Community

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 2020

We are taking a break from our Tuesday night "PRI Breathing Mechanics in COVID Times" webinar series this week, as Ron Hruska will be presenting on the American Academy of Physiological Medicine and Dentistry (AAPMD) webinar!

The title for thir webinar is "AIRWAY MANAGEMENT: Implementing Interdisciplinary Concepts Associated with Forward Locomotor Movement". This webinar discussion will outline how the body is moved forward during forward locomotor effort and how this effort influences and auto-regulates nasopharynx, oropharynx, hypopharynx and larynx airflow. Three questions will be addressed.

  1. How does forward locomotor movement (FLM) influence pharyngeal and laryngeal movement of air?
  2. How can one implement change in FLM patterns and improve pharynx and larynx air flow? 
  3. And finally, how can attributes of FLM be maintained or optimized by “airway” inter-disciplinary minded professionals when FLM ends?

This free webinar is tomorrow, May 19th at 9pm ET/8pm CT. To register, CLICK HERE!

Posted May 18, 2020 at 12:47PM
Categories: Science

In light of what is going on around all of us and the associated uncertainty of this virus that will no doubt continue into the summer months, we have made the difficult decision to once again postpone the Interdisciplinary Integration Symposium.

We do not feel that it is in the best interest of the Institute, the Speakers, or PRINation to try and host it this August, like we had hoped would be possible when we initially rescheduled. We really want to host this as a live event, rather than a streamed event. Each of the speakers have such strong messages that will be reinforced by live participation from both the other speakers as well as a full room of course attendees. This is what makes these Symposiums so special year after year. We also feel, because of so much uncertainty regarding our economy, transportation and US CDC guidelines, there would be many individuals who would not feel comfortable attending this August. Therefore, we are re-scheduling the Symposium to April 22-23, 2021. This year’s topic on Parkinson’s Disease and Extrapyramidal Disorders has garnered a lot of interest over the past several months, and we have no doubt that next year’s symposium will be one of the best ones yet!

We are planning to have our Anniversary Celebration next April as well. As symposium speaker and PRC physical therapist Jennifer Smart said, “Twenty-one years is a special number to celebrate too . . . the Institute has really come of age once it hits 21!” We are hopeful that you will still be able to join us in Lincoln for the symposium and this special anniversary celebration. 

We apologize for having to re-schedule this again, but we do feel that we are making the best decision for everyone involved. A lot of unsettling discomfort is being felt as a result of this global crisis, but we are hopeful that we will all be able to come together stronger than ever next Spring and have a room full of attendees excited to embrace this topic without stressing over social distancing and social traveling. Enjoying each other, collaboratively, socially and professionally make these Symposiums and their associated memories very special, and we hope that you will be able to join us in April 2021 for this overdue symposium and celebration!

Posted May 14, 2020 at 9:05AM
Categories: Courses

We had a great time last night on our first "PRI Breathing Mechanics in COVID Times" free webinar! We had around 250 people join us, and we look forward to hopefully growing this number in the coming weeks. If you missed the live webinar last night, you can access the recording on the Webinars page on our website. A PDF handout of the PowerPoint slides is also available on the Webinars page.

Below is the 3rd (of Ron's Top 10 Chest Wall COVID Breathing Techniques that we will be discussing further on these webinars) non-manual technique clinical reasoning break down. We invite you to review and try this technique a few times over the next week, as we will be discussing this and more on next Tuesday's webinar.

Standing Supported Left Glute Push

Let’s start with the title of this PRI Non-Manual technique.

This “standing” technique requires wearing shoes that provide good heel counter support, arch support and a toe box that will allow the toes and forefoot to easily spread out in the shoe. You will also need to push a table next to a wall to prevent it from moving forward as you push it forward with your hands (or you could use a kitchen or bathroom counter in your home). This PRI technique is designed to place one in a 'Valsalva-like' maneuver position between the exhalation and the inhalation phases, without blowing up a balloon and holding the expelled air or while pinching off the nose. 
 
