Science

We are excited to announce that PRI will be featured throughout 2017 on public television networks' "Voices in America with James Earl Jones" educational segment. The video segment has been distrubuted to public television networks in all 50 states. While airing schedules are not available to us, you might hear from patients or clients who happen to see this educational segment on Postural Restoration®.

In addition to the educational segment that they will be airing on public television, two other segments: "PRI in 6 Minutes" and "PRI in 60 Seconds" were produced and made available to us, and will be on our home page soon (see below). You are welcome to embed these videos onto your personal or professional website to help educate patients, clients, and the general public on the history behind the science of Postural Restoration®.

The "PRI in 60 Seconds" commercial will also be airing nationally on CNBC on Friday, January 6th at 8:30pm Eastern, 7:30pm Central, 6:30pm Mountain and 5:30pm Pacific time. So, set your DVRs or tune in to CNBC tomorrow night! Please note the commercial airing could land anywhere within an hour of the above scheduled times. In the past, we have been told that they have typically aired within 15 minutes of the schedule. Following this national airing, it will continue to air on CNBC in several different regions across the country.

Posted January 5, 2017 at 3:08PM
Categories: Videos Science

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.

Posted August 31, 2016 at 2:35PM
Categories: Clinicians Science

Can I use PRI materials when presenting an inservice, on my blog, or in an article, etc? This is a question that we are asked nearly every week.

All techniques, materials, and content created by the Postural Restoration Institute® (PRI) its employees and staff, and displayed or presented in any manner or format including but not limited to manuals, brochures, electronic presentations, CDs and DVDs, photographs, and web sites, are the proprietary intellectual property of Postural Restoration Institute, LLC and its founder Ron Hruska.  This content is protected by the copyright laws of the United States and by the 172 countries who are a signatory to the Berne Convention which established and provides copyright protection globally. 

This content may not be duplicated, published, displayed, or otherwise communicated or distributed in any country and in any language, without prior written permission from the Postural Restoration Institute, LLC.  

Permission to use this content can be obtained by contacting the Postural Restoration Institute, LLC. Permission requests are reviewed in a timely manner and in most cases, there is no fee for obtaining permission to use PRI content. Permission inquiries can be submitted using our new online PRI Copyright Permission Request Form.

The non-manual techniques provided in your appendix are intended for use with patients or clients and may be photocopied and distributed without written permission. Be sure to use the techniques without modification while including the copyright information found on the bottom of the page. Modification of any technique is prohibited. Digital copies of all PRI non-manual techniques are available on CD and can be purchased via our website.

For more information about correct use of PRI Copyrighted Materials and FAQ's, please read our "PRI Guide to Use of Copyrighted Materials".

Posted August 1, 2016 at 2:11PM
Categories: Science

There's a change coming...

The storm of change has blown across our conference table at the Institute (as evidenced by the sea of journal articles strewn in its wake). Jen Platt, Jen Poulin and I are on a mission, and with the help of our other faculty members, we are revising and updating the Myokinematic Restoration manual, power point and class. So....hunker down and brace yourselves and when the storm passes, enjoy the blue skies, tranquil calm and fresh smells of the new and improved Myokinematic Restoration class!

Posted June 27, 2016 at 3:14PM
Categories: Courses Science

The following article was inspired by the book, The Brain’s Sense of Movement by Alain Berthoz and the concepts taught by the Postural Restoration Institute (PRI). The purpose of this narrative is to explore the multisensory nature of PRI.

Traditionally, we presume that the goal of our PRI interventions is to create postural changes and thus function via first repositioning to achieve positional and neuromuscular neutrality by decreasing the dominant L AIC/R BC/R TMCC lateralized pattern, followed by retraining the body to be able to fully appreciate the submissive R AIC/L BC/L TMCC pattern, and finally restoring authentic reciprocal alternation between the two. This ultimately means the ability to walk and breathe utilizing all 3 planes of motion as well as have the movement variability capacity to experience other potential functional strategies of these synergistic patterns such as sports performance activities or simply carrying an object while walking.

Within this paradigm, we tend to think about inhibiting specific chains of muscle (members of the L AIC/R BC/R TMCC) while facilitating the opposing R AIC/L BC/L TMCC neuromuscular synergistic pattern. More details of these chains and their composition can be found at https://www.posturalrestoration.com/the-science. Depending on an individual’s specific patterns and where they are in their restorative process, some of these chains and plane of function (meaning sagittal, frontal, and transverse) may need to be emphasized more than others. However, the bottom line is that PRI practitioners are mainly considering within their treatment rationales which chain(s) of these synergistic patterns of neuromuscular function need to be inhibited/facilitated and the corresponding plane of emphasis. Again, this is all for the goal of efficient and effective movement.

