Carrie Langer, MPT, ATC, PRC
You and Karen Jiran were both members of the very first Postural Restoration Certification (PRC) Class in 2004. Tell us about how you and Karen first got to know each other, and the journey you took together in studying Postural Restoration and also opening a business, Kinetic Physical Therapy Institute together.
My journey into PRI started about 13 years ago while Karen and I worked for the same physical therapy company. We initially worked at different locations within the company and thankfully fate would have us working together after we were both transferred to the same clinic. Karen had started her PRI journey taking her first course months before me. My introduction into PRI came learning from Ron Hruska at the course called “An Integrated Approach to Treatment of Upper Half Musculoskeletal Dysfunction”, better known today as Postural Respiration. This was a game changer for me and opened up a whole new world involving the thorax and the diaphragm. Soon after, I experienced a course given in coordination with Inverse Technology called “The Influence of the Pelvic-Femoral Complex on Anterior Knee Pain”. I believe it was the suave James who taught this class and introduced Karen and I to the Protonics System. And then it was on to Chicago to learn about Myokinematic Restoration from Ron. Within that first year of hearing the terms “zone of apposition” and “Left AFIR”, I had taken 3 courses. At this point I was caught hook, line and sinker. Karen and I started teaming up with discussions, practicing every exercise we could on ourselves and amazed by the results we saw with our patients. Physicians started to see the positive changes and successes we were having with our patients. Our schedules began to fill up with referrals by name from around the area. As word spread our patient base began to change from simple cases to the more problematic and challenging. With this challenge came the need for more time to spend with these patients as we were working in a 30 minute per patient environment. The next hurdle was trying to negotiate with our employers about changing our schedules to accommodate the type of patients and referrals we were getting. This was difficult for both sides as a large system needs to keep the money flowing and what Karen and I were doing was not understood. The terms “VooDoo” were heard periodically throughout the offices. Karen and I continued to fight for our belief in what we were doing and shared our knowledge by trying to teach others within the company. Eventually, we were at an impasse: conform or move out on our own. We decided there was no going back and took the leap of faith. We had tremendous support from physicians and our families which made this move that much easier. I can happily say, there is not a day that goes by in which we regret our decision.
How have you (and Karen) built a practice with PRI? Have there been any struggles that you have encountered and what advice would you give, as a mentor to other therapists who are interested in operating their clinic utilizing PRI as a benchmark?
Karen and I were very fortunate in starting our clinic. When we set out our main goal was to be able to offer our patients the individual time and care they deserved and of course – to treat the way we wanted to treat. We had many physicians, peers and family that supported our decision and helped make it possible. There are many challenges in starting a clinic, including staffing, budgeting, building referrals, marketing decisions, EMR software, etc. Finding hard working and “PRI type thinkers” for staff can be difficult, but I feel we have been very fortunate in this area. Building referrals comes with time and I feel the best marketing is word of mouth. If your patients believe you care and you impact their life the news will carry to their family, friends, physicians, etc. In my opinion, the biggest challenge in our start up and even now is the insurance and reimbursement arena. Every year, sometimes every month, it is a game of what do we have to do this time to get paid less than before. As our current healthcare environment is in flux and the days of easy re-imbursement are well over, changes in how we practice need to occur. Karen and I decided at the start that we would keep our clinic as slim and trim as possible. Every staff member we have has been instrumental in this, including our ever important front desk personnel. As a clinic we have unified as a team to give each patient a quality and purposeful visit from beginning to end. My biggest recommendation for those PRI folks interested in starting up their own clinic is to stick to what you are good at, show people you care, and have a good support/business structure around you.
How has PRI and being a PRC therapist helped you overcome past professional challenges and propelled you to where you are today?
I believe PRI has opened many doors for me professionally. Not only has it allowed Karen and I to open a clinic and find our nitch, but it has challenged me to constantly learn from my peers and patients on a daily basis. As a Postural Restoration Certified (PRC) therapist I am pushed to work with some of the most challenging of patients. Even though this can be overwhelming at times it is what makes every week feel like I have accomplished that much more. It has also introduced me to many other health care providers such as dentists, podiatrists and recently, optometrists. Dr. Michael Hoefs, an orthonagthic dentist; Dr. Paul Coffin, podiatrist; Dr. Jessica Schara, optometrist; and others have all become invaluable and instrumental in helping our patients receive the complete care they need. I continue to hope this level of treatment coordination and sharing of knowledge will grow and become common practice throughout our health care system.
In addition to your role as a physical therapist, you also have a background in Athletic Training. Are you currently working (or consulting) with any athletic teams? If so, how does Postural Restoration® play a role when you are working with these athletes?
I have worked with different athletic teams over the years. These opportunities have involved group consulting and screening and also following a team throughout a season. These teams have ranged from high school to the professional level with the most recent being the Minnesota professional lacrosse team a few years ago. I have used PRI concepts in all of these endeavors. The biggest challenge was trying to educate and change old myths about muscle balance, stretching and off the field/court training. There continues to be such a high level of overtraining in the current sports world which is starting at a younger and younger age all the time. Working with the athletes themselves can be easier to convince them of PRI concepts as they can feel the changes to their body. The biggest challenge can be coordinating with other members of the team such as the coaching staff, training staff and parents. I am thankful for my experience in PRI as I feel it has given me something special to offer to this particular group.
Within the past year, you have hired Brent Albrecht, who was a member of the first Postural Restoration Trained (PRT) class in 2012. Having Brent on staff, how has this changed your practice? How long have you known Brent? What process or processes did you use to recognize the value of having Brent, who has worked in the sports performance and fitness fields on your staff?
Brent has become a valuable asset to what we can offer our patients. There are many patients we see in clinic that have very little muscle development or have the desire to do more than exercise at home and want to be pushed harder to meet their goals. Karen and I have often thought this was a missing link that needed to be addressed with many of our patients. Some need it because they want it and some need it because they don’t have enough structural strength to handle daily gravity or maximize ground reaction forces during daily activities. I feel it is a disservice to my patients to ignore their gym programs and other methods of exercise they do, as well as not recommend them when they obviously need to develop muscle. As we all know, these activities can make or break long term success of the patient. Prior to Brent, I would take time outside my hours to go to my patient’s gym and help them with setting up a PRI based program to build upon what we had worked on in the clinic. I have referred various patients ranging from a high school Jujitsu athlete to 60 year old patients wanting to get more out of their community center membership or cross country ski season. Brent’s knowledge is invaluable and I encourage many of my patients to take the next step with him.