What was your first introduction to PRI?
I was introduced to PRI while receiving PT as a DPT student at the University of Minnesota. My PT had spent a clinical rotation at The Hruska Clinic and was able to correctly identify the imbalance in my thigh muscles as the source of my chronic knee pain. It was very validating to learn about my very inhibited hamstrings since I could never believe that my quads were weak (as my referring sports med doc had suggested) since I was bike commuting daily and had originally injured my knee from training for bike races years prior. In PT, I distinctly remember my body loving the 90-90 Hip Lift PRI technique, but experiencing pain with the traditional PT step-downs. With this small introduction to PRI, I was hooked. My body resonated with PRI and I paid attention to that.
I took Myokinematic Restoration with Ron while still in grad school and it was love at first adduction drop! I was in awe of this rebelliously “zoomed-out” work and of its magnanimous and brilliant founder immediately. Since none of my clinical instructors had PRI training, it wasn’t until my job at Courage Center St. Croix in Stillwater, MN that I was able to use PRI with my adult outpatient clients. Referring physicians practically threw their patients with chronic pain into the warm-water pool there. These clients were eager to try anything that might help them and PRI fit the bill. The successes there spurred me to get out of the pool and pediatrics, and to move back home to Oregon to work at an outpatient orthopedic clinic. While there, I was able to study CranioSacral and visceral mobilization to augment what PRI could offer.
Tell us a little about your clinic, Shine Integrative Physical Therapy. As a young clinician, why did you decide to open your own practice in Portland, OR, which also includes a Yoga studio?
Physical therapy clients need time to be thoroughly heard, assessed, and educated as well as be instructed to correctly perform therapeutic activities and receive manual therapies (especially CranioSacral). Physical therapists need adequate time to assess their clients and treatment outcomes, as well as communicate with other health care team members, produce accurate documentation, and more. I never felt I could do this under the appointment time and business constraints at the outpatient orthopedic clinic I was at. So I left and opened Shine in June 2009. I chose the name Shine because of the optimism, joy, and empowerment the word embodies and because it hints at the spiritual aspect of true healing.
One of my main intentions in being on my own was to avoid the burn out I felt at the last clinic I was at. This meant prioritizing my overall health, creating sustainability, and maximizing my job satisfaction. One way this manifest was scheduling 1-hour appointments with a short break between each client. This is definitely against the typical “squeeze every billable unit out of the therapist’s schedule” business model but considering that I was doing everything in the business by myself and was learning everything as I went, it worked very well. The schedule is the same now as it was then and I don’t have any plans to change it. Clients deserve to be treated in a space that is vibrantly calm and filled with healthy, practitioners who are genuinely happy to be there. That is exactly what clients find at Shine.
After expanding and moving Shine twice in the first two years, I was blessed to receive a full build-out our current clinic and studio. Shine now employs two physical therapists, a clinic office manager, and a studio manager. Our independent contractors provide acupuncture, massage therapy, and Rolfing services. At least 30% of PT clients receive concurrent treatments of acupuncture, massage, or Rolfing. Many of our PT clients are referred to a yoga class during or after their rehab. With 22 classes per week at the studio, our practitioners can prescribe specific levels and types of therapeutic yoga classes for our clients to attend. Our entire team of practitioners and yoga instructors embrace PRI and this makes for very successful integration of services for Shine clientele.
How has your clinic been able to succeed in the constraining healthcare environment?
It is easy to get discouraged with the multiple constraints and limited reimbursement in our current healthcare environment. Much of what keeps Shine afloat financially is the online service integration (scheduling, billing, documentation) that we have from AthenaHealth, a fantastic accountant, and optimal insurance contracts from the Northwest Rehab Associates (NWRA). I am lucky to know a world-class graphic designer who created an eye-catching logo and an effective brand identity for Shine. This helps to make our marketing efforts more cost-effective, efficient, and enjoyable.
Obtaining consistent referrals from a broad and diverse network is a major reason we succeed. Many of our clients hear about us from their community yoga teacher, massage therapist, acupuncturist, or personal trainer. As PRI-educated therapists, we refer out to like-minded professionals and find that the dentists, vision therapists, and other health care practitioners return the favor. Partnering with our in-house acupuncturist and massage therapist as well as the yoga community has allowed for a steady flow of clients in both directions.
Hands down, our biggest referral source is our clients word-of-mouth. We are very fortunate in that Portland is a tremendously health-conscious and active city. Our clients want to be treated holistically and not as a body part so they are immediately resonate with our approach. A much higher percentage of our clients are self-referrals and end up telling their physician about us versus the other way around!
How did becoming a PRC therapist benefit you as a clinician and your practice? Any advice you would give to those who are considering the PRI credentialing program?
