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.
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.
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.
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).
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.”
“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!
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 Performance! Kasey 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!
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.
PRI nation, it’s good to be back!
I returned this week from my first opportunity to visit the great state of Louisiana. What a fantastic welcome this instructor received! I had the pleasure of introducing nearly the entire class to the science of Pelvis Restoration thanks to the host and hostess Chris and Karlie McDougall at Renew Physical Therapy. Chris, Karlie and the whole team at Renew were kind and gracious, and provided King Cake, and other local delicacies…and I got the baby, so I’ll be back!
The course involved great conversation and discussion about the theory, science and specifics of inhibiting, facilitating and integrating alternating function of a pelvis into our neuromechanical system. Thank you to PRC, Kyle Babin for your time and energy serving as the lab assistant during our many lab breakouts, you were excellent! This instructor enjoyed the discussion of how to implement PRI objective tests into a comprehensive triplanar picture of the position and tendency of a pelvis as part of the individual human system we assess. Many thanks to Payton Spell, Shaun Lopez, Jessica Lamothe, Lonnie Arroyo, David Giardina (even in the short time!) and more for your help with lab demonstrations and observation of objective tests and treatment techniques.
This group had an exceptional array of patterned movement strategies that made this an enjoyable cross-section overview of the greater population and a great venue for learning first hand. I did my part to eat Covington out of Gumbo and I very much appreciated being welcomed to enjoy an evening with the McDougall family for my very first Marti Gras parade. What an enjoyable spectacle!
Thank you again, my fine Louisiana friends, for an enjoyable learning experience in The Bayou, my best to each of you!
Do you have an interest in learning Postural Restoration but are not sure where to start? Would you like to be more efficient at using the PRI framework to evaluate your clients or patients? If you said yes to either of those, then the Affiliate course for Fitness and Movement is a perfect course for you!
This past weekend, James Anderson and I traveled up the west edge of Illinois to present at Advance Physical Therapy in Quincy. We had a large group with a mix of personal trainers, strength coaches, athletic trainers, football coaches, and physical therapists. For some attendees, this was their first course and then others had attended several previous PRI courses.... And that is the beauty of this course, it has something for everyone and is a good introduction or review of invaluable principles that can transform how we work with our clients, athletes, and patients.
Thank you to PRC Eric Ley, Natalie Stratton and the other Advanced PT owners for supporting their staff’s continuing education. It was a great opportunity to have so many team members at one course all together!
PRI Integration for Fitness and Movement is an advanced course that focuses on helping us look at movement and posture differently while integrating key Postural Restoration principles that promote symmetrical form and balance between the two halves of our axial frame. We are looking at how the ribs, thorax, pelvis and hips work together to empower the diaphragmatic mechanical advantage, optimize spinal relationships and the range of motion of our proximal ball and socket joints.
Here are some comments from this past weekends attendees:
“Great experience for my first PRI course. I feel like I can start looking at my clients posture differently while performing exercises and give more beneficial cues to prevent injury and improve overall function.”
“Absolutely the best explanation of ZOA that I have ever heard”
“I learned so much! The speakers were great and personal”
“Good course. I really took home more than other PRI courses I’ve attended. Speakers broke things down to understand ZOA effectively. I plan to incorporate this course in my current patient’s plan of care.”
Thanks again to Advance Physical Therapy in Quincy for hosting and coordinating with PRI to have us come out there! Check out the Affiliate course schedule to learn more and get to one of our affiliate courses this year! We have courses coming up in Richmond, VA and Fort Worth TX.
Pasadena Physical Therapy was the location of last weekend's Cervical Revolution. Locatelli Rao, P.T. hosted this course and it is always a pleasure to share time and knowledge with "Loc" on this PRI journey. I first met Loc two years ago in L.A. when I taught Postural Respiration and the questions he was asking then and now are some of the best. What is really gratifying is when a student can take a complex subject, like Cervical Rev, and break it down into component parts to provide a simple, sequential and detailed description of the concepts of the course. This has been a goal in Cervical Revolution to have students take a course and "get" the primary concepts with motivation to go back into the course manual and absorb more completely the material. Application on Monday morning means just getting the most important concepts, start to practice examinations of the cervical spine/neck, know the basics of what they mean and then experiment and provide PRI techniques! Yes PRI courses make our brains hurt a little as most students will attest while their enthusiasm for more expands with their craniums! One of the most powerful PRI techniques and taught in this course is the Active Left Lateral Pterygoid in Protrusion. After testing a student in lab with bi-lateral positive findings, this technique with just a few breathes demonstrated how powerful inhibiting a Right TMCC can be with a left lateral pterygoid. Not only was the R TMCC inhibited, but so were the BC and AIC chains bilaterally.
Follow up recommendations included Standing Cervical Cranial Repositioning with a Supine Active Sacro-Spheno Flexion which were demonstrated in lab with other students all producing immediate neutrality. A manual technique was provided on another student in lab called the Frontal Occipital Hold who was also bilaterally positive in testing. After this technique, he was neutral upon testing. That was astounding to all, especially this instructor! This course is really about autonomics and reflexive oscillatory function of a neck that has to be free to turn. Cervical Revolution is so fun to teach because of the power in it's application just like all the courses in PRI. Big Shout Out to Chad Moreau, D.C., CCSP, PRC for being our lab assistant again. Your support and presence always brings a positive force to the room. Thanks again Loc for you support, questions, restates, hosting and always expanding your knowledge.
Dominant cortical behavior and function as related to human bias and behavior has always been a strong interest, and passion of mine. In 2007 I wrote and compiled a course entitled ‘Impingement and Instability’ to begin a journey with those who have interest in the gifts of contact and oscillation. Four tabs were selected based on their importance in corporeal-sense, hemispheric influence, and biased lateralized behavior. Interaction of calcaneus, femur, hip/pelvis, and scapula anatomy through our extrapyramidal system is critical for reflexes, forward locomotor motion, complex dominant driven function and postural control. This has always been an ‘extrapyramidal’ based course. However, after thirteen years of presentation, I feel the Institute is at a great place to incorporate the significance of pressure, pronation, and push as it relates to these sites of interactive referenced modulated motor activity.
The extent of our creativity and capriciousness depends on both our soul and the soles we use to develop behavioral patterns associated with confidence built off of integrating contralateral, hemispheric and bio-tensegrity input. I was so excited this last weekend to discuss how we are regulated by self-regulating pressure of the scapula to capitalize on our ability to perform with things that push, propel and please us. The ground developed, directed and designed our anatomical behavior, while the earth’s gravity gave us the security to defend, offend and create without loss of life. This updated course has not really taken on a new course of direction, but definitely will take those, who attend, into dimensions never before looked at or addressed in the manner they are now presented and applied, with evidence that was not considered when addressing the reasoning for symptomology related to feet and hand haptics.
The re-assurance from the wonderful feedback I received after this course, re-assured me that the PRI nation is ready for the importance of variable femoral and scapula instability, and associated counterpart contralateral stability, as related to the metric embracement of calcaneal and pelvis impingement that directs and orchestrates the possible disharmony and dysfunction associated with pre-patterned forward locomotor movement. Thank you One on One Physical Therapy for hosting another PRI course. You all were so gracious with your time, support and assistance. Karen Warren PT, MPT, OCS, ATC the coffee was great from both cups, even when you lifted the left hand with the cup in it and your body’s mass moved to the right, (LAIC, RBC coffee). Dan Houglum MSPT, ATC/L, PRC, Jennifer Smart DPT,PRC and Michael DuBois DPT, OCS, TDN, CS USPHS/HIS provided so much insight and instructional feedback, thank you.