In the fall of 2017, Jen was contacted by Jessica Tidswell, PT, ATC, SCS, PRT, assistant professor for the Physical Therapy and Athletic Training programs at the University of Utah. We have requests for information, providers, course questions and many other inquires on a daily basis, but the request Jess had was different. She has the pleasure of working closely with the graduate athletic training students, and instructs several graduate courses while remaining clinically active through the University. She typically offers an Independent study as part of this course work and had a strong desire to somehow include PRI concepts as part of her 2017 fall semester. Jess has taken several PRI courses including all three primary courses as home studies, and after her conversation with Jen it was determined that our home study would be the perfect fit. Jess decided to focus the entire semester’s independent study on Pelvis Restoration. We were thrilled to have our course be the focus of a graduate level review and after a few more conversations with Jess, we had them up and running. Not only was this the first time the Home Study was used in this way, but she later decided to follow-up the fall semester this spring with the Myokinematic Restoration course for another semester long independent study. Jess is a pioneer in more ways than one. Receiving a Doctor of Physical Therapy in 2002, Jess was clinically active for several years before deciding something was missing. Her background and passion in Exercise Science and Athletic Training led her to return to school, as a student, seeking her second Bachelor’s degree in Athletic training. Jess recently completed her PRT credentialing and is the first DPT, ATC to be credentialed in our  Postural Restoration Trained™ (PRT) credentialing program. Highlights from several of the students who were a part of this Independent study can be read below, and an interview of PRT Jessica Tidswell can be read HERE.

Thank you to Jess, and the students from the University of Utah, who continue to seek a better understanding of our science, and make these semester reviews a success. If any educators are interested in setting up similar Independent Study courses, please feel free to contact me!

Student Reviews:

Upon signing up for this semester-long independent study Pelvis Restoration home study course, how much knowledge of Postural Restoration® did you have if any? If this was your first exposure to the science, what stood out the most to you about this novel way of looking at human asymmetry?

“This was my first exposure to Postural Restoration, and being able to look at postural muscles in a different way and how they affect the innominate bones changed the way I treat my athletes and improved my outcomes.” - Bryan Erspamer, ATC

“Prior to signing up for the independent study, I had previously taken the in-person postural respiration course. I was first exposed to PRI from an athletic trainer and mentor during my first job after graduating from undergrad. It immediately peaked my interests due to its holistic view of the human body. The concepts described by the institute on how our inherent asymmetries relate to dysfunction were initially hard to grasp as a young clinician. However, the more I asked questions and critically applied the science, the more that I knew this was going to be an essential part of my career. Initially, much of my treatment focus was on the location of the injury itself. The Postural Restoration Institute provided the big picture and not only altered how I care for my patients, but also totally revamped the way I view human anatomy.” - Chris Michaels, LAT, ATC

“The semester-long independent study of Pelvis Restoration was the first time I had been introduced to PRI. I appreciated how the PRI approach has a strong focus on the kinetic chain bilaterally. PRI showed a unique perspective to optimize total body function by addressing the inhibition and facilitation needs on each side of the body individually.” - Julia Villani, ATC

As you got closer to the end of the semester did the course material challenge your thinking, or way of looking at certain injuries or dysfunction, that you encounter as an Athletic Trainer? What are some of the ways that you plan on implementing this material, or how do you see this material being utilized in your setting in the future.

“PRI changed the way I treated my athletes, I went from using a lot of muscle energy techniques for short term relief, to putting athletes on PRI programs to actually resolve the underlying issues. Working with hockey players, I see a lot of chronic hip and low back pain. Due to the mechanics of skating hockey players are prone to being in a PEC pattern, so I see myself using PRI on a broader scale in the future, implementing these techniques team wide.” - Bryan Erspamer, ATC

“The course material throughout the semester was both challenging and eye opening. Learning about the intricacies of pelvic motion, how pelvic position relates to asymmetry and dysfunction, and how I can use the Postural Restoration® science to make a long term impact on my patients was career altering. I work with college softball players and often times they complain of shoulder pain, but after taking a more extensive history, I learn that they also suffer from chronic low back and/or knee pain. While doing exercises on the lower extremity as part of an upper extremity rehabilitation program can often seem strange to my athletes, after taking the pelvis course, I know that this approach is essential for long term, total body health. In the future, I hope to implement PRI as a part of my pre-participation physical examinations to screen my athletes and get them started on a Postural Restoration® program prior to competition.” - Chris Michaels, LAT, ATC

“Absolutely, my view of overuse injuries and dysfunctional movement has changed. Now, I not only address the chief compliant but I take a much more detailed look at the pelvis and how it may be influencing the issue. I plan on incorporating PRI techniques in most of, if not all of my overuse injuries and dysfunctional movements. I have yet to find an athlete that would not benefit from some level of PRI exercise.” - Julia Villani, ATC

Overall would you recommend an independent study PRI home study course to other graduate students? How did your view of the science of Postural Restoration® change from the beginning of the semester, once you had completed the course? (Any additional feedback or comments are welcomed below)

“I would absolutely recommend a directed independent study focused on PRI to any graduate level AT. I feel that this was the best way to be introduced to PRI as we had Jess directing us and always willing to answer any questions we might have had. The environment also allowed us to work together as graduate students and better understand the language, the science, and the implementation of PRI. As the semester progressed and I got more of a grasp on the concepts and science behind PRI, I was able to start implementing PRI programs in the clinic. In the independent study set up, I was always able to address any questions or problems I might have had with Dr. Tidswell.” - Bryan Erspamer, ATC

