Science

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

It is always nice to have a home game. Over the last two years I have had the good fortune to teach Myokinematic Restoration on both coasts and multiple points in between. This past weekend I was able to welcome a group of movement specialists to my little mountain town, Missoula, MT.

Revo Training Center hosted the course, and we had a great group consisting of Missoulians, Montanans, as well as representatives from WA, ID, AZ, NM, and TX. We opened the weekend with a discussion of a quote from Mr. Hemingway that is found on page 1 in the manual, “Never confuse movement with action”. We endeavored to appreciate how patterns of human asymmetry dictate the position of the body and ultimately whether the movement elicited by a muscle contraction supports the action we are striving for.

We focused on action around an acetabulum on a femur, on action that is preceded by appropriate position, and on action that requires inhibition of our dominant L AIC patterning. The group had great questions and insights throughout which fostered a running discussion that was not only enjoyable, but added to the depth and applicability of the course.

Thank you to Revo Training Center for hosting and thank you to all the attendees who spent a beautiful September weekend in Missoula. While we may not have been adventuring in the great outdoors, we hopefully all had a chance to expand our view of the human body in Big Sky Country!

Posted September 21, 2023 at 4:23PM
Categories: Courses Science

I had the great fortune to present Cervical Revolution to an in-person and virtual group, hailing from 10 countries.  This course takes the concept of humans’ neurological proclivity for right stance at the pelvis and thorax and carries it up to the neck, teeth, and cranium.
As we know from previous courses, right stance dominance creates complex neuromuscular patterned positions and movements and is heavily influenced by gravity, respiration, and overactive chains of muscles.  We introduced a new chain, the temporo-mandibular cervical chain (the TMCC), which, you guessed it, is over-referenced on the right.

The course was greatly enhanced by:
-    Our in-person attendees, who were instrumental in demonstration of objective tests and treatment techniques:  Lisa Bartels, DPT, PRC; Andrew Consbruck, DPT, PRC; Nate Dickes, PT; Eric Pinkall, PT, PRC; and Kurt Van Kulken, ATC.
-    Kelli Reilly, MSPT; Timothy McVaney, DDS; Nancy Wehner, BSDH, COM for sharing clinical observations and expertise.
-    Our virtual attendees, for thought-provoking questions and insights, most notably Evan Condry, PT; Alex de la Paz, PT; Christopher Lamb, NASM CPT; Peien Lu, PT; Donne Ordile, PT; Locatelli Rao, DPT, PRC; Laura Regan, DPT; and Alek Skorupa, LMT.  To those of you watching in the wee hours of the morning or late at night, thank you for hanging in there and participating in lab.
-    Jen Platt, DPT, PRC, for orchestrating everything this weekend – virtual views, answering questions, providing nourishment, and more.

Attendees gained an appreciation for the brain’s need to sense a new floor – at the occiput on atlas (OA) articulation.  This articulation, when in its proper position, allows the head to remain in equilibrium with the spine below.  Imbalanced left to right sensory processing and motor output occurs when the OA articulation is better sensed and over-referenced on the right side. The very health of the brain may be in peril when we over-reference our right sides too much and for too long.  For example, a “twist” results in the neck, compromising a vital opening for brain: the foramen magnum, which houses the brainstem and “cisterns” for cerebral spinal fluid, bathing and protecting our nervous tissue.

The OA compression-decompression (known as OA flexion and OA extension, respectively) reverberates into the cranium at the junction where the occiput meets the sphenoid.  This critical junction enables vector forces through the cranium to be distributed to the remaining paired bones of the cranium.  When over-referenced on the right, two commonly seen conditions develop at the sphenoid-occipital junction, or synchondrosis: left side-bending and its pathological cousin, right torsion.  

These cranial positions, maintained by the Right TMCC, place the paired temporal bones in a patterned position.  The temporal bones mirror the ilia of the pelvis and should exhibit alternating internal and external rotation, depending on the leg you’re standing on.  The other half of temporal-mandibular joint (TMJ), the mandible, too, is directed and held in patterned state.  Without temporal alternating activity, structures within the temporal bones (think mid-brain and vestibular) are deprived of their necessary compression-decompression cycles that are so vital for nerve function.  Our mandibles may lose their ability to move side to side, a prerequisite for upright left to right shifting when, say, walking.  In addition, alignment of our upper and lower teeth becomes skewed over time and may lead to mal-occlusions, such as cross-bites and open bites, and TMJ disc derangements.  One can now appreciate the need for dental collaboration and intra-oral splints to assist the process of restoring alternating tri-planar movement of the cervical spine (30-30-30) and temporal bones and a sense of alternating floors at the OA articulation.  Doing so promotes nervous system health, resolution of symptoms, and efficient functional movement.

