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Blog Posts in February 2018

Our 10th Annual Interdisciplinary Integration Symposium is coming up fast, and over the next few weeks I hope to shed some light on my enthusiasm for this event, so that you don’t miss this opportunity if you have the same interests.  These yearly symposium topics are selected based on experience and interests that developed though my patient interaction and intervention.  The topic selection is further strengthened by what I have read, witnessed, and discovered using lens that have various transparencies.  My perspective on the subject matter always is redefined and refined as I prepare for the symposium and as I work with each presenter and their related background and interest.  As April 19th approaches, I continue to recognize the re-occurrence of asymmetrical patterns of predictable functional and behavioral resistance.  We all “resist” when movement of the contralateral extremity, side, bone, etc. is not sensed moving in the opposite direction, secondary to behavioral resistance.  But we should also be mindful that resistance is required for directed expansion, unraveling, unfolding, respiration and compensation.

I chose the title “Postural Restriction:  An Interdisciplinary Approach to Alignment of Functional Patterns” because of its influence on alignment of malalignment.  Neurodevelopmental alignment, evolutionary alignment, pathologic alignment, inter-relationship alignment, and bi-pedal alignment as related to neurologic tension and soft tissue tension.  There are degrees of resistance in all of this “alignment,” as there are degrees of “malalignment.”  Patterns of resistance and re-tensing resistance guide and regulate us.  We all need resistance for meaningful growth and meaningful freedom.  Revolution sometimes is our only path to freedom, when meaningful growth succumbs to over-resistance.  A balance of tension is therefore, so important to all of us and I really hope this symposium will offer insight on how to achieve balanced resistance in day to day activity.   

In 2009, I read an article written by Matt Wallden, MSc Ost Med, BSc (Hons) Ost Med, CHEK IV , DO,ND who was an Associate Editor of the Journal of Bodywork and Movement Therapies and I have been following him and reading his work ever since.  I was so appreciative of his acceptance of our invitation to speak at this year’s Symposium on “The Evolutionary Basis of Tissue Restriction” and “Clinical Assessment and Interventions for Rebalancing the Body with Tissue Restriction.”  Matt lives in Surrey, UK and owns Matt Wallden Health & Performance, where he is clinically active as a C.H.E.K. practitioner, in addition to applying osteopathic and naturopathic philosophy and treatment.  Matt is also on faculty for the C.H.E.K Institute.  Our conversations with him have been so enlightening and I know he is truly looking forward to meeting all of you and integrate his thoughts regarding tissue restriction/resistance to clinical assessment and treatment.  I personally look forward to meeting him and spending time with him and know you will enjoy his delivery and personality.

Our other keynote speaker is also an osteopath and will be giving a presentation on “Archetypal Postures: What They Are and What Can Be Done To Achieve Them” as well as a discussion on “The Contractile Field:  A New Model of Human Movement.”  There is no speaker, writer, or individual who knows this subject material better than Phillip Beach, DO, DAC.  Phillip has a private practice in Wellington, New Zealand. In addition, he has lectured internationally for several years.  In 2010, he wrote a book entitled “Muscles and Meridians – The manipulation of shape.”  I feel so honored that he will be here in Nebraska to discuss relationships between symmetry, asymmetry and handedness as related to our archetypal posture and contractile fields of “default movement” and patterned vertebrates (humans).  I am very excited to hear him talk!  

Well that is a brief reflection….and over the next few weeks, I will continue to reflect on why I chose the other presenters and why they are so instrumental in this interdisciplinary engagement.  

Posted February 27, 2018 at 11:37AM
Categories: Courses

 I had the great privilege of changing patterns, positions and perspectives as I presented to the Vermont Youth Orchestra Association last week. This is a group of 78 of the most talented high school musicians in the state of Vermont.

As they celebrate a year of Tchaikovsky and practice his 5th symphony, we talked about playing related pain, it’s 68% prevalence in musicians 7-17 years old, spatial orientation bias, asymmetry in playing, and the importance of zones of apposition. I left them with a reference sheet of PRI prevention-based exercises in hopes of changing their fate.

