course was fantastic. When entering a black hole, one needs a guide named Ron Hruska. I can feel the effort, the labor of love, the hard work that has been put into this course (and all other courses). Thank you PRI team for continuing to lead the way. You inspire me to be better. Much love from Alpine PT in Seattle.”

I could not give this course, the way it was presented, without the direct input, production, and guidance that Jen provide both me and the audience. So grateful for her many roles she plays in this Institute, but now, because we know each other so well and the overall intent so well, the delivery and message is seamless, sincere and solid. This truly was the Institute’s first multisensory movement workshop that reflected the strength of the corollary movement sense needed for natural cognitive processing built around vestibular-ocular reflexive correlations. We also could not have made this workshop the ‘virtual reality’ workshop it was without the live presence of Amy Morris, PT, Phil DeNigris, CSCS, Rua Gilna, CPT, SFG1, PN1, and Dave Drummer, DPT, PRC. Their patience with my Socratic style of teaching and their willingness to objectively communicate what they felt, sensed, experienced and struggled with made multi-dimensional processing understandable and appreciable.

Thank you again for coming to Lincoln and participate in the manner in which each and every one of you did.  

Posted June 22, 2021 at 8:31PM
Categories: Courses Techniques Science

It was a wonderful weekend teaching a Pelvis Restoration as a “hybrid" course. Teaching to professionals attending the course in person and through Zoom was exciting and humbling. Thank you to everyone who attended. Your desire to learn and passion for the Science of PRI is amazing. We had great questions and interaction through both forums this past weekend. We had energy. We had passion. We had a desire to learn. I felt an improved understanding of the “external” support of the pelvis with tri-planar movement (especially the frontal plane) was understood at a deeper level for improved regulation of internal pressure and airflow. I felt course attendees appreciated the PRI objective tests and how they can assist them clinically to improve PRI Non-Manual Techniques selection for patient treatment. I also felt in insight was also gained in not only “re-positioning” the pelvis but then “re-training” that pelvis for left stance and right swing with our goal to “restore” for reciprocal and alternating movement.

We were “world-wide” this past weekend with course attendees from all across the U.S. and internationally. Thank you again for all that came. It was great to teach as it makes me a better clinician.

Posted April 21, 2021 at 4:36PM

After almost a year to the day of the country shutting down, this course marked a refreshing beginning to some normalcy with teaching PRI Myokinematic Restoration again. We had at least 50 participants virtually with attendees in and outside of the U.S. ranging all the way from Canada, Slovenia, and the UK. We had 9 in person attendees that made the trek to Lincoln and served as the “models” for our myokinematic lab portion.

We began the first morning with didactic material learning all about the patterns of the L AIC. This  included non pathology and pathology discussions in relation to the compensatory demands of the femur in the acetabulum. Respiration demands, underlying neurology and asymmetry helped to shape and understand the reasoning behind the L AIC pattern.

The weekend concluded with an ample amount of lab and hands on time, learning to assess position of the hip, compensatory findings, and frontal plane performance testing with the Hruska ADDuction test and Hruska ABDuction test. The attendees then went through myokinematic techniques to restore and retrain pathomechanics of the pelvis.

We had several thought provoking questions and the enthusiasm was great from the group and could be felt even virtually!

Posted April 1, 2021 at 4:58PM
Categories: Courses Techniques Science

The Midwest started warming up to a balmy 22 degrees on the way to reaching almost above freezing on Saturday morning for the first Postural Respiration Live/Live Stream course this year. There were seven live attendees some of whom drove over 5 hours on slick and icy roads to take their first Postural Respiration course while almost 40 others from all over the country, and even internationally from Slovenia, attended this course. Ron and I had a discussion the day before I taught and it was a real inspiration to be able to emphasize to the new students the concepts of not just rib movement and diaphragm function but the importance of pressure and flow inside a chest wall and how that not only affects position and posture but every system in the human body. We spend a lot of time on the orthopedic consequences of neurologic patterns in this course but it is what is inside the chest wall in terms of how we direct air into chambers and how that affects whether ribs move up or move down, and torsos left or right as a critical element of Postural Respiration and all PRI courses. The Posterior Mediastinum has become more of an emphasis than ever before along with the role of the first rib in initiating the lifting of the rest of the ribs below it during respiration. This class really got the relationship between the right apical chest wall and the left posterior mediastinum with the role of how important inhibition to these chambers of the chest wall is.

