Science

As we gear up for tonight's first webinar, below is Ron's breakdown with clinical reasoning for the second technique discussed in the free PRIVY trial video titled "Integrated Pulmonary Compliance". If you haven't yet checked out this free video, it is a great introduction to the webinar searies that begins this evening. Stay tuned, as we will be discussing more PRI non-manual techniques related to chest wall compliance in the coming weeks on our "PRI Breathing Mechanics in COVID Times" free webinar. To register for tonight's first webinar, please CLICK HERE!

Standing Wall Supported Resisted Ischial Femoral Ligamentous Stretch

Let’s begin with the title of this PRI Non-Manual Technique.

You will need to purchase approximately 5 to 7 feet of medium resistant therapeutic tubing. You can find information on the PRI Website under “Products” (and then click on "Materials") and purchase from Stretch Well, green colored medium elastic tubing. The Stretch Therapy Deluxe green tubing has hand handles included. However, you can perform this activity without band resistance, by placing your hands on the edge of a chair that easily slides forward as you reach forward. You will also need to find a book that is approximately 1 to 3 inches in height, at least 12 inches long and 7 to 10 inches deep.

When performing this activity in “standing” you will be able to use the floor as an anchor and a “wall” as “support” for distraction of your lower and upper posterior chest walls.  [This position on the floor and on the wall will allow you to primarily sense and focus on mid to low back lengthening as the accompanying posterior and lateral chest walls expand]. As you move your arms forward in performing the following outlined activity, the “ligamentous” soft tissue, including your accompanying hamstring muscle, that attaches to your “ischial” seat or sit bone and to your “femur” or thigh bone, more than likely, will feel tight. This tightness and/or “stretch” is the result of your abdominal wall of muscle contracting, as you reach forward with “resistance” from the therapeutic bands in your hands and the bands of elastic, soft tissue attached to your “ischial seats”. Therefore, the floor you are “standing” on, the “wall” your low back and hips are resting on, and the bands that are looped around the hands or the friction from the legs of the chair the hands are resting and pushing forward on, are all providing the forces needed for your left and right diaphragm leaflets, inside your two respective chest chambers, to open and expand and stretch both the inside and outside chest walls. This expansion, under the above guided resistance, allows one chest chamber to ideally open better when closure of the other chest chamber occurs, and vice versa. This PRI Chest Wall technique, minimizes pulmonary or lung static function, maximizes elastic tissue recoil of the chest walls, equalizes pressure when all four extremities are alternating or involved with lifting, and assists with optimizing immune responses.  

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 with your hips directly over your feet. Place a book that is 7 to 10 inches deep between the door and the back of your heels.  The back of your heels will help you sense the wall you are about to touch with your low back and hips. This heel sense, together with the sense of the floor you are standing on, will provide the anchoring your abdominal wall will require for upon contracting as you reach forward with your hands to relax and open your posterior chest wall and or back muscles.   

By also anchoring therapeutic tubing in the door at a height slightly above shoulder level, and around both of your hands, you will begin to sense the need to engage your abs, lower your head and shoulders and move your upper chest walls forward as your mid back and chest walls simultaneously move back. The same type of activity will occur if you place your hands on the top of a chair or stool on wheels.  

If you have difficulty sensing your abdomen muscles contract and it is difficult to round out your middle to lower part of your back, your anterior chest wall is too elevated.  Place a rolled-up towel between the upper part of your thighs, as high as you can get it. This rolled-up towel should be wide enough so that when you bring your knees together your knees will not touch. By placing this bolster between your upper thighs and squeezing your knees toward each other, your back muscles will relax and your ligaments at the back of your hips will be more easily stretched out as you lower your body with your muscles that attach to the two ischial seats. These muscles are called your hamstrings and will enable you to maximize your diaphragm’s influence on chest wall mechanical activity that will enable better upright perfusion of oxygen into posterior and lateral lobes of the lungs, that may be ‘locked up’ because of over contracting back muscles used for postural stabilization. Therefore, by pulling your two hips apart with the bolster between the knees, that are moving toward each other, you are essentially decompressing not only the pelvis that lies between the hips, but also the spine that lies between both chest walls. This decompression of the ‘chest wall’ spine decongests the lung tissue associated with congestion of lung tissue (alveola) that is incapable of opening because of spinal compression. By squeezing the bolster between your thighs, as you are doing with this PRI technique, you are essentially reducing the ‘squeeze’ on the posterior lungs.  

