Welcome to the Postural Restoration Community! This is where you will read the latest industry news, hear about upcoming events, find helpful deadline reminders, and view a plethora of additional resources regarding our techniques and curriculum. The great part about it is--not only can you can view the entries we post, you can also post about the things that matter to you. Did you find an interesting article about a technique you learned in one of your courses? Do you have a patient case study you want to share with other professionals? Simply click "Submit an Entry" and follow the easy steps towards getting your information published in the PRI Community!
Myokinematic Restoration originally scheduled in Spokane, WA, has been moved to Seattle, WA on May 31-June 1st! There are still a handful of seats available, so if you are in the Northwest, be sure to register soon. The early registration rate of $445 has been extended until next Wednesday, May 21st!
Like most of you, I am a clinician when I enter this site. But like many of you, I am a spouse, parent and community member as well—just a person. These blogs are written as pragmatic, candid discussions about my experiences as a PRI practitioner. Like you, my treatment style is a product of the training I have received. That training has come from a wide variety of sources—so I certainly qualify as eclectic by definition. However, every good clinician uses their most powerful and effective tools the most, whether they process that fact or not. I am no different in that regard either.
From time to time over the years, I’ve fielded questions about whether I am a PRI “fundamentalist.” This is a good question, and one worthy of discussion. The well-intended question is “do you use ONLY PRI to treat your patients?” The short answer is “No.” The longer, slightly more complete answer is “when I treat a patient and they return to clinic objectively neutral with PRI functional tests that equate to the level of functional strength that they desire but still have focal symptoms, then I treat with focal treatment techniques.” I use my most powerful and effective treatment techniques first and often times don’t need others. And yes, the most powerful techniques I’ve ever utilized are PRI techniques.
That said, I think it best to discuss this concept by way of actual clinical examples. The following is a story about one patient with the diagnosis of left shoulder biceps tendinosis who I treated intermittently over an 18 month span, the strategy I used to treat him and the clinical results that I found. Names have been changed to protect the innocent and in order to maintain a readable text, I have grossly summarized the care of this patient. The clinical findings listed are predominantly to give the reader a feel for the symptomology, goals of the patient and style/type of treatment used.
Don’s Story:
Diagnosis: “biceps tendinosis”
“Caused” by AC jt spurring, subacromial impingement according to his physician, the radiograph and MRI
The mechanism of injury was insidious, first becoming a limiting factor 3-4 months prior to evaluation. The patient’s ROM was functionally limited into abduction, flexion and IR, less limited with ER. There was noted adverse neural tension with median and ulnar nerve biased UENTT’s. Neer sign, Hawkins Kennedy and empty can tests were positive. Comparable sign with resisted elbow flexion and supination, active and resisted horizontal abduction. PRI testing revealed a PEC patient who showed a bilateral BC pattern.
The patient wanted to be able to raise his arms overhead to enable him to perform various ADL’s including woodworking, wanted to be able to again play his accordion, which he had been unable to do for several months.
This was a classic example of working with an “old-school” orthopedic physician and patient. Good physician, hard-working patient. I initially described the positional influence of the brachial chain because I knew it was most important and tried to treat the patient in that fashion. However, the patient’s script for PT from the physician was specific and called for scapular stabilization, rotator cuff strengthening and the patient had discussed specifics about what PT would involve before arriving. When what I felt was best for the patient was not supported by the patient or his physician, I chose to follow the script as directed. I did what was comfortable and familiar to the physician, patient and myself—I used an ‘eclectic’ approach which included: As much “PRI” as the patient would tolerate–a few non-manual techniques to attempt to reposition, Butler neuromobilizations to address adverse neural tension, Gr I-III joint mobilizations to inhibit tone and mildly increase posterior-inferior capsular length, MWM’s to achieve end range pain-free ROM (IR and abduction most notably in this case), pain free rotator cuff, ST AND TS stabilization to the hilt.
