"What Introductory PRI Course Should I Take First?"
Hello PRI world of thinkers and learners! Jesse Ham here, chiming in on a topic that has been and will continue to be a worth-while discussion: What is the best way to get clinicians engaged into looking at movement through a PRI lens? Or, put another way, what PRI introductory course will be the best to take first? There really isn’t a right or wrong answer. This is my impression from my experience personally as a clinician and from listenting to others' responses after they have taken various courses.
If we were all blessed with Ron Hruska’s ability to shift paradigms, take in seemingly limitless amounts of information, integrate it together and apply what we learned, then there would be a simple solution. We would all take a week-long PRI Introductory course called Postural Myokinematic-Pelvis-Respiration Restoration. Not only does this title not fit on the front of a manual, it’s a mouthful to pronounce, much less digest and apply all at once.
Even if we could get a week off consecutively to attend such a course, most of us will be on “new information maximum” somewhere between the afternoon of the first day and mid-morning of the second day. After taking my first Myokinematic Restoration Course "four score and seven-plus years ago," I recall the need to work with it on many patients, review the manual, PRI blogs and emails, and just process the base concepts for quite some time. So, since the best introductory course is a bit bulky, I pose a feasible strategy for where to begin taking the three introductory courses, Postural Respiration, Pelvis Restoration and Myokinematic Restoration.
To do so, I will take a small tangent here: Before I was aware of this Institute, in fact before I went to PT school, I was aware that clinicians struggled mightily treating IS (Ilio-Sacral) joint dysfunction. There were seemingly as many special tests and strategies for treating this joint as there were clinicians and instructors. Some said the IS joint didn’t move at all, others said it needed to be manually mobilized if it wasn't functioning properly. Every static and dynamic imaging study had been done, with conclusions that gave very little insight from a clinician’s standpoint. I studied Cyriax and all the derivatives up to Mulligan's work presently, I studied Gary Gray’s viewpoint. I reviewed the various clinicians’ work who were, in part, responsible for muscle energy techniques to continually self-mobilize the ilium on the sacrum. There are many more who contributed to this IS joint's body of research and treatment techniques, I have merely brushed over a few. The take home here is that after PT school and several years of practice, I had no definitive answers as to how to affect the position of this joint and maintain that effect for my patients as they moved in a triplanar world of forces.
Then I started to take on the world of PRI and its viewpoint as to how to effect this IS joint's position. As I became more adept at utilizing PRI concepts, I was far more successful at treating maladies related to IS dysfunction. But there were still some patients that I had to constantly reposition, those who were never free of a relatively constant "HEP." Far too many (~20-25%) of these patterned IS dysfunction patients were “better” but not well. They still needed consistent intervention, were not integrated and therefore I was not happy. Loose ends and unanswered questions still bothered me for some of my IS patients.
Along came Lori Thomsen and later Jen Poulin teaching Pelvis Restoration. Mind you, the concepts of pelvis position are woven into Postural Respiration and Myokinematic Restoration, and this discussion does not apply strictly to IS dysfunction--that was just one of my conundrum diagnoses that I use as an example here. But from my experience I was not as effective at those “tough ones” that we all have until I began to appreciate the position of an inlet and an outlet of a pelvis. Specifically, how that inlet and outlet position enables me to integrate a thorax with lower extremities optimally to allow a patient to attain reciprocal, alternating function and live their lives free from the bondage of perpetual, unsustainable diagnosis-specific exercises to maintain their function.
The above is my abbreviated rationale to the question I posed for the title of this piece. For those of you who skipped to the end of the book and like short answers, mine is this:
If I had it to do again, I’d take Pelvis Restoration first, followed relatively closely by Myokinematic Restoration and Postural Respiration.
Thanks for taking the time to review this blog. I will enjoy reading your experiences and story about what introductory worked well for each of you!