To place as much low back on the wall that you can, in Step 4, you may want to slowly and carefully bring your knees slightly forward as you are exhaling through your pursed lips. Try to keep your heels and feet flat on the floor as you are reaching forward with your outstretched hands and arms. Many of you will not be able to place your low back on the wall, and may only be able to sense your rear on the wall, as you attempt to round your back while reaching forward with your arms and knees as your body gently lowers. The most important thing about Step 4, is to reach with your hands and arms, resisted or unresisted, while you “round” your mid to low back, during this exhalation phase of movement.

Step 5, is where the magic happens. The magic is when your inhalation effort through your nose, after performing Step 4, continues to open up the entire chest wall cavities on both sides, along with all the underlying alveolar tissue in your lungs. The position you worked so hard in achieving is now serving as a platform for diaphragmatic inhalation without resorting to muscles that over compress the posterior lung tissue. Those muscles lie both directly in front of your neck and in the back of your chest walls.  
As you continue to breathe in through your nose and out through your mouth, or through pursed lips, let the air move your chest. Assist this chest movement by drawing in the air (Step 7) and compressing it out by reaching further forward with your arms, as the weight of your anterior body opens up the posterior body (Step 8).

The resistance provided by the forces through the arms, the wall and the floor allow you to receive the floor, the wall and the space in front of your arms as the space inside of your chest walls expand and elevate your body; as it is being lowered gently, softly and peacefully to the ground. When you stand up, in Step 10, focus on maintaining “push” through the heels, the hands and the inner thighs as your entire chest remains opened, relaxed and uncoiled. Breathing should be effortless at this stage, because of true postural support offered by muscles that keep the posterior chest walls elevated, and the anterior chest wall opened and lowered, for maximum lung perfusion and ventilation.

Posted May 5, 2020 at 2:01PM
Categories: Techniques Science

As an introduction to our free "PRI Breathing Mechanics in COVID Times" webinar series that is debuting tomorrow, we invite you to view a free trial privy episode titled "Integrated Pulomonary Compliance". During this privy episode, Ron and I discuss lung compliance and two techniques that are incredibly valuable for maximizing pulmonary compliance during this COVID-19 pandemic. As promised, Ron has broken down this technique and provided further reasoning behind the title and each step of the technique below. Stay tuned for the second technique, which will be posted to our website tomorrow. And, don't forget to REGISTER for week one of our free webinar series, which debuts tomorrow at 6pm CT.

Standing Supported Right Step Around with Right Quadratus Lumborum Stretch and Right Apical Expansion

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

You need to be in a “standing” upright state, preferably with good arch and heel cup supporting shoes on, as you hold on to a “supporting” dowel, pool stick or some type of rod in your right hand. The right hand needs to be in a position where the palm is down and the thumb is up, as your hand is wrapped around the stick. [This will position and assist your “right apical” or upper chest wall into an “expansion” state, or more open state, which is one of the desired area that this activity will focus on.] The right foot will “step around” the left foot to assist in lengthening, or “stretch”, a muscle that is connected to the top of your iliac crest or hip bone, the last rib of your rib cage and the first four vertebrate of your lower back. This muscle, the “right Quadratus Lumborum”, often becomes very short, tight and restrictive when your upper chest doesn’t turn or rotate to the right as your lower chest turns or rotates to the left. This muscle also can limit lower trunk and hip turning or rotation and forward movement to the left at the low back; as a result of the backside of the last right rib being held down by this muscle. [This right low back area will be the other desired area you will be focusing on.]