In my recent previous article (http://www.posturalrestoration.com/community/post/2633/biasing-bilateralism-with-unilateral-sensory-and-manual-integration-by-heather-carr?id=2633), I discussed the interrelated somatosensory nature of neuromuscular function. This means that the brain is programmed not only to simply facilitate or inhibit various agonistic and antagonistic chains of muscle but that this mechanism is accompanied by the ability to also sense and feel these contractions, accompanying body segment positions, and movement relative to each other. To be more specific, our somatosensors (such as tactile, proprioceptive, and kinesthetic receptors) are feeding the brain information regarding position, velocity, and acceleration. In PRI, we refer to these as reference centers. PRI teaches 6 key ones (as described in the Impingement and Instability course) that when one has the ability to sense they most likely can also simultaneously engage the corresponding desired neuromuscular chains and hence movement patterns for better function and performance. The brain does not aim to separate motor from tactile, proprioceptive, and kinesthetic processing but needs all of this information for proper motion. In cases where there is impairment here, such as with a stroke or peripheral neuropathy, movement capability can become significantly dysfunctional.

Let’s take this a step further. When processing somatosensory signaling, the brain concurrently needs other sensory signals that are crucial for desired movement goals. This includes vestibular, visual, and auditory reception and thus perception. The vestibular receptors provide critical information to the brain such as where the head is oriented with respect to gravity, its velocity and acceleration, as well as the plane of its motion. In fact, the semicircular canals are organized in 3 perpendicular planes with one another which enables the differentiation between sagittal, transverse, and frontal vectors of head movement. This triplanar architecture is reflected in the subcortical areas where the 3 dimensional directional information is retained and further integrated with visual, auditory, and somatosensory signals. Furthermore, muscles are represented in the brain by their “eigenvectors”, their own virtual vectors that convey the amplitude of force exerted by each muscle and its corresponding plane of action. There seems to exist patterns of redundancy with the orientation of the planes of the semicircular canals to how the brain processes 3 dimensional movement and position to enable more consistent sensory processing. For example, the three pairs of extraocular muscles are approximately parallel to the planes of the semicircular canals likely making it easier for the brain to reconcile triplanar multisensory information.

What is important to understand is that without the merging of ALL the sensory information, the brain will not be able to completely know its position and movement with respect to itself, the ground, and other objects. For example, without synchronized signals from both the visual the vestibular systems, the brain wouldn’t be able to tell whether the body and/or the environment is moving. Without appropriate integrated tactile, proprioceptive, and kinesthetic signaling, the brain has no idea where its body segments are positioned relative to the head and the ground. Without proper visual processing, the body loses information regarding orientation of the position of self with relation to the environment coupled with reduced direction, speed, and acceleration of movement signaling. Furthermore, the auditory system also provides information regarding environmental space as patterns of sound are detected and contribute to an individual’s orientation relative to their surroundings. In sum, postural positioning and movement with respect to the self, ground, and other objects is dependent on all of these sensory signals.

Not only do we need authentic sensory signaling from the vestibular, visual, auditory, and sensorimotor systems but this information must be perceived by the brain in a coherent manner. Thus the term, “neurosensory coherence,” describes this phenomenon. There are certain parts of the brain such as the superior colliculus, cerebellum, and lateral geniculate nucleus of the thalamus that are especially important for merging these signals together and communicating with around 20 other brain structures. In fact, these sensory pathways are so intertwined that some neurons can respond to different types of sensory receptor signals. For example, 2nd order vestibular neurons fire from both oculomotor and neck efferent signals as well as incoming afferent vestibular, visual, and proprioceptive signals. Some bimodal neurons can be fired with either visual or tactile input and thus can create the same perception. The visual stimulus of a finger moving to touch one’s face can be perceived as actually touching the face without real contact due to the overlapping tactile and visual receptor field function. Some cases of hemi neglect have shown that injection of cold water into the ear and thus stimulating the vestibular system can temporarily alleviate symptoms of neglect including hemianopsia (seeing only ½ of a visual field) and/or hemianethesia (reduced sensation on ½ of the body). Likewise, somatosensory stimuli (example of transcutaneous electrical-stimulation) as well as visual stimuli (such as prism glasses) can also reduce symptoms of neglect. What this means is that a somatosensory stimulus can simultaneously be perceived as a somatosensory, vestibular, or visual stimulus and vice versa. The somatosensory primary cortex seems to have no preference for the various sensory inputs. There are a variety of neurosensory patterns in the brain that can all contribute to neurosensory perception and body schema. Therefore, movement ultimately creates and requires a symphony of somatosensory, visual, vestibular, and auditory sensory signaling that must be properly synchronized, merged, and modulated together with other cortical and subcortical discharge. When this neurosensory coherence occurs, desired and efficient movement is permitted. Therefore, in cases where this is not occurring the clinical dilemma involves figuring out which sensory system(s) to manipulate to achieve the desired functional outcome.