After using this approach twice per week for 8 weeks, the patient had achieved all mobility goals, and all but one functional goal. He still could not play his accordion for more than 5 minutes without having symptoms of left shoulder pain but was happy with his progress, reporting he was 90% better. At his 8 week f/u with his physician, the decision was that he was “better enough” and was to discharge to HEP in short order. I outlined his final HEP that he would agree to and wrote a semi successful discharge summary to “continue with independent HEP per physician’s orders.”
Sounds like a common 90% successful PT intervention, right? I had met all of the mobility and all but one of the functional goals that I had set and the patient and physician were pleased with my work. I had done exactly what they had asked. So why wasn’t I entirely happy?
To be continued…
Check on the new recent email that has been posted, where James Anderson answers a course attendees questions on the FA Range of Motion charts in the Myokinematic Restoration course manual.
CLICK HERE to read Jame's response, and to check out all the recent email questions in the archives!
Check out this newly released article by Emily Soiney, titled “Taking Yoga to the Next Level-Postural Restoration-Inspired Yoga for the Athlete: The Frontal Plane”. Emily is also busy preparing for the first PRI Integration for Yoga affiliate course which will be held in Portland, OR on September 13-14th! Additional seats have just been opened for this course, so if you are interested in attending be sure to reserve your seat today. CLICK HERE to register!
Jen Poulin will be traveling with her husband, Chris to the UK this summer to share PRI overseas! Pro Sport Physiotherapy in York, England will be hosting Myokinematic Restoration on July 26-27, 2014. Physiotherapist Martin Higgins, along with fitness professional Kevin Duffy will be hosting the course, and space is limited! If you are interested in attending, be sure to sign up soon!
CLICK HERE to register for the course!
Don't miss the opportunity to take the Cervical-Cranio-Mandibular Restoration course taught by Ron Hruska in Richmond, VA on May 17-18th! The early registration deadline is this Friday, and we are still a few registrations short of confirming this course. If you are currently signed up, and want to help make sure this course doesn't get cancelled, phone a friend and invite them to attend the course with you.
CLICK HERE to sign up for the course!
Christy Peterson (PRC) and I gave a riding clinic April 6 and 7 at her facility (Riverside Physical Therapy) in Ord, Nebraska. This was an ideal setting, because Christy’s facility is located on her farm which has an outdoor arena for riding. Participants trailered their horses in from the surrounding area. All were competitive riders (mix of Western and English disciplines), some of whom were competing at the World level.
After PRI evaluation and treatment, followed by some PRI-based exercises designed specifically for riders, each rider saddled up! They were tasked with integrating what they learned off-horse to on-horse…challenging but powerfully effective. Riders must be able to move their seat, arms/hands, and legs independently of each other in order to guide and lead the horse successfully and perform well. This requires extraordinary body awareness, subtle controlled movements, and centering to the ground (not the horse) atop a powerful animal that has its own asymmetries. Riding is a complex sport and often referred to as an artform.
It has been my experience over the past 3 years that many of the cues traditionally used by riding trainers are misinterpreted by riders and promote an extension pattern. I cringe when I hear these particular cues: “sit tall”, “chest up”, “shoulders back”. Interestingly, a term that both Christy and I use to highlight and promote flexion for riders is the word “collection”. Riders know and understand this term, because it is used to describe a state of posture and movement of the horse. “Collection”: moving back to front; getting hind legs under the belly for powerful movement, balance, and control; top line of the horse lengthened and bottom line shortened. So, when we get a rider into an All-Fours position, a 90-90 Hip Lift, or a Supported Standing Wall Reach and ask them to “collect”, they will instinctively reach their knees forward with a posterior tilt of the pelvis to “move from behind” and activate their hamstrings. Pretty cool! It is also a helpful cue for the seated posture of riders in their saddles…lumbopelvic flexion with the front of the hips open.
Christy and I both learned from working with each other, and the participants seemed to appreciate the dual point of views. We are in the process of planning more clinics, since we had such a positive response. Each participant received an individualized 2-hour session with both Christy and I.
