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

The 2nd Quarter PRC and PRT Updates email has been sent out today. If you are a PRC or PRT, please check your email for the latest PRI news and updates. If you didn't receive the email, please email me!

Like most of you, I am a clinician when I enter this site.  But like many of you, I am a spouse, parent and community member as well—just a person.  These blogs are written as pragmatic, candid discussions about my experiences as a PRI practitioner.  Like you, my treatment style is a product of the training I have received.  That training has come from a wide variety of sources—so I certainly qualify as eclectic by definition.  However, every good clinician uses their most powerful and effective tools the most, whether they process that fact or not.  I am no different in that regard either.

From time to time over the years, I’ve fielded questions about whether I am a PRI “fundamentalist.”  This is a good question, and one worthy of discussion.  The well-intended question is “do you use ONLY PRI to treat your patients?”  The short answer is “No.”  The longer, slightly more complete answer is “when I treat a patient and they return to clinic objectively neutral with PRI functional tests that equate to the level of functional strength that they desire but still have focal symptoms, then I treat with focal treatment techniques.”  I use my most powerful and effective treatment techniques first and often times don’t need others.  And yes, the most powerful techniques I’ve ever utilized are PRI techniques.

That said, I think it best to discuss this concept by way of actual clinical examples.  The following is a story about one patient with the diagnosis of left shoulder biceps tendinosis who I treated intermittently over an 18 month span, the strategy I used to treat him and the clinical results that I found.  Names have been changed to protect the innocent and in order to maintain a readable text, I have grossly summarized the care of this patient.  The clinical findings listed are predominantly to give the reader a feel for the symptomology, goals of the patient and style/type of treatment used.


Don's Story:

Diagnosis:  "biceps tendinosis"
"Caused" by AC jt spurring, subacromial impingement according to his physician, the radiograph and MRI

The mechanism of injury was insidious, first becoming a limiting factor 3-4 months prior to evaluation.  The patient’s ROM was functionally limited into abduction, flexion and IR, less limited with ER.  There was noted adverse neural tension with median and ulnar nerve biased UENTT’s.  Neer sign, Hawkins Kennedy and empty can tests were positive.  Comparable sign with resisted elbow flexion and supination, active and resisted horizontal abduction.    PRI testing revealed a PEC patient who showed a bilateral BC pattern. 

The patient wanted to be able to raise his arms overhead to enable him to perform various ADL’s including woodworking, wanted to be able to again play his accordion, which he had been unable to do for several months.

This was a classic example of working with an “old-school” orthopedic physician and patient.  Good physician, hard-working patient.  I initially described the positional influence of the brachial chain because I knew it was most important and tried to treat the patient in that fashion.  However, the patient’s script for PT from the physician was specific and called for scapular stabilization, rotator cuff strengthening and the patient had discussed specifics about what PT would involve before arriving.  When what I felt was best for the patient was not supported by the patient or his physician, I chose to follow the script as directed.  I did what was comfortable and familiar to the physician, patient and myself—I used an ‘eclectic’ approach which included:  As much "PRI" as the patient would tolerate--a few non-manual techniques to attempt to reposition, Butler neuromobilizations to address adverse neural tension, Gr I-III joint mobilizations to inhibit tone and mildly increase posterior-inferior capsular length, MWM's to achieve end range pain-free ROM (IR and abduction most notably in this case), pain free rotator cuff, ST AND TS stabilization to the hilt.

After using this approach twice per week for 8 weeks, the patient had achieved all mobility goals, and all but one functional goal.  He still could not play his accordion for more than 5 minutes without having symptoms of left shoulder pain but was happy with his progress, reporting he was 90% better.  At his 8 week f/u with his physician, the decision was that he was "better enough" and was to discharge to HEP in short order.  I outlined his final HEP that he would agree to and wrote a semi successful discharge summary to "continue with independent HEP per physician's orders."

Sounds like a common 90% successful PT intervention, right? I had met all of the mobility and all but one of the functional goals that I had set and the patient and physician were pleased with my work.  I had done exactly what they had asked.  So why wasn’t I entirely happy?


To be continued...

Posted May 10, 2014 at 1:29PM
Categories: Clinicians

I recently found myself, once again, defending the wonderful science that Ron and everyone at the Institute have been so generous to share with us all. In this instance, the forum was a Facebook conversation (most of which can be viewed here) where PRC candidates Bill Hartman and Zac Cupples, along with myself, expressed our experiences with PRI to a group of contraians and skeptics.

