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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!

Blog Posts in May 2014

I just recently finished reading "It's a Jungle In There" by David Rosenbaum. This cognitive psychology overview, with a Darwinian perspective, touched on 'perceiving more than is really there'. Phenomena often reflect "top-down" processing. The term refers to high-level interpretation biasing perception, so perception is not just dictated by immediate sensory data or "bottom-up" processing, but is also shaped by expectations. Over-competition and under-cooperation among relevant neural representatives can bias perception.

The last course I taught in Richmond, VA was Cervical-Cranio-Mandibular Restoration, and it was attended by a number of 'neural representatives' that were once "bottom-up" processors and are now "top-down" perceivers. I really enjoyed their cooperation and non-competitive communication!

Posted May 28, 2014 at 2:23PM
Categories: Clinicians Books

There is now a Postural Restoration Google Group! We welcome fellow PRI practitioners to join! The purpose of this group is to facilitate the exchange of PRI based concepts, ask advice about challenging cases, post important research articles, and create discussion regarding any PRI ideas or techniques that you care to share.

Examples of some topics:

Heart Rate Variability Analysis, Thoracic Mobilization, and Autonomic Dysfunction

Pesky Patho PECs and Clinical Pearls for the Art of Inhibition and Facilitation

To join, email HeatherCarrDPT@gmail.com. She will then send you an invitation to accept. 

Posted May 28, 2014 at 8:04AM
Categories: Clinicians

Are you curious what books Ron has been reading lately? Well here they are! These are the most recent additions to his desk (and the PRI resource center). As you can tell by all the purple tabbed pages, the book he just finished is "It's a Jungle in There" by David A. Rosenbaum. Stay tuned for a short synopsis on this book next week!

Ron's May 2014 newly acquired books include:

  • It's a Jungle in There: How competition & cooperation in the brain shape the mind
  • Mindwise: How we understand what others think, believe, feel and want
  • Autonomic Neurology
  • Inheritance: How our genes change our lives and our lives change our genes
  • The Tale of The Dueling Neurosurgeons
  • Think: Why you should question everything

If you have read any good books recently, be sure to comment on  his story to let us know what books we should be getting next!

Posted May 23, 2014 at 8:57AM
Categories: Books

The Cantrell Center in Georgia is currently looking to hire a Licensed or License-Eligible Physical Therapist and Physical Therapist Assistant- new graduates welcome!  Mike Cantrell is a faculty member for the Postural Restoration Institute.  He is growing his staff and this opportunity is one that doesn’t come along often.  You can contact Mary Oakley PT, CHT at the Cantrell Center at vpop@cantrellcenter.com for more information.

Located in Warner Robins, Georgia, the Cantrell Center is located in the Middle of the state!  Just a quick drive to Atlanta or the beach, Warner Robins offers convenience to any interest without the crime rate and elevated costs of a larger city.  Visit the website of the Warner Robins Regional Chamber of Commerce for more information about the city of Warner Robins.

What makes The Cantrell Center a great place to work?

  • Outstanding Work Environment
  • Commitment to Clinical Excellence
  • Team Atmosphere
  • Ethical Standards & Values
  • Competitive Benefits Package
  • We have FUN!


As part of the Cantrell Center Team, you will collaborate with dedicated individuals while building your own career.  This is a place where each team member's gifts and experiences come together - creating an atmosphere of integrity, encouragement, and most of all - a place where patient care is paramount.  


To learn more about The Cantrell Center for Physical Therapy & Sports Medicine, visit our website (http://www.cantrellcenter.com/), find us on Facebook- https://www.facebook.com/cantrellcenter, or check us out on YouTube here or here.

Posted May 22, 2014 at 5:50AM

PRI once again made a debut in Poland with Myokinematic Restoration. This time in the town of Opole in south west (seen in the pictures). We had 27 professionals, and Postural Restoration was very well received. I plan to introduce the Postural Respiration course to this group later in the year.

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Posted May 21, 2014 at 2:00PM
Categories: Courses

We have added a Postural Respiration course on August 23-24th in Loveland, CO! I can only imagine Colorado will be as beautiful as this photo in late August. What a great way to cap off the summer with a PRI course in Colorado! If you are interested in attending this course, CLICK HERE to get registered today.

Posted May 16, 2014 at 12:15PM
Categories: Courses

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!


 

Posted May 15, 2014 at 1:53PM
Categories: Courses

The 2nd Quarter PRC and PRT Updates email has been sent out today. If you are a PRC or PRT, please check your email for the latest PRI news and updates. If you didn't receive the email, please email me!

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...

Posted May 10, 2014 at 1:29PM
Categories: Clinicians

I recently found myself, once again, defending the wonderful science that Ron and everyone at the Institute have been so generous to share with us all. In this instance, the forum was a Facebook conversation (most of which can be viewed here) where PRC candidates Bill Hartman and Zac Cupples, along with myself, expressed our experiences with PRI to a group of contraians and skeptics.

As a means to provide closure, I constructed a response which provides a synopsis of therapeutic intervention as well as an explanation of how PRI prinicples help me intervene. After a wealth of positive feedback via social media, Jen and Ron asked me to share it here for the brilliant community of PRI clinicians. The response begins in the quoted text below.

Thanks to all of you for being such an inspiration and for positively influencing my education as a physical therapist.

"It's becoming increasingly clear that the path to system variability and pain-free movement is gated by neuroception (i.e. limbic threat appraisal) and autonomic nervous system output. And its these two properties of the nervous system which govern the effects of the innumerable methodologies therapists use to expunge system rigidity. 

Autonomous of discipline or method, clinicians intervene at the level of the receptor (rods, otoliths, mechanoreceptors, etc.), engendering unique signal transduction and transmission into a sea of equal status patterns which participate in collective summing within the brain. 

We'd hope our therapeutic inputs contribute to a modification in the perceptive capabilities of the patient, though (as we all know) this is not always the case. Some inputs never reach the level of perception while others exceed the adaptive capacity of an already rigid system, perpetuating chronic limbic hijack and sympathetic dominance.

But a positive change in perception opens valuable cortical real estate for neuroplastic remapping via graded exposure, which is the substrate for system variability. This is really the goal of any physical therapy intervention.

So, how do we know we're dealing with a rigid system in the first place? And furthermore, how can we evaluate the efficacy of our inputs with respect to restoring system variability? 

Beyond many other "systems" I've experimented with, PRI seems to provide the most cogent answers to the above questions. And it's the "umbrella" which explains, to me, why other methods work.

What PRI provides is a means to identify a predictable pattern of ANS-mediated anti-gravitational motor output for a collection of systems held in some degree of rigidity. The perspective they bestow is quite comprehensive; PRI is a unified system respective of ALL sensory inputs capable of influencing reticular output (mechanoreception, vision, audition, etc.). 

But woven through its complexities, their simple orthopedic testing and treatment algorithms provide a reliable means to assess this aberrant output, as well as evaluate the systemic and perceptual perturbations that might follow any therapeutic intervention (PRI, Mulligan, Maitland, MDT, ART, etc). 

Because interventions can be both synergistic or antagonistic to the pattern PRI presents, utilizing a withdrawal A-B-A study design during a treatment session (with the patient functioning as their own control) upholds an element of internal validity beyond what other systems might be able to provide. I'd argue this makes PRI a powerful adjunct to anything you're already doing, as we scrounge for external validity in a increasingly heterogeneous population.

PRI treatment aims to recapture reciprocal and alternating movement in three planes across the three girdles of the body. And PRI is never about fixing posture - it's about restoring system balance, variability, and adaptive potential." 

Posted May 9, 2014 at 9:01AM
Categories: Clinicians
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