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 with your hips directly over your feet. Place your right hand on the dowel or stick at right shoulder level.  Place the dowel’s or stick’s other end on the floor at approximately arm reach in front of the right foot. This step is important because it begins to put your right shoulder and chest in a position where your air flow can begin to move more easily into your right upper lobe of your right lung under your right anterior and lateral chest walls.  

As you try to cross your right foot in front of your left foot, you may notice that you can not make a perfect “T” with your right foot perpendicular to your left. If you can not make a “perfect T”, do the best you can. Both feet need to be, however, flat on the floor. This means you should feel your inside arches of your feet hit the bottom of the shoe as you put weight through each foot. Step 2 provides the anchor needed for your right lateral and back side of the chest to open up as you stand in the final position as outlined in Step 5, and as you breathe in when in step 6.  

By slightly bending your knees, in Step 3 your low back will relax and your mid to upper back of your chest, on both sides of your back, will expand and gently begin to open up during normal breathing. By “shifting” or moving your left hip back, your body weight will be directed and moved over to the left foot, more than the right. Try very hard to keep your right arch and foot on the floor as you do this. Your entire lower body and lower chest will be turning to the left as your upper chest is essentially turning to the right, simultaneously. As your left lower posterior chest wall is lengthening, decompressing and beginning to open, your right lateral chest wall is simultaneously opening.

Begin to “round our your trunk” in Step 4 by slowly lowering your left arm, as your right arm is held up the dowel, that is secured by your right hand.  Slowly breathe in through your nose and out of your mouth, as you lower your left shoulder. Simultaneously place emphasis on rounding your back to open the back of your chest walls on both sides of your back. Take a few seconds and pause after each ‘breathe out’ through your mouth, before you take a new one in through your nose. This pause allow your mid back to expand, open, and loosen any “mucous” in the posterior regions of your lower and mid lobes of your right lung and your lower lobe of your left.

As you continue to breathe in and out, begin to “reach for your right toes with your left hand” during the exhale phase of this slow, methodical breathing cycle you are in. You may not be able to touch your left toes. This is OK. Over time as your chest wall becomes more flexible, you may get close to your toes, or you may actually touch them. Let the back side of your right leg or hamstring area dictate on how far to reach with your left hand as you exhale. This is not a right hamstring stretch activity, although you will feel that area being pulled. More importantly, let your right hamstring region hold, stretch and anchor you as you breathe in slowly to fill and expand the back side of your left lower chest. This will allow your left posterior lower lung lobe and right anterior upper lung lobe to open, drain and exchange air more efficiently.

After you have arrived at a comfortable state of reaching with your left hand toward your right toes, concentrate on filling your right upper lung and stretching open your right upper anterior chest wall, as you slowly take deep breaths in, after each long breath out. Try very hard to “maintain” your hand and foot positions as indicated in Step 6. This ensures good respiratory mechanics for ventilation of lung surfaces in the upper lobe under your right, upper, anterior and lateral chest wall; a region of our body that is often compressed and restricted because of handedness and our human asymmetrical bias toward managing posture through our right body activity.

Step 7 reminds you to accept the “stretch” you should feel through your “hips, back and right chest wall”. This stretch sense is especially desirable upon exhalation. So exhale, and pause, to experience this wonderful “lung” related stretch sense. Your diaphragm will work so much more effectively, after this final step. Your chest walls, in general, will expand so much more efficiently and your ventilatory gas exchange will enhance your mood, behavior and decision making.
   
By continuing the sequence recommended, in Step 8, your chest wall reciprocal movement associated with inhalation and exhalation mechanics, will allow better alternation of chest wall movement when you walk and swing your arms and legs and when you sit and turn to one side and then the other, or when you lie down and turn one direction followed by another. This PRI technique fosters more desirable, unrestricted chest wall mechanics, lung drainage and diaphragmatic productivity both at rest and with upright bilateral extremity movement.