As a means to provide closure, I constructed a response which provides a synopsis of therapeutic intervention as well as an explanation of how PRI prinicples help me intervene. After a wealth of positive feedback via social media, Jen and Ron asked me to share it here for the brilliant community of PRI clinicians. The response begins in the quoted text below.

Thanks to all of you for being such an inspiration and for positively influencing my education as a physical therapist.

"It's becoming increasingly clear that the path to system variability and pain-free movement is gated by neuroception (i.e. limbic threat appraisal) and autonomic nervous system output. And its these two properties of the nervous system which govern the effects of the innumerable methodologies therapists use to expunge system rigidity. 

Autonomous of discipline or method, clinicians intervene at the level of the receptor (rods, otoliths, mechanoreceptors, etc.), engendering unique signal transduction and transmission into a sea of equal status patterns which participate in collective summing within the brain. 

We'd hope our therapeutic inputs contribute to a modification in the perceptive capabilities of the patient, though (as we all know) this is not always the case. Some inputs never reach the level of perception while others exceed the adaptive capacity of an already rigid system, perpetuating chronic limbic hijack and sympathetic dominance.

But a positive change in perception opens valuable cortical real estate for neuroplastic remapping via graded exposure, which is the substrate for system variability. This is really the goal of any physical therapy intervention.

So, how do we know we're dealing with a rigid system in the first place? And furthermore, how can we evaluate the efficacy of our inputs with respect to restoring system variability? 

Beyond many other "systems" I've experimented with, PRI seems to provide the most cogent answers to the above questions. And it's the "umbrella" which explains, to me, why other methods work.

What PRI provides is a means to identify a predictable pattern of ANS-mediated anti-gravitational motor output for a collection of systems held in some degree of rigidity. The perspective they bestow is quite comprehensive; PRI is a unified system respective of ALL sensory inputs capable of influencing reticular output (mechanoreception, vision, audition, etc.). 

But woven through its complexities, their simple orthopedic testing and treatment algorithms provide a reliable means to assess this aberrant output, as well as evaluate the systemic and perceptual perturbations that might follow any therapeutic intervention (PRI, Mulligan, Maitland, MDT, ART, etc). 

Because interventions can be both synergistic or antagonistic to the pattern PRI presents, utilizing a withdrawal A-B-A study design during a treatment session (with the patient functioning as their own control) upholds an element of internal validity beyond what other systems might be able to provide. I'd argue this makes PRI a powerful adjunct to anything you're already doing, as we scrounge for external validity in a increasingly heterogeneous population.

PRI treatment aims to recapture reciprocal and alternating movement in three planes across the three girdles of the body. And PRI is never about fixing posture - it's about restoring system balance, variability, and adaptive potential." 

Posted May 9, 2014 at 9:01AM
Categories: Clinicians

Hello, PRI community! 

A quick note to announce that Launch Sport Performance is currently seeking a Licensed Physical Therapist to work in our new elite facility.  Launch Sport Performance is the first Postural Restoration Certified facility in Maryland and DC area.  Located in Rockville, MD, we utilize and integrated approach to help athletes reach their peak.   Experience with athletes is preferred, but Postural Restoration experience is a must.   Recent graduates welcome!

For more information, please contact Kristen Spencer at kristen@launchsp.com or 478-987-9697.

Kristen

Posted May 9, 2014 at 8:50AM

For those in Colorado interested in discussing PRI, the Colorado PRC therapists Lisa Kelly, Scott Kosola, and Craig Depperschmidt are planning a quarterly informal meeting to talk PRI. Our first one will be Saturday, May 31st 2p.m. at The Point Sports Medicine and Rehab. Address is 6801 W. 20th St., Suite 203 Greeley, CO. Lisa, Scott, and Craig will be leading topic discussion but the meeting will be informal and open to the needs and interests of the group. Email Craig at craig.depperschmidt@reboundsportspt.com with any questions! 

Posted May 8, 2014 at 4:51PM
Categories: Clinicians

Hey everyone, thought I’d drop in a brief example of how a PRI paradigm helps me in clinic.

