Pelvis Restoration

An Integrated Approach to the Treatment of Patterned Pubo-Sacral Pathomechanics

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Course Format

This advanced lecture and lab course is designed to assist clinicians with those complex patients that are struggling to restore reciprocal function of their pelvis. The clinician will gain an appreciation for the influences of an asymmetrical pelvis and how this imbalance contributes to pelvis dysfunction. We will explore in detail the function of the pelvic inlet and outlet as it relates to anatomy, respiration, and asymmetry in a multiple polyarticular chain system. Participants will be able to restore pelvic and respiratory neutrality through a PRI treatment approach while keeping individual activities of daily living in mind.

Education Level: Advanced
Student Faculty Ratio 16:1

Instructional Methods: Lecture, demonstration & lab, clinical application, case studies, and Q&A

Live Stream courses will take place from 8am-5pm CT each day, and certificates of completion/CE credit will be awarded the following week after completion of the course evaluation survey and short post-test. For more information on whether your state/organization is approved for CE approval, please click on the “Accreditation” tab below. Live Stream courses will be engaging, interactive and include demonstration of objective testing and/or non-manual techniques, in addition to course attendees being able to ask questions throughout the course. All that’s needed on your end is reliable internet access, a webcam, microphone and speaker (or a smart phone can be used if you do not have a computer or laptop with this capability). The course manual will be shipped directly to you 1-2 weeks before the course. *International registrants will receive access to a digital version of the course manual. In addition, participants will receive access to the recording of the live stream course for 14 days to review the material, and re-watch any material that may have been missed due to connection issues. Those who attend in-person during a live streamed course will also receive access to the recording for 14 days. Extensions beyond this 14 day review are not available. ***Please note: In order to receive access to the recording for review, you must participate in person on the Live Stream course with your camera on for at least half of the course (8 hours). If you sign up for the course and do not participate in at least 8 hours of the live stream, you will not receive the recording and you will not be refunded. Also, once course manuals have been shipped (or emailed to international attendees), there will be no refunds for cancellations.***

Identify musculature of the pelvic inlet and outlet.
Explain how the respiratory diaphragm integrates with pelvic diaphragm function and rehabilitation.
Recognize pelvic asymmetry and understand the relationship of pelvic asymmetry and pelvis function required for rest, upright work, and pleasure related activity.
Identify the recommended treatment algorithm for each PRI pattern pertaining to the pelvis.
Outline how to design a postural isolation and inhibition program that includes the integration of appropriate pubo-sacral dynamics to restore normal reciprocal pelvic inlet and outlet function.

Day One

7:30am – 8:00am	Registration and Light Breakfast
8:00am – 8:30am	Introduction to Pelvis Neutrality
8:30am – 10:00am	Left Anterior Interior Chain (AIC) Influence on the Pelvis
10:00am – 10:15am	Break
10:15am – 11:15pm	PEC Influence on the Pelvis
11:15am-12:00pm	Pahologic PEC Influence on the Pelvis
12:00pm – 1:00pm	Lunch (on your own)
1:00pm – 3:00pm	Examination Tests and Assessment (Demonstration) Standing Reach Test Adduction Drop Test Pelvic Ascension Drop Test Passive Abduction Raise Test Functional Squat Test Hruska Abduction Lift Test
3:00pm – 3:15pm	Break
3:15pm – 4:45pm	Examination Tests and Assessment (Lab)
4:45pm-5:00pm	Functional Relationships

Day Two

7:45am – 8:00am	Sign-In and Light Breakfast
8:00am – 9:30am	Respiratory Influences on the Pelvis
9:30am – 10:00am	Respiratory Influences on the Pelvis (Lab)
10:00am – 10:15am	Break
10:15am – 12:00pm	Treatment of Pelvis Dysfunction as it Relates to the Left AIC Pattern
12:00pm – 1:00pm	Lunch (on your own)
1:00pm – 2:00pm	Treatment of Pelvis Dysfunction as it Relates to the Left AIC Pattern (Case Study)
2:00pm-3:00pm	Treatment of Pelvis Dysfunction as it Relates to the PEC Pattern (Case Study)
3:00pm – 3:15pm	Break
3:15pm – 4:30pm	Treatment of Pelvis Dysfunction as it Relates to the Pathologic PEC Pattern
4:30pm-5:00pm	Other Treatment Considerations