“I would strongly recommend the independent study PRI home study course to other graduate students. Taking this course alongside my classmates has created a collaborative learning experience that extends beyond the classroom. Throughout the semester, my classmates and I would meet in the clinic to either talk through questions we had from the course, or practice the special tests and exercises we learned during class time. I think the best part of taking this course as an independent study was that even once the class ended, a sort of PRI culture was created amongst the students who took the class. We all still make a point to check in with one another to discuss how we are applying the material and how we might be able to improve the way we utilize the concepts with our patients. We also have an online group where we share research, videos, and other useful material related to PRI. The independent study PRI home study course has fostered an environment of continuous learning and has changed the way we treat our patients.” - Chris Michaels, LAT, ATC

“I have no hesitation recommending a home study course to other graduate students. In my experience, newly certified athletic trainers have a limited number of tools in their toolbox to address overuse injuries and dysfunctional movement. This course not only helped me deepen my knowledge of pelvic anatomy, but also how imbalances in the core and pelvis reflect through the kinetic chain.” - Julia Villani, ATC

We recently received a copy of PRT Jessica Kisiel’s newly released book Winning The Injury Game – Alignment Strategies for Healing and Performance, and wanted to share the news with PRI Nation. Below are a few words from Jessica about her story and inspiration for writing the book.

“I was diagnosed with severe hip osteoarthritis (OA) at the peak of my professional mountain biking career. The devastating pain in my hip and back made it impossible for me to cycle comfortably. Upon receiving an orthopedic surgeon’s advice to prolong a hip replacement as long as possible, I set out to find an alternative path to healing. Winning the Injury Game tells the story of my journey from pain and desperation back to hope and competitive athletics. This book shares the lessons I learned as a patient and coach, providing a mix of personal and client experiences with professional knowledge. I am happy to say that I have not had that hip replacement, and I still enjoy playing a variety of sports. The aim of Winning the Injury Game is to help you to do the same. You can overcome your injury—and you can confidently return to pain-free activity for the long-term!”

Do you have patients or clients who want to learn more about their pain and the process of recovery from someone who has experienced what they are going through, and has an understanding of the importance of alignment, balance, wellness, and performance? If so, you should check out this personal and inspiring book, which includes many references to Postural Restoration®.

Jessica is offering a 10% discount to PRI providers, which can be purchased on her website The Pain Free Athlete, using the code PRI10 . PRI does not sell or benefit from the sale of this book.

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

Gratefully, Ron

アメリカの皆さんこんにちは！

Hello everyone!

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

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

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

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

                           Position A                                                               Position B

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

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

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

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

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

　(89) Left Stance Interrupted Swing

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

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

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

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

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

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

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

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

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

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

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

On a sunny Sunday in June, the staff at Advance Physical Therapy in Chapel Hill, NC invited second year physical therapy students from UNC Chapel Hill to attend a screening for treating pain and dysfunction using Postural Restoration. The experience produced many and varied positive outcomes for all involved. We thought other PRI clinicians might like to know what we learned.

On the students: I teach PT students annually each spring. Inevitably this endeveour culminates in a line of young, high achieving, overworked, overstressed, mostly PEC’s at my door. Further, after years of attending courses within the institute, it seems the most dysfunctional and complex patients are often the PT’s sitting around me. We ourselves realize the profound benefits of PRI most when we feel the effects personally. As with PT practitioners, when PT students are offered plausible mechanisms for their chronic painful states, and more when they are changed by PRI, openness to the approach is enthusiastic. Working with students in this way seems powerful toward the PRI paradigm shift we would like to see within PT. The students also offered helpful feedback with regard to comparing different clinician handling for PRI tests.

On our clinicians: With 12 willing student subjects in the clinic, we couldn’t resist the temptation to try a bit of inter rater reliability among our clinicians for 3 basic PRI screening tests: Adduction Drop Test (ADT), Humeral Glenoid Internal Rotation (HGIR) and Cervical Axial Rotation (CAR).

In looking at our findings, it seems consistency among us was good for ADT and HGIR. Our values for CAR were frankly inconsistent, giving us an opportunity to discuss and problem solve on the utility and practice of CAR, as a group. Related topics entering later discussions included:

• use of pillows and other forms of support during testing to accommodate clinicians capacity and patient comfort – perhaps changing patient tolerance for testing?,
• anthropomorphics influencing decision-making (for example should a short femur on a wide pelvis drop as far as a long femur on a narrow pelvis?),
• unique descriptions and measures during testing ranging from formally measured degrees, to estimates of %, or use of ++, each often with written distinctions for quality of motion and leading to diagnosis and treatment thinking,
• pelvic/hip instability, frank hypermobility influencing test results, esp. false negatives?,
• SI dysfunction perhaps influencing test results in strange patterns like + R ADT, - L ADT?,
• repeated testing influencing test results?

On our clinic as a whole: All together at a follow up meeting, we watched each other do these same tests, this time on one subject, to discuss our individual thinking without the “blinding” we employed with the students. In the end we discovered we each employed unique positioning and preferences for support. Our collective descriptions, thinking and rationale for ratings were insightful and got us all looking more creatively about our own process with a greater likelihood of being in the same neighborhood, if not exactly the same page as our fellow PRI clinicians.