In this technique, the force applied by the table and floor allow the tongue and mouth to close off the airway and properly use the abdominal muscles and the diaphragm to exhale and inhale without engaging the neck or back under moderate pressure created by closing off the pharynx with the pharyngeal muscle and the larynx/trachea with the tongue muscle. This voluntary control of the abdomen is maintained during the entire technique, without having to think about how to “hold” the contraction of the abdominals during both phases of the respiration cycle. It is a wonderful way to teach someone how to inhale with good opposition to the diaphragm so that its effectiveness on opening up the mid and lower chest wall is maximized, as the subconscious effort of maintaining abdominal stabilization is minimized.

The “support” of the upper extremities, offered by the stable table or counter, also allows one to lift the right leg up and the right foot off the floor as the left glutes "push” the body forward to further stabilize the lower trunk and pelvis as the right hip is raised up. This activity co-activates more integrative assistance from the right hip flexors, the right lower trapezius and long head of the triceps and left abdominal wall. When all said and done the tension and internal pressure created by the lengthened anterior shoulder and hip flexors enables one to breathe with the diaphragm under high compliance and forgiveness of lateral and posterior chest wall tension.
 
This technique is, therefore, a good technique because the lateral, posterior, apical and base surfaces of both lungs can expand easily upon diaphragmatic contraction, secondary to chest wall compliance and the gravitational force displaced on the abdominal contents. The internal organs fall anteriorly and off the front of the thoracic and lumbar spine. It is also, an excellent postural drainage technique for the posterior lobes of the mid to lower lungs, preceding the standing positional induced coughing that more than likely will follow with those who are experiencing difficulty breathing because of fluid-filled alveolar sacs.

Here are some additional comments about the steps that follow the title and pictorial examples, along with the reasoning for the procedural step.

Stand with your feet parallel to each other and directly under both hips. While keeping both heels on the floor lean forward to place your outstretched hands on the table in front of you. Now move your feet back so that your back is close to being parallel with the surface your hands are supported by, and the floor or ground you are standing on. You should feel a gentle stretch through the back of your heels and lower legs. Maintain heel contact with the floor or ground surface, especially on the left side.

These first two steps are important because you are now in a position where anything you do from this point on will foster more uniform opening of the entire circumference of your chest walls. This position, as reflected by the person in the second photo, also indicates that the attachment sites of the latissimus muscle on the side of your chest wall is in its lengthened state, as both of its attachment sites are distracted from each other. In other words, the arms are moving away from the mid to low spine, as the spine is more rounded than “U” shaped in this position.

This is an optimal position for the diaphragm to be in for coastal or mid to lower rib cage expansion upon contraction. It also is a great position for one to sense the abdomen lift the abdomen up against gravity and feel how one’s own body weight can serve as an element for abdominal strengthening with optimal diaphragmatic influence on the chest wall mechanics for ideal ventilation and perfusion at the anterior base of each lung’s lower lobes.
   
Shift your left hip back in Step 3 to engage your right hand as a pusher and to sense, activate, and lengthen your left outside hip muscles in preparation of using these same muscles to lift your right foot a few inches off the floor. While keeping your back parallel to the floor, in other words do not let your mid back sag toward the ground, lift your right knee up and your right foot off the floor/ground. The weight of your body should now be felt through both wrists and hands, your left hip, your abdominals especially on the left, (if you feel your right abdominals more than the left, you need to push more with your right hand into the table you are supported by) and the entire bottom of your left foot. This ‘highly integrated contracted’ position replaces the need to do this activity by blowing up a balloon correctly using PRI methodology.

Now hold this position as you take a deep breath in through your nose as you “push” with the above musculature and reference sites, outlined in Step 3. Then blow out through pursed lips or your mouth slowly by pushing slightly more with above muscles and sites. The most important consideration in Step 4 is to transition slowly from exhalation to inhalation with a “pause” (Valsalva pause) in between the exhalation and inhalation phase, without losing the “push” from your body while breathing in this reciprocal state of glossal sealing and pharyngeal closing during respective inhalation and pre-exhalation reciprocal breathing.