Anatomy & Physiology

Avery AF, O’Sullivan PB, McCallum M J. Evidence of pelvic floor muscle dysfunction in subjects with chronic sacro-iliac joint pain syndrome. Scientific Conference of the IFOMT, Perth, pp.35-38, 2000.
Bendová P, Růzicka P, Peterová V, et al. MRI-based registration of pelvic alignment affected by altered pelvic floor muscle characteristics. Clin Biomech 2007;22:980–7.
Bo K, Sherburn M, Allen T. Transabdominal ultrasound measurement of pelvic floor muscle activity when activated directly via a transversus abdominal muscle contraction. Arch Phys Med Rehabil: 2001:82.
Broski SM, Murthy NS, et al. The adductor magnus “mini hamstring”: MRI appearance and potential pitfalls. Skeletal Radiol. 2016;45:213-219.
DeLancey J. Structural support of the urethra as it relates to stress incontinence: The hammock hypothesis. Am J Obstet Gynecol 1994; 170: 1713-23.
Gruss LT, Schmitt D. The evolution of the human pelvis: changing adaptations to bipedalism, obstetrics and thermoregulation. Phil. Trans. R. Soc. B 2015; 370:20140063. http://dx.doi.org/10.1098/rstb.2014.0063
Hulme J. Pelvic pain and low back pain. Phoenix Publishing. Missoula, 2002:
Hulme J. Beyond kegels: Fabulous four exercises and more to prevent and treat incontinence. 2nd ed. Phoenix Publishing. Missoula, 2002.
Hodges PW. Is there a role for transversus abdominis in lumbo-pelvic stability? Manual Therapy. 1999: 4(2): 74-86.
Lee D. The pelvic girdle: An approach to the examination and treatment of the lumbo-pelvic-hip region. Churchhill Livingston, 1999.
Netter FH. Atlas of human anatomy. New Jersey, CIBA-GEIGY Corporation, 1992.
Neumann P. Pelvic floor and abdominal muscle interaction: EMG activity and IAP. Int Urogynecol J. 2002: 13: 125-132.
Nygaard I, Thompson F, et al. Urinary incontinence in elite nulliparous athletes. Obstetrics and Gynecology: 1994: 84: 2
Nygaard I. Does prolonged high impact activity contribute to later urinary incontinence? A retrospective cohort study of female olympians. Obstetrics and Gynecology: 1997:90:5.
Obey MT, Broski SM, et al. Anatomy of the adductor magnus origin: Implications for proximal hamstring injuries. The Orthopaedic Journal of Sports Medicine. 2016;4(1). Accessed online January 2016 ahead of publishing.
Pool-Gou dzwaard A, Dijke G, et al. Contribution of pelvic floor muscle to stiffness of the pelvic ring. Clinical Biomechanics 19 (2004) 564-571.
Sapsford R. The pelvic floor – A clinical model for function and rehabilitation. Physiotherapy December 2001; 87: 620-629.
Sapsford R, Hodges P, Richardson C. Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn 2001: 20: 31-42.
Shafik A. The histomorphologic structure of the levator ani muscle and its functional significance. Int. Urogynecol J 2002: 13: 116-124.
Stansfield E, et al. The evolution of pelvic canal shape and rotational birth in humans. BMC Biology. 2021(19):224.
Sultan A. Pudendal nerve damage during labour: prospective study before and after childbirth. British Journal of Obstetrics and Gynaecology. January 1994, Vol 101:22-28.
Wallace K, Herman H. Female pelvic floor function, dysfunction and treatment level 1. Prometheus Group, Minneapolis 2008.
Wijma J, et al. Perineal ultrasonography in women with stress urinary incontinence and controls: The role of the pelvic floor muscles. Gynecolocig and Obstetric Investigation. 1991;32(3):176-179.
Willett GM, Keim SA, et al. An anatomic investigation of the ober test. Am J Sports Med. 2016 Mar;44(3):696-701.