Posted May 4, 2020 at 8:09PM
Categories: Techniques Science

We are excited to announce a Free “PRI Breathing Mechanics in COVID Times” Webinar Series beginning next week. We have been receiving phone calls and emails with questions on how the science and techniques of PRI can be applied to COVID-19 patients. What do we recommend, and why? Well, if you have been wondering the same, we will discuss all of this and more over the next several weeks on this webinar series.

As Ron discussed earlier this week in our Zoom Director’s Meeting, he feels like he has come full circle, that is 360 degrees from where he started almost 40 years ago; and where the profession of physical therapy started. Many of the first non-military patients that were treated in 1918, when the Women’s Physical Therapeutic Association was started, were children who were having difficulty breathing because of the Polio epidemic that ramped up in the United States in 1910. Chest physical therapy was well recognized by 1948 and physical therapists and physiotherapists around the world were taking responsible measures and opportunities to ‘restore lung function’ after acquiring an illness or after surgery.

In more recent years, several studies have questioned the use of intermittent positive pressure breathing (IPPB) machines and have caused many respiratory therapy departments to look to chest physical therapy as a replacement for IPPB. Respiration, ventilation and breathing are all influenced by our postural positions and patterns we are in at the time we are exchanging gas. Therefore, breathing mechanics are postural mechanics. The Postural Restoration Institute’s (PRI) concepts and scientific applications, are today used by many health care providers who collaborate with other disciplines that are mindful of the importance of keeping oral airway and lung airways open. This interdisciplinary practice reflects our early colleague’s effort in taking responsibility for the restoration of lung function through human mechanical intervention, prior to or following events that challenged lung airway position and drainage.  

Postural positioning is necessary for postural drainage, and the importance of coupling proper breathing mechanics with positioning enhances lung perfusion, expansion, and compliance to help fight off respiratory illnesses such as COVID-19 and to help acquire lung and chest wall function that speed up recovery following COVID or other viral acquisitions. This is why we are so excited to share PRI concepts, considerations and advice on how to keep your chest and lungs mechanically efficient and physiologically effective.

Just yesterday, a good friend and colleague, Cheryl Chase, PT, PRC emailed us and shared an old book that she pulled out of her desk titled “Postural Drainage and Respiratory Control, 3rd Ed”, which was published in 1971. Her colleague is going to provide an in-service on postural drainage, something that all physical therapy education programs cover, yet many PT’s have never clinically used. In the direct words of Cheryl, “I am so saddened by our current pandemic crisis, but also delighted that this current situation creates opportunities for new dialogues. It seems strangely serendipitous to coincide with the 20th anniversary of the Institute.” This message truly hit home. This is not how we imagined we would be celebrating our 20th anniversary. Yet, in some ways, it is blessing because with all of the messages and questions we have been receiving, we know that we can contribute to this opportunity for new dialogues amongst the general public and across multiple disciplines.

So, we invite you, and your friends and family to join us for this free webinar series, happening every Tuesday at 6pm CT (starting May 5th). Invite someone who has always wanted to know more about PRI, or maybe those who have questioned the “why” behind your use of Postural Restoration®. During this pandemic, we have witnessed humanity helping each other more than ever, and we are hopeful that the dialogues we can spread through this webinar will help thousands across the world.

*If you miss any of the weekly live webinars, they will also be posted to our website, so you can go back and view them later.

PRI Breathing Mechanics in COVID Times
Tuesdays at 6pm CT
CLICK HERE to register to join the webinar

*Pre-registration with your name and email will be required each week

Posted May 1, 2020 at 3:22PM

On April 18th and 19th our Institute hosted its first live stream course on the importance of maintaining and facilitating the tone and tension needed for 30 degrees of cervical symbiotic movement. Two cortical hemispheres, two communities of inter-neuronal highways, two lateralized sets of appendages and two autonomic systems of drive, that are all associated with one “neck” of their being.  Regardless of the side of the relationship that is more dominant, or more sensed, or more patterned around a vertical axis, or more associated with emotion, fear, decision making, or physiology, both sides have to communicate with biased biologic messages going up and down through their one and only neck.

