Kristi Jagels - MS, PT, PRC
How did you become interested in PRI and when did you attend your first course?
Actually, I stumbled onto my first PRI course the fall of 2002. Twice a year, the Nebraska Physical Therapy Association offers a variety of courses for continuing education. I happened to choose the course entitled "Myokinematic Restoration - An Integrated Approach to Treatment of Lower Half Musculoskeletal Dysfunction" with instructor Ron Hruska. He was describing me with my mild scoliosis and movement pattern. I had chronic neck and back pain all through high school and college. I struggled with exercise induced asthma during basketball and track season. I had frequent headaches and the dreaded migraines started in college. This course was enlightening! After 6 years practicing therapy and previous continued education courses, this was the only course that left me with a desire to know more about a specific treatment method in physical therapy.
Within that same year of taking my first PRI course, I attended Postural Restoration (Hybrid class before Postural Respiration). Because I own my practice, I did not feel restricted in trying something different from traditional physical therapy. I began to integrate the PRI approach with my patient load. I would offer free therapy with nursing staff and friends to hone my PRI testing and techniques. It was both rewarding and frustrating at the same time. Rewarding in the fact that I witnessed immediate results in treating patients and I knew that this PRI approach was undoubtedly a method I wanted to pursue. Frustrating because I didn't have another PT to collaborate with. Because I was a sole practitioner going through the PRI concepts, at times I found it difficult to thoroughly interpret and apply the best treatment plan.
In 2009, I opened a second clinic and Ben Sudbeck, DPT, came on board. He had practiced with PT's who attended PRI courses and was vaguely aware of the science. Together we began our endeavor to attend PRI courses, taking in as many as possible. And so, we both continued to expand and improve our PRI knowledge together.
It became increasingly evident to me that the basic understanding of PRI principles was just a small part of the broader science behind PRI. The secondary courses, affiliate courses, PRI Vision and the annual symposium have been vital in my growth and understanding in effective treatment of patients - how to get to the root cause of symptoms quickly.
What has been the biggest challenge with having your own practice?
The biggest challenge is relaying what we do that is so different. Because of PRI, we are operating in a niche market that is saturated with physical therapy clinics. Because of PRI, we are different than the norm. As a business owner, it's not always comfortable being 'different'. My husband and I own the clinic together and we have had many late-night discussions on the direction of our clinic. I was determined to have PRI as our primary focus of the clinic. I wanted to set ourselves apart from traditional physical therapy. As we started to market our business, the challenge was explaining PRI in print and radio ads. How do you explain to doctors and other healthcare professionals that we integrate with dentistry or optometry?
Somewhere in the process, I stepped over the line to become fully invested in PRI. There was no looking back. We brought on our three physical therapist assistants through the PRI journey and they began to quickly recognize the direction our clinic was taking. The heavy use of modalities became days of the past. We no longer treated the right shoulder like the left. We were able to relieve neck tension by addressing a respiratory system or left leg awareness. Therefore, having like-minded employees jump on board with PRI was easy. It would be a challenge to bring on an employee that wasn’t open minded in trying something different. Even bringing on another PT to the clinic would be a challenge if they didn't already have a taste of PRI. The PRI approach is a continual learning process over several years of courses and clinical experience. Therefore, there's a challenge of surrounding yourself with other likeminded therapists who are willing to do something that can be difficult and outside the norm.
What would you say to other PT's who are considering taking a PRI class or becoming Postural Restoration Certified?
Words cannot describe how valuable PRI has been to us. Not only am I being recognized nationally but also internationally. The problem with PRI is that it can take a physical therapist out of their comfort zone. It takes work...a lot of work. Each patient has a very specific treatment plan and no two patients are the same. For the typical patient in our clinic, PRI is successful and results oriented with sports rehab, musculoskeletal pain and post-operative rehab. But, if I neglect a patient’s pes planas (flat foot) then my treatment plan will not be effective...if I neglect a patients occlusal bite (how teeth touch) then a patient can lock back into their strong pattern of movement or pain...if I didn't have an understanding of how both eyes need to work together for particular patients, then all my efforts to help these patients are unsuccessful.
The entire staff at the Postural Restoration Institute, the practitioners teaching the courses, the like-minded therapists and medical professionals all are wonderful people to know and work with. The Institute is willing to help you through the process and they truly care. You will learn how to reach out and integrate with other professionals, like a dentist, within your community. There are many therapists and medical professionals who reach out to each other in a PRI group email. The PRI website is a great source of information as you go through your leaning process.
The 'find a provider' link on the institute’s website has been a great tool for doctors to refer their patients to us. Even our local health professionals will write on the script 'PRI eval and treat'. Patients will tell us their doctor recommended PRI therapy because of the results and not to expect the same physical therapy from past experience.
