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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 July 2014

Anybody know how to get ahold of a Protonics Brace?

Posted July 31, 2014 at 9:41AM
Categories: Products

We are excited to announce a new PRI Vision course, PRI Vision Integration for the Baseball Player! This course will be taught by Dr. Heidi Wise and Ron Hruska, and will be offered the day after the PRI Integration for Baseball courses scheduled this November.

"This will be a different course from our Postural-Visual Integration course.  We we will be introducing assessments specific to baseball that help those working with the players in the training room understand when the visual process is affecting players’ physical ability to bat and throw.  There will also be concepts and activities taught that can be used in the training room and on the field to help reduce negative visual influences on the visual influences on these abilities, even without additional integration with an optometrist. “ – Dr. Heidi Wise, OD, FCOVD

To learn more about this course and to register click here.

Posted July 30, 2014 at 2:06PM

There is a fairly common phrase in medicine that states: “When you hear hoofbeats, think horses not zebras.”  It was used in the 1940’s by Dr. Theodore Woodward of the University of Maryland Medical School while teaching medical interns.  To this day, ‘zebra’ is the American medical slang for coming up with an elaborate diagnosis when a more common explanation is more likely.  (Gotta love Wikipedia sometimes). 

However, I remember a surgeon I worked with about 20 some odd years ago, my first real mentor, telling me once:  “Sometimes when you hear hoofbeats, it’s not horses, it IS zebras.”  It was then I began to realize the complexity of the human body and the incredible responsibility I was taking on when people entrusted their care to me.

I share this with you in part because I have had an interesting case which ended with a unique diagnosis and it reminded me of the zebras that are lurking all over our patients.

Without going too much into the scenario that I believe most of us who are trained in PRI are familiar with, which is: “I’ve been to a bunch of other people who have evaluated and treated me and no one can really seem to figure out what is wrong with me.  Dr. XX sent me to you.”  Which fairly quickly turns into: “I can’t believe how much better I have been feeling!” 

I do like to clarify with these people that I’m just the messenger :)

Fit, middle aged woman who had a fall off a horse >8 years ago and fractured her sacrum.  She had been able to get back to some degree of activity, but was limited with increased walking, any jogging, limitations with her skiing and problems with being in any one position--sitting or standing--for periods of time.  MRI to spine and hip ruled out underlying pathology in the spine and hip, for what they were looking for, and one of the cleanest looking pelvis x-rays in terms of position and alignment I have seen.

L AIC and bounced around between a PEC and B BC early on, as she over-abdominalized (my word) everything.  Very compliant which helped a lot in her management and she was very aware of her positioning and making appropriate corrective changes.

She progressed very well with her care and she noticed other things which she had been dealing with were clearing up as well (back and shoulder issues).  She found her activity level was able to increase commensurately and as a big skier, she really liked the techniques she was given which helped her with her left-footed turns (turns to the right).  Neutrality above and below the diaphragm would go back and forth at times, but she consistently presented with HALT scores of at least 3/5.

Her problem was residual discomfort deep in her left lower gluteal / ischial tuberosity region.  Technique after technique were introduced to address the pelvic floor, stretch posterior capsule, manual interventions to this area often helped, but sometimes didn’t, and self-soft tissue work (i.e. ball/foam rolling to the area) did not maintain mobility.  Palpable thickening of the long head biceps femoris / quadratus femoris region and we just couldn’t get it to “shut off”. 

These are the kind of things that keeps me awake at night, saying:  “What am I missing?!”   (Orthotics and oral appliances were assessed for as well).

Her history and palpation also suggested a sacrococcygeal issue which external techniques did not reduce.  I sent her to a gifted osteopath I use for further workup of an anteriorly displaced coccyx.  X-rays confirmed this, but it also showed that. . . . her sacrotuberous ligament had calcified--completely!  What I had perceived as an area which wouldn’t work right, turned out to be something that was, well, never going to work right.