   

A few minutes ago I finished a face time conversation with Maureen Henderson PT, PRC regarding our 20th year anniversary as an Institute. She also told me she would be sending me a book written by Robin Wall Kimmer, entitled ‘Braiding Sweet Grass’.  She said the book reminded her of our relationship and the role the Postural Restoration Institute serves for masting. Mast seeding, also called "masting", is the production of many seeds by a plant every two or more years in regional synchrony with other plants of the same species. Mast seeding is an effective defense because the seed predators become satiated before all the seeds have been consumed.

   

On November 3rd, 2001 Maureen attended her first PRI course, Postural Restoration (the name of this course was changed to Postural Respiration in 2004) on the campus of the University of Minnesota. She reminded me that she was tired and had jet lag but wanted to go to this course because of the inter-connectedness associated with the material in a course she received from a recent course she attended on ‘Protonics’ that was taught by Karen Swanson PT, through the Postural Restoration Institute. “The core of my being is that everything is connected and meeting you and hearing you for the first time satisfied my core”, was a statement that resonated with me, because we truly have similar DNA, similar thoughts about purpose, similar respect for nature and trees… Both Maureen, and my son, RJ, know that we are all truly connected, just as all trees are.

  

Trees and plants talk to each other using an internet of fungus. Hidden under our feet is an information superhighway that allows plants to communicate and help each other out. Mycelial networks of fungus allows individuals (trees) who may be widely separated, to communicate and help each other learn new ways to survive, commit new mistakes, and to boost their host plants’ immune systems.  Fungi have been called ‘Earths’ natural internet (Paul Stamets 2008 TED talk on “Earth’s Natural Internet”). Both the tree trunks and our human necks need biologic tone, social tension and regional connected support that is enhanced through “masting”, so that a few of us who breathe and respect the science of PRI can further nurture the evidence behind the need for 30 degrees of cervical rest. Our “masting” effort, our inter-neuronal highways, and our interconnected hemispheres just got a huge boost from live streaming on April 18th and 19th , through the use of the internet; just like the trees we walk under that are getting a huge boost from the Mycelia fungi that never stop networking.

Full Cervical Revolution Live Stream Photo Album

Kind Regards,
Ron

Posted April 24, 2020 at 8:38PM

Please check out this 6 minute video and accompanying blog article to learn a PRI based technique to help improve lung health amidst COVID-19.

It was a high honor for me to teach the updated Impingement and Instability course for the first time at Pro-Active Physical Therapy in Ft. Collins, Colorado. Preparing for this course over the last couple of months with Ron has been one of the more exciting and inspiring times in my career. I showed up on the first day of the course wearing a purple dress shirt, a color I have never worn for a PRI course in all my years as a presenter.

You may know that purple is the signature color of this institute, for many intriguing reasons. The color purple represents passion. It also represents royalty, and the institute’s longstanding acknowledgement of cortical function as the true king of human movement and performance. Wearing purple to this new updated Impingement and Instability course represented my newfound commitment to principles I have heard Ron talk about for nearly 20 years, but have not fully understood until I came to appreciate how he organized the new material in this updated course. I wore purple to declare that I am “all in” on concepts that I now realize have always guided Ron and that truly make this institute what it is, a neurological institute.

Impingement & Instability, Fort Collins, CO - James Anderson

We began the first day exploring the intriguing and powerful concept Ron has termed “functional cortical dominance”. On the surface it seemed like a novel concept. But in retrospect, it didn’t seem new at all, having listened closely to Ron develop and define this concept at essentially every Interdisciplinary Symposium since the institute started having them. We discussed sensory input from both sides of the body to both sides of the thalmus and midbrain, and the magic of the corpus collosum when assessing the pre-patterned sense our bodies and brains experience before they become a pattern. We also discussed the concepts of interoception, egocentric sense, esoteric sense, corporeal sense and compression sense to round out a truly “mind-blowing” sensory morning.

