Science

“I have several cases I can apply this to already.”

“The course met the objectives to the full extent. Loved the course!”

“I am so glad I finally got to do a PRI course!”

“I learned a tremendous amount of information that my client base can benefit from.”

The physical therapy team of Charles George VA Medical Center hosted the most recent Postural Respiration course. This facility is considered among the top VA hospitals in the country, noted for its clinicians’ care and expertise. Surrounded by the splendor of the Blue Ridge Mountains, the 40 attendees, comprising PTs, OTs, PTAs, ATCs, DCs, and one student contemplated the asymmetrical diaphragm and its influence on pelvic-femoral and rib cage position and function. Movement starts with diaphragm, driving our lower half to one side while our upper half counter-rotates to the other. It’s a neurological concept, and it's what allows humans to be adept at things like throwing a ball, dancing, and doing flips and twists mid-air. Rib cages come in all shapes and sizes, formed not just by genetics but also by the activities a person engages in, positions they hold themselves in, and his or her unique responses to physical and emotional stress. However, regardless of rib morphology, every cage is under the influence of a powerful diaphragm that pulls it to the right, driving predictable patterns of air flow and movement. When not countered, and if skewed too far for too long, the result is pain, rib deformity, poor physiology, shortness of breath, anxiety, etc.

Lab time was generous to allow proficiency in PRI techniques, both manual and non-manual, and objective tests that indicate an individual’s neurological patterning and presence of pathology. Attendees experienced the power and swiftness of PRI’s neurological techniques -- inhibition and facilitation – to create changes to pathology-producing patterns. There isn’t a patient population out there that wouldn’t benefit from the PRI approach. Thank you to lab assistants Josh Owen, ATC, PRT, and Tracy-Lynn “I am SO ready to get my PRC” Schuster, DPT, whose guidance and clinical expertise provided clarity throughout the weekend. Great to see PRC clinics well-represented: Josh Olinick’s Steps for Recovery, Jen and Chris Poulin’s Sandhills Sports Performance, Advance PT, and Tracy Lynn’s Schuster Physical Therapy. Thank you to our avatars Debra Albrecht, PT; Nathan Crosby, DPT; Charles Fairbanks, PTA; Anthony Figuera, DPT; Linda Gutowski, DPT; Carl Heldman, DPT; Megan Humpal, PT; Caroline Lounsbury, ATC; Christiana Marron, DPT; and Pete West, DPT. Also thank you to our reader, Onyeamaechi Arinze, PT (my apologies again for botching your name all weekend. If we meet again, I’ll need to shorten it to “O”!). Finally, thank you so much to our hosts, who made the weekend go smoothly: Nathan, Anthony, Carol Harty, Deanna Mihok, Monica Sety, Keith Silcox, Pete, and Sharon Wisner. It was a pleasure to meet you all! Charles George VA will be hosting Pelvis Restoration in 2020. I highly recommend a visit to Asheville for this course. Be sure to treat yourself to a few days before or after the course to enjoy the gorgeous hikes and all that Asheville has to offer.

Posted September 27, 2019 at 4:59PM

It was another great PRI weekend in Santa Barbara, CA. Thank you Peter for hosting this past weekend. The breakfast burritos and fruit and your hospitality were amazing. The theme of the weekend was applying the science and concepts of PRI at the pelvis with patients with simplicity. Understanding these concepts and tests assist with making PRI non-manual techniques much easier with better patient outcomes. It was a great group of practitioners with a passion for PRI and learning. Many were attending their 3rd or 4th PRI course and we had three newbies in the group. Thank you for a wonderful weekend. I was humbled to be your "coach" for the weekend.

Posted September 20, 2019 at 5:33PM
Categories: Courses Techniques Science

Rosencutter Ultra Fitness, also known as Rosen-Cutting Edge Fitness, was the location of their second hosted PRI course this past weekend. Nick Rosencutter is always looking for a way to help his clients improve whether it is thru strength and conditioning, nutrition, the latest in soft tissue workand especially PRI as it applies to performance and rehabilitation. Rosencutter Ultra Fitness had six of their trainers in attendance including Nick and they have a team approach integrating PRI into client programming. Position prep is part of their programming to provide sense awareness for neutrality before, during and after workouts. We discussed this weekend that PRI loves extension for power and performance--we just don't want you to stay in extension. Equally, and perhaps more important, is the issue of rest and neutrality via flexing into neutral with adequate rib internal rotation.

