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Blog Posts in 2011

Thank you to everyone who attended the presentation by Ron Hruska and Jason Masek at the Mid-American Athletic Trainer’s Association (MAATA) - Annual Symposium in Omaha, Nebraska.  Please click on the presentation titles below to view or print the Power Point presentation. To learn even more, we hope you’ll consider attending one of our introductory courses: Myokinematic Restoration or Postural Respiration. PRI is recognized by the Board of Certification, Inc (BOC) to offer continuing education for certified athletic trainers (#P2376). This approval currently applies to PRI live and home study courses

Postural Restoration - Biomechanical Influences on the Athlete’s Lower Half
Postural Restoration - Biomechanical Influences on the Athlete’s Upper Half

Should you have any additional questions or feedback from the Symposium presentation, please contact us.

Posted March 18, 2011 at 1:05PM

A while back we received a great question from Joyce Wasserman, PT, PRC on Tinnitus.  Read her question and Ron Hruska’s response…

“I am looking for references that link tinnitus to suboptimal dental occlusion or absence of centric occlusion. I’d appreciate any leads, names of journals or websites, that I should be looking at. Has any of the PRC therapists been able to help people with tinnitus, alone or in collaboration with a dentist?”

Tinnitus, or ringing in the ears, can be a very confusing and often poorly understood symptom.  Tinnitus and dizziness are the two most frequently asked about symptoms, both here in the clinic and through the internet.  From the reading that I have done, it is thought to occur when the brain areas involved in hearing spontaneously increase their activity.  Therefore, it is associated with virtually all disorders of the auditory system.  It is not limited to ringing of the ears, but may be perceived as whistling, buzzing, humming, hissing, roaring, chirping or other related sounds. 

There appears to be three forms of tinnitus.  The last is more of an osteopathic thought process approach.  Nonetheless, I’d like to cover all three briefly in this response to a question received by a PRC therapist about the relationship between tinnitus and dental occlusion.  The first most common form of tinnitus according to James B. Snow Jr., a physician at the University of Pennsylvania, and former director of the National Institute on Deafness and other communication disorders, arises from damage to the inner ear, or cochlea, caused by exposure to high volumes of sound.  Dr. Snow also states that drugs such as aspirin, quinine and aminoglycoside antibiotics, cancer chemotherapeutics and other ototoxic agents, and infections and head injuries.  He goes on to state that if the inner ear is damaged, input decreases from the cochlea to the auditory centers of the brainstem, such as the dorso cochlear nucleus.  This input loss may lead to increased spontaneous activity in the nucleus neurons as a result of inhibition that has spontaneously been removed. 

The second most common form or theory of tinnitus is autonomic nervous system stimulation from increased neuromuscular tension.  Retraining therapy, a process that can take a long time, often two years or more, can help reduce this tension from the autonomic nervous system.  This process is called habituation of reaction.  Tinnitus then becomes quieter for longer periods of time and eventually or hopefully will disappear or become a natural part of the background noise or “sound of silence”.  This is sometimes referred to as habituation of perception.  This won’t happen if or while the tinnitus is still classified by the person experiencing it as a threat, negative experience, an undiagnosed symptom, or while the individual is under a lot of emotional stress.  Many tinnitus patients have hyperacousis or high degrees of sensitivity to external noise and therefore they seek and search for quiet environments to work in.  In this respect, according to information from, they are their own worst enemy.  Supposedly, if strong beliefs about the threatening nature of tinnitus are maintained, the survival style or condition response mechanisms in the subconscious brain insure that it is continuously monitored and therefore the condition itself will not improve.  Imaging studies confirm increased neural activity in the auditory cortices of those experiencing tinnitus.  Their brains also show increased activity in the limbic structures associated with emotional processing.  Other symptoms that sometimes appear alongside tinnitus, such as emotional distress, depression, dizziness, and insomnia, may have a common basis in some limbic structure such as a nucleus accumbens. 

In addition to the two most common forms of Tinnitus, that is damage to the inner ear and increased tension from the autonomic nervous system stimulation, I find that there is a very strong relationship between tinnitus and those who are experiencing temporal bone disorganization or temporalis overuse.  Clenchers, grinders, and trismus oriented individuals often experience tinnitus associated with hyperactivity of musculature that is attached directly to the temporal bone which houses the inner ear.  There does not appear to be a relationship between tinnitus and externally or internally rotated temporal bones at this time according to the literature, however, it does stand to reason that this third reason for tinnitus is strongly related to the position and orientation of a muscle called the tensor tympani muscle that inserts on the manubrium of the malleus bone and originates or attaches directly to the sphenoid bone and the temporal bone.  It lies in our auditory tube and its main action is to tense the tympanic membrane along with the stapedius muscle of the ear.  It also contains cerebellar input related to the ability to adapt to vision as well as hearing.  Since this muscle makes the tympanic membrane taught if it is put in a position where it is lengthened it can also influence its own innervation by the mandibular division of the trigeminal nerve.  It can have a direct impact on the external surface of the tympanic membrane. 