I hope to extend these types of clinics across the country…beginning with NE, MD, VA, PA, NC. If you are interested in hosting one of these types of clinics, please contact me at Lilla@MovementControlSpecialists.com or visit www.EmpoweredRider.com.
Posted by Lilla Marhefka (PRT).
Seattle, WA (Myokinematic Restoration) – “I had a blast in Everett, Washington this past weekend. Betsy and Zach are now PRC’s and that made me proud as I met Betsy when I was training to teach this course! Zach provided excellent support as my lab assistant. The jet-lag was worth all the hole control and appreciation for integration of pattern and position. This group was a mix of PRC’s, aspiring PRC’s, and some brand new to the science of PRI. The questions, dialogues and paradigm shifts were alive and well. I only wish I could have had more time to teach and explore this beautiful part of our country. I look forward to many more trips to the NW corner of the country. Olympic PT staff and the new friends I met from the region were awesome! Sorry for all the corny jokes and tangents, but hey I’m Jen Poulin, what would a PRI course be without my stand-up routine mixed in?!” – Jen Poulin
Santa Clara, CA (Pelvis Restoration) – “Thank you Zenith Strength for hosting me this past weekend in Santa Clara, CA. This course covers a lot of material in two days and with half the class being new participants….whew they got their feet wet. I feel the course participants appreciated our normal human asymmetry with the pelvis having muscles anterior/posterior, lateral, and inferior on both the left and right side that need to be in the correct position for optimal function. Certain muscles on the left or right side need to be “off” or inhibited while others need to be “on” or facilitated. Joint position influences muscle position. Once you see it, it’s hard to deny it. It was a great weekend!” – Lori Thomsen
Tucson, AZ (Myokinematic Restoration) – “I had a fantastic weekend in Southern Arizona discussing the restorative power of the left hamstring. Besides positioning the lower half for tri-planer function, this muscle helps sustain the breathing patterns needed for single leg dynamics without adverse compensation. Preserving hamstring function allows use of the left adductors without compensation from the left hip flexors, and also use of the right abductors without compensation from the right lateral ab wall. This type of isolated muscle sequencing is what makes this course so exciting. And, Oh yeah, how could anyone even consider a visit to Tucson, Arizona, without dining at my favorite restaurant, Cafe Poca Cosa!” – James Anderson
It looks like we are going to have beautiful weather for our 6th Annual Interdisciplinary Integration Symposium this week. Safe travels to Lincoln!
This was the second time that I had the pleasure of teaching at Finish Line Physical Therapy in New York City, and I am always grateful for their genuine appreciation and interest in PRI. After a weekend of Postural Respiration, I know most of them will not forget how to integrate left abdominals with left posterior mediastinum and right lateral thoracic expansion. I hope they became "lifted" as much as they "lifted" me on a wonderful rainy weekend in New York!
This past week, PRI has been featured in two different news outlet stories!
Yesterday’s issue of the USA Today included an article about Arizona Diamondbacks pitcher Bronson Arroyo and his stategy to stay off the disabled list, which includes PRI and blowing up balloons. CLICK HERE to read the article online. PRT’s Neil Rampe and Andrew Hauser along with the entire Arizona Diamondbacks athletic medicine and performance staff deserves some kudos here!
In another story, PRC therapist Jon Schultz from Des Moines, IA was featured by a local television station KCCI News8 in the story titled "How Learning to Breathe Could Help Your Recovery". To see this great video, CLICK HERE!
Having recently returned home to Australia from visiting Ron and his team at Hruska Clinic and the Postural Restoration Institute, I can honestly say that I found the experience observing this brilliant team as second to none. Ron and his staff were such warm, hospitable people who so generously shared their knowledge and expertise, and the opportunity to witness their Practice in action has been nothing short of life changing. I want to take this opportunity to sincerely thank both Ron and his team for welcoming me to Lincoln, and I am excited to continue my studies with PRI and look forward to visiting the clinic again in the future. Regards, Jason Thomson.
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