Holly Spence - PT, PRC
The Postural Restoration Institute was formally founded in 2000, July of that same year you took your first Myokinematic Restoration course. How did you come to find out about the Institute and what led you to sign up for your first course?
My PRI journey actually started in 1998. Michelin Carroll PT, ATC had taken Ron’s Protonics course sponsored by EMPI for her athletic training CEU’s. She came back all excited about his approach to management of patella-femoral, hip, and lumbar spine dysfunctions and it was intriguing that the device was only used on the left side despite the side of pain?!? She introduced us to some of the principles and we were all interested in hearing more. So, that same year Ron actually came and taught a course at the clinic I was working at in Vermont. The course was called Postural Restoration. I was immediately inspired by what he taught. The principles made so much sense to me.
After your first exposure to PRI and your initial courses, how did it affect the way you treated patients? It is often hard for some people to incorporate this science immediately after taking a course; did you find this to be true?
It truly revolutionized the way I treated patients. I found it melded so many orthopedic, osteopathic, respiratory and neurological principles into one!! I loved the whole system approach. It was really quite phenomenal!!
I began using the PRI tests as well as traditional orthopedic tests and soon started seeing much quicker changes with my objective tests using PRI manual and non-manual techniques. I would also use the PRI tests to validate whether various traditional therapeutic exercises were helping and the patient could see for themselves if they were not. I would then explain why. I still do this to some extent but now my patients accept my PRI methods since that is why they are seeing me.
It definitely took time to integrate the PRI approach but the more I used it the more confidence I obtained. Luckily my patients trusted me. I spent a great deal of time rereading the manuals and referring to them throughout the day. I think I was at the perfect time in my career and was ready to learn more so that exploring PRI and putting in the extra time was easy. I also had co-workers to have discussions with, more courses to take, and calls /emails/ questions to Ron.
I had started my career working with neurologically impaired patients which I believed helped me with some of my PRI transition. Concepts such as lateralization, facilitation, inhibition, hypertonicity, left sided neglect, righting reactions, reflexive verses volitional patterns, developmental sequencing, ambient visual issues and so forth were known to me from treating the neurologically impaired population. I had also taken many courses over the prior 13 years including Muscle Energy, Strain/Counterstrain, Maitland and Brian Edwards’s spinal mobilization, Brian Mulligan, Upledger Cranial/Sacral etc., but I was still finding there were barriers to maintaining results with many patients. I realized that stress was one of the barriers. I was also a bit disappointed in the segmental orthopedic approach. I quickly recognized the cohesion of my neuro and orthopedic manual therapy segmental training with Ron’s PRI approach and started getting lasting results!! I also began understanding more about the respiratory mechanism and how that related to the stress response and the impact on the postural muscle system.
In what ways did you initially incorporate PRI into your treatment? (Exercise Techniques, Breathing Education, Cueing….etc.) Has your method of utilizing the science changed throughout the years?
In the late 90’s early 2000’s the Protonics was used a lot. We did not have as many of the non-manual exercise techniques we have today. We used a lot of 90/90 exercises, some side lie and upright exercises. Brachial chain exercises were very limited compared to what we have now. I used the manual techniques and spent lots of time teaching about proper breathing with the exercises we had at the time. There were no other courses yet. No Integration or Impingement and Instability! I was still finding gaps and then out came the Cervical-Cranial-Mandibular course!!! Yaaay!!!
The method of utilizing the science has grown though the years as I have attempted to stay current with what Ron and the Institute develop. Of course that has meant taking the courses more than once for the upgrades and to add the new ones. I have found using the reference centers and improved training from The Institutes faculty on skills/communications for finding and feeling (facilitating and inhibiting) specific muscles has helped me in more recent years.
I continue to feel inspired every day. My approach to care now is much more comprehensive than in the early years. It does get easier to recognize where to begin and why certain techniques fail to give you the results you were expecting to see. I do feel like I get successful results much sooner as I have become more fluent in PRI. I am also much quicker at recommending proper shoe wear, orthotics, dental referrals, neuro optometry referrals, or referrals to other integrative providers.
It seems like the number of professionals that are starting their own practices continues to grow. You have successfully run Cornerstone Physical Therapy for several years now. Do you have any recommendations to someone who is just starting off? What, if any influence did the science of Postural Restoration have on your private practice?