The external surface of the tympanic membrane is innervated by the oriculo temporal branch of the mandibular nerve and the oricular branch of the vagus nerve.  The internal surface of the membrane is supplied by the tympanic branch of the glossopharyngeal nerve.  Temporal and sphenoid orientation, therefore, can have a both direct and indirect impact on the autonomic nervous system, trigeminal innervation, and vagal activity.  Clinically, keeping the temporal innominates aligned, stable, and functioning in a reciprocal manner with respiration and mandibular activity is important to keep the tympanic membrane, tympanic cavity, and septum of the auditory muscular canal aligned.  Through manual or non-manual techniques using PRI principles and philosophy, I have been able to change the frequency and intensity of this irritant.  Many of these same patients also need to be evaluated by a dentist with a strong background in TMD and occlusion and it’s always helpful to work with a dentist who has a cranial-gnathic orthopedic mind.  Being familiar with the different lesions of the cranium that can occur with malocclusion is always helpful in restoring proper cranial symmetry with a bite. 

In addition to this I’ve also had success in working with optometrists, specifically COVD trained optometrists, who presently understands the autonomic nervous systems influence on accommodation and tension across the cranium as a result of vestibular constraint secondary to visual and spatial lack of integration.  Hopefully, this overview will help anyone working with a patient experiencing tinnitus.  Obviously, we’re excited that the physical and physiological implications associated with tinnitus, can be corrected or reduced using methodology that diminishes the asymmetrical issues at the temporal region as well as the hypersensitivity associated with torque placed on the temporal bone itself. 

Posted March 17, 2011 at 1:35PM
Categories: Science

Ron Hruska and Dr. Wise are diligently working on the Interdisciplinary Integration course this morning! As a result, I now have in hand, four pre-reading recommendations for your weekend enjoyment:)

Astigmatism…with a Twist by Steve Gallop, OD
Vision Development by Heidi Wise, OD
Visual Conditions of Symphony Musicians by Paul Harris, OD
Reflexes, Learning and Behavior by Sally Goddard

Posted March 11, 2011 at 2:18PM

We are thrilled that so many of you are planning to attend the upcoming Annual Interdisciplinary Integration course! The course is filling up quickly. With just 4 seats remaining, I encourage you to register soon to ensure your seat at the course. You won’t want to miss this opportunity!

“The three days will offer anyone with an interest in vision or the vestibular systems an opportunity to learn how basic cranial, cervical and thoracic mechanics can be influenced not by what we see, but by where we have to put ourselves to see it.”

Posted March 11, 2011 at 2:10PM

“It’s been the best money I’ve ever spent on continuing education.”

CLICK HERE to read “What I learned in 2010” by Eric Cressey, CSCS.  Eric’s discussion of asymmetry learned from attending both Myokinematic Restoration and Postural Respiration has been featured by TNATION. Eric is president and co-founder of Cressey Performance near Boston, MA.  A highly sought-after coach for healthy and injured athletes alike, Eric has helped athletes at all levels – from youth sports to the professional and Olympic ranks – achieve their highest levels of performance in a variety of sports.  Behind Eric’s expertise, Cressey Performance has rapidly established itself as a go-to high performance facility among Boston athletes – and those that come from across the country and abroad to experience CP’s cutting-edge methods.  Eric is perhaps best known for his extensive work with baseball players, with more than four dozen professional players traveling to Massachusetts to train with him each off-season.

An accomplished author, Cressey has authored over 200 published articles in all.  Eric has published five books and co-created four DVD sets that have been sold in over 50 countries around the world.  Eric has been an invited guest speaker in five countries and more than one dozen U.S. states. His Master’s thesis, “The effects of 10 weeks of lower-body unstable surface training on markers of athletic performance,” was published in the Journal of Strength and Conditioning Research, and Cressey was a co-author for the International Youth Conditioning Association’s High School Strength and Conditioning Certification.

Eric’s writing and his work with athletes have been featured in such local and national publications as Men’s Health, Men’s Fitness, ESPN, T-Muscle, The Boston Globe, The Boston Herald, Baseball America, The Worcester Telegram, Perform Better, Oxygen, Experience Life, Triathlete Magazine, Collegiate Baseball,, The Metrowest Daily News, Parents and Kids, and EliteFTS.

Posted February 27, 2011 at 1:04PM
Categories: Clinicians

Greetings PRI therapists!  Many of you have e-mailed or called me waiting for our recommended shoe list for 2011. HERE IT IS!.  All of us at the Hruska Clinic spent well over two hours evaluating and trying on shoes for this 2011 list.  Please know that there may be shoes that are not included on this list that we did not examine.  I would encourage you to examine shoes that you are questioning for a good heel counter, minimal to no lateral heel give, ability for your patients to find and feel their arches and to push off their big toe when walking. Most importantly, make sure your patients can maintain neutrality with PRI tests with their shoes.  What works for one patient can be different for another.  It’s difficult to evaluate all the shoes on the market.