Sean Fitzgerald MPT DPT PRC EPPM

Posted February 26, 2018 at 1:27PM

This past weekend I had the pleasure of returning to ATI Physical Therapy in beautiful Everett, WA just outside Seattle. Betsy Baker Bold has been serving PRI as a hub in the greater Seattle area for many years and we at PRI were once again welcomed into her clinic at ATI with open arms for a learning adventure, this time for Myokinematic Restoration. With Erin Rajca, DPT, PRC to assist with lab and Agnes as the backdrop screen for the projector, we had a high quality environment to take in some high quality PRI movement science. Meg Tyner, DPT, ATC, CSCS from New York earned the rockstar award for her ~3,000 mile journey to Seattle!

Matthew Krings, PT, Jaclyn Stoerzbach, DPT, Diane Wiggin, PT, and Stefanie Wren, PT among many others provided thorough and insightful questions regarding asymmetrical polyarticular chains of muscle and how to integrate these and other PRI principles into practice. Thank you Hollie Young, PT, Jonathan Losch, SPT, Michael Murphy, DPT, OCS Kyle LaLiberte, ACSM EP-C, Alexa Degel, DPT and others for your help during the various lab demonstrations of manual and non-manual techniques throughout the course designed to attenuate and balance normally asymmetrical laterality of an AIC pattern.

On Sunday morning we woke to what I understand to be a relatively large snowfall for the area. This group of attentive, enthusiastic learners not only arrived early, but stayed engaged throughout and added to course content with well-considered discussion throughout. This Instructor thoroughly enjoyed dialogue regarding origins of pathology due to compensatory patterns as well as discussions of what, when and how to address post-operative patients with the same symptoms before and after procedures using PRI principles for AF and FA movement.

Thank you again Betsy, Erin, Agnes and the whole crew I learned with this weekend--and Tuline Kinaci, ATC for reminding us all that our traits are as habituated as they are innate. Once again, Seattle wowed me.

Posted February 22, 2018 at 10:39AM
Categories: Courses

New York, New York. What a fun weekend we had! James and I had the opportunity to hang out with some accomplished and energetic professionals this past weekend in downtown Manhattan as we taught the PRI Integration for Fitness and Movement Course for the first time in 2018. Thank you so much to PRC Alicia Ferriere, Michael Conlon, and the Finish Line staff for hosting and welcoming us into their beautiful and innovative clinic. Great place to go to for PT and recovery in NYC! James and I were able to launch some of the new material and get fitness and movement professionals exposed to how to optimize three dimensional core activation and train the abdominals to enhance ventilation mechanics and trunk stability. The course attendees were well mixed with seasoned PRI enthusiasts looking for fresh insight and ideas to enhance their integration of progressing pelvic-thoracic relationships, as well as new inquisitive minds looking to understand what the PRI science is all about. The mix in attendees gives us a chance to unite and learn from one another as this course is not a course which focuses on pathomechanics and pathology but instead talks about key biomechanical principles involved to preserve postural relationships, functional symmetry, spine health and rotational control, as well as emphasize how to better organize and prime muscle groups to promote single leg control and power for gait. I love how the course continues to grow, evolve, and progress the utilization of PRI and helps us all appreciate the natural delicacies of our complex biomechanical machine. I’m excited for all the cool places we get to travel to this year to share this material – St. Louis - Salem – Burlington, VT - Charlotte, NC - Los Angeles – Chicago - and Philadelphia.

Posted February 21, 2018 at 10:19AM

It was a refreshing weekend in Albuquerque, NM, for several reasons. Since I had to use my snow blower three times before I left, it was great to see the sun and feel 60 degree weather again. More importantly, it was very refreshing to have the opportunity to explore human patterning and performance with so many individuals new to the science of PRI.

The introduction of the concepts of neutrality and asymmetry started our weekend. And those concepts were followed by why and how does the L AIC pattern develop and become the dominant neuromechanical pattern in our body. And that lead us into our conversation of normal mechanics vs. normal compensatory mechanics vs. pathological mechanics due to this dominant L AIC pattern.