I guess my advice is to be passionate about helping others, do not be afraid to ask why if things are not going the way you expected, and be humble when searching out the answers. I would also add that it’s important to build healthy relationships with your patients, your staff, and other healthcare providers that are like minded. It may not be for everyone but it sure is exciting having common goals with your peers and other professionals. Having your own practice is very fulfilling, even after 19 years!!
PRI was instrumental for me with starting my own practice. I was considering Medical or Osteopathic school. I was so passionate about PRI and how much more I could do to empower and help my patients heal that I stayed in the PT profession. I am fully committed to the science of PRI and have had a PRI center since 2007. We have many more challenges today with reimbursement but at the end of the day I love going home knowing that I have done the very best I could to help the patients I was fortunate to treat that day.
You have taken nearly two dozen PRI courses. What drives you to continue learning? In your opinion how have the courses evolved over the years?
I may have already touched on this. I love the science behind PRI. It makes sense to me. I continue to see changes that still seem magical even though I have a better understanding of why! It is so satisfying to know you have made a tremendous impact on someone else’s life.
The evolution of the courses has come from basic Myokin/Postural Respiration/ to Cervical/Cranio/Mandibular, Pelvic, I&I, Integration, Vision, Cervical Revolution, Occlusal etc. They help you treat the patient as a whole person. Now when I evaluate and treat a patient I can blend all the courses and use the tools/methods that are applicable. I have been a PT for 33 years and still have the desire to learn more! PRI fulfills my desire!!
I recently got the opportunity to see you in New York, at the Occlusal Cervical Restoration course. It was our pleasure to meet your friend and colleague Dr. Dara Chira. As our understanding of Integration and application continues to grow, how has the collaboration with a local Dentist changed your approach? Could you briefly explain how you utilize each other for patient care for anyone who is interested in working with a dentist?
I started working with Dr. Dara Chira in the early 2000’s. I was looking for a dentist to help with my patients as recommended by Ron. I had the opportunity to work with a couple of her patients who were referred to me by Gayle Myers MD, who practices functional medicine and biodynamic osteopathy. Dara is an orthodontist who is not just about moving teeth!! This is so important.
I quickly realized that Dr. Chira and Dr. Myers appreciated the relationships with airway, neutral TMJ position, occlusion, and the postural muscle systems influence. Finding a dentist who gets this is critical in my mind. The three of us have been a team for years now, and we all continue to learn more about each other’s profession, as well as respect the need to work together for optimal outcomes for our patients. Dara tends to be the quarterback so to speak with our more complicated team patients. Dara understands that the restorative dentistry is the last phase of treatment. I suppose I got lucky again with being aligned with her early on in my PRI journey.
The state of Vermont was not only one of the first locations for PRI but continues to host several courses each year. What do you love most about your community and the people within it?
I am so proud of my community for embracing PRI and for searching for optimal therapeutic approaches to patient care. We have some amazing PRI clinics in a small geographical area. It is also so satisfying to receive referrals for “Postural Restoration PT” from physicians, dentists, orthodontists, psychologists, naturopaths, chiropractors, acupuncturists, massage therapists, yoga and Pilates instructors , patients, the list goes on. Our little community is so progressive!!!
You have spoken at several conferences and other events throughout the years, do you have any upcoming presentations or conferences you are interested in attending over the next year?
Yes, I have been invited to NYC next weekend to attend “Lips Rule at NYU” First annual meeting at NYU School of Dentistry taught by two other members of our team, Dr. Michael Gunson DDS, MD (Arnett/Gunson facial reconstruction surgeon for face airway and bite) and Jeffrey McClendon DMD Dental Restoration. Dara and I will be going down to the Big Apple together again which gives us time to discuss cases, learn, share and have fun!!
Dara teaches in the orthodontia program at Boston University and she and the students have asked me to come down and talk with them this fall. I will be scheduling that soon.
I am also drooling over the Airway Summit this November in Las Vegas that Ron will be speaking at. I am not sure my schedule and resources will allow me to attend. We will seeJ
I truly enjoy coming to Lincoln and hope to be able to attend the Symposium next year. I am still trying to get to the Pilates course!!
When you are not seeing patients what do you enjoy doing the most with your free time?
I love this question too!! I love spending time with my family and friends. I have a special passion for horses. Spending time at the barn with my horse “Alex” performing dressage training and hacking in the fields is my favorite hobby. We compete some on a national level and just earned our USDF Bronze medal at a horseshow two weeks ago!! I also love to ski and bike!! Vermont is beautiful year round!