Respiration

Abe T, Kusuhara N, et al. Differential respiratory activity of four abdominal muscles in humans. J Appl. Physiol. 80(4): 1379-1389, 1996.
Bordoni B, Marelli F, et al. The five diaphragms in patients following cardiac surgery in sternotomy: An observational study. Int J Complement Alt Med. 2017; 7(6):00245.
Bordoni B, Zanier E. Anatomic connections of the diaphragm: influence of respiration on the body system. Journal of Multidisciplinary HealthCare. 2013:6 281–291.
Bradley H, Esformes J. Breathing pattern disorders and functional movement. The International Journal of Sports Physical Therapy, Feb 2014, 28-38.
Chaitow L. Breathing pattern disorders, motor control and low back pain. J Osteopathic Medicine, 2004; 7(1): 34-41.
Clifton Smith T, Rowley J. Breathing pattern disorders and physiotherapy: inspiration for our profession. Physical Therapy Reviews. 2011;16(1):75-86.
Gordon KE, Reed O. The role of the pelvic floor in respiration: A multidisciplinary approach. J Voice. 2018 Nov; Epub ahead of print.
Hodges PW. Looking beyond the pelvic floor: An integrated clinical approach to the assessment and exercise management of continence and low back or pelvic pain. Combined Sections Meeting Las Vegas, NV February, 2009.
Hodges PW, Sapsford R, Pengel LHM. Postural and respiratory functions of the pelvic floor muscles. Neurourol. Urodynma. 26:362-371, 2007.
Johnson K. An integrated approach for treating the OB patient: Treating the five diaphragms of the body, part 1. AAO Journal. Winter 1991.
Lee DG, et al. Stability, continence and breathing: The role of fascia following pregnancy and delivery. Journal of Bodywork & Movement Therapies. 2008 Oct;12(4):333-48.
Park H, Han D. The effect of the correlation between the contraction of the pelvic floor muscles and diaphragmatic motion during breathing. J Phys Ther Sci. 2015 Jul; 27(7): 2113–2115.
Peper E, Cohen T. Inhale to breathe away pelvic floor pain and enjoy intercourse. Biofeedback. 2017; 45(1):21-24.
Perri M, Halford E. Pain and faulty breathing: A pilot study. J Bodywork and Movement Therapies 8: (4): 297-306, 2004.
Santos R, Bulbena A, et al. Association between joint hypermobility syndrome and panic disorder. Am J Psychiatry 1998: 155: 1578-1583.
Shimozawa Y, Kurihara T, et al. Point prevalence of the biomechanical dimension of dysfunctional breathing patterns among competitive athletes. J Strength Cond Res. 2022 May 24. doi: 10.1519/JSC.0000000000004253.
Talasz H, Kofler M, et al. Breathing with the pelvic floor? Correlation of pelvic floor muscle function with expiratory flows in healthy young nulliparous women. Int Urogynecol J. 2010; 21:475-481.
Talasz H, Kremser C, et al. Phase-locked parallel movement of diaphragm and pelvic floor during breathing and coughing – a dynamic MRI investigation in healthy females. Int Urogynecol J. 2011; 22:61-68.
Zone of Apposition References – Postural Respiration PRI Course Manual. Available online www.posturalrestoration.com.