Within the paradigm of PRI, we assume an inherent asymmetry and lateralization of the postural system. However, based on the information presented in this article, I hope you are now also assuming this includes an asymmetrical and lateralized sensory system. Once again, the brain merges all of this information together for processing posture and movement modulation. The brain is actually constantly checking to see if how it predicted position and motion was indeed perceived as accurate. Furthermore, this information is not just being used to only put us in certain positions and permit movement but also is concurrently telling us where we are located in space relative to the ground and peripheral environment. Movement is orientation and orientation is movement. For example, the brain regulates the firing threshold of a motor neuron. This threshold (meaning how easy or difficult it is to fire) is influenced by the position of the body part and thus also has a spatial dimension within it. Considering both the agonist and antagonist facilitation or inhibition tendencies (think PRI patterns), these thresholds convey spatial information because of their correlation to different body segment angles. This is one of the main principles that PRI non-manual techniques are based on.  We are attempting to encode new threshold relationships between agonists and antagonists in synergistic patterns in specific positions which concurrently encode new spatial patterns with vestibular, visual, and auditory frames of reference. 

To help understand this concept even more, wherever you are right now pause to do the following: Acknowledge the position you are in and how this feels. For example, if you are sitting where do you and don’t feel pressure? What angles are your body segments at? Can you sense whether your body is leaning or rotated in a particular direction? Are you moving? Are you on an object that is moving (car) or are you moving on an object (walking on the ground)? Are objects moving around you (cars or people)? What sounds do hear? Are they coming from far or near? Now for the punchline: ALL of what you just experienced, including what you see and hear is YOU. Not only is your body but also what you perceive beyond your personal space is YOU. It is YOUR NEUROSENSORY WORLD. The question then becomes: is your neurosensory world coherent on both sides of not only your body but also SPACE which includes the visual and sound fields?

If you exist in a lateralized body and world, you therefore not only posture and move differently on each side but you also perceive space such as the ground, gravity, objects, and sound asymmetrically as well. PRI practitioners are typically trying to teach our patients and clients to position and move in new ways to become less lateralized. However, in reality we are also simultaneously teaching them a new orientation and perception of space. Therefore, when you are working with your patient or client, try to imagine their entire neurosensory world (as you just practiced) and perceived reality. This “imagination” of neurosensory perception is what Ron Hruska bases his neurosensory decision making recommendations on.  He interacts with patients to figure out how best to modulate their neurosensory world to achieve authentic reciprocal alternating body and space coherence.

In conclusion, the L AIC/R BC/R TMCC dominant pattern promotes a neurosensory illusion of being half lost in space and body. Therefore, when you are instructing your patients and clients in a PRI technique, consider not just the specific muscles and plane you are trying to inhibit or facilitate but also the corresponding sensory pieces to them. Many of these aspects are already in the techniques whether you realized it or not. Basically, any time you reposition the postural system you are concurrently reorienting its perceived space. Consider what other sensory mediums you can use to achieve this. This is why the Postural-Visual Integration course is so powerful because it emphasizes the visual aspect of our space which is a huge piece of our neurosensory world. I am really looking forward to learning how the auditory system can be engaged to instill coherent space and body function at this spring’s annual symposium…….

Posted January 22, 2016 at 11:15PM
Categories: Clinicians Science

This year we are offering an optional Interdisciplinary Integration evening series on Thursday, Friday, and Saturday of Advanced Integration. You must be signed up for Advanced Integration to attend these sessions. They will be offered from 5:15-6:30pm each night if you would like to attend. 
Thursday-Dr. Rebecca Hohl and Ron Hruska will present on Dental Occlusion. 


Friday- Dr. Heidi Wise will present on PRI Vision


Saturday- Dr. Paul Coffin will present on Podiatry.

Posted September 17, 2015 at 6:48PM
Categories: Science PRI Vision

Two weeks ago, we travelled to St. Louis, MO for the 66th Annual NATA Clinical Symposia & Expo. Matt and I had a great time meeting nearly 600 Athletic Trainers at our PRI booth. There is a lot of excitement for PRI in the Athletic Training field, especially having Evidence Based Practice (EBP) CEUs for Myokinematic Restoration, and more courses to come!

