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 June 2014

I had a fantastic time at Northeastern University in Boston with a super group of 50 people who were very hungry for Postural Respiration, Neurology and Biomechanics! Thank you Art for hosting what turned out to be a great PRI Collaborative weekend! And thank you to Chris Poulin, Donna Behr and Michael Niedzielski for teaming up with me to support the effort as capable lab assistants and resident experts of PRI. 

We outlined the three dimensional nature of diaphragm dysfunction and the three planes of restorative diaphragm motion needed to fully realize left Zone of Apposition with the analogy of a right dominant Manta Ray. When teaching complex topics, I've found that analogies either really help or tend to really confuse. In this case, the group really latched on to the  three dimensional aspects of diaphragm function to help both the left hemi-diaphragm function more as a respiratory muscle and to help the right hemi-diaphragm function more as a postural stabilizer of the asymmetrical human thorax. #moveyourmantaray. We also described the diaphragm's role as the premier tri-planer performance muscle in the human body, with the capacity to unlock available movement in all three planes. #boom! #unleashthebeast!

Thank you to everyone in attendance for coming together to make this weekend great, but a special thank you to Jaakko who traveled all the way from Finland and to Jack who traveled all the way from Australia! Thanks for your passion and your support!

Posted June 25, 2014 at 12:00PM
Categories: Courses

John Nyland did a nice job commenting on sports specialization in his editorial article in the June issue of JOSPT. If you have access to this article, be sure to take a look at it. Experiencing diversification in "physical, cognitive, affective and psychosocial environments" at all ages, probably also contributes to transfer of learning between cognitive, psychobehavioral and physical neurological processes.

Posted June 23, 2014 at 4:42PM
Categories: Athletics Articles

It is with much excitement that we announce that chiropractors are now eligible to apply for the Postural Restoration Certified (PRC) credentialing program. This discussion began several years ago, and with an increase in interest from the chiropractic community more recently, the PRI Board of Directors made the decision to extend an invitation to chiropractors to apply for the PRC credentialing program. The Postural Restoration Certified (PRC) credentialing program began in 2004 and since that time, 123 physical therapists, occupational therapists and physical therapist assistants have been PRC credentialed.

CLICK HERE to view the PRC requirements and to download an application. PRC applications are due on September 15th, and is limited to the first 30 applicants. PRC testing takes place in Lincoln on December 8-9th, following our Advanced Integration course.

If you are interested in applying for PRC or if you have any questions about the credentialing program, please feel free to email me!

Hi everyone! I just wanted to share a fantastic experience I had earlier this month!

I was invited to speak at SPATS (South Padre Athletic Training Seminar) hosted by VATA (Valley Athletic Trainers’ Association) last weekend. Since they gave me a total liberty of picking my own presentation topic, I took full advantage of it and decided to use that opportunity to spread the PRI word. My lecture topic was “Let’s Blow Up a Balloon! Breathing in Orthopedic Rehabilitation.”  Since my time was limited, I choose not to go in depth on the polyarticular chains and explain all the PRI terminology (i.e. L AIC, R BC etc). Instead, I focused on the left-and-right difference of the diaphragm, the importance of restoring the ZOA, and learning how to…EXHALE!!!! There were many attendees (mostly ATs, but also some PTs, DCs and MDs) and it was truly fun to watch approximately 300 people blowing up balloons! It was very well-received as many participants came to talk to me afterwards, asking about the PRI concepts and courses. I am glad to say there’s a growing interest in PRI down here in South Texas!

CLICK HERE to view my presentation!

I have the benefit of being associated with some outstanding thinkers and PRI practitioners.  Whenever and wherever we get together, conversation eventually drifts toward discussion of PRI principles and application.  One of our greatest challenges has been to unravel the foundations from which Ron Hruska evolved the Postural Restoration Institute system of evaluation and treatment that we all utilize with such great success. 

The following are just a couple of questions that we have posed and our attempts to reach conclusions and greater understanding.  If anything it may stimulate some thought and initiate some discussion.

What are we actually measuring when we place a patient on the treatment table and perform our PRI testing algorithm and what is our goal for treatment?

I clearly recall a conversation over lunch between Eric Oetter, Mike Robertson, and myself during the PRI Pelvis Restoration course at the Cantrell Center for Physical Therapy and Wellness. We were discussing the concepts of adaptive capacity, adaptive potential, movement variability, what we are actually measuring when evaluating a patient on the treatment table, and how this affects performance.  