Stay tuned for more discussion on Ron's Top 10 Chest Wall COVID Breathing Techniques on our upcoming webinars and blog!

Posted May 6, 2020 at 7:15PM
Categories: Techniques Science

As we gear up for tonight's first webinar, below is Ron's breakdown with clinical reasoning for the second technique discussed in the free PRIVY trial video titled "Integrated Pulmonary Compliance". If you haven't yet checked out this free video, it is a great introduction to the webinar searies that begins this evening. Stay tuned, as we will be discussing more PRI non-manual techniques related to chest wall compliance in the coming weeks on our "PRI Breathing Mechanics in COVID Times" free webinar. To register for tonight's first webinar, please CLICK HERE!

Standing Wall Supported Resisted Ischial Femoral Ligamentous Stretch

Let’s begin with the title of this PRI Non-Manual Technique.

You will need to purchase approximately 5 to 7 feet of medium resistant therapeutic tubing. You can find information on the PRI Website under “Products” (and then click on "Materials") and purchase from Stretch Well, green colored medium elastic tubing. The Stretch Therapy Deluxe green tubing has hand handles included. However, you can perform this activity without band resistance, by placing your hands on the edge of a chair that easily slides forward as you reach forward. You will also need to find a book that is approximately 1 to 3 inches in height, at least 12 inches long and 7 to 10 inches deep.

When performing this activity in “standing” you will be able to use the floor as an anchor and a “wall” as “support” for distraction of your lower and upper posterior chest walls.  [This position on the floor and on the wall will allow you to primarily sense and focus on mid to low back lengthening as the accompanying posterior and lateral chest walls expand]. As you move your arms forward in performing the following outlined activity, the “ligamentous” soft tissue, including your accompanying hamstring muscle, that attaches to your “ischial” seat or sit bone and to your “femur” or thigh bone, more than likely, will feel tight. This tightness and/or “stretch” is the result of your abdominal wall of muscle contracting, as you reach forward with “resistance” from the therapeutic bands in your hands and the bands of elastic, soft tissue attached to your “ischial seats”. Therefore, the floor you are “standing” on, the “wall” your low back and hips are resting on, and the bands that are looped around the hands or the friction from the legs of the chair the hands are resting and pushing forward on, are all providing the forces needed for your left and right diaphragm leaflets, inside your two respective chest chambers, to open and expand and stretch both the inside and outside chest walls. This expansion, under the above guided resistance, allows one chest chamber to ideally open better when closure of the other chest chamber occurs, and vice versa. This PRI Chest Wall technique, minimizes pulmonary or lung static function, maximizes elastic tissue recoil of the chest walls, equalizes pressure when all four extremities are alternating or involved with lifting, and assists with optimizing immune responses.  

Here are some additional comments about the steps that follow the title and pictorial examples, along with the reasoning for the procedural step.

Stand with your feet parallel to each other and with your hips directly over your feet. Place a book that is 7 to 10 inches deep between the door and the back of your heels.  The back of your heels will help you sense the wall you are about to touch with your low back and hips. This heel sense, together with the sense of the floor you are standing on, will provide the anchoring your abdominal wall will require for upon contracting as you reach forward with your hands to relax and open your posterior chest wall and or back muscles.   

By also anchoring therapeutic tubing in the door at a height slightly above shoulder level, and around both of your hands, you will begin to sense the need to engage your abs, lower your head and shoulders and move your upper chest walls forward as your mid back and chest walls simultaneously move back. The same type of activity will occur if you place your hands on the top of a chair or stool on wheels.  

