Thank you Ryne Gioviano at Achieve Personal Training and Lifestyle Design for being a great host site to this most recent installment of Impingement and Instability. It’s great to have additional host sites pop up in the Chicago Area, or as several course attendees called it, “The City”. Even though people from many other cities might disagree with Chicagoian's claim to that particular title, we at PRI really appreciate the good people in and around Chicago and are grateful when we are able to meet, teach, and learn from more of them.

This course is always a joy to teach because we are able to view and discuss things through a secondary level lens vs the primary level lens the 3 introductory courses are presented in. I like to tell people that this course is an opportunity for us to thank you and reward you for your ongoing commitment to learning the PRI science and your persistence sticking with the primary level material. It is one our first opportunities to have more advanced discussions about the fundamentals behind the PRI science to help you be even more successful with the material you have been learning in the primary level courses. In other words, questions that we might have redirected back to a more fundamental place in a primary course, we are now more than happy to discuss in full detail, with a more complete explanation of why a patient or client may have a particular problem and how we intend to intervene to solve what may be a more compensatory and neurologically unstable version of their original pattern.

Instability throughout the body was discussed in context with the lateralized influence of the Left AIC/Right BC Pattern, and the associated bias with neurological reference centers and asymmetrical respiration when in this pattern. A deeper look at the positional components of the gait cycle all the way up the kinetic chain from the calcaneus to the diaphragm on both the left and right sides helped explore these tendencies. We had great participation throughout the class, but a special thanks to Jim Peters, PT for being our model of calcaneal instability and later ankle/hip security after getting into a pair of appropriate footwear. We also were able to explore the scapular instabilities that can emerge when things like the Subscapularis is overlooked, or when the Lower Trap, Upper Trap and Serratus Anterior are functioning in the wrong plane(s) or not functioning at all.

A great weekend with a super great group of dynamic professionals. I would like to specifically thank Vivian Lea for traveling all the way from Hong Kong to be in attendance for this course. I know you had to be in America for other reasons, but even so, it was so awesome to have you with us while you were here. It was our pleasure having you in the course with us. Thank you to Julia Glick, PT from Lakeshore Physical Therapy for again bringing such a great attitude and for continuing to ask so many great questions. Thank you Skip George, DC, PRC for sending Chris Guar-in, CPT all the way from beautiful San Diego, California to take this course. He did a super job learning and participating on both days. He was a clear leader for the class and you would have been proud of him Skip. Also, thank you to Honami Abe, ATC for coming all the way from Southern Methodist University (go Mustangs!) and for your interest in collaborating with other PRI minded professionals in the Dallas area. I know you'll love getting to know Amy Goddard, PT, PRC and her great staff at Go Sports Therapy.

This past weekend I spent some time at this famous institution teaching Myokinematic Restoration. I’d like to take this opportunity and commemorate a moment and talk about perspectives. The moment that I am commemorating is the weekend I got to spend mentoring Kasey Aikin PT, DPT, PRC, as she journeys toward independence as an instructor for the Institute. The perspective to which I refer is Kasey’s and mine, which I imagine will differ a bit. Kasey participated as a lab assistant along with the capable mind of THE Donna Behr PT, MS, DPT, PRC, who so many of you already know. But Kasey also had an additional task. She was not just learning or refining her PRI/Myokinematic skills, she was also learning to be an instructor, so this weekend becomes even more important for her from that perspective. As I spoke of specifics like L AF IR, the AIC, FA IR, management of specific diagnoses and refining skills like the Hruska Adduction Lift Test, Kasey was...absorbing, processing, smiling, reinforcing, thinking and determining how she could best teach the material. I admired what I saw as she worked toward her goal of being an instructor. She could, I think, have taken some of the material at any given moment and presented it. I would’ve enjoyed seeing her do it. Soon, she will. I imagine she will be quite edgy when she does but I think the class to whom she speaks will benefit greatly from her now-forming style. I invited Kasey to write about this weekend from her perspective and the ensuing words you see are from her. As for Wellesley College...put me down as grateful to have been there and I thank you Tim Snyder MS, ATC, LAT for being a great host.

From Kasey:

Walking into a PRI course as a “student” with Mike Cantrell has always been a guarantee of gaining several pearls of wisdom applicable day one while at the same time a comedy relief deciphering his southern similes and metaphors. This course was no different minus my mindset this go round as I wasn’t just a “student” anymore. The crew attending were primarily from the northeast so it’s always neat leaving the south and finding common ground with people on the other side of the country. Lab assisting with Donna Behr was awesome, she may be the nicest lady living in Boston. Seeing the light bulb moments of the attendees go off during lab is always the thrilling part of PRI and what continues to bring anyone back to PRI courses time and time again. The New York “triplets” were super enthused with the material and I’m always impressed to see strength and conditioning specialists diving into Myokin. The Maine crew had excellent questions and honed in on their testing skills. Overall, what an enriching experience while trying to navigate presenting the intricate science of PRI to do it justice. Thanks to all the attendees for the thought provoking questions and Mike Cantrell for continued mentorship and support!

