Clinicians

I recently did an interview with FitCast Podcast where I went over some of the concepts of the Postural Restoration Institute, breathing mechanics and applications. It is about 60 minutes long and is available as a FREE download.  The podcast can be accessed here:  http://thefitcast.com/episode-312-intro-to-pri-w-michael-mullin. Enjoy!

Posted November 8, 2014 at 12:40PM

The new Hamstring Protonic System (Protonics X1 System) is now available for purchase online. For those who might not be familiar with the Hamstring Protonic System, it was originally developed and patented by Ron Hruska in 1995 and has been used by clinicians for many years in treatment of patello-femoral pain, SI joint pain and many other symptoms related to the Left AIC pattern. Click here to access more information written by Ron Hruska on when a Hamstring Protonic System might be recommended.

PRC therapist Lisa Bartels recently submitted a letter with us sharing her excitement for the return of the Hamstring Protonic System as well as more information. There is also a special discounted program being offered for Postural Restoration Certified (PRC) and Postural Restoration Trained (PRT) professionals. 

Click here for more information or to order your new Hamstring Protonic System (Protonics X1 System)!

Posted October 7, 2014 at 7:38PM

Colorado PRI meet up! Join fellow PRI addicts for our quarterly Colorado gathering. Lisa Kelly PT, PRC will review the recent vision course and Craig Depperschmidt PT, PRC and Scott Kosola PT, PRC will reveiw manual techniques and when to use them. There should be plenty of time for discussion as well. 9a.m.- Noon on Saturday, October 25th at Rebound Sports and Physical Therapy in Fort Collins. Address is 2211 S College Ave #300, Fort Collins, CO 80525. Email Craig at craig.depperschmidt@reboundsportspt.com with any questions.  

Posted October 3, 2014 at 4:14PM
Categories: Clinicians

Last month, Ron Hruska was interviewed by a physical therpaist colleague, Paul Potter, and the podcast interview is now available online. To listen to Ron's input on "Three Keys to Creating Your Dream Practice", CLICK HERE! You can also download the podcast on iTunes as well.

Posted September 29, 2014 at 7:02PM
Categories: Interviews Clinicians

There is now a PRI Book Club!

The Postural Restoration Google Group will be discussing Right Hand, Left Hand: The Origins of Asymmetry in Brains, Bodies, Atoms and Cultures by Chris McManus starting on Nov 3, 2014. In order to take part in the fun you must join our google group. The Postural Restoration Google Group is a great forum for PRI practitioners to discuss challenging cases, share important research articles, and simply discuss any topic that is PRI related. 

To become a member please send an email to HeatherCarrDPT@gmail.com and she will send you an invitation to join.

Posted August 20, 2014 at 5:12PM
Categories: Books Clinicians

I continue to dive deeper into the physiology, anatomy, and biomechanics of both horse and rider, in a passionate effort to understand how 2 asymmetrical beings come together to produce fluid, balanced, floating movement in the world of equestrian disciplines. This is a rather lofty goal I have set for myself, because this type of movement is rarely achieved, EVEN at the elite levels of Dressage. CLICK HERE to read more!

Hello triplanar thinkers!

For those wondering, the picture is relevant because it shows a technique not often considered for the condition treated:  keeping a severed hand alive by grafting it to the patient’s ankle, then later replanting the hand back on his arm. 

The conclusion of my story about Don didn’t involve any external fixators, but the treatment that he needed might surprise some of you.  To review, Don was the patient with left shoulder bicipital tendinosis whom I treated in part I (link) with the “gold standard” conservative orthopedic approach and part II (link) with the according postoperative approach as a good therapist has been trained to.  As mentioned, I outline this case to review the path that is so very accepted and yet, in my experience since I began training with PRI, not the most effective.  Don’s story concludes below:

Don returned to clinic 8 months after discharge with a new diagnosis of left shoulder pain with the remarks on the script “MRI negative” and “eval and treat.”  This is generally understood as physician lingo for “I have no idea what to do now…good luck with all that.” 

Upon evaluation, Don reported that these left shoulder symptoms started about 2-3 months after we discharged him from PT intervention in spite of his persistence with his HEP and “it was all back to the starting point three months later.”  He still tested as a bilateral brachial chain patient with a PEC pattern, again was positive with impingement tests—Hawkins-kennedy, empty can, Neer sign.  He was frustrated, unable to work in his wood shop or play his accordion for more than 10 minutes without severe pain.  At this point, the patient and I discussed that fact that I had let him down to a degree because I wanted to take a different approach before surgery, but didn’t want to irritate Don or his referral source.  He understood, accepted my apology and we moved forward.