If you have difficulty sensing your abdomen muscles contract and it is difficult to round out your middle to lower part of your back, your anterior chest wall is too elevated.  Place a rolled-up towel between the upper part of your thighs, as high as you can get it. This rolled-up towel should be wide enough so that when you bring your knees together your knees will not touch. By placing this bolster between your upper thighs and squeezing your knees toward each other, your back muscles will relax and your ligaments at the back of your hips will be more easily stretched out as you lower your body with your muscles that attach to the two ischial seats. These muscles are called your hamstrings and will enable you to maximize your diaphragm’s influence on chest wall mechanical activity that will enable better upright perfusion of oxygen into posterior and lateral lobes of the lungs, that may be ‘locked up’ because of over contracting back muscles used for postural stabilization. Therefore, by pulling your two hips apart with the bolster between the knees, that are moving toward each other, you are essentially decompressing not only the pelvis that lies between the hips, but also the spine that lies between both chest walls. This decompression of the ‘chest wall’ spine decongests the lung tissue associated with congestion of lung tissue (alveola) that is incapable of opening because of spinal compression. By squeezing the bolster between your thighs, as you are doing with this PRI technique, you are essentially reducing the ‘squeeze’ on the posterior lungs.  

To place as much low back on the wall that you can, in Step 4, you may want to slowly and carefully bring your knees slightly forward as you are exhaling through your pursed lips. Try to keep your heels and feet flat on the floor as you are reaching forward with your outstretched hands and arms. Many of you will not be able to place your low back on the wall, and may only be able to sense your rear on the wall, as you attempt to round your back while reaching forward with your arms and knees as your body gently lowers. The most important thing about Step 4, is to reach with your hands and arms, resisted or unresisted, while you “round” your mid to low back, during this exhalation phase of movement.

Step 5, is where the magic happens. The magic is when your inhalation effort through your nose, after performing Step 4, continues to open up the entire chest wall cavities on both sides, along with all the underlying alveolar tissue in your lungs. The position you worked so hard in achieving is now serving as a platform for diaphragmatic inhalation without resorting to muscles that over compress the posterior lung tissue. Those muscles lie both directly in front of your neck and in the back of your chest walls.  
As you continue to breathe in through your nose and out through your mouth, or through pursed lips, let the air move your chest. Assist this chest movement by drawing in the air (Step 7) and compressing it out by reaching further forward with your arms, as the weight of your anterior body opens up the posterior body (Step 8).

The resistance provided by the forces through the arms, the wall and the floor allow you to receive the floor, the wall and the space in front of your arms as the space inside of your chest walls expand and elevate your body; as it is being lowered gently, softly and peacefully to the ground. When you stand up, in Step 10, focus on maintaining “push” through the heels, the hands and the inner thighs as your entire chest remains opened, relaxed and uncoiled. Breathing should be effortless at this stage, because of true postural support offered by muscles that keep the posterior chest walls elevated, and the anterior chest wall opened and lowered, for maximum lung perfusion and ventilation.

Posted May 5, 2020 at 9:01AM
Categories: Techniques Science

As an introduction to our free "PRI Breathing Mechanics in COVID Times" webinar series that is debuting tomorrow, we invite you to view a free trial privy episode titled "Integrated Pulomonary Compliance". During this privy episode, Ron and I discuss lung compliance and two techniques that are incredibly valuable for maximizing pulmonary compliance during this COVID-19 pandemic. As promised, Ron has broken down this technique and provided further reasoning behind the title and each step of the technique below. Stay tuned for the second technique, which will be posted to our website tomorrow. And, don't forget to REGISTER for week one of our free webinar series, which debuts tomorrow at 6pm CT.

Standing Supported Right Step Around with Right Quadratus Lumborum Stretch and Right Apical Expansion

Let’s start with the title of this PRI Non-Manual technique.  

You need to be in a “standing” upright state, preferably with good arch and heel cup supporting shoes on, as you hold on to a “supporting” dowel, pool stick or some type of rod in your right hand. The right hand needs to be in a position where the palm is down and the thumb is up, as your hand is wrapped around the stick. [This will position and assist your “right apical” or upper chest wall into an “expansion” state, or more open state, which is one of the desired area that this activity will focus on.] The right foot will “step around” the left foot to assist in lengthening, or “stretch”, a muscle that is connected to the top of your iliac crest or hip bone, the last rib of your rib cage and the first four vertebrate of your lower back. This muscle, the “right Quadratus Lumborum”, often becomes very short, tight and restrictive when your upper chest doesn’t turn or rotate to the right as your lower chest turns or rotates to the left. This muscle also can limit lower trunk and hip turning or rotation and forward movement to the left at the low back; as a result of the backside of the last right rib being held down by this muscle. [This right low back area will be the other desired area you will be focusing on.]