I would advise those considering the PRC to do more than just consider it. This process is so very challenging and rewarding that you can do nothing but improve by pursuing it. From the reviewer feedback on my application to the testing itself, I was validated and uplifted throughout. I observed my clinical reasoning skills congeal in a very efficient way. I especially enjoyed finding research articles that supported PRI, analyzing my case studies to see how I can improve as a clinician, and being with PRI staff and my fellow PRCs for a full week. The camaraderie was unimaginably strong and we all had so much fun, despite the stress that we put on ourselves. I felt as though was tapping in to this incredibly supportive community of very wise, caring, and passionate individuals. Even from my first class, but more now that I have earned the PRC, I sense this immense connection within the PRI family. This support lifts me up everyday and it seems to have magnetized a number of wonderful opportunities my way, including this interview, writing a chapter in Kyndy Boyle’s upcoming book, and hopefully the opportunity for teaching someday.
Another benefit of the PRC program is the sense that our clients are reassured by the clinic’s PRC status. It communicates that we are committed to this PRI work and –even if they don’t quite know what that means- it piques their interest. Another great benefit is access to all of the PRC updates and perks. I am always thrilled to see what PRC updates Jen has accumulated for us with her frequent emails and the PRC site. I use these resources extensively for patient handouts, presentations for referral sources, and research for staff in-services frequently.
Tell us a little about your Yoga background, and what you are currently doing with Yoga. How have you been able to integrate Postural Restoration® concepts into your Yoga classes?
I found yoga during my sophomore year at Oregon State University. There was a deep sense of imbalance from the compensation of running on a torn right meniscus for over one year pre-operatively and not receiving rehab post-operatively. So, I sought out a local studio and really liked how the practice provided a balance of fitness components including cardiovascular, strength, flexibility, and relaxation. Between learning all the new physical postures, I began to recognize and appreciate the more subtle aspects of the practice, too. Linking your breath to a particular pose to flow through the sun salutation and exploring the lower, middle, and upper sections of the lungs in 3-part breathing are two examples of ways I felt the spiritual practice embedded in each class. Yoga means union, and I experienced a felt-sense of this.
Unfortunately around that same time I found yoga, a well-meaning PT at a clinic I worked at as an aide told me that my knee pain was due to tight hip flexors. With that in mind, I allowed my yoga practice to become primarily focused on hip flexibility. Without a thorough assessment of what my true issues were, without a consistent teacher (poor college student), and with a competitive background to boot, I inadvertently created the dreaded pathomechanical PEC pattern in my body.
After earning my DPT, I took two 200-hour yoga teacher trainings and I taught to regular and specialized classes, including to kids with special needs and prenatal, as well as anatomy and therapeutic workshops. I integrated PRI concepts into my classes and eventually into teacher trainings I have been invited to present at. I studied yoga philosophy and resonated with the many rehabilitative concepts speaking from yoga’s ancient texts. Statements like “your connection to the Earth (asana) should be steady (sthira) and easeful/joyful (sukham)” sounded a lot like Ron encouraging us to get our clients neutral and stable so they could rest and feel better.
After the Pelvis Restoration course in March 2011, I put my yoga practice on hold to commit to resolving my patho PEC and bilateral BC patterns. Now I am back practicing in a more skillful way than just stretching out my hips! Last February, I began a Postural Restoration-Inspired Yoga class at Shine Yoga. This class is specifically sequenced in a way that optimizes Right AIC while inhibiting PEC, BC, and Right TMCC patterning. In each class, I integrate PRI tri-planar activities, emphasize zone of apposition, Left AF IR, and PRI reference centers. I emphasize some of the many yoga principles that complement PRI, such as: drishti (steady gaze), kumbhaka (pause after exhale), “back-body” (posterior mediastinum), mulabandha (optimal pelvic floor tone), alternate nostril breathing (to balance the left and right sides of the body), and relaxing visualizations to calm the CNS. The students are enjoying returning to postures that used to hurt them before finding PRI.
Unfortunately, despite significant overlap in the intentions and healing potential of PRI and yoga, many PRI clinicians and other healthcare practitioners only see the results of Western culture’s body-obsession that passes as yoga today. Namely, the physicality of yoga has been over-emphasized in the US. As I’ve briefly mentioned, there is so much more to yoga and regardless of the style of yoga one practices, the student will undoubtedly gain improved self-awareness. We know this can have multiple benefits, for rehab and for the preventative aspects of living including better stress management, improved mental and emotional wellness, and making healthy lifestyle choices. Once a yoga teacher told me that she doesn’t practice yoga for herself so much as for others. That ultimately she practices because she knows that yoga helps her be a better person and that is what she wants to bring to the world. There was no mention of obtaining longer hamstrings…
It has been an amazing journey and I’m thrilled to be able to integrate all the healing that I have received. It is an honor to be able to share PRI and yoga with so many. I look forward to continuing to cultivate more dialogue and provide integrative education in a way that is useful and accessible to PRI clinicians and yoga students alike. To that end, I am happy to be a resource for any PRI-related yoga questions you may have. You can email me at: emily@shinephysicaltherapy.com . Namaste’!