This latest installment of the Postural Respiration course in New York City was notable for several reasons. First, the group was a very large and a very diverse and dynamic group of professionals, with 29 out of the 50 in attendance being first time attendees at a live PRI course. Second, my three lab assistants for the course were fantastic in every way. Thank you to Neal Hallinan, Sean Light and Brad Gilden. You three really helped to ensure a great learning and lab experience for everyone in the course. And third, the new updated version of this Postural Respiration course material really inspires, clarifies and defines the foundational principles of the institute in a meaningful way.

This updated course manual uses tons of great references to teach the concepts of static asymmetry, dynamic respiration and patterned respiration with clarity and authority. The well established history of PRI using objective tests to monitor position and respiratory function was further enhanced with the new Posterior Mediastinum Respiratory Reach Test. The group did a great job of picking up what we were doing with this new brachial chain test, and appreciated the reproducibility of the test for patient and client utilization on their own at home. Another highlight was the time spent on and clarification of both lower trap and serratus anterior function on each side and in each respective plane in the Left AIC/Right BC Pattern. The newly updated and expanded reference titled "The Influence of Patterned Respiratory Function on the Left and Right Abdominals, Lower Trap and Serratus Anterior" was especially useful in this regard.

Another highlight was how well the lab time turned out for everybody in attendance. There were plenty of treatment rooms and treatment tables and we scheduled enough time for each lab, whether it was an assessment lab or manual technique lab, to give everyone a good experience. Again, kudos to my excellent lab assistants for giving everyone the time and attention they needed to have a meaningful experience in lab. You three are top notch professionals clearly committed to sharing what you have come to know and that commitment made this course wonderful for all in attendance. And thank you for helping to explain how important interdisciplinary integration is when it comes to working with professionals who may not be licensed to perform manual techniques developing relationships with professionals who are. We always appreciate the interactive and interdisciplinary dialogue.

And lastly, I would like to thank yoga instructor Giulia Pline for your willing help in this course as a class demo and reference for our learning. You were willing to demonstrate patterned respiration in the Left AIC/Right BC Pattern using PRI special tests and then receive the manual techniques in front of the group to help us learn how to perform the tests and techniques in the lab. You were the prototypical Left AIC/Right BC Pattern, representing the underlying pattern that exists underneath all other compensatory patterns that could show up in our lives. After your assessment, it was fun to spend the rest of the course talking about rib immobility or compensatory patterns like Superior T4 Syndrome, with the goal in mind of becoming like you, on the way to becoming neutral, whether we used manual or non-manual techniques to get there.

Who knew that following Ron’s advice many years ago to find a dentist who appreciates the influences of airway, neutral TMJ position and occlusion would take me to Vilnius, Lithuania?  I have had the privilege of working with a multidisciplinary team of dentists, Dara Chira DMD orthodontist, Jeff McClendon DMD restorative dentist, and Michael Gunson DDS, MD orthognathic surgeon for the treatment of complex TMD, Airway and Occlusal patients.  We have been invited to speak at various dental conferences on our multidisciplinary approach to care (Lips, Teeth, and Tongue to Toes).  Most recently we spoke at the Baltic Sea Community on Orthognathic Surgery and Orthodontics Spring course on “The Gravity of Temporomandibular Disorders Treatment “in Vilnius, Lithuania. 

The conference opened with dental radiologist Dania Tamimi BDS, DMSc presenting on radiographic evaluation of the TMJ.  I just about fell out of my seat when she showed a left cranial side bend and how it affects the TMJ, mandibular position and occlusion!! This made my discussion of the RTMCC so much easier for the participants to understand. There were lectures by orthodontists, and orthognathic surgeons as well.  Dr. Mariano Rocabado DPT presented arthrokinematics of the craniovertebral and craniomandibular areas with the influences of manual therapy on the cervical spine and its impact on neutral TMJ.  All the lectures and especially Dania and Dr. Rocabado's lectures were a perfect set up for our team to close the meeting with how we work together to achieve balance for our patients on so many levels.  My part was very well received as I was able to develop the PRI concepts from an Advanced Integration approach including LAIC, RBC, RTMCC, muscle chains, forward head posture, asymmetrical patterns and the importance of the diaphragm and attaining proper breathing mechanics and ZOA with its influences on temporal and mandibular position and function.  It was great fun demonstrating a balloon technique to 230 participants from 30 different countries!!! I am very excited about the feedback we got after and how open minded the group of dentists were to the idea of occlusion being more than just about the teeth!!! They really do like looking at teeth though!!!!

We were able to stay a few extra days and tour Lithuania and Latvia which included a tour of a 14^th century castle on Trakai Island, Riga, Hill of Crosses and The Rondale Palace!! The trip was absolutely extraordinary!!!

I am so grateful for all the continued education and support that Ron, Jen, Jason, RJ and many others have had over the years in helping me understand the science of PRI, the application of PRI for better patient outcomes and for helping me with spreading the word to other professionals on how important it is for patients to work with a PRI minded clinician.