I am aware that we all have similar stories we could share and it is so easy to get hung up on the desire to try and figure it out and provide a solution.  I was chasing pain in some ways, thinking I could provide an answer and solution to make it all go away.  But I was also chasing inconsistent findings, which is what I kept trying to attach to her ongoing low-level symptoms.

She is very pleased with where she is at, fully aware of her HEP and self-management and is very grateful with the care she received from, well, all of us reading this.  The treatment she was provided “changed her life” in many more ways than just the problem she came to us with.  But an important reminder to remember the zebras that we all have and that what we are able to offer our patients is truly a gift, but it is something that we should recognize has its limitations.

Michael J. Mullin

Posted July 28, 2014 at 2:35PM

Mike Cantrell is currently in England and is headed to the city of York in North Yorkshire to teach Myokinematic Restoration this weekend! Here is a picture with Mike and his daughter Sophia visiting Big Ben and the UK Parliament in London yesterday. We can't wait to see more photos from Mike's trip and to hear all about the course!

Posted July 25, 2014 at 9:36AM
Categories: Courses

We are excited to announce that Matt Hornung, ATC joined the PRI staff earlier this month as Education Coordinator. Matt is busy training with all the PRI office day to day activities, and also in learning the course material. He will be attending his first PRI course, Myokinematic Restoration in Indianapolis next month! To learn more about Matt and how he became interested in PRI, click here!

Posted July 23, 2014 at 4:19PM

ProActive Physical Therapy has an immediate opening for PRI educated/interested Physical Therapist/ Physical Therapist Assistant in Beautiful Southern Idaho.  We are a Postural Restoration Center since 2004 looking to hire a Clinician interested in furthering their PRI based Career Path.  Excellent Salary, benefits, practice setting, and beautiful location in close proximity to Sun Valley, Boise, and Salt Lake City.  Contact 208-677-2489, or email proactivetherapyburley@gmail.com

Posted July 17, 2014 at 1:55PM

It's that time of year again.....summer is flying by and Fall is just around the corner which means that the deadline for PRC and PRT applications are as well! Postural Restortaion Certified (PRC) applications are due on September 15th, and Postural Restoration Trained (PRT) applications are due on October 15th.

Postural Restoration Certified (PRC) credentialing is available for PT's, PTA's, OT's and Chiropractors, and Postural Restoration Trained (PRT) credentialing is available for Athletic Trainers (with Certification through the BOC) and Strength and Conditioning Coaches (with CSCS Certification through the NSCA or SCCC Certification through the CSCCa).

To download the PRC application, click here!
To download the PRT application, click here!

Please note that both credentialing programs will be limited to the first 30 applicants, so we do recommend submitting your application early. If you have any questions, please email me!

Hello triplanar thinkers!

For those wondering, the picture is relevant because it shows a technique not often considered for the condition treated:  keeping a severed hand alive by grafting it to the patient’s ankle, then later replanting the hand back on his arm. 

The conclusion of my story about Don didn’t involve any external fixators, but the treatment that he needed might surprise some of you.  To review, Don was the patient with left shoulder bicipital tendinosis whom I treated in part I (link) with the “gold standard” conservative orthopedic approach and part II (link) with the according postoperative approach as a good therapist has been trained to.  As mentioned, I outline this case to review the path that is so very accepted and yet, in my experience since I began training with PRI, not the most effective.  Don’s story concludes below:

Don returned to clinic 8 months after discharge with a new diagnosis of left shoulder pain with the remarks on the script “MRI negative” and “eval and treat.”  This is generally understood as physician lingo for “I have no idea what to do now…good luck with all that.” 

Upon evaluation, Don reported that these left shoulder symptoms started about 2-3 months after we discharged him from PT intervention in spite of his persistence with his HEP and “it was all back to the starting point three months later.”  He still tested as a bilateral brachial chain patient with a PEC pattern, again was positive with impingement tests—Hawkins-kennedy, empty can, Neer sign.  He was frustrated, unable to work in his wood shop or play his accordion for more than 10 minutes without severe pain.  At this point, the patient and I discussed that fact that I had let him down to a degree because I wanted to take a different approach before surgery, but didn’t want to irritate Don or his referral source.  He understood, accepted my apology and we moved forward.