Here are some additional comments about the steps that follow the title and pictorial examples, along with the reasoning for the procedural step.

Stand with your feet parallel to each other and with your hips directly over your feet. Place your right hand on the dowel or stick at right shoulder level.  Place the dowel’s or stick’s other end on the floor at approximately arm reach in front of the right foot. This step is important because it begins to put your right shoulder and chest in a position where your air flow can begin to move more easily into your right upper lobe of your right lung under your right anterior and lateral chest walls.  

As you try to cross your right foot in front of your left foot, you may notice that you can not make a perfect “T” with your right foot perpendicular to your left. If you can not make a “perfect T”, do the best you can. Both feet need to be, however, flat on the floor. This means you should feel your inside arches of your feet hit the bottom of the shoe as you put weight through each foot. Step 2 provides the anchor needed for your right lateral and back side of the chest to open up as you stand in the final position as outlined in Step 5, and as you breathe in when in step 6.  

By slightly bending your knees, in Step 3 your low back will relax and your mid to upper back of your chest, on both sides of your back, will expand and gently begin to open up during normal breathing. By “shifting” or moving your left hip back, your body weight will be directed and moved over to the left foot, more than the right. Try very hard to keep your right arch and foot on the floor as you do this. Your entire lower body and lower chest will be turning to the left as your upper chest is essentially turning to the right, simultaneously. As your left lower posterior chest wall is lengthening, decompressing and beginning to open, your right lateral chest wall is simultaneously opening.

Begin to “round our your trunk” in Step 4 by slowly lowering your left arm, as your right arm is held up the dowel, that is secured by your right hand.  Slowly breathe in through your nose and out of your mouth, as you lower your left shoulder. Simultaneously place emphasis on rounding your back to open the back of your chest walls on both sides of your back. Take a few seconds and pause after each ‘breathe out’ through your mouth, before you take a new one in through your nose. This pause allow your mid back to expand, open, and loosen any “mucous” in the posterior regions of your lower and mid lobes of your right lung and your lower lobe of your left.

As you continue to breathe in and out, begin to “reach for your right toes with your left hand” during the exhale phase of this slow, methodical breathing cycle you are in. You may not be able to touch your left toes. This is OK. Over time as your chest wall becomes more flexible, you may get close to your toes, or you may actually touch them. Let the back side of your right leg or hamstring area dictate on how far to reach with your left hand as you exhale. This is not a right hamstring stretch activity, although you will feel that area being pulled. More importantly, let your right hamstring region hold, stretch and anchor you as you breathe in slowly to fill and expand the back side of your left lower chest. This will allow your left posterior lower lung lobe and right anterior upper lung lobe to open, drain and exchange air more efficiently.

After you have arrived at a comfortable state of reaching with your left hand toward your right toes, concentrate on filling your right upper lung and stretching open your right upper anterior chest wall, as you slowly take deep breaths in, after each long breath out. Try very hard to “maintain” your hand and foot positions as indicated in Step 6. This ensures good respiratory mechanics for ventilation of lung surfaces in the upper lobe under your right, upper, anterior and lateral chest wall; a region of our body that is often compressed and restricted because of handedness and our human asymmetrical bias toward managing posture through our right body activity.

Step 7 reminds you to accept the “stretch” you should feel through your “hips, back and right chest wall”. This stretch sense is especially desirable upon exhalation. So exhale, and pause, to experience this wonderful “lung” related stretch sense. Your diaphragm will work so much more effectively, after this final step. Your chest walls, in general, will expand so much more efficiently and your ventilatory gas exchange will enhance your mood, behavior and decision making.
   