In my practice, I treat about 25% postoperative patients.  Yesterday, I began a session with a patient who is seven weeks status post right ACLR who I had been predominantly treating "per protocol guidelines" with the patient improving functionally using that approach.  However, yesterday the patient presented subjective symptoms similar to those of pes anserine bursitis in the affected knee--she could not straighten her knee very well and noted end range pain, had difficulty with normal stride length on the right and could not stand on her affected right leg without severe pain in the anteromedial right knee.

Objective findings showed straight leg raise 65°on the right (60 left) adduction drop test positive bilaterally, Hruska adduction lift test 1/5 bilaterally and a 20° lack of end range knee extension on the right.  Patient had palpable tenderness over distal aspects of the semitendinosus and semimembranosus, noted comparable sign with resisted knee flexion. There was palpable tenderness over pes anserine bursa of the proximal tibia and noted swelling in the same area.

After repositioning the patient, she had 5° lack of extension, or 15° improvement, 85 degrees of SLR, the ability to stand and walk on the right knee without pain and significantly increased step and stride length functionally.  Patient was then able to perform functional closed-chain strengthening activities without pain and will now be progressed through a PEC algorithm of treatment integrated with her postoperative protocol. 

Though I begin implementing PRI concepts of respecting position, triplanar functional control and utilizing polyarticular muscle chains that affect postoperative care at different times dependent upon the patient, the apt time presented itself to me with this patient at the start of this session. 

Attaining neutral position of a pelvis gave functionally “longer” hamstring musculature, taking the strain off of the distal attachment sites of the medial hamstrings, thus decreasing pain, increasing functional end-range extension ROM and immediately allowing me to progress with rehabilitation of her right knee s/p ACLR.  In this case, PRI principles and techniques allowed me to progress a patient s/p ACLR more quickly than with traditional orthopedic rehab methods alone and will improve not only the patient’s recovery from surgery, but her quality of movement and function during and after recovery.  A fun session for both therapist and patient!
 

Posted May 1, 2014 at 11:55PM
Categories: Clinicians

PRI is teaming up with Southern California University of Health Sciences to host Myokinematic Restoration on May 31-Jun 1st in Whittier, CA! Don't miss the opportunity to take this course taught by Ron Hruska later this month. In addition to CE approval for PT's, ATC's, and strength coaches (through the NSCA), this course has also been approved through the California Board of Chiropractic Examiners!

The early registration deadline is TOMORROW, so don't miss this opportunity. Register today online or by calling 888-691-4583!

Posted May 1, 2014 at 9:03AM
Categories: Courses

Myokinematic Restoration (Boston, MA) - "What a great weekend in Boston with my dear PRI friends Donna Behr and Mike Mullin!  We had a large group of new therapists and strength and conditioning specialists to the science of PRI.  My husband Chris and I flew up to Boston early to catch a few baseball games and relax before the course. I even had the opportunity to spend a few hours at the Body Worlds Exhibit!  It was a great primer before teaching myokin! I left with a new love of Boston!  The clinicians left the Myokinematic Restoration course anxious to learn more about the Power of PRI and Position! Go Soxs!" - Jen Poulin

Posted April 30, 2014 at 3:05PM
Categories: Courses

If you are interested in one of the Myokinematic Restoration courses listed below, be sure to register soon, to ensure that we don't have to cancel these courses. The early registration deadline is THIS FRIDAY, and if we have not reached the minimum attendance of 15, we may unfortunately have to cancel. CLICK HERE to register today!

Myokinematic Restoration - Pittsburgh, PA    May 31-June 1st

Myokinematic Restoration - Whittier, CA       May 31-June 1st    
*This course is approved by the California Board of Chiropractic Examiners as well!

Myokinematic Restoration - Spokane, WA     May 31-June 1st

Posted April 29, 2014 at 12:27PM
Categories: Courses

Check on the new recent email that has been posted, where James Anderson answers a course attendees questions on the FA Range of Motion charts in the Myokinematic Restoration course manual.

CLICK HERE to read Jame's response, and to check out all the recent email questions in the archives!

Posted April 24, 2014 at 10:51AM
Categories: Clinicians Courses
First ... 2 3 4 5 6 7 8 9 10 11 12 13 Last

Products

CD Bundles
Non-manual Techniques
Manual Techniques DVD
Manual Techniques
Illustrations
PRIVY
PRI Video for You