I also had the opportunity to present at this conference for the first time. The topic of my presentation, "The Influence of Pelvis Position on Hamstring Injuries: To Stretch or To Strengthen" drew around 450 people into the room, with standing room only. For those who were unable to get into my presentation, they will have the opportunity to listen to it on the NATA Online CEU Center in the near future. I have also attached my presentation handouts HERE!

Dan Houglum, MSPT, ATC/L, PRC also presented at this year's conference. The title of Dan's presentation was "Asymmetrical Posture and Common Pain Related Syndromes". He also had a nearly full room, with Athletic Trainer's eager to learn more about PRI. Dan is also willing to share his presentation handouts, which I have attached HERE!

Posted July 9, 2015 at 7:59PM
Categories: Athletics Science

There is a “silver-lining” to nearly every negative situation in which you find yourself.  If you open yourself up, you can find the positives and then use your experience and knowledge gained to help others…hopefully, creating a “greater good” in the universe.  I hope the following story, lessons learned, perspective, and insight are informative.

The aftermath of a very personal health situation brought me in to see Lori Thomsen at the Hruska Clinic.  She took me on as a patient one year ago.   Realizing quickly that I was a candidate for PRI Vision intervention, I was assessed by Ron Hruska and Heidi Wise the same day and prescribed a specific pair of PRI lenses.  I filled the prescription and followed up with Lori the next day. 

Lori guided me through a program consisting of upright exercises.  (Exercises in the Vision program are primarily upright activities, because you are learning how to use the floor to propel yourself forward through all phases of the gait cycle, using the PRI Vision lenses as a tool.)  Coincidentally, at this same time, I was beginning to more fully appreciate the need to get my own clients “on their feet”.  Admittedly, I was designing exercise programming primarily for the supine, side-lying, and all-fours positions.  Having received Lori’s instruction for my own upright activities, I was able to more adeptly implement upright activities with my own clientele, especially when it came to teaching L mid-stance.  I believe I have been able to avoid major pitfalls/setbacks and progress my clients more quickly than I might have, if I had not been a patient of Lori’s.

[Side Note:  It is important to make a distinction between assessing one’s ability to center themselves in L or R mid-stance (as is part of the PRI Vision assessment) versus teaching L mid-stance and other phases of the gait cycle at the appropriate time in one’s rehab/training program.  Assessment does not involve cueing; teaching does.]

The most enlightening piece of information Lori taught me was the use of the quad during mid-stance.  As a member of the PRI faculty, Lori teaches the Pelvis Restoration course.  She frequently refers to her “3 Amigos”: L abdominal wall, L quad, and L hip.  It wasn’t until I was a patient, when she actually took me through the integration of the “3 Amigos” on MY body, that I fully appreciated the quad in L mid-stance.

I think perhaps that the quad is overlooked when teaching L mid-stance, due to overemphasis on the L heel.  Let me try to explain in an admittedly round-about way J 

In L mid-stance you should feel 75-80% of your body weight traveling down into the back half of your foot (mid-arch to center of heel). Your left foot should be firmly planted on the ground without the toes lifting up in front.  I have witnessed individuals lifting their toes or entire forefoot into dorsiflexion when cued to: “find your left heel” or “press down through your left heel” .  I have inadvertently used these types of cues and seen those little toes wiggling around in the shoe, trying to lift up.  Sometimes it helps to have the client go barefoot, so you can see if they are “cheating” with their toes.  “Cheating” with the toes IS cheating, because it is extension. Toe extension kicks on dorsiflexors…kicks on hip flexors…kicks on low back, etc. etc.  (There are certainly those who walk as “heel-diggers”, pulling themselves forward through this entire list of muscles. These are very extended individuals who tend to use their pecs as their abdominals and present with significant FHP.) 

PRI programming accentuates “sensing” or “feeling” your left heel making contact with the ground in mid-stance, because those in LAIC patterns tend to bypass the L heel altogether during the gait cycle.  Their L foot tends to be in constant plantar flexion, so the first part of the foot that hits the ground on heel-strike is the arch or the ball of the foot (late mid-stance to early toe-off phase).  Maybe we take the client/patient through proper heel-strike phase, but in mid-stance, we should be teaching them to merely “sense” or “feel” their left heel vs. “press” or “dig” their left heel.