During the first 3 visits, we established that his bilateral brachial chain pattern and according left shoulder dysfunction was not the root of his dysfunction, but rather the manifestation of a “bottom up” pelvis patient whose primary difficulty was in maintaining frontal plane position of his pelvis. 

The key to Don’s left shoulder function?  Right posterior inlet inhibition of his pelvis.  During the seven visits we treated Don using a PRI approach after the gold standard of orthopedic medicine and orthopedic physical therapy had failed to maintain his shoulder function for more than 3 months, his symptoms resolved.  He left the clinic a reciprocal, alternating, smiling woodshop athlete with bilateral HADLT tests of 4/5 at 72 years of age, “tickled” that he could play his accordion as long as he wanted without pain for the first time since before he first went to see the doctor more than two years prior.  Don is in occasional contact for the past 6 months with no return of symptoms, lots of activity and happy thoughts. 

Six-month follow-up with no return of symptoms after the rest of my conservative clinical skills, an appropriate surgery and present day gold-standard postoperative care was unsuccessful.  These are the types of outcomes that keep my passion for this science alive and accelerating.  Moreover, these are the types of patient successes that remind me to be gentle but bold about intervention that I know clinically to be the most effective tool I have in the entire tool chest.

Clearly, each patient is different, and no, I have not seen a consistent correlation over time between the diagnosis of left shoulder bicipital tendinosis and the need for right posterior inlet inhibition.  The objective tests guided me to find the appropriate treatment, not my innate ability to hear the pelvis or shoulder speak to me. 

The point here is not to create a case study for anyone to memorize to use in the future for that one seemingly random patient.  Rather, I hope that the take home is that there is a chance that this gentleman didn’t need as much intervention as he ended up having.  And, even in the face of the “old school” telling you exactly what they want from PT intervention, the risk is worth the reward if one can just take the first three or four visits to break down barriers to a different way of approaching an age-old mechanical dysfunction of a “shoulder.”

Thank you for reading, perhaps you can save a few visits for a few of your patients by way of my experience with Don.   My best to you!

Jess

Posted July 13, 2014 at 10:03AM
Categories: Clinicians

The Postural Respiration courses have been filling up quickly this year! Don't miss out on this course in Las Vegas, NV, which is being hosted by the Cirque du Soleil Performance Medicine team at the MGM Grand on September 27-28th. Hurry and register today, as I do expect this class to fill quickly just like all the other Postural Respiration courses have this year!

Posted July 10, 2014 at 2:59PM
Categories: Courses

I had a wonderful weekend on the beautiful campus of Stanford University discussing all things PRI. Thank you Steven DiLustro for you persistence in working to put this course together. Thank you Brandon Marcello for your willingness to have us train the fantastic folks on your staff and for giving us all such a great experience. And thank you to my new friends from The Golden State Warriors and Cal State Northridge, who I look forward to working more with in the future. You guys were fantastic!

It was a pleasure to have both a PRC and a PRT as my clinical support and lab assistants. Thank you Julie Blandin, PRC and Caleb Chiu, PRT for your professionalism and willingness to help others learn concepts and answer questions. You two teamed up to help give all attendees a great learning experience.

And lastly, I need to thank the one and only Juan Pablo from the Stanford Men's Basketball Strength staff. I so appreciate all the extra time you took to be a personal tour guide for us while we toured all parts of the beautiful Stanford campus. You went above and beyond my expectations as a host and really made me feel like a welcome addition to your campus and facilities. Thanks again for all the time and attention you gave to help make our experience at Stanford the best!

James Anderson, MPT, PRC

Posted July 8, 2014 at 11:42AM
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