One of the non manual techniques we focused on was the Standing Serratus Squat and the importance of learning how to perform it. This is one of PRI's more difficult positions to competently perform and that there are often precursors, especially with reaching and squatting techniques, to help facilitate this most important technique. Just because it is challenging to perform doesn't mean that students shouldn't master it and then teach their patients. This is one of many techniques that help strengthen an individual's diaphragm and give them a "sense", which was one of the key words of the weekend, of thier ribcage moving backwards!

And for forward locomotion, that is, to move forward, one most move a ribcage back! Questions came in fast and furious which is a delight for instructors since it helps to gauge where the attendees are in their understanding and to reinforce and repeat concepts that are needed to provide a good foundation to understand this course well enough to begin to apply. The students in this course were helping teach Postural Respiration by their re-states and questions with energy and enthusiasm. Shout out Meghann Vanslager and Jennifer Bacon who drove from Kansas then had a 5 hour drive home with work the next day! Thanks to Ian Katanec for being on a 9 hour time difference in Slovenia and everyone else that spent their weekend with us as over half of the attendees that were either brand new to PRI or first time attending Postural Respiration. Most of all, thanks to RJ Hruska who was my wingman performing audio and visual expertise with changing camera angles for lab and keeping things going smoothly during these virtual attendance times.

Posted March 3, 2021 at 9:07PM
Categories: Courses Techniques Science

There are four kinds of documentation that most of us use to change our behavior:  
1)  Learning oriented tutorials.
 2) Goal oriented how-to guides.
3) Understanding-orientated discussions.
4) And, information-oriented reference material.


Each of these four types of documentations usually have instances within the document that refers to related information elsewhere in the same document. This is important as it forms a network structure of relations that exist between different parts of data, dictionary-internal as well as dictionary-external. If the cross-reference mechanism is well designed, visibly or technically, the reader, and in this case, the course attendee, will be able to follow each and apply ‘cross-reference’ event, to the referenced content whether the content is presented visibly or technically.  


The last example, of the four listed above, enhances usability and application of content in each of the PRI Non-Manual Techniques. Documentation or description that identifies direct reference and referent sites of consistent interest; is required so documentation that indirectly implicates cross references from these and other discrete or unconsidered sites can provide content-strategies to meet the desired needs and expectations, from both the provider and the participant.


As the author of these techniques, and as the author of cross-referencing design associated with each technique, effort to ensure that location and content of the target of the cross-reference in each technique needs to be consistent, regardless of the aptness of the provider or the participant.  


These opportunities to provide my reasoning behind each of the techniques, that were selected by this course’s participants, are not exceeded in any other course offered in PRI. Therefore, the guidance I offer to answer questions on the ‘why’s, ‘when’s, ‘who’s and ‘what’s regarding each technique’s reference’s, referent’s, and cross-reference’s content, is an absolute unique opportunity for both the author and the attendee seeking behavior modification through documentation that is resourcefully dissected at a level that is unsurpassed in this Institute.  Each technique (documentation) dissection experience is truly one of the most rewarding things I have done in my life.  And I am grateful.

 
I want to thank Dan Houglum, Torin Berge, Dave Drummer, Jen, Hannah and RJ for their assistance in making this course so enjoyable to teach and apply to “real” life limitations and likenesses.

Posted February 4, 2021 at 4:18PM
Categories: Courses Techniques Science

What a fun experience it was to be able to connect with the 37 participants from last month’s live stream pediatrics course! With the new format, we were able to reach attendees in Japan, Canada, Poland, and India! James and I also brought the PRI science to 6 new (“VIP”) clinicians! Further, the audience was made up of yoga instructors, OT’s, personal trainers, and of course, PT’s. The participants seemed to enjoy the many videos of PRI treatment with children of all ages and all skill development levels. We were even able to do some demonstrations with kids! A special shout out to Jen Platt, Nancy Hammond, Libby Lostetter, and anyone else who let us use your children for a spotlighted kid demo! And the adult attendees who participated in demonstrations were also greatly appreciated as it brought a nice richness to the learning experience.