Treatment Considerations & Interdisciplinary Integration

Basu S, Kakade PP, et al. Influence of abdominal and hamstring muscle activation exercises over iliotibial band stretching on a positive Ober’s test in subjects with low back pain. Global Journal for Research Analysis. May 2017 Volume 6 Issue-5
Bo K. Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work? International Urogynecological Association: 2004: 15 76-84.
Bordoni B, Zanier E. The continuity of the body: Hypothesis of treatment of the five diaphragms. The Journal of Alternative and Complementary Medicine. 2015; 21(4):237-242.
Boyle K. Clinical application of the right sidelying respiratory left adductor pull back exercise. IJSPT 2013;8(3):349-358.
Deindl FM, Vodusek DB, et al. Pelvic floor activity patterns: Comparison of nulliparous continent and parous urinary stress incontinent women: A kinesiological EMG study. British Journal of Urology (1994) 73, 413-417.
Fernandes J, Chougule A. Effects of hemibridge with ball and balloon exercise on forced expiratory volume and pain in patients with chronic low back pain: an experimental study. International Journal of Medical Research & Health Sciences, 2017, 6(8): 47-52.
Hodges PW, Heijnen I, et al. Postural activity of the diaphragm is reduced in humans when respiratory demand increases. J Physiology (2001), 537.3, 999-1008.
Isbit J. Nature knows best. 2008.
Jackson LR, Purvis J, Brown T. The effects of postural and anatomical alignment on speed, power and athletic performance in male collegiate athletes: a randomized controlled trial. IJSPT. August 2019;14(4):623-636.
Kage V, Naidu S. Effect of iliotibial band stretching versus hamstrings and abdominal muscle activation on a positive Ober’s test in subjects with lumbopelvic pain: a randomized clinical trial. International Journal of Therapies and Rehabilitation Research. IJTRR 2015, 4:4.
Karimi N, Fathizadeh M, et al. Efficacy of pelvic repositioning exercises on pain, hip and shoulder range of motion and disability of the patients with chronic non-specific low back pain: a single blinded randomized controlled trial. Journal of Rehabilitation Sciences and Research. 2021;8(3):106-114.
King PM, Myers CA, et al. Musculoskeletal factors in chronic pelvic pain. J Psychosom Obstet Gyneacol. 12 (1991), Suppl., 87-98.
Nygard I, Glowacki C, Sallzma C. Relationship between foot flexibility and urinary incontinence in varsity athletes. Obstet Gynecol. 1996 Jun;87(6):1049-51.
Oleksy L, Mika A, et al. The influence of pelvis reposition exercises on pelvic floor muscles asymmetry. Medicine (2019);98:2.
O’Sullivan PB, Beales DJ. Changes in pelvic floor and diaphragm kinematics and respiratory patterns in subjects with sacroiliac joint pain following a motor learning intervention: A case series. Manual Therapy 12 (2007) 209-218.
Pool-Goudzwaard AL, et al. Relations between pregnancy-related low back pain, pelvic floor activity and pelvic floor dysfunction. Int Urogynecol J Pelvic Floor Dysfunct. 2005 Nov-Dec;16(6):468-74. Epub 2005 Apr 1.
Santa Mina D, Au D, et al. A pilot randomized trial of conventional versus advanced pelvic floor exercises to treat urinary incontinence after radical prostatectomy: A study protocol. BMC Urology. (2015)15:94.
Sapsford RR, Hodges PW, Richardson CA, et al. Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurouro Urodyn 2001: 20: 31-42.
Smith M, Coppieters MW, Hodges PW. Postural response of the pelvic floor and abdominal muscles in women with and without incontinence. Neurology and Urodynamics 26:377-385 (2007).
Smith M, Hodges P. Incontinence and breathing disorders are associated with development of back pain. 10th World Congress on Pain; Sidney, Australia, 2005.
Smith MD, Russell A, et al. The relationship between incontinence, breathing disorders, gastrointestinal symptoms, and back pain in women. Clin J Pain. 2013.
Tenney HR, Boyle KL, DeBord A. Influence of hamstring and abdominal muscle activation on a positive ober’s test in people with lumbopelvic pain. Physiotherapy Canada. 2013;65(1)4-11.
Thompson J, O’Sullivan P, et al. Difference in muscle activation patterns during pelvic floor muscle contraction and valsalva maneuver. Neurology and Urodynamics 25: 148-155 (2006).

Muscular Skeletal Asymmetry and Influence on the Pelvic Floor

Boyle K. Managing a female patient with left low back pain and sacroiliac joint pain with therapeutic exercise: a case report. Physiotherapy Canada. 2009;63(2):154-163.
Handrich K, et al. Asymmetry of the pelvic ring evaluated by CT-based 3D statistical modeling. Journal of Anatomy. 2020 May; 238:1225-1232.
Lee LJ, Chang AT, Coppieters MW, Hodges PW. Changes in sitting posture induce multiplanar changes in chest wall shape and motion with breathing. Respiratory Physiology & Neurobiology 170 (2010) 236-245.
Nguyen JK, Lind LR, et al. Lumbosacral spine and pelvic inlet changes associated with pelvic organ prolapse. Obstet Gynecol. 2000 Mar;95(3):332-6.
Sahinkanat T, Arıkan DC, et al. Effects of lumbar lordosis and pelvic inlet orientation on the outcome of the transobturator tape sling operation in women. Arch Gynecol Obstet. 2011.
Smith M, Russell A, Hodges P. Do incontinence, breathing difficulties, and gastrointestinal symptoms increase the risk for future back pain? The Journal of Pain. Aug 2009;10(8):876-886.

