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 2014

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

PRI® Integration for Yoga is growing! Will you be there?

Due to an outstanding number of registrants, this first-ever PRI® Yoga course will now be held in the historic downtown Portland Embassy Suites. We have secured >50 more seats, so reserve yours today.
https://www.posturalrestoration.com/programs-courses/affiliate-courses/integration-for-yoga

This weekend is shaping up to be one of the best PRI events you will ever attend! Save your money on a rental car as the hotel is just blocks from the airport lightrail. No need to bring an umbrella either; September is a gorgeous and dry time to visit the Pacific NW. Massage therapists will be offering chair massage at breaks and if the yoga and breathing doesn't get you relaxed enough, the hotel has a complimentary Happy Hour, two hot tubs, and a salt-water pool. Plan on spending an extra night or two in Portland and visit our beautiful mountains, beaches, and forests in this food-lover's paradise. No taxes here either, so shop away!

This innovative course applies the therapeutic principles from the Postural Restoration Institute® (PRI) to yoga. Join us and explore fundamental PRI® concepts, including asymmetrical human movement patterns, neutrality, and diaphragmatic breathing. You will learn PRI® assessment tools and yoga pose modifications to create PRI®-inspired yoga sequences that serve to both prevent and rehabilitate injuries. With both classroom and on-the-mat experiences, this weekend is not to be missed! The intended audience for this course is licensed health care providers and fitness professionals, however experienced yoga students are also welcome. 

Posted July 4, 2014 at 3:50PM

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:

http://www.ncbi.nlm.nih.gov/pubmed/24502841

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

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
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