Any time I get to teach in Lincoln, it always feels like a homecoming. It’s an honor to be able to teach at PRI and get to spend time with the PRI family. The group of attendees in person really embraced the idea of family. We had pelvic floor PTs, PT students from Regis University in Denver, strength and conditioning specialists from University of Nebraska, a chiropractor and a plethora of other PTs all uniting for the two days over Myokinematic Restoration. By the end of it, a sign up sheet had been passed around so they could all stay in touch. As an instructor, this was such a special thing to see.

We discussed the importance of determining position before facilitation; what a left anterior chain objectively presents as; the ability to determine a hip with some soft tissue pathology vs non pathology; and a host of treatment techniques to help these findings.

The online attendees had excellent questions and the lab times were fulfilled to the max because of the eagerness among the attendees. It was a great course and I look forward to my next time in Lincoln.

It was so appropriate to have my first attempt to be the lead instructor for the entire, two-day Cranial Resolution Course to occur on St Patrick’s Day, since I was feeling quite green regarding how to teach this tertiary material. Fortunately, people were very kind and appeared to appreciate my simplifications, analogies and/or clinical examples of the frequently complex didactic concepts that are introduced in this course (like how the ANS and CNS interact with each other). Ron, who was sitting in the front row, was remarkably restrained, even though it must have been hard for him since these are the concepts that have been behind PRI, and so dear to his heart, right from the very start.  

What I found so exciting was that out of the 46 people in attendance from all over the globe, half of them were attending Cranial Resolution for the first time! That indicates to me that more people are recognizing the need, and are now ready to start, to integrate neurological concepts into their PRI practice. From my own personal experience, I accept that learning when and how to consciously introduce such things as lateralized neural rhythms into your practice may take a while to grasp. What I truly wanted to get across, especially to those first-time attendees, was that the techniques taught in this cranial course were never meant to replace the foundational material from the primary and secondary courses, they were meant to augment it. And that appropriately using the concepts introduced in Cranial Resolution may be able to help your patients make changes faster, more effectively and in a way that is perceived differently. Learning how and when to utilize them may not be quite as algorithmic as techniques learned in the primary courses, but I hope that I was able to share enough specific examples to progress practitioners from ‘just trying’ seemingly random, sensory-modifying techniques to better understanding WHY and WHEN they might appropriately recruit them to each of their client’s unique situations.

I was thrilled to have 6 PRI faculty in attendance at my inaugural session of teaching this course. Their supportive presence constantly reminded me of the strong foundation this course stands upon. Because even though I personally have found that the concepts taught in Cranial Resolution have been a game changer for my practice, there is no way anything can ‘change the game’ if there isn’t already a game being played by a strong set of recognized and accepted premises and principles.  

I know I was nervous, I read from the slides more than I wanted to, and I spoke too fast. These are all issues that I will actively work on for future renditions of this course. But like I said earlier, even though I may be comfortable with the material presented, I am still green at presenting it, especially to all the bright and inquisitive individuals who have pursued PRI to this tertiary level. What I hope came across, however, is how much I love this material – and want to get others to feel the same way. It’s not hard, it’s just different. And ‘different’ is cyclically needed, otherwise we have nothing to which we can compare or reference normal.  

Thanks to all who attended – and plan to attend in the future!

The ENT Institute of Atlanta played host to the most recent Postural Respiration. This course encouraged attendees to look below the head and neck for “bottom-up” influences on the conditions you treat. What do hip pathology, low back pain, headaches, and TMD have in common? A thoracic diaphragm that is patterned in its position and activity.

We discussed how the static asymmetries of our torso lead to overactive chains of muscle below the diaphragm (anterior interior chain and posterior exterior chain) and above the diaphragm (brachial chain). These chains create dynamic patterns of breathing that become entrained in our nervous system and that can restrict healthy alternating, reciprocal movement when upright. Numerous videos were presented that reflect how patterned breathing influences walking: poor posterior right arm swing, reduced thorax rotation and center of mass shift onto the left leg, and waddling, to name a few. Our stronger, better leveraged right diaphragm creates twist and torsion of the airway which, in turn, promotes inefficient strategies to pull air in, including belly and neck breathing, with their associated forward head posture, hyperinflation, and overly extended thoracic spine and rib cage. Neurologically-driven patterns of airflow define how we sense ourselves in the space around us, how we move through it, and our vulnerability to pain and injury.  

Many thanks to Kaitlin Blankenship, ATC; Jose Crespo, PT; Mischelle Hardwick, PT; Allison Robbins, PT; Tre Tate, CPT; and Adria Wofford, PT for volunteering to model the tests and techniques.    

Kristen Spencer, PT, PRC, was invaluable in assisting with lab and adding clarity to questions and concepts.  

The practitioners at ENT Institute did an awesome job of accommodating us guests: Jose; Ann Gerber, PT; Jennifer Hansen, PTA; Mischell; Jennifer Harrell, PT; Deisy Nunez Aguirre, PT; Allison; Olivia Terrell, PT; and Cristen Walker, PTA.   

I hope you get the chance to host again. If so, Cervical Revolution would be a natural fit for your caseload.  You will learn about the influences of an additional chain of muscles, the temporal mandibular cervical chain. You will gain an understanding of how the concepts of Postural Respiration and patterned air flow apply to the cervical spine and cranial patterns and their potential to create malocclusion, TMJ dysfunction, headaches, and visual-vestibular disturbances, all of which you routinely address in the clinic.

I felt right at home with the clinicians at Finish Line Physical Therapy, all seasoned runners. Photos of their and their patients’ running accomplishments, all smiles at the completion of a race, adorn the space – and make for the perfect back-drop to discuss the impact of undesirable airflow patterns, habitual use of accessory muscles of breathing, and a restricted diaphragm on movement.

Asymmetry is the rule of the body and brain. As such, humans, by design, exhibit a right-sided preference, which is reinforced by a culture that favors sitting and a lifestyle made easier by technology. The result is a form of “hemi-neglect” of left sided muscles of grounding – hamstrings, gluts, and abdominals – needed for weight-shifting. Rib cages remain under the influence of muscles that don’t promote alternating internal and external rotation and the associated sense of expansion and recoil. The result is a form of left or bilateral COPD, with its distinctive hyperinflation.

   
Stiff, patterned rib cages and abdominal oblique disuse cause the diaphragm to undergo twist and torsion that, in many cases, cannot get out of. This twist of our respiratory system is a significant mechanism underlying the many syndromes and injuries that we confront in the clinic.

Many thanks to our weekend avatars, whose willingness to demonstrate and receive techniques enabled us all to better understand PRI concepts: Patrick Cronin, PT; Laura Gibbons, PT; Laura Loftus; Iris Platt, PT; RikkiLynn Shields. Thank you Yohei Takada, PT, PRC and Andrew Xenophontos, CSCS, PRT for your tremendous help in lab, coaching the attendees in the nuances of the manual and non-manual techniques, allowing them to experience the power and influence of these techniques on the neuro-muscular system. Finally, thank you to the physical therapists at Finish Line PT for being gracious hosts: Mandy “I WILL blow up a balloon” Fox, Connor Hesselbirg, Jaclyn Massi, Ryan Matisko, Timothy Waanders, and Jimmy Williams.

 
Finish Line PT is a clinic for runners and triathletes, people who strive to be their best selves. To all of the course attendees, I hope the material you learned this weekend will help take you to new heights in your careers and shift your stride to a new way of looking at, and improving, movement.