Our conclusion was that what we are actually measuring as PRI-educated therapists and coaches is the capacity of our client/athlete to adapt to the ever chaotic nature of the environment they are perceiving.  Positive findings during examination such as a positive Adduction Drop Test, limited apical expansion, or loss of shoulder rotation was merely indicative of a human system incapable of demonstrating variability ultimately controlled by the central nervous system.  More specifically an autonomic nervous system shift toward sympathetic dominance.

I was reminded of this PRI lunch after reading a blog post recently that referenced the following study:

In essence, what the researchers found in the study was that pain-free subjects demonstrated variability in the muscle activity of the erector spinae during a repetitive lifting task and those with low back pain did not demonstrate this variability as well as experiencing increased pain during the task.

The authors’ conclusion was that reduced variability of muscle activity may have important implications for the provocation and recurrence of LBP due to repetitive tasks.

Needless to say, this study is somewhat validating for our discussion group of PRI faithful.

Truth be told, after searching there are many studies that support our lunchtime conclusion; and movement variability as a favorable concept in human function is not a new concept having its foundations in dynamic systems theory. 

From Shumway-Cook and Woollacott’s Motor Control:  Translating Research into Clinical Practice:

“… in dynamic systems theory, variability is not considered to be the result of error, but rather as a necessary condition of optimal function.  Optimal variability provides for flexible, adaptive strategies, allowing adjustment to environmental change, and as such is a central feature of normal movement.”

What the PRI model provides is a non-invasive real-time measurement of system variability determined by autonomic nervous system tone.  While EEG, heart rate variability, or galvanic skin response may be preferred methods to determine autonomic tone, these are not tools commonly used by a practicing physical therapist in a clinical setting or a coach in the training room nor would they be practical. 

The goal of treatment then becomes restoring an optimal level of variability to the system to allow for optimization of behavior and maximization of performance.

We came up with a statement that encompassed our entire discussion that included the influence of variability on pain and performance.  I still have the notes on my iPhone dated 8/24/13: 

"Restoring variability to the human system is the ultimate goal to promote neuroplastic change creating a relatively permanent change in behavior that provides adaptability within the system to cope with variability in the environment."

In PRI terms, our goal is help a patient achieve neutral (restore variability) and then recruit the appropriate PRI planar families (neuroplastic change to remap the three planes in the brain… Thanks to Zac Cupples!) to restore reciprocal and alternating movement (change behavior to cope with the environment).

How did Ron Hruska arrive at the concept of using simple, common orthopedic tests as effective PRI measurement tools?

As mentioned above, as physical therapists our measurement tools are limited by practicality.  If we look at PRI from a strictly biomechanical perspective, the PRI methodology provides for a low barrier of entry to a PT who has never been exposed to its concepts before.  Myokinematic Restoration looks, sounds, and feels like biomechanical course, but we all know that it is not.  This is a brilliant way to provide understanding to a group with more than a few preconceived notions, right?

While I certainly cannot speak for Ron, and I’m willing to be wrong, I believe there is more to this process, and this came from a conversation I had with Eric Oetter over Sunday breakfast.

From our first day in an introductory PRI course we are shown that asymmetry because of in-utero development and positioning, brain hemispheric dominance, asymmetrical vestibular development, and internal anatomical differences is normal, expected, and predictable.  Determining patterning that represents discord in the system then seems to be impossible until your realize that the skeletal system, is inherently symmetrical.  Therefore there is no better way for a physical therapist to determine the state of the system as a whole than identifying asymmetries or patterns via our typical orthopedic testing.

The brain processes and integrates all sensory inputs, internal and external, and generates behavior, including motor behavior, based on our perceptions with respect to the environment, emotional status, and previous experiences.  I don’t think it’s unreasonable to consider that the ability to produce reciprocal and alternating movement is not only an effective measure of autonomic tone but also a key measurement of overall health.

Bill Hartman, PT

Posted June 13, 2014 at 2:17PM
Categories: Clinicians Articles

CLICK HERE to read faculty member, Mike Cantrell's newest paper that he has written titled "The Soccer Player's Tug of War: A Simple Understanding of Athletic Pubalgia and Sports Hernias".