By continuing the sequence recommended, in Step 8, your chest wall reciprocal movement associated with inhalation and exhalation mechanics, will allow better alternation of chest wall movement when you walk and swing your arms and legs and when you sit and turn to one side and then the other, or when you lie down and turn one direction followed by another. This PRI technique fosters more desirable, unrestricted chest wall mechanics, lung drainage and diaphragmatic productivity both at rest and with upright bilateral extremity movement.

Posted May 4, 2020 at 3:09PM
Categories: Techniques Science

We are excited to announce a Free “PRI Breathing Mechanics in COVID Times” Webinar Series beginning next week. We have been receiving phone calls and emails with questions on how the science and techniques of PRI can be applied to COVID-19 patients. What do we recommend, and why? Well, if you have been wondering the same, we will discuss all of this and more over the next several weeks on this webinar series.

As Ron discussed earlier this week in our Zoom Director’s Meeting, he feels like he has come full circle, that is 360 degrees from where he started almost 40 years ago; and where the profession of physical therapy started. Many of the first non-military patients that were treated in 1918, when the Women’s Physical Therapeutic Association was started, were children who were having difficulty breathing because of the Polio epidemic that ramped up in the United States in 1910. Chest physical therapy was well recognized by 1948 and physical therapists and physiotherapists around the world were taking responsible measures and opportunities to ‘restore lung function’ after acquiring an illness or after surgery.

In more recent years, several studies have questioned the use of intermittent positive pressure breathing (IPPB) machines and have caused many respiratory therapy departments to look to chest physical therapy as a replacement for IPPB. Respiration, ventilation and breathing are all influenced by our postural positions and patterns we are in at the time we are exchanging gas. Therefore, breathing mechanics are postural mechanics. The Postural Restoration Institute’s (PRI) concepts and scientific applications, are today used by many health care providers who collaborate with other disciplines that are mindful of the importance of keeping oral airway and lung airways open. This interdisciplinary practice reflects our early colleague’s effort in taking responsibility for the restoration of lung function through human mechanical intervention, prior to or following events that challenged lung airway position and drainage.  

Postural positioning is necessary for postural drainage, and the importance of coupling proper breathing mechanics with positioning enhances lung perfusion, expansion, and compliance to help fight off respiratory illnesses such as COVID-19 and to help acquire lung and chest wall function that speed up recovery following COVID or other viral acquisitions. This is why we are so excited to share PRI concepts, considerations and advice on how to keep your chest and lungs mechanically efficient and physiologically effective.

Just yesterday, a good friend and colleague, Cheryl Chase, PT, PRC emailed us and shared an old book that she pulled out of her desk titled “Postural Drainage and Respiratory Control, 3rd Ed”, which was published in 1971. Her colleague is going to provide an in-service on postural drainage, something that all physical therapy education programs cover, yet many PT’s have never clinically used. In the direct words of Cheryl, “I am so saddened by our current pandemic crisis, but also delighted that this current situation creates opportunities for new dialogues. It seems strangely serendipitous to coincide with the 20th anniversary of the Institute.” This message truly hit home. This is not how we imagined we would be celebrating our 20th anniversary. Yet, in some ways, it is blessing because with all of the messages and questions we have been receiving, we know that we can contribute to this opportunity for new dialogues amongst the general public and across multiple disciplines.

So, we invite you, and your friends and family to join us for this free webinar series, happening every Tuesday at 6pm CT (starting May 5th). Invite someone who has always wanted to know more about PRI, or maybe those who have questioned the “why” behind your use of Postural Restoration®. During this pandemic, we have witnessed humanity helping each other more than ever, and we are hopeful that the dialogues we can spread through this webinar will help thousands across the world.

*If you miss any of the weekly live webinars, they will also be posted to our website, so you can go back and view them later.

PRI Breathing Mechanics in COVID Times
Tuesdays at 6pm CT
CLICK HERE to register to join the webinar

*Pre-registration with your name and email will be required each week

Posted May 1, 2020 at 10:22AM

Products

CD Bundles
Non-manual Techniques
Manual Techniques DVD
Manual Techniques
Illustrations
PRIVY
PRI Video for You