Clinicians

If you haven't read it yet there is a new blog up at the Hruska Clinic website about how PRI activities create new movement patterns, and what may be an issue if it doesn't stick.  Also the word mnemonic is used for all you spelling bee champions. Click here to check it out!

Posted November 13, 2015 at 3:16PM
Categories: Clinicians

Many patients with an active R TMCC pattern will need disclusion of the teeth to inhibit the TMCC.  In my practice, our go-to resource for that inhibition occurs via a lower mandibular bite splint. Click on this link to see part 1 (of a 3 part series) http://caugheydds.com/clear-thin-strong-splints/ of a step-by-step file on how we build our splints clear, thin and strong.

Elizabeth Caughey DDS

Posted November 12, 2015 at 6:59PM
Categories: Clinicians

"Femoroacetabular impingement: Mechanisms, diagnosis and treatment options using Postural Restoration. Part 2" written by Jason Masek, PT, ATC, CSCS, PRC has been published in SportEx. For more information or to purchase a copy of the article, please visit www.sportex.net. To receive 20% off your purchase of the article, you can use the coupon code: 20AUTHOR. Part 3 of this three part series will likely be published in October.

Posted July 14, 2015 at 2:18PM

It was great to meet everybody once again in Boston this past weekend, where Jennifer Poulin delivered a powerful course. Observing future PRI practitioners in the USA and in Poland, I have come to the conclusion it is very difficult for all of us to switch to analyzing our clients from a MOTION perspective, instead of ACTION or FUNCTION. For example, when performing the Adduction Drop Test, most of us think about the best, purest FA extension followed by femoral adduction. We as clinicians should place much more emphasis on understanding what are we testing, and why this particular test is performed in certain position? Staying specific to the example above, we are assessing AIC, meaning neuro-muscular action of flexion, abduction and external rotation of lower extremity on a stabilized trunk. Through this movement, we are testing if AIC action can be alternate with reciprocal movement of extension followed by adduction of femur on the stabilized socket. We have to isolate the testing position the best way by using one's body and surface on which person is lying. Be aware of both the client and your own position in space. This will allow you to obtain the best proprioceptive feedback without using excessive physical force and undesirable increase in client's neuro-muscular tone. If applied correctly, your testing will become true and repeatable!

Posted June 11, 2015 at 7:22PM
Categories: Clinicians Courses

Julie Blandin was recently interviewed for our Featured Interview section, and in this interview she talks about her career path and professional development and how she got involved in PRI. She also discusses a couple teasers for a new course that will be hosted for the fist time in 2015,  PRI Integration for Fitness and Movement. Click  HERE to read the full interview.

After spending an amazing weekend in Boston, its clear that Art Horne and the Boston Sports Medicine Performance Group are in a class of their own when it comes to hosting a sports medicine and performance symposium. The quality of the experience for this year's Summer Seminar and the attention to detail was as good as it gets for both attendees and presenters. 

I was humbled to be invited to deliver both a keynote address on realizing tri-planar performance through the respiratory diaphragm and a breakout session where I talked about the relationship between the foot and ankle and the thorax. My keynote address followed Dr. Robert Sapolsky, one of the world's leading neuroscientists from Stanford University, who spoke on the topic of Stress, Disease and Coping. The other two keynote speakers were from England, Al Smith, a performance consultant for UK Sport World Class System and Dr. Vincent Walsh, a professor of human brain research at the Institute of Cognitive Neuroscience, University College London. 

Besides a host of great breakout sessions, we were all able to experience a group round table discussion with the Canadian National Basketball Performance Team. The group consisted of Sam Gibbs, Head Therapist, Charlie Weingroff, Strength and Conditioning Lead, Roman Fomin, Senior Scientist, Marc Bubbs, Sports Nutrition Lead and Jason Meehan, Assistant Therapist. Another certified PRI therapist, Allen Gruver, presented one of the breakout sessions on the topic of alternating and reciprocal thoracic integration for the overarm athlete.  

I was able to travel to Boston with my wife Karen.  We had a great time looking at the eclectic architecture of Boston on our way to Fenway Park and riding bikes as we followed the Freedom Trail.  We really enjoyed an impromptu VIP tour of the old Boston Arena thanks to Mike McKenney, Asst. Athletic Trainer at Northeastern University.

All in all it was an amazing weekend that adds to the many reasons I love Boston. Thanks again, Art Horne, I'm looking forward to the BSMPG Summer Seminar 2016.

Posted May 20, 2015 at 4:32PM
Categories: Clinicians

Last month, an article titled "Femoroacetabular Impingement: Mechanisms, Diagnosis and Treatment Options Using Postural Restoration. Part 1" written by Jason Masek, PT, ATC, CSCS, PRC was published in SportEx, a medical journal published in England covering topics of physical therapy and sports medicine. This is Part 1 of a three part series that Jason is authoring for the journal on this topic. For more information or to purchase a copy of the article, please visit www.sportex.net. To receive 20% off your purchase of the article, you can use the coupon code: 20AUTHOR.

CLICK HERE for a sneak peak of the article!

Jason Masek, ATC, CSCS, PT, PRC spoke at the 2015 NCSA Coaches Conference January 9 in Louisville, KY. He spoke about how posture begins with proper rib cage position, which leads to better breathing and ultimately, better athletic performance. He emphasized how the postural position that you start in will affect the position that you end in. Hyperinflation and how to manage athletes with this problem was also discussed. Watch the video HERE.

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

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 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 2, 2015 at 4:07PM
Categories: Clinicians Articles
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