The job of strength and conditioning professionals is to help clients and athletes become stronger, faster, more skilled at movement and especially durable whether you are a grandmother picking up grand kids or an olympic speed skater. Since this class was attended by so many strength and conditioning individuals, the issue of "saggitalization" was explored as well as the ability or inability to maintain or achieve competent transverse plane-ability in rotational sports. Since all sports require rotation for power and performance, the ability to orient a pelvis fully left and right then have adequate and full counter rotation of a ribcage is a must for what is known as separation of torso and pelvis.

Testing and non-manual techniques are always "ah ha" moments as they relate to position pelvis, femur, ribcage, scapulae and even neck. What is driving these positions in this course and the best answer when a student is called upon? The diaphragm of course! Manual techniques included the big three that we cover in Postural Respiration as well as a two person infra-clavicular pump that is often needed for a person that loves to stay in extension even after the best efforts via non-manual techniques to get them neutral. Also in attendance were physical therapists, a massage therapist and an ATC from Alaska who was travelling locally with the hockey team he works with. Shout out to Nick and all of his staff for their support and enthusiasm this weekend.

Posted September 19, 2019 at 4:05PM
Categories: Courses Techniques Science

This Geriatrics course is a refreshing Affiliate Course that frequently surprises attendees because all of the useful information it has in it. After the course C.M. writes, “This is one of the most influential PRI courses I have taken, providing a thorough overview of the science and concepts that challenge both the beginner and the experienced PRI clinician. Excellent.” B.B. said, “This was a great review of PRI which brought so many pieces together, while simplifying the exercises for geriatric patients.” CV said, “I love the evaluation and treatments, and they can immediately be applied to all patient types, especially geriatric and frail. The manual was easy to navigate and overall, this was a fantastic course. My favorite so far!”

James anderson teching PRI for Geriatrics in Seattle WA

Seattle Washington is is a great place to be most any time of the year. Loved all the chic waterfront restaurants and cool shops on this trip. A big thank you to the crew at Alpine Physical Therapy for being such great hosts, ...again. 3 PRC credentialed practitioners in the same clinic makes for a great learning environment. Thank you Jeremiah, Chris, and Eli. We look forward to being back next year in February for the other end of the spectrum when Lisa Mangino and I present the new Pediatrics Course. So excited to share this exciting material with all the cool practicians in the Seattle Area.

Posted September 16, 2019 at 9:34PM
Categories: Courses Clinicians Science

As all the PRI Faculty will tell you, having the opportunity to teach a PRI course in Lincoln at the Postural Restoration Institute is kind of like a homecoming. Even though it isn't really our "home court," it does feel like it. That's a testament to Hannah, RJ, Sage, and, of course, Ron and Jen. As I said in our introduction at the beginning of the course, those new to PRI couldn't have picked a better course than this one for their first dive into the science of PRI.

Myokinematic Restoration, Lincoln NE, Postural Restoration Institute

It was such a great experience to teach with Kasey Aikin, our newest PRI faculty member. She did an awesome job, and I'm eager to watch her develop and grow into her new role. We had two other PRC's in attendance as well this weekend: Lisa Bartels and Jason Masek. They have been integrated in PRI for many years, and it was so beneficial to the attendees to have them in class and during lab. Additionally, we had five other attendees who had attended multiple PRI courses prior to this one.

Myokinematic Restoration, Lincoln NE, Postural Restoration Institute

Myokinematic Restoration, Lincoln NE, Postural Restoration Institute

With all the experience in the room, with Ron and Jen providing context during the course and lab, and with the interest and energy from the attendees, the course proved to be a very fertile environment for those new to the science of PRI. Kasey presented an excellent opening and really set the table for the rest of the weekend. We opened the course with discussing osteokinematics and myokinematics surrounding the relationship between the pelvis and femur. And we finished the day with a great repositioning wrap up, which lead us right into Day 2. Kasey again set the table with another stellar opening session, and the table was set for our day of lab.

Dan Houglum, Postural Restoration Institute

Our lab times were very productive and engaging. And a lot of it was due to where we were, and the expertise in the room. I have to thank Lisa, Jason, and Jen for their help during our labs. Kasey ran a great lab session on Sunday afternoon, as well. We were fortunate to have nearly 7 hours of lab during this course. We had a 4.5:1 ratio of student to PRC in the lab. I'm not sure the first time attendees realized how valuable the lab time was, and how much we were able to get out of the time we had.