I’ve since been in touch with some of the attendees to see what they thought about the new format and a common comment is how nice it is to have the recording of the class for 10 days following the weekend to go back and review and refresh! It worked out so well, we are planning another Live Stream for August 28-29, 2021 with hopefully a couple in person courses as well. Check out the schedule, and tell your friends! Lastly, huge shout out to co-presenter, James Anderson, producer, RJ Hruska, as well as to Hannah Hankins and Jen Platt for all of the scheduling, manual edits and production, technical help and behind the scenes planning that putting a course like this together requires! And last but not least, thanks to Ron Hruska for the genius foundation! Hope to see you in 2021!

Teaching the Geriatrics Course via live-stream was awesome for a number of reasons. First, it was great to be in Lincoln Nebraska in person at the Postural Restoration Institute. You take something like that for granted when travel and human interaction is restricted the way it has been. I love being at the institute and associating with their staff because it reminds me of coming home to good friends and family. So good to see Hannah, Matt and Jen and to spend time getting caught up with all the fun events in their lives. It was also super great to have Jen’s expert assistance as the producer of the entire course experience. I couldn’t have done it without her and the amazing AV technology and teaching environment available at the institute. Thank you so much for ensuring that things went so well for the course attendees.

A second reason the course was awesome is that these live-stream courses give the instructor more time to discuss and practice the actual exercise techniques. The break out lab sessions to practice testing and treatments in traditional live courses become individualized learning sessions that can be taught very efficiently via live-stream. Not only are the tests and treatments taught more efficiently, but the recording of the course is available to the learner for further review at home after the course to solidify the learning experience. So I was able to teach, demonstrate and guide the course attendees through more of the actual exercise techniques with this new learning format than I am normally able to.

And the last reason the course was awesome was the actual course attendees and the things they had to contribute. We had a broad range of professionals from all parts of the US, across Asia and Europe. We were all together at the same time, irregardless of time zone, and shared in one another’s learning. There are too many of you to thank, but please know your attendance at the course and your contributions made the experience much better for all of us. The questions you asked via live discussion and via chat submission, together with the many comments shared throughout both days made the course especially fun for me. Thank you everyone and I hope the additional review days after the course proved to be a strong addition to your overall learning.

Posted July 28, 2020 at 8:43PM

We had a great time last night on our first "PRI Breathing Mechanics in COVID Times" free webinar! We had around 250 people join us, and we look forward to hopefully growing this number in the coming weeks. If you missed the live webinar last night, you can access the recording on the Webinars page on our website. A PDF handout of the PowerPoint slides is also available on the Webinars page.

Below is the 3rd (of Ron's Top 10 Chest Wall COVID Breathing Techniques that we will be discussing further on these webinars) non-manual technique clinical reasoning break down. We invite you to review and try this technique a few times over the next week, as we will be discussing this and more on next Tuesday's webinar.

Standing Supported Left Glute Push

Let’s start with the title of this PRI Non-Manual technique.

This “standing” technique requires wearing shoes that provide good heel counter support, arch support and a toe box that will allow the toes and forefoot to easily spread out in the shoe. You will also need to push a table next to a wall to prevent it from moving forward as you push it forward with your hands (or you could use a kitchen or bathroom counter in your home). This PRI technique is designed to place one in a 'Valsalva-like' maneuver position between the exhalation and the inhalation phases, without blowing up a balloon and holding the expelled air or while pinching off the nose. 
 