Postural Restoration, Impingement & Instability, James Anderson

And then our learning took on a new dimension when we brought Hilary O’Conner, PT up front for an exploration of some of these new concepts. Thank you Hilary for being willing to demonstrate your lack of intuitive sense on and for your sinister side, your inability to perceive your non-routine hand when standing on your routine leg and your inability to sense compression, centering and grounding on your incorporeal side because you lacked the necessary compressive sense across both of your scapulas. And all of this made it difficult for your hands to direct properly sensed and sequenced forward locomotor motion (a dynamic integrated full body sensory experience I used to inadequately refer to as mechanical gait).

Impingemenet & Instability, Postural Restoration Institute, James Anderson

Postural Restoration Institute, Impingement and Instability

Wow, really? Did I just say all that? We need to take a serious time-out at this point and state the obvious… this post sounds more like Ron Hruska than Ron Hruska himself as I look back at what I’ve just written. But the way he has designed the new course content really helps me appreciate more clearly what he has always been trying to convey to persistent and loyal PRI learners like myself. And he advanced my understanding of sensory integration and cortical function, without losing any of the longstanding content we have all come to appreciate in the Impingement and Instability manual, making the old material look quite new. Pretty cool Ron. Two words… patient leadership.

With many other things that could be said about the updated Impingement and Instability course, let me just summarize this course write up with the following. It’s a personal testimony in the form of a question posed by a very attentive and intuitive course attendee on the morning of the second day. Ben Hendricks, PT raised his hand and asked, “Is it possible that a person could feel more grounded on the left side just by listening to your presentation yesterday?” All I could do was smile and laugh as I looked around the room and saw the concepts sink in just a little further. From Ben’s written evaluation survey at the end of the course, I share the following: “Mind blowing! I was able to go to my left leg for the first time, just by listening to the lecture. Afterwards, by hearing to get onto my left leg over and over during that first day of lecture, and going back to the right leg felt different, as if I couldn’t go there as good as before. It doesn’t get more neuro than that.” 

Posted March 19, 2020 at 5:01PM
Categories: Clinicians Courses Science

“Lots of evidence-based practice.”
“I plan to integrate the information immediately into my practice.”

Thank you to Heather Golly, ATC, PhD, Beth Marschner, DPT, and Dawn Mattern, MD, faculty at Minot State University, in Minot, North Dakota, for hosting Postural Respiration this past weekend. We were able to sneak this course in before the travel and conference bans were enacted and had plenty of hand-sanitizer at our disposal!  

MSU was the host site for Myokinematics last year, so most attendees had that course under their belt.  It served as a springboard to understanding how the top half of the body, the thorax, influences and is influenced by the lower half.

Our ability to fully and properly compress and decompress our bodies – the thorax, abdominal, pelvic, and cranial chambers -- in the space around us is dictated by air flow patterns provided by hemi-diaphragms that are in position to do so.  This is compromised if abdominals, which wrap around the lower ribs and shape the hemi-diaphragms within to preserve their length-tension properties, aren’t sensed and facilitated.  Therefore, training the abdominals first and foremost for respiration, not core stability, is imperative.  All our movements and physiology, from HRV, digestion, and the ability to concentrate, depend on this.

One attendee grappled with when to consider prone “I’s”, “Y’s”, and “T’s” in their program.  This led to a helpful discussion, and paradigm shift, on the need to first address thoraco-scapular mechanics, as achieved by diaphragm position, rib cage expansion, and alterations of air flow patterns, before introducing scapula on thorax activity.  Without proper respiratory mechanics in place, muscles of the scapula acting on the thorax are simply out of position and lack meaningful leverage to provide safe, effective cervical and upper extremity joint performance.