Posted June 13, 2014 at 11:18AM
Categories: Clinicians Athletics

Columbus, OH - "A weekend of enlightenment and fun was had by all as Anthony Donskov hosted Myokinematic Restoration at his great facility: Donskov Strength and Conditioning.  Many new faces were exposed to the science of understanding complex human biomechanics as they relate to asymmetrical movement patterns. I had a great experience and made many new friends." - Mike Cantrell 

Posted June 11, 2014 at 2:24PM
Categories: Courses

“Its Monday Morning, I’ve just taken my first PRI course and now what do I do and where do I start?”

If you have just taken your first PRI course and you feel a bit overloaded with information, don’t feel alone.  The first time I went to a PRI course, can I tell you I was intrigued, stunned and just a bit intimidated all at the same time?  I didn’t know what the heck I was doing so on Monday morning I had a bunch of people blowing up balloons! (Take the Postural Respiration course and you will know what I mean!)

In fact, the entire body of knowledge of PRI can feel like one big elephant you are trying to digest.  And you know the old question, how do you eat an elephant?  One bite at a time!

The first thing to do is what you learn in every course and that is to breathe and relax. There is a lot information here that needs to sink in over time and you won’t get it all the first time. No one that has taken one of these courses has gotten it all the first time but if a door is opened to your curiosity and caring to learn more you are definitely on the right track!

What helped me in my overwhelm was to create a picture in my mind of some of the basics.  For instance, we aren’t symmetrical and never will be but the point is to manage asymmetries and get neutral. Then, have a simple picture anatomically of the basic asymmetries left and right side and how they affect position and posture thru polyarticular chains.  Remember how the diaphragm is the key player and you have a simple way to describe what you are doing to yourself, patients or clients.  They will be impressed by just a short, and I mean short, description of their anatomy and how it affects them.

On Monday morning, pick one person you feel comfortable with to experiment on.  If you have a colleague that has gone to a course practice with them.   Tell your patient that you just got out of a course and you want to try some powerful tools with them.    If you took a Myokinematics course, practice an abduction drop test and show them one basic exercise.  It is best that you practice that exercise yourself and continue to practice PRI tests and exercises yourself, so you know what it feels like and what to feel when you are in position for facilitation and inhibition.  PRI works best when we are managing our own asymmetries!

Immediately you have knowledge and application of assessment and corrective positioning that is really sophisticated and you have just scratched the surface.  You can build on this by learning a new assessment or two with a new corrective position every day.

Have your manual close.  Refer to it, study it and get a more detailed picture in your mind of how the human body works and how you can be more effective.  This is called building a body of knowledge and it doesn’t happen overnight but you can get results and get excited with just the basics and build on top of them.

If you went to a live seminar, order the home study course and review it a few times.  If you got a home course, go to a live course to interact with the instructor and fellow students.  Pack a bunch of questions in your bag when you go!  If you get a little frustrated with all the information and it doesn’t make sense all at once, then you are a normal human being!  Hang in there.  The good news is that becoming more skilled and competent is satisfying and meaningful and that building a body of knowledge and expanding what you know is just plain fun!   

Posted June 10, 2014 at 9:21AM
Categories: Clinicians Courses

Pittsburgh, PA - "I had a great weekend teaching an entire class of 17 newbies to the science of PRI with Myokinematic Restoration. Jeremy Smith was a great host and we all enjoyed his facility at Iron City Elite in the suburbs of Pittsburgh. It was truly an interdisciplinary meeting of PT’s, DC’s, ATC’s, CSCS’s and personal trainers. We all had a blast learning together. These individuals left excited about trying out their new knowledge of respiration and AFIR!  Yes, Ron they all  got the concept of hole control in the Iron City!  Go #prination!  It was great to see the influence of social media on the spreading of this great nation!  It was fun to meet in person some of my PRI twitter followers! "#Welcometotheforest #nogoingback @lewis61FP” One of my favorite post course tweets!" - Jen Poulin