My thanks to Jennifer Bacon, Meghann Vanslager, Kelli Reilly, Kellen Goertzen, Joe Siracusano, Kristen Wassung, and Benjamin Sandman for their wonderful questions. Honestly, we had great questions from nearly everyone in the room. I think every course attendee asked a question at some point during the weekend, which just shows how great a group we were fortunate to have. For many reasons, this particular Myokinematic Restoration course was unique, and Kasey and I feel very fortunate to have been a part of it.

Austin! The Texas state capital. I traveled there to visit with the best little PT house in Texas! Star Physical Therapy. I was there to teach Impingement & Instability.  Jon Hupp PT, PRC is the owner of Star and he is a dang good clinician and a good man.  Many of you may know Jon but did you know that his daughter Skylar is an elite gymnast? She will likely get a nice scholarship as a result of her gymnastic skills. His son Sterling just started his senior year in high school football and has been doing some good playing so far! Jon’s wife’s name is Bear. Yes! Bear! I LOVE that! I met her and the minute I did I knew she was a nice lady and a kind person. She spends her time taking care of the kids and doing a ton of administrative work for Star. 

Speaking of a ton, this I&I class had a TON of participants!  Around 40. That’s a big class size for a secondary course but...well...Texas.  A dentist named Alice Lam dropped by the first morning to visit. I do some work with Dr. Lam in Houston and she is fascinated with PRI.  I&I is a complex course that explores WHY your patients have Impingement phenomena.  Did you know that they WANT to impinge? It’s neurological. That’s probably why so many veteran PRI clinicians were there. There were 5 PRC’s there: Jon Hupp, Steve Cuddy, James Guzman, Sarah Luin and Josh Elrod as well as PRT, Josh Ogden.  At the other end of the spectrum we had two PT students there. Both of them are my friends: Steven Blair and Phillip Wuellner. 

I&I explores calcaneal, patellar, hip and scapular Instability and the varied impingements that can and do occur as a result. Be prepared for multiple surprises when you take this class.  Some comments from this past weekend: “This changed how I look at the Hruska Adduction Lift Test!” “It changed how I consider the position of the heel as I address my scapular programs to decrease humeral glenoid mechanics.” Oh, and did I mention the ribcage? The deep-dive into detailed mechanics of the existing respiratory variations puts a massive neurological spin on ribcage-scapular function. Whew! I got a little crazy there for a second. Thanks Ron Hruska, for my mild derangement. I cannot WAIT to see all of you in this most fascinating course.

"Wow" was the word of the weekend at Cantrell Center for Physical Therapy, Sports Medicine and Wellness. This was one of the most enthusiastic groups this faculty member has observed with half of the attendees being new to PRI. In addition, The Cantrell Center had half of the total number of students in attendance which made this a real team effort for their facility and created a stronger culture of PRI for their facility. What I loved about this group was the balance of great questions and re-states from every one of the new students as well as the "veterans". There were two PRC's, including lab assistant Ken Smith, who stated what we all experience attending a PRI course-no matter how many courses we have had is that there is always more to absorb and learn!

Cantrell Center Exercise Physiologist "Gentle" Giant Jalen Lawrence asked some great questions on how to apply PRI to power lifting and being able to learn how to better "axial load" when lifting. This was one of the most important questions for his athletes. In addition, we discussed that PRI loves extension for performance. We just don't want to live there all the time and that flexing and internally rotating ribs is needed to down-regulate a system and help restore autonomic balance. HRV or heart rate variability was discussed in the context of Postural Respiration concepts. Autonomic function with parasympathetic inhibition upon inhalation vs. parasympathetic facilitation upon exhalation was discussed as a needed balance for HRV. Since breathing is such a common dysfunction, considering most of our patients present in a hyper-inflated, neurologically extended state, understanding diaphragm function and airflow management is a critical issue. This is not only an issue with people that come into our clinics with pain and dysfunction. It is a performance/recovery issue as well. Shout out to Mehmet, Marion and Michael from Florida who asked great questions and brought great energy. Thank you to all in attendance for making my weekend flow so well with all of you especially the "Cantrell Gang" who can collaborate and apply PRI in a supportive setting. Ken Smith, PTA, PRC was golden as our lab assistant and his energy helped move all of us along. Finally, thank you Tassie Cantrell for such a beautiful facility, great food and wonderful staff that attended and helped all weekend with set-up and clean-up duties.

