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

Congratulations to Michal Niedzielski, who recently had an article that he wrote about PRI published in a Polish Rehabilitation Journal! In addition to this article, Michal has translated and taught Myokinematic Restoration to colleagues in Poland, and is currently working to translate and teach Postural Respiration and Pelvis Restoration in Poland as well!

Posted April 1, 2015 at 8:45PM
Categories: Clinicians Articles

Happy April! And I mean it, that's no Fool's joke.

'Tis the month of Interdisciplinary Integration (better get your spot!), and to celebrate, I wanted to post up a link to a write up on this past December's Advanced Integration course.

It's four parts (one for each day of the course). All parts have all been published, so here is part Ipart IIpart III, and part IV.

Hope this gets your brain gears moving a little like it did mine.

-Lance Goyke

Posted April 1, 2015 at 1:35PM
Categories: Courses Clinicians Science

“It doesn’t matter whether you’re an 80-year-old smoker, a 23-year-old Olympian, or a regular, fit guy-odds are the way you’re breathing right now is flooding your body with stress hormones, compromising your joints and mobility, bottlenecking your energy and undermining your performance in the gym and everyday life. Fourteen times a minute, you become a little weaker and a bit duller.

Hruska is on a mission to change that. Step one is understanding how your body is organized.”

Ron Hruska was recently interviewed by Men’s Health along with Bill Hartman and Neil Rampe discussing Postural Restoration, after Trevor Thieme, Senior Editor for Men's Health attended a Postural Respiration course last year. Topics discussed include: optimal breathing and the typical respiration patterns, asymmetry, PRI in pro baseball, and common compensations that can cause neck, back and joint pain.  

The 90/90 hip lift with balloon was shown as a way to get your diaphragm in a position to work correctly, helping you to breathe appropriately and avoid chronic stress which can increase your risk of dementia by 67%, stroke by 59% and diabetes by 45%.

“You can think of neutrality of being functionally symmetrical- the ability to shift your center of gravity from one side to the other, to breathe efficiently with both lungs, and to maintain position of your true core. “Being neutral helps everything,” says All-Star first baseman Paul Goldschmidt. “When I lift, I’m stronger. When I run, I’m faster. It allows me to fully express my power and speed.”

If you haven't already, go out and grab the April 2015 Men’s Health issue and flip to page 144 to read the article, which they refer to as the "#1 Greatest Health Tip Ever!"

The article that originally appeared in the April issue of Men's Health is now online, you can read it here!

Posted March 25, 2015 at 3:21PM

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 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 March 15, 2015 at 9:42PM
Categories: Clinicians

Dallas Wood, ATC, CSCS, PRT and Zachary Nott, CSCS, SCCC, PRT are the next speakers featured in our speaker spotlight for the upcoming Interdisciplinary Integration Symposium on April 16-17th in Lincoln! Dallas and Zach will be presenting on two related topics: “Integrating Limitations for Required Optimal Human Performance” and “Safely Strengthening and Conditioning Those Who Function in ‘Un-Safe’ Situations”.

These two human performance specialists utilize their expertise as Postural Restoration Trained (PRT) professionals working with the Department of Defense. Integrating PRI into training with the operators they work with is not always an easy process, however they have found success, and their knowledge on these topics is something you will not want to miss. Here is what they had to say about their upcoming presentations:

“Integrating Limitations for Required Optimal Human Performance”

When your client can't or won't control their extension bias, you need an integrated approach to help them get the most out of performance. Creating an environment to effectively utilize multiple disciplines to help your client perform optimally maybe what is required. Integrating limitations to move them forward can give them the reference points to be successful.

“Safely Strengthening and Conditioning Those Who Function in ‘Un-Safe’ Situations”

Is an extended system always suboptimal? In certain specialized populations, patterns that the clinician or trainer would normally abstain from may be unavoidable. Certain strategies can be used to prepare a client for activities that require or encourage extension, as well as allow them to manage this pattern when at rest. 

To see a complete list of speakers or to register for the upcoming Interdisciplinary Integration course, CLICK HERE!

Posted March 10, 2015 at 3:19PM
Categories: Courses Clinicians

Mike Cantrell was recently featured again on a teleseminar interview with Joe Heiler on Sportsrehabexpert.com. On this interview, Mike discusses a few case study examples with some athletes he has worked with including diagnoses of: sports hernia, femoral acetabular impingement and shoulder impingement. To listen to this interview for free on Sportsrehabexpert.com, click here! Sportsrehabexpert.com frequently has interviews and topics of PRI discussion, so if you haven't checked it out, be sure to do so!

Posted March 9, 2015 at 8:06PM
Categories: Clinicians Interviews
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