During the first 3 visits, we established that his bilateral brachial chain pattern and according left shoulder dysfunction was not the root of his dysfunction, but rather the manifestation of a “bottom up” pelvis patient whose primary difficulty was in maintaining frontal plane position of his pelvis. 

The key to Don’s left shoulder function?  Right posterior inlet inhibition of his pelvis.  During the seven visits we treated Don using a PRI approach after the gold standard of orthopedic medicine and orthopedic physical therapy had failed to maintain his shoulder function for more than 3 months, his symptoms resolved.  He left the clinic a reciprocal, alternating, smiling woodshop athlete with bilateral HADLT tests of 4/5 at 72 years of age, “tickled” that he could play his accordion as long as he wanted without pain for the first time since before he first went to see the doctor more than two years prior.  Don is in occasional contact for the past 6 months with no return of symptoms, lots of activity and happy thoughts. 

Six-month follow-up with no return of symptoms after the rest of my conservative clinical skills, an appropriate surgery and present day gold-standard postoperative care was unsuccessful.  These are the types of outcomes that keep my passion for this science alive and accelerating.  Moreover, these are the types of patient successes that remind me to be gentle but bold about intervention that I know clinically to be the most effective tool I have in the entire tool chest.

Clearly, each patient is different, and no, I have not seen a consistent correlation over time between the diagnosis of left shoulder bicipital tendinosis and the need for right posterior inlet inhibition.  The objective tests guided me to find the appropriate treatment, not my innate ability to hear the pelvis or shoulder speak to me. 

The point here is not to create a case study for anyone to memorize to use in the future for that one seemingly random patient.  Rather, I hope that the take home is that there is a chance that this gentleman didn’t need as much intervention as he ended up having.  And, even in the face of the “old school” telling you exactly what they want from PT intervention, the risk is worth the reward if one can just take the first three or four visits to break down barriers to a different way of approaching an age-old mechanical dysfunction of a “shoulder.”

Thank you for reading, perhaps you can save a few visits for a few of your patients by way of my experience with Don.   My best to you!

Jess

Posted July 13, 2014 at 3:03PM
Categories: Clinicians

It is with much excitement that we announce that chiropractors are now eligible to apply for the Postural Restoration Certified (PRC) credentialing program. This discussion began several years ago, and with an increase in interest from the chiropractic community more recently, the PRI Board of Directors made the decision to extend an invitation to chiropractors to apply for the PRC credentialing program. The Postural Restoration Certified (PRC) credentialing program began in 2004 and since that time, 123 physical therapists, occupational therapists and physical therapist assistants have been PRC credentialed.

CLICK HERE to view the PRC requirements and to download an application. PRC applications are due on September 15th, and is limited to the first 30 applicants. PRC testing takes place in Lincoln on December 8-9th, following our Advanced Integration course.

If you are interested in applying for PRC or if you have any questions about the credentialing program, please feel free to email me!

Hi everyone! I just wanted to share a fantastic experience I had earlier this month!

I was invited to speak at SPATS (South Padre Athletic Training Seminar) hosted by VATA (Valley Athletic Trainers’ Association) last weekend. Since they gave me a total liberty of picking my own presentation topic, I took full advantage of it and decided to use that opportunity to spread the PRI word. My lecture topic was “Let’s Blow Up a Balloon! Breathing in Orthopedic Rehabilitation.”  Since my time was limited, I choose not to go in depth on the polyarticular chains and explain all the PRI terminology (i.e. L AIC, R BC etc). Instead, I focused on the left-and-right difference of the diaphragm, the importance of restoring the ZOA, and learning how to…EXHALE!!!! There were many attendees (mostly ATs, but also some PTs, DCs and MDs) and it was truly fun to watch approximately 300 people blowing up balloons! It was very well-received as many participants came to talk to me afterwards, asking about the PRI concepts and courses. I am glad to say there’s a growing interest in PRI down here in South Texas!

CLICK HERE to view my presentation!

I have the benefit of being associated with some outstanding thinkers and PRI practitioners.  Whenever and wherever we get together, conversation eventually drifts toward discussion of PRI principles and application.  One of our greatest challenges has been to unravel the foundations from which Ron Hruska evolved the Postural Restoration Institute system of evaluation and treatment that we all utilize with such great success. 

The following are just a couple of questions that we have posed and our attempts to reach conclusions and greater understanding.  If anything it may stimulate some thought and initiate some discussion.