In this technique, the force applied by the table and floor allow the tongue and mouth to close off the airway and properly use the abdominal muscles and the diaphragm to exhale and inhale without engaging the neck or back under moderate pressure created by closing off the pharynx with the pharyngeal muscle and the larynx/trachea with the tongue muscle. This voluntary control of the abdomen is maintained during the entire technique, without having to think about how to “hold” the contraction of the abdominals during both phases of the respiration cycle. It is a wonderful way to teach someone how to inhale with good opposition to the diaphragm so that its effectiveness on opening up the mid and lower chest wall is maximized, as the subconscious effort of maintaining abdominal stabilization is minimized.

The “support” of the upper extremities, offered by the stable table or counter, also allows one to lift the right leg up and the right foot off the floor as the left glutes "push” the body forward to further stabilize the lower trunk and pelvis as the right hip is raised up. This activity co-activates more integrative assistance from the right hip flexors, the right lower trapezius and long head of the triceps and left abdominal wall. When all said and done the tension and internal pressure created by the lengthened anterior shoulder and hip flexors enables one to breathe with the diaphragm under high compliance and forgiveness of lateral and posterior chest wall tension.
 
This technique is, therefore, a good technique because the lateral, posterior, apical and base surfaces of both lungs can expand easily upon diaphragmatic contraction, secondary to chest wall compliance and the gravitational force displaced on the abdominal contents. The internal organs fall anteriorly and off the front of the thoracic and lumbar spine. It is also, an excellent postural drainage technique for the posterior lobes of the mid to lower lungs, preceding the standing positional induced coughing that more than likely will follow with those who are experiencing difficulty breathing because of fluid-filled alveolar sacs.

Here are some additional comments about the steps that follow the title and pictorial examples, along with the reasoning for the procedural step.

Stand with your feet parallel to each other and directly under both hips. While keeping both heels on the floor lean forward to place your outstretched hands on the table in front of you. Now move your feet back so that your back is close to being parallel with the surface your hands are supported by, and the floor or ground you are standing on. You should feel a gentle stretch through the back of your heels and lower legs. Maintain heel contact with the floor or ground surface, especially on the left side.

These first two steps are important because you are now in a position where anything you do from this point on will foster more uniform opening of the entire circumference of your chest walls. This position, as reflected by the person in the second photo, also indicates that the attachment sites of the latissimus muscle on the side of your chest wall is in its lengthened state, as both of its attachment sites are distracted from each other. In other words, the arms are moving away from the mid to low spine, as the spine is more rounded than “U” shaped in this position.

This is an optimal position for the diaphragm to be in for coastal or mid to lower rib cage expansion upon contraction. It also is a great position for one to sense the abdomen lift the abdomen up against gravity and feel how one’s own body weight can serve as an element for abdominal strengthening with optimal diaphragmatic influence on the chest wall mechanics for ideal ventilation and perfusion at the anterior base of each lung’s lower lobes.
   
Shift your left hip back in Step 3 to engage your right hand as a pusher and to sense, activate, and lengthen your left outside hip muscles in preparation of using these same muscles to lift your right foot a few inches off the floor. While keeping your back parallel to the floor, in other words do not let your mid back sag toward the ground, lift your right knee up and your right foot off the floor/ground. The weight of your body should now be felt through both wrists and hands, your left hip, your abdominals especially on the left, (if you feel your right abdominals more than the left, you need to push more with your right hand into the table you are supported by) and the entire bottom of your left foot. This ‘highly integrated contracted’ position replaces the need to do this activity by blowing up a balloon correctly using PRI methodology.

Now hold this position as you take a deep breath in through your nose as you “push” with the above musculature and reference sites, outlined in Step 3. Then blow out through pursed lips or your mouth slowly by pushing slightly more with above muscles and sites. The most important consideration in Step 4 is to transition slowly from exhalation to inhalation with a “pause” (Valsalva pause) in between the exhalation and inhalation phase, without losing the “push” from your body while breathing in this reciprocal state of glossal sealing and pharyngeal closing during respective inhalation and pre-exhalation reciprocal breathing.

Stay tuned for more discussion on Ron's Top 10 Chest Wall COVID Breathing Techniques on our upcoming webinars and blog!

Posted May 7, 2020 at 12:15AM
Categories: Techniques Science
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