You will see a “S-M-L” after each shoe and this is referring to the build of the individual that the shoe works for (ie. small, medium, large).  In addition, I have identified if the shoe is motion control, stability or neutral for your added information.

I can’t identify another shoe as awesome as the 2009 Asics Foundation, but I will continue on my quest for shoe greatness.  Shoes change every 12 to 18 months and the 2010 model of the Foundation is good but it’s not “greatness” like the predecessor.  Also, don’t grab your AED when you see a Mizuno on the list.  Jason, Dave, Jen and I all tried it on and validated it’s presence on the list.  Shocking, but they did change the design so make sure it’s the WaveRider 14.

I would encourage you to go to your local running store and assess these shoes for yourself so you can make appropriate recommendations for your patients. 

We hope this helps you all out!

Lori Thomsen

Posted February 25, 2011 at 11:50AM
Categories: Products

Last weekend, more than 20 Postural Restoration Certified (PRC) Therapists gathered in Salt Lake City, Utah for the 3rd National PRC Conference! The conference was deemed a great success and included the following presentations:

Jen Poulin - Importance of the Glute Med
Lori Thomsen - Interdisciplinary Integration and Vision Update; Pelvic Floor Dysfunction & New PRI Tests
Mike Cantrell - Postural Respiration Updates and Algorithms
James Anderson - Gait: Inhibition or Delay
Gibbie Duval, Jacob Wurth and J.R. Epley - Keynote Speakers on PRI in Strength & Conditioning

It was a great time of networking and sharing our passion for PRI!

Posted February 22, 2011 at 10:30AM

Ron Hruska and I sat down today with Jason Masek who is the chair of our recently formed Recognition Committee. This Committee was created last year to review and recommend processes for Certified Athletic Trainers and Strength and Conditioning Coaches to achieve recognition for their training in Postural Restoration. The Committee will be conferencing again soon to discuss many pending details. In the meantime, we are sharing with you the course recommendations that have been reviewed and accepted by PRI. 

Course Requirements:
Myokinematic Restoration
Postural Respiration
Impingement & Instability
Advanced Integration will be recommended, however, not required.

Posted February 16, 2011 at 6:00AM

After having countless meetings, integrative discussions and patient co-assessment and co-treatment interventions with Dr. Heidi Wise and Dr. Bob Edwards, I thought I would give an overview of the upcoming Annual PRI Interdisciplinary Integration course being held in April. Dr. Wise, Dr. Edwards and I are excited about interacting together and with you as we cover up-to-the-moment clinical advances and evidence-based successes in improving visual functional integration, using PRI positional and neurological principles. We will discuss and demonstrate how neurological input and output to the eye interacts with vestibular, postural-related autonomic function.

For the PRI Therapist, attending this course will help you assess a patient who is having difficulty in achieving or maintaining neutrality. We will offer an overview of the autonomic system, spatial awareness, binocularity, visual accommodation, orbital orientation, and patterns of postural adaptation resulting from the asymmetrically challenged vestibular system. This is an excellent opportunity to learn how eyewear can help or hinder a PRI intervention. Additionally, patient management strategies to facilitate visual integration will be presented, including PRI program sequencing to maximize integrated outcomes.

For those of you who know me, you know I’ve had a passion for the eye for a long time. The eye is integration. Our balance, our reference centers, our autonomics, our spatial patterns, and our learned behaviors are all reflected and revised by the visual system and visual cortex. This course will address this descending input and cortical interference by identifying ascending treatment intervention limitations and ruling out other system influences.

This course will identify up-to-date clinical information on global-orbital and orbital-global mechanical patterns, frontal plane limitations of the head and neck on the thorax as a result of visual influences on the sagittal and transverse planes, and postural imbalances as a result of visual-vestibular (spatial neglect) challenges. These include influences of un-corrected or corrected astigmatism on orbital position and ocular muscle, and autonomic-accommodation on system extension.

The three days will offer anyone with an interest in vision or the vestibular systems an opportunity to learn how basic cranial, cervical and thoracic mechanics can be influenced not by what we see, but by where we have to put ourselves to see it. Achieving neutrality can be frustrating for a PRI Therapist if neutral vision is restricted. Future PRI Vision-trained optometrists will understand how to use the visual system and ocular kinematics to achieve a balanced, neutral oriented visual system. This futuristic integrated-minded course will offer all participants an opportunity to become active in this PRI Vision process. I’m very excited about it! - Ron Hruska

Posted February 14, 2011 at 2:56PM
Categories: Courses

Jason Masek has been busy blogging at the Hruska Clinic. CLICK HERE to read his patient-friendly analogies.

Posted February 9, 2011 at 3:03PM
Categories: Clinicians
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