What are we actually measuring when we place a patient on the treatment table and perform our PRI testing algorithm and what is our goal for treatment?

I clearly recall a conversation over lunch between Eric Oetter, Mike Robertson, and myself during the PRI Pelvis Restoration course at the Cantrell Center for Physical Therapy and Wellness. We were discussing the concepts of adaptive capacity, adaptive potential, movement variability, what we are actually measuring when evaluating a patient on the treatment table, and how this affects performance.  

Our conclusion was that what we are actually measuring as PRI-educated therapists and coaches is the capacity of our client/athlete to adapt to the ever chaotic nature of the environment they are perceiving.  Positive findings during examination such as a positive Adduction Drop Test, limited apical expansion, or loss of shoulder rotation was merely indicative of a human system incapable of demonstrating variability ultimately controlled by the central nervous system.  More specifically an autonomic nervous system shift toward sympathetic dominance.

I was reminded of this PRI lunch after reading a blog post recently that referenced the following study:

http://www.ncbi.nlm.nih.gov/pubmed/24502841

In essence, what the researchers found in the study was that pain-free subjects demonstrated variability in the muscle activity of the erector spinae during a repetitive lifting task and those with low back pain did not demonstrate this variability as well as experiencing increased pain during the task.

The authors’ conclusion was that reduced variability of muscle activity may have important implications for the provocation and recurrence of LBP due to repetitive tasks.

Needless to say, this study is somewhat validating for our discussion group of PRI faithful.

Truth be told, after searching there are many studies that support our lunchtime conclusion; and movement variability as a favorable concept in human function is not a new concept having its foundations in dynamic systems theory. 

From Shumway-Cook and Woollacott’s Motor Control:  Translating Research into Clinical Practice:

“… in dynamic systems theory, variability is not considered to be the result of error, but rather as a necessary condition of optimal function.  Optimal variability provides for flexible, adaptive strategies, allowing adjustment to environmental change, and as such is a central feature of normal movement.”

What the PRI model provides is a non-invasive real-time measurement of system variability determined by autonomic nervous system tone.  While EEG, heart rate variability, or galvanic skin response may be preferred methods to determine autonomic tone, these are not tools commonly used by a practicing physical therapist in a clinical setting or a coach in the training room nor would they be practical. 

The goal of treatment then becomes restoring an optimal level of variability to the system to allow for optimization of behavior and maximization of performance.

We came up with a statement that encompassed our entire discussion that included the influence of variability on pain and performance.  I still have the notes on my iPhone dated 8/24/13: 

"Restoring variability to the human system is the ultimate goal to promote neuroplastic change creating a relatively permanent change in behavior that provides adaptability within the system to cope with variability in the environment."

In PRI terms, our goal is help a patient achieve neutral (restore variability) and then recruit the appropriate PRI planar families (neuroplastic change to remap the three planes in the brain… Thanks to Zac Cupples!) to restore reciprocal and alternating movement (change behavior to cope with the environment).

How did Ron Hruska arrive at the concept of using simple, common orthopedic tests as effective PRI measurement tools?

As mentioned above, as physical therapists our measurement tools are limited by practicality.  If we look at PRI from a strictly biomechanical perspective, the PRI methodology provides for a low barrier of entry to a PT who has never been exposed to its concepts before.  Myokinematic Restoration looks, sounds, and feels like biomechanical course, but we all know that it is not.  This is a brilliant way to provide understanding to a group with more than a few preconceived notions, right?

While I certainly cannot speak for Ron, and I’m willing to be wrong, I believe there is more to this process, and this came from a conversation I had with Eric Oetter over Sunday breakfast.

From our first day in an introductory PRI course we are shown that asymmetry because of in-utero development and positioning, brain hemispheric dominance, asymmetrical vestibular development, and internal anatomical differences is normal, expected, and predictable.  Determining patterning that represents discord in the system then seems to be impossible until your realize that the skeletal system, is inherently symmetrical.  Therefore there is no better way for a physical therapist to determine the state of the system as a whole than identifying asymmetries or patterns via our typical orthopedic testing.

The brain processes and integrates all sensory inputs, internal and external, and generates behavior, including motor behavior, based on our perceptions with respect to the environment, emotional status, and previous experiences.  I don’t think it’s unreasonable to consider that the ability to produce reciprocal and alternating movement is not only an effective measure of autonomic tone but also a key measurement of overall health.

Bill Hartman, PT

Posted June 13, 2014 at 7:17PM
Categories: Clinicians Articles
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