I capped off my weekend in Lincoln with Jen Platt and her family with an awesome experience at the U. of Nebraska Women’s volleyball game. You know you’re in for a treat if 92,000+ fans pack the stadium, as they did the previous week.  Put this on your to-do list the next time you’re in Lincoln on game day.  Hopefully you can snag a ticket!

Posted September 21, 2023 at 3:48PM
Categories: Courses Science

The Impingement & Instability course has been a clinician's course for a long time. And that is even more the case now than ever before. I&I has evolved into an excellent precursor for the PRI Cervical, Cranial, Voice Box, and Forward Locomotion courses. This was very evident in the most recent presentation of I&I, which just happened to be the final delivery of this course for 2023.  

Since it is a Secondary Course, the course has the opportunity to go into several different directions, depending on who is in attendance and the questions the attendees ask. This is one of the primary reasons that each I&I course is different every time it's presented.  

We were able to touch upon content from a multitude of courses, but our focus remained on the value and necessity of both Impingement and Instability as great concepts, which lead us into the value of alternating compression and decompression to increase our ability to become less functionally cortically dominant. Being able to properly manage a system below C7 allows management of issues above C7 to become easier. As a result, we start drawing the connection between the scapula and calcaneus from very, very early on Day One.  

My thanks to Torin Berge, PT, PRC, for his help digest and break down the 4 unique non-manual techniques that are in this course. We were able to have an in-depth discussion about the value of these techniques, which was a treat. My thanks to Nancy Hammond, PT, PRC and Hayley Kava, PT, PRC for their questions and presence. And none of the live-stream would have been possible without RJ Hruska and his direction and production of this course.  It is not lost on us that the live-stream has expanded PRI Nation, and I am eternally grateful for all of those in attendance who live in other parts of the world.

 

If you haven't had an opportunity to attend the I&I course, I would encourage you to do so as every course is different, depending on the movement specialists present. My thanks to all of the movement specialists who were in attendance, and I look forward to teaching this course in 2024.

Posted September 13, 2023 at 6:35PM
Categories: Courses Science

Last weekend I had the honor of presenting Cranial Resolution in Chapel Hill, NC. Although most in attendance had previously taken this course, a few multiple times, several were dipping their toes into this material for the first time.  I was proud, gratified, and extremely relieved that, by the end of the weekend, everyone was expressing an energized and clinically relevant understanding of the functional relationship between the ANS and CNS - and the role that our lateralized cortical and subcortical biases and nasal passages play in influencing what we so often ‘orthopedically’ address. I had the privilege of witnessing the occurrence of serial eureka moments. These were illustrated through the cognitively insightful questions and enlightening discussions that, as one attendee put it . . . were “cathartic.”

The PRI giants at Advance PT, Susan Henning, Jean Masse and Lisa Mangino, who hosted the course, could not have been more welcoming. Their hospitality went above and beyond. I also owe a huge thanks to the incredible avatars who could not have demonstrated the autonomic concepts any better. Jean, for allowing us to use her beautifully neutral system to illustrate how the interruption of nasal flow can immediately and predictably alter one’s sense of ground and gravity (and so dramatically change a SLR test)! Kaisa for demonstrating how someone progresses through the treatment algorithm, including when and how to address an apparent dysfunctional autonomic limitation by effectively using one of the thoracic cranial resolution techniques. And a special thanks to Joe, who let me positionally challenge him to illustrate how, when, and why modifications may need to be made, and what significant gains can be achieved by addressing the autonomic nervous system.

I finished Sunday more excited than ever to be teaching this material. I cannot express how grateful I am to the institute for having the confidence in me to translate and present this aspect of Ron’s monumental work. To me, the ANS is where PRI begins. I honestly feel that gaining a basic grasp of how the ANS integrates with the CNS makes all the other courses so much easier to comprehend. It explains why things are happening and illuminates (and fortifies) the importance of the positioning, referencing, and sequencing of each and every one of the steps that are so methodically spelled out in all of the non-manual techniques.  

This was my first time teaching this course solo and I will be eternally grateful to everyone who attended for making it such a successful and meaningful experience. The dynamic of this group was incredible.

Posted September 5, 2023 at 8:15PM
Categories: Courses Science

I had the great pleasure of teaching Myokinematic Restoration in Lincoln, NE on August 11th and 12th. It was two days of soaking in an attitude of gratitude to be able to discuss something I am passionate about to a worldwide audience. United States, Australia, China, and Canada were represented with clinicians spread out all over the county from Florida to Washington and everywhere in between.

I also had the great privilege of attending the musical Hamilton in Lincoln with my PRI Family on Friday night. Hamilton's message of hope, perseverance, and coming together resonated well with the Myokinematic themes of persevering through our right biasness and getting appropriate muscles to come together to balance our imbalances.