Completing advanced training and coursework to become a PRC is highly recommended. The primary and secondary courses are a fraction of the integral coursework of how all systems are connected in treating each and every patient. Ron Hruska is passionate in providing a strong institute of excellence. The process to complete your certification could be intimidating, but I gained an enormous amount of confidence and a deeper understanding of PRI.
What is the typical patient that you see in your clinic (if there is one)?
The typical patient tends to be a musculoskeletal strain, sprain or repair. But with PRI, I am able to take that to another level with more success than traditional PT. What's more enjoyable is treating that same patient’s underlying symptoms that are directly related to their initial complaint. For example, I am able to teach the patient how a particular exercise will not only address their knee pain, but how that same exercise also addresses their chronic low back tightness and headaches.
What areas of patient care excite you the most?
I enjoy the younger patients only because their pattern is easier to change and address before the symptoms are ingrained. I am amazed at how many kids come in with strong cranial torsion. If we are fortunate enough, we see them before permanent teeth are removed or before braces. It is a blessing to validate these kids' chronic complaints using PRI intervention. They present with real struggles that no kid should have to go through. They have a range of symptoms that we take very seriously such as; panic attacks, difficulty swallowing, migraines, EIA (exercise induced asthma), shortness of breath, chronic joint pain, poor sleep patterns and daytime fatigue. They honestly don't know what 'good' feels like. It is a blessing to have these kids come into our clinic before they go further down this strong cranial torsion or strain. I am ever more grateful to integrate with dentists who are able to help these kids as they progress through PRI rehab.
The other patient I get excited about are the ones who have been everywhere and tried everything. These patients come in to our clinic and are desperate for help. Oftentimes they are told that we are ‘different’ than any previous physical therapy experience. They have tried A, B C and completed X, Y, Z without lasting results. Often these patients have a long rap sheet of symptoms and quite honestly, they just want their life back. Occasionally I will need to integrate with the PRIME program, PRI Vision, my local dentist or a dentist that is able to assist with cranial torsion. Because we are so close to Dr. Paul Coffin, there are certain times I will have a patient drive to Sioux City versus doing the impressions here for PRI orthotics. I am grateful for the trust placed in me when a patient will need further intervention that is not covered by medical insurance.
Who have been your mentor(s) within PRI?
There are so many...I strongly feel that anyone going through the PRI process needs another therapist to bounce ideas off. My coworker, Ben Sudbeck DPT, PRC has been by my side through the ups and downs of understanding PRI. Without a doubt, there were times when we would take two steps forward and one back as we both pursued our PRC.
As a clinician progressing through PRI coursework learns how to quickly and effectively treat a patient, there will be times that you have a piece of the puzzle, but not the whole puzzle. Fortunately, I live 2 hours away from the Hruska Clinic. It was there that I worked with PRC's Jen, Dave, Torin, Jason, Lori, Ron and Dr. Heidi Wise in finding that missing piece to the puzzle. Because of the amazing mentoring of these clinicians, I have exponentially gained a wider skill set to treat my patients. I can now recognize when a like-minded dentist or optometrist is needed to integrate with a patient’s plan of care, sooner than later.
How do you go about mentoring others in your profession?
A doctor’s office once warned us that there were other clinics promoting PRI therapy. I think they were expecting me to be concerned that this clinic would be encroaching on my practice. Instead I replied how beneficial it is to have more therapists learn and integrate PRI techniques in their practice. I would enjoy to having more PRI clinics around our area.
I thoroughly enjoy planting the PRI seed with undergraduates applying for PT school. By showing the benefits of PRI on themselves and with current patient load, they can see and feel the changes instantly. Most of these students are needing to meet the required observation hours in a variety of physical therapy settings. Once they see what we do differently, or better yet experience PRI on themselves, they want to know more. We talk about the process of PT education and the all-important continuing education after graduation. It's easy to tell which students ‘get it’. They ask all the right questions and I keep feeding their inquisitive minds. They often come in for more observation beyond what is their required hours in applying for PT school. I find that these students have watched PRI videos, they've been on the website, they have tried the exercises and can feel the results. Those are our future PRI therapists. The sooner you plant the PRI seed and make them aware of this asymmetrical system and how we treat that pattern, the sooner we will see our profession recognize PRI.
What types of activities do you enjoy doing in your free time?
My family is my free time. We enjoy summer nights in the backyard by the fire. Making meals together with a dose of healthy conversation is now a very cherished commodity as the last two kids are in high school and the oldest will soon be married this summer. As with most families, we are on the go with the kids' extracurricular activities. I am a baseball mom who probably cheers too loud. I am a horse mom who loves to get up at 4 am to assist my daughter at horse shows on minimal sleep. I am a soon to be mother-in-law, looking forward to little ones running around. I used to enjoy running until I fractured my left heel (in the PRI world, that is critical). I download books and sneak in casual reading over lunch, at the ball field or at a horse barn. And very recently, I've discovered a new love for history and politics.