As we moved into myokinematic behavior as a result of the L AIC pattern, Karen Bexfield, PT, asked a great question: why is our focus on the frontal plane? That question helped focus our conversation around the necessity to get out of system extension, either unilaterally or bilaterally. And helped drive our conversation around the idea that if the frontal plane isn't intact, then transverse plane motion will occur in the incorrect location and manner, causing further compensatory patterns, some of which will result in more pathology. When it's time to be "Batman," be "Batman." But when it's time to be "Bruce Wayne," be "Bruce Wayne." And we need to be "Bruce Wayne" much more often on both sides than we currently are.

We were fortunate to have a lot of lab time to focus on the value and application of the Hruska Abduction and Hruska Adduction Lift Tests. We were also very fortunate to be able to spend a lot of time in lab so we could experience several of the non-manual PRI techniques ourselves. The hamstring is the gate keeper of the gait cycle! My thanks to Nathanael Smith, ATC, CSCS, for being a great host and allowing us to use his awesome facility. New Mexico is just starting to gain traction in PRI, and it's exciting to see a facility like Nathanael's adopting PRI concepts. Meeting Nancy Allen , PT, was a real treat for me. She's been exposed to PRI for several years, and it turns out she grew up in South Dakota, not far from where I grew up! Small world!

My thanks to Nancy as well for bringing along her co-workers, Karen Bexfield and Andrea Deyloff, so they could get their first taste of PRI. My thanks to Pat Fraser, PT, for her great questions. Thank you to Alanna Phillips, a PT student, for making the trip for her first PRI exposure. Thanks to Karen Russo, PT, Lukasz Sokol, and Nathanael Smith for letting us use you as our demonstration models. Thank you to Sandra West and Emily Blair, DC, for their enthusiasm and great comments. And thanks to Maritza Castro, ATC, for making the trip all the way from the Dominican Republic for the course!

Posted February 20, 2018 at 2:52PM
Categories: Courses

Giving a PRI course on occlusal positional consideration and occlusal influences on human positional sensorium and pattern was one of the highlights of my career and life. “After 45 years of ‘pre-dental major’ exploration, non-conformist intuitive processing and integrative pattern exposure and recognition and ‘irrational’ clinical appreciation that was built off of ‘effect and cause’ experience, “I was prepared to present ‘post –dental’ reasonings and recommendations. This first power point slide is powerful because it reflects my 45 years of pre-dentistry and the foundations of PRI. It is a course designed for dentists who are interested in patterned occlusion and its relationship to human patterned asymmetrical and functional limitation.

This was the first time I gave this one day course – however, I have been preparing 45 years to discuss spheno-palatine influence on bite patterns, teeth behavior  and personalities, the five meanings of ‘OA’ as related to that frontal plane, occlusal-calcaneal cortical function, and occlusal impact on dynamic freedom.

I want to thank Jen Platt for her ‘first row’ student perspective and advice and for her patience and producer role, that she has perfected over the years of working with this director. Other shout outs to Hannah Janssen for her acting and functional performance and to Matt Hornung for his editing, visual production and camera mastery. Without my comrades at the Hruska Clinic, refinement and resolution of this vast subject matter would be tyrannical. Jason Masek MSPT, ATC, CSCS, PRC, Lori Thomsen MPT PRC, Torin Berge MPT , PRC, Dave Drummer DPT, PRC and Heidi Wise OD, FCOVD. Thank you for your patience, kindness and ongoing support. I love you all so much.

I also want to thank Rebecca Hohl DDS MS, Chris Campbell DDS, Mark Vanicek DDS, Susan Christensen, DDS, and their respective staffs. Without their integrative mindedness and effort, the research that supports the didactic information provided by this course would have limited clinical significance and measurable outcomes.