Whittier, CA  - "This weekend I had the wonderful opportunity to present Myokinematic Restoration to a significant number of “new” PRI course attendees on the campus of Southern California University of Health Sciences, where 600 chiropractic students graduate yearly. This was a high cerebral powered group and kept me on my toes, which fueled me to the max daily.  Because of this infusion I reminded myself that our left hemispheres make all of us human. By teaching this class I once again was reminded of the human need to use our left hemispheric mindedness for Left AIC patterning. We often are encouraged to facilitate certain antagonistic muscle in PRI to oppose three planes of left hemispheric activity or the Left AIC pattern. But it is because of courses like this I get to focus on what is really important to focus on, the inhibition of Left AIC overactive muscle, so that we can involve our right hemispheric creativity and bilateral function. It was so much fun to discuss and demonstrate the need to inhibit the left gluteus maximus and the right adductor group of the leg to restore bilateral use of our bodies in the frontal plane. This Left AIC position also includes sagittal and transverse patterned muscle that needs to be inhibited for tri-planar bilateral success. Therefore, focusing on inhibition programs for the left iliacus and the  left psoas and the right bicep femoris was equally rewarding for me to think about. However, the need to disengage a left tensor fascia latae muscle that is trying to move the left acetabulum on the femur for AFIR is so important to occasionally be mindful of, just as remembering the importance of reducing the right quadratus lumborum activity that more than likely is being used in attempting to gain right acetabular external rotation on the femur (Right AFER).  I absolutely love discussing this kind of neuro integration and neuro inhibition in the facilitation of desirable lateralized direction." - Ron Hruska

Seattle, WA - "I enjoyed a sunny beautiful weekend teaching Myokinematic Restoration in majestic Seattle Washington with the staff from PRO Sports Club in a great facility designed for rehab, fitness and sports performance. Thanks Carl for being such a great host and for trusting me on my movie recommendations. They say it can rain a lot in Seattle, but I’ve never seen it, because it’s always sunny and beautiful when I go.

Grateful to be so well assisted by Betsy Baker-Bold, PRC from Olympic Physical Therapy and to see her be so willing to share all she knows. An open attitude with a desire to effectively mentor others has always helped make this Institute great.

We had a great time discussing hot topics like pelvic and hip position, ligamentous muscle, muscle function in three planes and human performance. Its so great to see PRI grow and expand across the Pacific Northwest with several different clinicians and clinics all jockeying to be the next host site for whatever the Institute may be planning to teach in the region". - James Anderson

Posted June 5, 2014 at 11:29AM
Categories: Courses

To summarize part I for those who didn’t see it, I treated a gentleman with biceps tendinosis giving my best efforts to treat within the realm of what the patient and his physician expected.  He was pleased, reported 90% improvement and had met all but one of his functional goals—and I wasn’t content.  I wasn’t content because I hadn’t been bold/confident enough to risk the referral source by advocating for the patient like I had wanted to.  When things had a hitch, I had broached the subject of asymmetry several times, with a discussion of thorax and diaphragm position combined with respiration being key to arthrokinematics and myokinematics of the affected left shoulder briefly.  But the feedback each time was something of the “dang kids and their wide-eyed plans.”  So, I deferred to the ‘gold standard’ treatment of the day for said diagnosis outlined briefly in part I of this story with some PRI principles intertwined the best I could without the patient’s objection.

Three months later, Don arrived for this second round of PT with a diagnosis of left shoulder s/p arthroscopic subacromial decompression with a distal clavicle resection and biceps tenotomy.  His orders were specific to “ROM and strengthening” and he had a firm grip on what he wished to achieve per his physician’s orders.  Though I mentioned that, after the first couple of weeks, it would be wise to treat the cause rather than the symptoms of his left shoulder problem, he only agreed we’d reassess after a few weeks.

I saw him once a week for three weeks and he attained full ROM, felt wondersplendiferous (there is a small reward for whoever first tweets the three root words for this nonsensical term) and he was touting my praises loudly when he arrived at the fourth visit.  No pain, full motion, strong, highly functional at home and with hobbies.

Most of you reading this have been there.  We pray this patient maintains this status and we don’t want to be the bad-news “physical torturist” because sometimes they are functional for a long time this way.  Knowing his reluctance to work outside the realm of he and his surgeon’s normal, I stood down.  He had met all of his goals, he did have functional strength, motion and his goals were met.  I simply reminded him that I had done very little, that there was likely still a root cause of this now-recurring left shoulder dysfunction, not to feel hopeless if it did ever recur, wished him my best and discharged him—physician and patient goals met.  

For now.

I’m interested in your feedback, stories, predictions for part III, anything you'd like to add to this little story so far.  Again, this is outlining a classic case where the road less traveled is a bit risky, and in this case I took the easy way out with some objective data to support my decision. 

Part III coming soon…

Posted June 2, 2014 at 10:15AM
Categories: Clinicians


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