You were a member of the very first Postural Restoration Certification (PRC) Class in 2004. Tell us about how you first got interested in Postural Restoration and the journey that you have taken since attending your first Postural Restoration course.
I initially became intrigued by Postural Restoration over 17-plus years ago when I was a student athletic trainer at the University of Nebraska-Lincoln. During that time, Ron Hruska had been asked to consult with various athletes regarding their chronic natured injuries, with athletic pubalgia and osteitis pubis being the most prevalent. I had the opportunity to observe these consultations in which he had placed these athletes in the most awkward positions and had these athletes blowing up balloons. At the time I had no idea what he was trying to accomplish and I thought this was the most bizarre thing I had ever seen! Shortly thereafter the medical staff started to utilize the Protonics Neuromuscular System for athletes suffering from chronic knee pain. The science behind this system really intrigued me in that activating a hamstring changed the position of the pelvis and in turn influenced the mechanical demands placed on the knee. So I really knew at that point there was more to rehabilitation than just looking at the joint and/or extremity involved and I was always asking myself “WHY?” or “WHAT IF?” questions as it related to more traditional orthopedic injuries.
After my undergraduate schooling I attended the University of Minnesota and was a graduate assistant athletic trainer, with my primary responsibility being football. During my time there I was responsible for the rehab of various injuries and I had taken some of my knowledge from UNL and utilized the Protonics Neuromuscular System with various athletes. After graduating with a Masters in Kinesiology, I pursued my physical therapy degree at Des Moines University-Osteopathic Medical Center. It was there that I started to appreciate the answers to the “WHY” and “WHAT IF” questions. I was grateful to have the opportunity to be trained in an osteopathic mindset. This education was invaluable to my current career as a Postural Restoration therapist in that I had been instructed in a very strong curriculum that discussed biomechanics, pathomechanics and the various relationships that a joint, structure or system may have on another. During my last year of physical therapy school I had the opportunity to have a clinical affiliation at the Hruska Clinic. It was during this time that I appreaciated all that I learned from PT school and put the pieces of the puzzle together.
Following graduation from PT school, I was hired as a full-time physical therapist at the Hruska Clinic. I am truly blessed to be a part of this organization. We have one of the best staffs that anyone could be a part of and having the opportunity to work along Ron Hruska is invaluable. I don’t think I have ever met an individual who is more passionate than Ron. He is and will always be one of my strongest mentors. On a personal level, I consider him a close friend and a father figure in many regards. We have both gone through a lot of ups and downs over the last 12 years not only from a professional standpoint but also on a personal level. Through my tenure here I always remind Ron, the staff and myself that “there is only one Hruska Clinic”. It is here at the Hruska Clinic where the origin and clinical advancements of Postural Restoration occur. It is hard to believe that after this year there will be over 100 individuals credentialed in PRI. This says a lot for these individuals to have the faith, passion and expertise in Postural Restoration. There is not a week that goes by that I have not been able to learn something new as it relates to PRI. I am thankful for being able to work with a staff who all has a common belief, that being PRI. I am thankful for all the patients I have been able to meet and treat from across the United States, Nebraska, and Lincoln. There is truly no place like the Hruska Clinic!
As a Physical Therapist at the Hruska Clinic and a member of the Associate Faculty for the Postural Restoration Institute, you have had the opportunity to in-service many physicians, dentists, athletic trainers, etc. locally and also around the county. What advice would you give to those who are interested in educating other healthcare professionals about PRI in their communities? What in-services have you had the opportunity to do this year and do you have any arranged for 2013?
I have had the opportunity to do many in-services and presentations during my career. My first recommendation would be to try to make the presentation as simplistic as possible. Postural Restoration concepts/philosophies can be overwhelming for the beginning learner. I try to take these concepts/philosophies and use analogies and/or bring these concepts into practical/realistic manner. I always try to remember back when I took my first course and experienced frustrations of the “Whys” and “Hows”. To this day there are many concepts that can be learned or taught in a different manner. How one individual interprets information may be different from another’s interpretation. I am constantly learning from my colleagues at the Hruska Clinic in how they explain information to their patients. Furthermore, talking with physical therapists across the nation whether it is at a PRI course or through email also helps one get a better understanding of how individuals interpret PRI concepts.
I most recently had the opportunity to speak with a group of Athletic Trainers and Physical Therapists at South Dakota State University and am excited to be presenting at the National Athletic Trainers Association (NATA) convention in Las Vegas, NV in June 2013.
You also hold the credentials of Athletic Trainer Certified and Certified Strength and Conditioning Coach. Tell us about your background in these fields and how you feel Postural Restoration applies to these two professions. What advice can you share with other ATC’s and strength coaches from around the country who are interested in successfully integrating Postural Restoration?