The feedback and input were invaluable and I am excited for the next opportunity to relate human patterned asymmetrical occlusal contact and referenced sense to the asymmetrical pattern that coincide or contribute to human pattern development and the behavior recognized  by the Postural Restoration Institute

Posted February 16, 2018 at 3:37PM
Categories: Courses

There I was in Hotlanta and as the rain poured down!  40 of us PRI nerds gathered at One On One Physical Therapy and spoke about all things Postural Respiration. I didn’t get to take very many pictures this time around because I was busier than a centipede at a toe-counting contest! Honestly, if I wasn’t answering questions...I was asking MORE questions. This audience was chock full of eager minds and new professionals visiting PRI concepts for the very first time. How honored I was to have the opportunity to go over the complexities of normal and abnormal respiration, the role of the diaphragm as a postural muscle and a respiratory muscle, rib kinematics as they relate to human asymmetry. I had two of my own former employees who are both Postural Restoration Certified (PRC) helping in the labs: Adrian Baker DPT, PRC and Kristin Spencer MPT, PRC. Adrian and Kristin were extremely helpful and valuable assets during the weekend and I am grateful to both of them. One On One Physical Therapy is a great host site and the facility was laid out nicely for a good class. Karen Davis Warren MPT, OCS, OTC made sure we had what we needed and I’m pretty sure she is planning on hosting another PRI course in the future. Present in the audience was Amos Mansfield ATC the head Athletic Trainer at Mercer University in Macon, GA. Amos is hosting Myokinematic Restoration at Mercer on March 3-4 and I would invite all to attend as this course dovetails very well with Postural Respiration. I look forward to seeing you all next month and in continuing PRI courses in the future. Let’s explore the science together!

Posted February 13, 2018 at 2:25PM
Categories: Courses

Hruska Clinic hosted visitors from Japan

Earlier this January we were blessed to host 2 gentlemen from Japan; Koichi YAMADA and Akira YOSHIMOTO; who came to Lincoln to see how our staff utilizes the science of Postural Restoration(R) in a clinical setting. They spent a day mentoring with us in the clinic as well as some time with the staff at PRI. Here is their testimonial in their best of English as well as some fun pictures from their time. Little do they know that we learned as much from them as we hope to have shared with them. We hope to continue to grow these types of relationships with passionate dedicated professionals wherever they are!

Read their comments here!

Posted February 1, 2018 at 4:05PM

I can't begin to explain how much fun I had teaching this past weekend, for many reasons. One of the main reasons is the site host this past weekend was one of my very good friends, Suzie Maciel. Suzie and I went to PT school together, and we have been great friends ever since. She is responsible for PRI coming to Sacramento, as well as the success of our class this weekend. We had some IT issues, and Suzie was a real hero. My eternal gratitude, my friend!

We had a ton of great questions that helped us keep focused on our progression from normal mechanics to pathological mechanics. We were fortunate to have a very diverse class of rehab and strength professionals. It is both refreshing and exciting to have so many first-timers to the science of PRI. To have the privilege of introducing PRI to health care professionals, and sharing the ride with those eager to learn, is so enjoyable.

Our weekend started with a mechanical discussion and progressed to how patterned mechanics dictate muscular performance. We also discussed how we need to keep our muscles in the proper "Boy Band." There are times to be "Batman," and times to be Bruce Wayne. We discussed why the neuromechanics of patterned behavior leads to compensation, and how some compensation is expected, and others lead to pathology.

We were fortunate to have plenty of lab and demonstration time. My thanks to Dade Donovan, DC, for being our model for our repositioning demonstration. He has a classic L AIC presentation, and was the optimal model for our learning. , Additionally, Cole Hughlett, DPT, provided us the opportunity to learn how his testing revealed differing results when compared to Dade. We also had a great introduction to the Hruska Adduction and Abduction Lift tests, as well as how they are linked to the gait cycle. Which lead us into our discussion of how the hamstring is the gate keeper of the gait cycle. Susie Buchanan was a great model for us to learn and see how underlying every PEC is a L AIC.

My thanks to Robert "Pete" Lucente for his awesome and timely questions. Melissa Stahl, Teresa Wooden, Tim King, Joel, Smith, and Andrew Hughey kept us honest during lecture, and asked insightful questions during lab. And a huge thank you to Caleb Chiu, CSCS, PRT, for his help during the weekend. He is a fantastic lab assistant, and was invaluable in adding important points of discussion that needed to be clarified or emphasized more. An additional thank you to Taylor Lewis, MA CSCS, PRT, RKC II for his help during our labs. Having two certified individuals in the course really helped the course run smoothly and allow the first timers more access to how to apply the science of PRI from two very experienced practitioners.

Posted February 1, 2018 at 9:07AM

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