Everyone appreciated and learned from those who stepped up to demonstrate non-manual techniques and to act as patient models for lab:  Stephanie Boespflug, PTA, PRC (my fellow PRC 2011 alum), Beth Marschner, Kirk Mason, DC, Terry Quijano, ATC student, Rebekah Rye, ATC, and Shane Williams, ATC student.  They enhanced and clarified how we define R BC/L AIC patterned activity and how we differentiate this presentation and its treatment considerations from that of superior T4 and B PEC compensations. Thank you also to Kari Harris, DPT, and Heidi Folk, PT, for adding to the discussion with insightful questions and personal clinical examples. I appreciated everyone’s warmth and hospitality, North Dakota-style. Thank you all for a wonderful weekend. The Institute looks forward to bringing more courses to your neck of the woods!

Posted March 13, 2020 at 8:49PM
Categories: Courses Clinicians Science

 Surrounded by the tall pine trees of North Carolina and golf courses in every direction one can look, we had 2 full exciting days exploring the power of myokinematic restoration. Discussing how the acetabulum moves on the femur was an appropriate discussion in a community full of golfers when discussing rotation and the appropriate muscles of the hip complex to help achieve rotation. We learned about the inherent pattern (s) of the human body that position our pelvis and ribcage along with tests that help guide our treatment to restore these positions. We had a sharp group of attendees who remained interested and engaged through the last hour of the course which was impressive. We had attendees that made the trip from Canada which is always exciting to see the science of PRI spreading to other countries!


- Kasey Aiken

I had a great weekend hosting, teaching and mentoring Kasey at my home clinic Sandhills Sports PerformanceKasey Aiken did a great job introducing the principles of PRI as they relate to the hip and pelvis. We discussed a dominant left AIC and patho and non-patho compensatory patterns during upright activity as it relates to the Hip and Pelvis.

We were joined by PT’s, CSCS, SPTs, SPTA, ATCs, new graduate of PT, Massage therapist and a chiropractic physician!

Our clinic was represented by Pat Tanner, ATC, Jena Landgam, SPTA, Kelsie Giannoulis, DPT, Brooke Thomas, DPT and brand new to our group Pierce Adams CSCS and Johanna Nisenholtz.  Johanna was my PT student earlier this year. It was so great to have her in her first official PRI class. We look forward to Johanna joining our staff this year!

Thanks #PRINation for growing with us!

Posted March 12, 2020 at 9:50PM
Categories: Clinicians Courses Science

Enjoyed a great weekend at the University of Missouri teaching the primary course classic Myokinematic Restoration. This course is essentially an expanded and updated version of my very first PRI course, its the first course I learned to teach as a new Faculty member 20 years ago, with material that continues to mean a lot to the work I do on a daily basis. Thank you to Joe Pope, DPT, PRC for assisting me with the course and helping give all the attendees a great overall experience. Your additional comments from your own experience learning the science of PRI were very valuable and I could tell were much appreciated by course attendees.

The course was taught at the Missouri Orthopedic Institute on South Stadium Drive across the street from the Hearness Center Basketball Arena and diagonally within view of the neighboring Faurot Football Field. Seeing this field brought back a memory from my college days that I may share just because its nice to reflect on the glory days, when Nebraska Football was dominant and we expected to win the National Championship every year. I'm also sharing this memory for those of you reading this who are not old enough to remember what I'm talking about, because its something you should know about.

The #1 ranked Nebraska Cornhuskers rolled into Columbia back in 1997 expecting an easy win and they ended up pulling out a squeaker that has come to be known as "The Miracle in Missouri". If you don't know what I am talking about (or even if you do), you should do an internet search and watch the spectacular (and very lucky) play called the "Flea Kicker". It's a signature memory for Nebraska Football fans in the 1990's and a pivotal reflection point for current fans hoping current Head Coach (and Flea Kicker Quarterback) Scott Frost will take the program back to its glory days. I think Matt Davidson still gets paid to retell the story of that play to anyone who will listen.