I have had the opportunity to work in the Athletic Training arena at two major university settings. My primary sport responsibilities were football and other Olympic sports including Track and Field and Baseball. Having worked in this setting sometimes the saying “easier said than done” applies. For those of you that have worked or are currently working in such a setting you can appreciate how Postural Restoration concepts apply to many of the athlete’s conditions. In the athletic setting you see a vast array of injuries whether they are acute or chronic in nature, yet often times the manner in which they are treated can often provide different results. I have found Postural Restoration to be very effective in the treatment of chronic conditions in this setting. Sometimes you need to “clean the slate” and start from scratch and think “outside the box”. Many times the traditional way of thinking will take you a long ways however when you see recurrent episodes of the same injury and no resolution it often asks you the questions “why” and “how”. Due to the time constraints and the volume of athletes seen in this setting it is often difficult to implement PRI from a purist perspective. The simpler you can make it the better. My experience is that many of these athletes are PEC’s and are constantly exposed to extension positions whether it is on the playing field or in the weight room. I feel that the PRT credential has and will continue to address the many obstructions that occur in the athletic setting. By understanding position, patterns, and postures and implementing PRI concepts to include tri-planar activity (more specifically the frontal plane) will assist in the prevention and management of athletic injuries. I have had the opportunity to implement various screenings for various sports and have realized that some sports have more extensive movement patterns than others and that you have to individualize your treatment plan based on the demands of the sport which sometimes does not always follow PRI concepts/philosophies. For example, it would be impractical to tell a gymnast or a diver not to extend their back or tell a football player never to perform squats. It is the nature in which they are performing the activity that matters. We as PRI professionals have a strong bias against extension, yet extension is just one part of a fundamental movement within the sagittal plane. Extension is acceptable, however it is when these individuals become extension dominant and cannot appreciate the flexion component within the sagittal plane that it becomes a problem.
My experience within the weight room is limited. However, throughout my career I have had the opportunity to consult with many strength coaches, athletic trainers and personal trainers across the country from the high school to the professional setting. Most of these individuals have had that “A Ha” moment through the implementation of PRI. It is in my professional opinion that technology has sometimes hindered the thought process of treatment. The latest innovative modality and/or piece of weight room equipment are not always the answer. There is an extensive amount of money spent within these settings for their own intent and purposes, most often recruiting. I feel that often times these individuals get “caught up in the moment” from such technological advances and tend to forget about the basics to include anatomy and biomechanics. It is when you get exposed to PRI that you have that “A Ha” moment and appreciate the “Why’s” and “How’s”.
You have served on the PRC Application Review Committee, and played a large role in helping establish the Postural Restoration Trained (PRT) credentialing process, which included 5 members of the first class in January 2012. What advice would you give to those who are considering the PRT credentialing process?
My advice to any individual that is considering applying for the PRT process is to attend the 4 required PRI courses (Myokinematic Restoration, Postural Respiration, Pelvis Restoration, Impingement and Instability). For most individuals they have obtained the basic knowledge of PRI concepts through the didactic coursework. It is within the clinical setting in which these individuals have the upper advantage because they often see it right before their eyes and can make the appropriate adjustments to correct/treat a specific movement pattern, posture, or injury. I encourage all individuals working within this arena to continue to expand PRI concepts/philosophies within their respective fields whether it is in the weight room or athletic training room. Postural Restoration therapists around the country are looking for individuals such as these to “bridge the gap” from a progressing an individual from a rehabilitative perspective to functional performance perspective.
When not seeing patients, I can usually find you researching articles on the computer. What topics specifically interest you and how do you use the research that you find?
I enjoy reading any research that relates to PRI. Specific topics that interest me are the diaphragm, cranial torsions, dental integration, and osteopathic literature. Often times PRI is criticized that it is not evidence based. It is through my experience that it is by fact that a lot of the information out there has been researched but no one has put all the pieces of the puzzle together. I get more out of a 1950-60’s osteopathic article than I do a 2012 research article on ACL rehabilitation. It is the vintage articles that provide me with a lot of insight in that they stick to the fundamental basics: anatomy, physiology, and biomechanics. Any article that differentiates the left and right sides of the body and accepts that the human body in asymmetrical is a great find! Furthermore any article that provides a biomechanical explanation of “how” or “why” something occurs is also a treasure. I am extremely biased towards osteopathic literature in the sense that these articles can relate to structure and function. Most of the articles that I find are not researched within the USA, but rather come from Brazil, Australia, New Zealand, United Kingdom, Belgium and Sweden.
You have also done a lot of writing over the years. This includes the Cough-Variant Asthma: Responsive to Integrative Management and Postural Restoration case report which was published in EXPLORE journal, and many series articles for the Performance Conditioning newsletter. Are you currently working on any projects? What advice would you give to others who would like to get involved in submitting articles or case studies for publication?
I enjoy writing but often cannot find the time to write. I am currently working on an article regarding the proper mechanics and position of an Olympic squat and PRI implications. I also have other topics with other authors across the country including scoliosis, ribcage position and the throwing shoulder, and PRI in the athletic setting. The biggest piece of advice I would provide to any individual wanting to submit an article is to choose only one or two PRI concepts within your article. There is a vast amount of information to be covered with one or two concepts and often time I find myself going on tangents and bringing in other valid relationships rather that sticking to the task at hand.