There is so much to consider when one focuses on the interplay between our autonomic nervous system, our somatic nervous system and our central nervous system. And, there is so much to get excited about when the interplay of these systems can be modified, re-integrated, re-oriented and re-calibrated through oscillation of novel conscious and un-conscious sensory afferentation. Our behavior, i.e. psychology of the conscious, revolves and resolves around fluctuation of brain lateralization, hemispheric specialization, dominance (subjective experience) as it relates to our brain’s individual unique asymmetrical and emotional processing. (page 31 of Cranial Resolution). According to the authors of ‘The Intersubjective Perspective’ (thank you Michael Zhao), focus on inter-related subjective experience unveils forms and patterns that conscious experience repetitively and unconsciously assumes over time (page 101). Therefore, our subjective experience of resolving conscious experience and patterns of behavior and biology through novel integration of these three nervous systems could generate “access to the underlying structures and organizing principles and patterns that unconsciously govern psychological life”. I absolutely love discussing behavior as it relates to evidence based autonomic research. The attendees at this course in NYC gravitated towards behavior as it relates to the limitation of subjective frames of interrelated and integrated nervous systems and their respective developed references. Thank you Borbala Suranyi for being my avatar! Thank all of you in attendance who asked poignant and clinical questions. The award to the one that asked the most insightful and driving questions that pushed us into wonderful engaging response from the entire group, goes to Jeff Eckhouse. Finally, thank you Alicia Ferriere and Finish Line for hosting another PRI course in NYC. I definitely feel at home when I am there.  

Cranial Resolution, New York City, Postural Restoration Institute

Posted August 21, 2019 at 9:11PM
Categories: Clinicians Courses Science

As we prepare for the first ever PRI Integration for Pediatrics course this October in Chapel Hill, NC it is hard not to be excited! Anyone who works with children on a daily basis knows how rewarding it can be. However, when it comes to getting them to exhale into a balloon, or squeeze a ball between their knees it can become challenging very quickly. Lisa Mangino, PT, DPT, PCS, C/NDT, PRC has spent countless hours considering the many ways PRI can be incorporated into a Pediatric setting, and through the creation of this particular Affiliate course we can all learn her intervention stragies which she applies to a younger population of patients.

Check out the video below for a sneak peak of some of the ways Lisa incorporates PRI into her practice!

And for more information about this course as well as the dates and locations it is being held, check out the PRI Integration for Pediatrics course page!

Posted August 20, 2019 at 2:41PM

Had a beautiful weekend with Kasey Aikin, DPT, PRC in my home state of Nevada teaching Myokinematic Restoration to a really great group. A big thank you to our generous host at the University of Nevada Sports Medicine, Jay Henke, M.Ed, LAT, ATC. He made us feel right at home in every way and even provided me with a list of his favorite local places to eat, which is a treat for a foodie like me. The University of Nevada Reno is nestled in the mountains and foothills of northwest Nevada, which is something you really need to see if you haven't been. As an alumni of the University of Nevada, I have really come to appreciate the northwestern Nevada beauty of Reno, Carson City and Lake Tahoe. Returning to my home state helped me again appreciate all the great people who live there.

And it was a treat to be able to co-teach with the newest PRI faculty member in training, Kasey Aikin, DPT, PRC. She does a great job with the Myokinematic Restoration course material and is really able to connect with the class attendees. She is from the great state of Texas and she brings a hospitality all her own wherever she goes. It was an honor to get to team-teach this course with her and to get to both teach and learn from her this weekend. She reaffirmed what I already knew about our PRI Faculty, that we are all unique with our own unique gifts, attributes and passions that allow us to connect in special ways with a variety of course attendees. Kasey is definitely passionate and she made the course experience great for everyone in attendance.

PRI Faculty James Anderson and Kasey Akin co-teaching Myokinematic Restoration

This Myokinematic Restoration course material is really useful for all types of clinicians as well as sports medicine and strength and conditioning professionals for a variety of reasons. First, it outlines which muscles are needed for non-compensatory gait mechanics when in the Left AIC Pattern and what the specific deficits are on each side. Second, it explains and outlines the use of Ligamentous Muscle as a powerful resource for stabilizing hip joint or pelvis instabilities. And third, it provides 2 powerful resources, The Hruska Adduction Lift Test and the Hruska Abduction Lift Test, to monitor pelvic and hip gait performance in all 3 dimensions.

Lab practice during the Postural Restoration Institute Myokinematic Restoration course, Reno, NV
 
I was first drawn to the science of Postural Restoration via the material in this course. It challenged my thinking and gave me a structural framework for prescribing movement and outlining performance that I rely on heavily to this day. The course is a great introduction to PRI for people from all backgrounds and it remains one of my favorite to review, utilize and teach.

Posted August 1, 2019 at 7:07PM
Categories: Clinicians Courses Science
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