Another reason I tell that story is that 1997 was the year I met Ron Hruska. I was a student at the University of Nebraska Medical Center and we had a guest speaker come in one day to teach our physical therapy class about temporomandibular dysfunction. I had no idea at the time that I was listening to a man who would in time have a more dramatic impact on my career than any of the good professors I was being taught by in my current course of study. These professors gave me the fundamentals of joint structure and function, muscle function and general rehabilitation, but I remember wanting so much more in terms of "real-life biomechanics". And it wasn't until Ron presented courses on lumbopelvic and hip dysfunction that I started to feel satisfied thinking through what I thought was really going on.

This Myokinematic Restoration course was my first hook, because it answered questions about biomechanics and human movement that I hadn't even asked myself before meeting Ron. Questions like, "What is the position of the acetabulum relative to the femur on each side and why does it matter?", "What is ligamentous muscle and why is it necessary?", "What is the performance strength of the acetabulum in early stance on the left and in late stance on the right?", "How does the performance strength of the femur relate to the performance strength of the acetabulum?", "What actually is acetabular hole control?", and my favorite,..."What is the function of the obturator internus and what is its role in upright human function?"

All of these questions and more are answered in the current version of the Myokinematic Restoration course. How grateful I am that I was able to consider such important questions so early on in my career and that I, like Matt Davidson, so much later in our careers, still get paid to tell my version of the story to anyone who will listen.                                                                                                                                                                                                                                                                                          

If there are three bones that have always had an impact on my course of study as related to respiration, airway, occlusion, oral function, head and neck position, speech, vocal cord dysfunction, tongue compensation, nasal flow, autonomics in general, auditory sense and the soft and hard palates, it is the temporal and occipital bones. Three very important nerves go through the most infamous foramen of mankind, the Internal Jugular Foramen (IJF). When the lumen or congruence of this foremen is challenged our bodies know it. Cranial mal-position and underlying associated predictable human torsional constraint increases the need for compensation and  work around this malpositioned set of paired bones, on an accompanying occiput bone that orients and houses the medulla and brain stem in off-centered state of un-rest. This positional state of unrest feeds neurologic information to our mid brain and associated cortices that are directly associated with my course of study, outlined above.   

Re-orientation of these two paired IJFs can have a major impact on ANS, SoNS and CNS function and behavior, secondary to the compression or lack of compression on these three nerves. The glossopharyngeal nerve innervates the stylopharyngeus muscles, the vagus nerve innervates the levator veli palatini, the salingopharyngeus, the palatoglossus, the palatopharyngeus, and the pharyngeal constrictor muscles, and the accessory nerve innervates the trapezius and the sternocleidomastoid muscles. I will not go over these three nerves sensory innervation, but these nerves are instrumental in how we physically, physiologically and psychologically behave and operate. Cranial mal-guidance provided by the calvaria, temporal and occiput bones and their associated torsional patterns of function can be resolved through PRI based sacral cranial repositioning and through PRI based thoracic cranial resolution, that incorporates cranial oscillatory alternation. Having the opportunity to outline and teach the reasoning behind these PRI techniques and considerations, offered by this unique course, through the involvement of the sinus cavities, the palatine bones, and the pharynx, is as fulfilling for me as any course I have ever written, designed or taught.

 

I would like to thank Amy Goddard PT, DPT, OCS, CSC, PRC and her staff, once again, for hosting another PRI course at her expansive and accommodating facility. Gail Kaiser PT, OCS, thank you for your willingness to participate in my demonstration autonomic orthotics. And Stephanie Irizarry Pt, CLT-LANA, PRC your presence is always welcomed because of your love for Pantone 269 C (purple), your predictable body performance through autonomic filtering, and your on-going smile. Jennifer Bullock PT, DPT, OCS, PRC your input, discussion and feedback was so invaluable. I honestly believe, this is ‘your course’ if there ever was one offered by PRI. I truly love everything you stand for and represent.  

    

Posted March 4, 2020 at 10:08PM
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