Back to the quad…  In L mid-stance, the quads should be in an eccentric contraction phase around the knee joint, counter-balancing the eccentric contraction of the hamstrings.  Because the knee is slightly flexed in mid-stance, the quad is on a slight stretch but holding tension, getting prepared for the propulsion phase where the concentric action of the quad takes over (stretch-shortening).  There is a “springiness” to the quad, unless the L foot is not firmly planted or the L hemi-pelvis is anteriorly tilted.   In either of these cases, the quad is acting more concentrically. 

I like the word “springiness”, because it reflects my most recent reflections on mid-stance.  “The first modal peak [of the vertical component of ground reaction forces (GRF)] occurs during the first half of support and characterizes the portion of support when the total body is lowered after foot contact.” (Hamill and Knutzen, Biomechanical Basis of Human Movement).  This is mid-stance. 

When I ask my clients if they “feel” the floor under their feet, sometimes they look at me like I am crazy.  When teaching L mid-stance, I have begun asking them if can “drop” their bodyweight (75-80%) into the L foot and “allow” the L left leg to “accept” that weight.  Now, maybe they can sense some weight, actually the GRF pushing up into their left foot (through the “springy” eccentric quad).  Now they have a point of contact from which to propel forward.  They are not in a constant state of  “pulling” or “lifting” themselves off the floor with vision, jaw, neck, shoulder, low back, and/or gastroc muscles.  [Side note in regards to Cervical Revolution:  all of this “lifting” and “pulling” through the kinetic chain, bottom-up, is to no avail, because ultimately there is gravity crushing down on all of those lifting forces, meeting at the skull and generating cranial compression.]

When you really think about this, walking is hard stuff!!  Each leg has to be able to “accept” 75-80% of your body weight in able to propel forward and not evade this difficult task with the above-listed extensor and pulling muscles. 

Again, back to the quad…  “If you can feel your L quad, Lilla, your L abs should automatically be kicking on”, Lori says during our session.  The quad is one of the markers for integration from the ribcage to the pelvic inlet through the pelvic outlet to the femur. 

I’m in L stance with pelvis rotated left, L foot flat on ground, upper body rotated right, reaching out and down with left arm to facilitate both trunk rotation and thoracic flexion, a bit of thoracic abduction to help find L abs.  I’m doing everything right, but still no abs.  When I “press” down into the ground, as suggested, I am concentrically activating my quad, and it is difficult to posteriorly tilt my pelvis and reach the knees forward.  However, when I think of “dropping” my weight onto my L leg (feeling those GRFs and a “springy” eccentric quad), I can reach my knees forward with posterior pelvic tilt, effectively bringing my pelvis under my ribcage so that they are in a position to access the side abs.  YEAH and whew!

I didn’t mention the third amigo, the L hip (Glute Med), which comes into play in the frontal plane, balancing the forces of the IC Adductor.  I am certainly not downplaying the role of this amigo in L mid-stance!  I only wanted to emphasize the important role of the quad (a muscle that is not given as much “press” in teaching L mid-stance), because Lori’s instruction certainly helped me, both personally and professionally.

Attached are 2 short video demonstrations.

Toe Extension MCS

Quad MCS

Lilla Marhefka, PhD, HFS, CSCS, PRT

Posted April 28, 2015 at 2:11PM
Categories: Videos Clinicians Science

Have you ever struggled to explain to a colleague, patient, family member or friend what the Postural Restoration Institute is? If so, you will love this new video that we have created. While it was a couple years in the making, it turned out great, and kudos to Matt Hornung for finishing up this project over the past few months! Hope you enjoy it!

Posted April 21, 2015 at 8:50PM
Categories: Videos Courses Science

In PRI, we are typically focusing on creating a reciprocal and alternating neuromuscular system. However, our neuromuscular system is connected with all the other systems in our body. There appears to be a coupling between autonomic, central, endocrine, and gastrointestinal systems which, in parallel with our neuromuscular system, are also asymmetrical and rhythmically shifting. “Asymmetry, Lateralization, and Alternating Rhythms of the Human Body” has been broken up into 5 parts describing this phenomenon in addition to the story of how and why our asymmetry came to be. It can also be accessed at on my website where I have written on other various topics that relate to PRI. 

CLICK HERE to read Part 5: "Connecting Ultraradian and Neuromuscular Rhythms of the Human Body"

CLICK HERE to read Part 4: "How Does One Reconcile an Asymmetrical Neuromuscular System?"

CLICK HERE to read Part 3: "How Did Humans Become Asymmetric?"

CLICK HERE to read Part 2: "What Does Asymmetry Provide for a Human Being?” 

CLICK HERE to read Part 1: "The Prevalence of Human Asymmetry and Lateralization"

Posted April 14, 2015 at 1:32PM
Categories: Articles Science
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