We had a fantastic in person audience who didn't want to loose their "Shot" at learning and appreciating patterns and positions. Nicolas took a break from his final semester of PT school in Florida to remind us the learning is "Non-Stop" and gave us a great student perspective on the material. When he becomes a Physical Therapist in December he will remember to never be "Satisfied" unless he is integrating test and retest principles of A-B-A evidence based practice.

Michael attended his 14th PRI class and gave us a fantastic historical perspective as he has known Ron Hurska since 1994, knowing that "You'll Be Back" for more as we are traveling on our PRI journeys. Matt, a former employee of the institute and Ron's "Right Hand Man", spent time with us before he begins his role as a P.A. next week in Omaha.


 
We had an absolute gift in Allison who was our primary avatar for demonstration. She helped us learn that if you don't feel the "Burn" of a left IC Adductor and left anterior glute med you may be "Helpless" managing left stance phase of gait with a pathological left hip capsule. She was able to "Blow Us All Away" by getting a 4/5 Hruska Adduction Lift score at the end of Day 2 by being such a great PRI demonstrator for the camera.

Gavin brought high level thought process and questions and taught the class to "Say No to This" overactive right adductor we often deal with. Cas's left hip wanted to be in "The Room Where it Happens" of left AF IR to assist in reducing torque at the knee, while Joshua was excited for "What Comes Next?" as it relates to AF position and shoulder function and control for his baseball players at Baylor.

Chase and Kyle were kind enough to sit up front and "Wait For It" until Sunday afternoon for treatment techniques based off the Hruska Adduction Lift Test so that their neurological patterning and need for left stance and right swing could "Stay Alive".

Wyatt thought "That Would Be Enough" after the facilitation techniques, but was kind enough to "Take a Break" at the end of Day 2 in order to demonstrate a proper Plantar Flexor inhibition in the All 4 Belly Lift Walk.

In the end, I think all of us realized that the "World Was Wide Enough" for more knowledge and integration of PRI concepts, appreciating asymmetries, patterns, and positions. "Who Lives, Who Dies, Who Tells Your Story" may depend on our ability to efficiently assist our patients and clients in managing out right and left sides of our body.

Big thanks to everyone attending the live stream and contributing to the discussion with their questions and attentiveness. Special shout out and thanks to RJ for running such a smooth two days juggling the technology, answering and facilitating questions, and being such a positive influence for the Institute.

Posted August 23, 2023 at 2:37PM
Categories: Courses Clinicians Science

I had the distinct pleasure to have the opportunity to travel to Munich, Germany, and teach the PRI courses Myokinematic Restoration and Impingement and Instability. It was a very rewarding experience to see how the science of PRI is received in another part of the world. And it was a great experience to be immersed in a different culture for almost two weeks.  

The first course presented was Myokin. We had 25 people attend the course from varying parts of Germany as well as neighboring countries Spain, Slovakia, Slovenia, and Austria. This was a unique experience because usually when Myokin is presented, 90% of the attendees have never taken a PRI course before. For this course,19 of the attendees had taken multiple PRI courses, as well as Myokin previously. I made a point right away to make sure we ensured that those who had not taken a PRI course previously had a great experience.

As a result of so many of the attendees being PRI veterans, we had many, many great questions and discussions. And while some of questions pertained to other PRI coursework, we were able to stay on course and continue to meet the needs of those who were new to PRI. I'm not sure I have ever taught a PRI course where every single attendee asked at least one question. But that was the case with this stellar group. Such energy and interest in the science an application of PRI concepts!

The second course we presented was Impingement and Instability. Because this is a Secondary Course in PRI, everyone had taken several PRI courses previously. Again, this led to lively discussion and questions. We were able to use the concepts of I&I and start building a bridge between the Primary PRI courses and the other Secondary and Tertiary PRI Courses. I&I is an ever-evolving course. It was immensely rewarding to have the opportunity to help these attendees in their PRI journey to better understand and apply the science and concepts of PRI.

 

My eternal gratitude to the Lindbergs Academy for hosting us for back-to-back weekends. Their hospitality was top notch. My thanks to Julia Felbar, FRA, Maria Sowmardi Jauker, FRA, Angelo Gorsch, PT, and Dr. Hooman Skaraztavakol for their questions and interest in all things PRI. It was awesome to have Kazu Nishimura, PT, PRC with me and helping with lab during Myokin. Spending time with Kazu was such a blessing, and his contribution was immensely appreciated and valuable to me and the other attendees.

It was an experience I will not forget. Those in attendance were lovely and soaked up the material. PRI is global. And the science does translate to other countries and cultures as we are all humans and we all have patterns. Thank you, Munich!

Posted August 16, 2023 at 3:40PM
Categories: Courses Science
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