Muscular Influence on Pelvic Floor Function

Deindl FM, Vodusek DB, et al. Pelvic floor activity patterns: Comparison of nulliparous continent and parous urinary stress incontinent women. A kinesiological EMG study. British Journal of Urology (1994); 73:413-417.
Depledge J, et al. Management of symphysis pubis dysfunction during pregnancy using exercise and pelvic support belts. Physical Therapy. 2005;85(12):1290-1300.
Hodges P, Smith M, et al. Breathing with the pelvic floor: Coordinated activity of the pelvic floor muscles during inspiratory and expiratory efforts. The University of Queensland. Available at https://www.ics.org/Abstracts/Publish/46/000390.pdf
Hodges PW, Heijnen I, GAndevia S. Postural activity of the diaphragm is reduced in humans when respiratory demand increases. J Physiology (2001), 537.3, 999-1008.
Junginger B, Baessler K, Sapsford R. Effect of abdominal and pelvic floor tasks on muscle activity, abdominal pressure and bladder neck. Int Urogynecol J (2010) 21:69-77.
Radziminska A et al. The impact of pelvic floor muscle training on the quality of life of women with urinary incontinence: a systematic literature review. Clinical Interventions in Aging. 2018; 13:957-965.

Pelvic Floor Mid Zone

O’Sullivan PB, Beales DJ. Changes in pelvic floor and diaphragm kinematics and respiratory patterns in subjects with sacroiliac joint pain following a motor learning intervention: A case series. Manual Therapy 12 (2007) 209-218.
Thompson J, O’Sullivan P, et al. Difference in muscle activation patterns during pelvic floor muscle contraction and valsalva maneuver. Neurology and Urodynamics 25: 148-155 (2006).
Urquhart DM., Hodges PW, Allen TJ, Story IH. Abdominal Muscle Recruitment A Range of Voluntary Exercises. Manual Therapy 10 (2005) 144-153.

Anatomy

Muscular Structures of the Pelvic Floor
Pelvic Inlet: diaphragm, rectus femoris, sartorius, internal obliques, transverse abdominis, iliacus
Pelvic Outlet: hamstrings, IC adductor magus, gluteus maximus, piriformis, coccygeus, pubococcygeus, obturator, iliococcygeus, puborectalis, urogenital diaphragm

Anterior Interior Chain (AIC)
Muscles: Diaphragm, Psoas, Iliacus, TFL, Vastus Lateralis, Biceps Femoris
Opposition Muscles: Hamstrings, Gluteals, Internal Obliques
There are two anterior interior polyarticular muscular chains in the body that have a significant influence on respiration, rotation of the trunk, ribcage, spine and lower extremities. They are composed of muscles that attach to the costal cartilage and bone of rib 7 through twelve to the lateral patella, head of the fibula and lateral condyle of the tibia. These two tracts of muscles, one on the left side of the interior thoraco-abdominal-pelvic cavity and one on the right, are composed of the diaphragm and the psoas muscle. With the iliacus, tensor fasciae latae, biceps femoris and vastus lateralis muscles this chain provides the support and anchor for abdominal counter force, trunk rotation and flexion movement.

Posterior Exterior Chain (PEC)
Muscles: Latissimus Dorsum, Quadratus Lumborum, Posterior Intercostals, Serratus Posterior, Iliocostalis Lumborum
Opposition Muscles: Abdominal Obliques

Standing Reach Test

Position

Patient stands upright with knees fully extended and arms at side of trunk.
Ask patient to align feet with each other so they are parallel.
Make sure clothing is unrestricted.
Keep shoes on.

Mechanics Without Hip Shift

Ask patient to reach down toward floor as arms move forward and hips move back.
Instruct patient to keep back rounded in attempting to touch toes with fingertips.
Encourage the patient to exhale as they reach toward the toes.
Measure distance from fingers to floor in inches.

Mechanics With Hip Shift

Ask patient to reach down toward floor as right fingers overlap left fingers, arms move forward and as hips move back.
Instruct patient to keep back rounded in attempting to touch left toes with both left and right fingertips, while shifting left hip back.
Encourage the patient to exhale when reaching toward the toes with knees fully extended.
Measure distance directly in front of left toes from fingers to the floor in inches.
Repeat procedure on other side by asking patient to reach down toward floor and right toes, accordingly.

Left AIC: Inability reflects:Lack of right anterior left posterior inlet, lack of left anterior and right posterior outlet, hyperactivity of left anterior and right posterior inlet, or hyperactivity of right anterior and left posterior outlet

PEC: Inability reflects: Lack of bilateral posterior inlet and bilateral anterior outlet, or hyperactivity of bilateral anterior inlet and bilateral posterior outlet.

*ability to touch toes with + Adduction Drop Test & + PADT = Pathological PEC

Pelvic Ascension Drop Test (PADT)

The patient lies on their side with the top and lower hips and knees flexed to 90 degrees.

The patient is then instructed to actively bring the top leg back to neutral while maintaining 90 degrees of knee flexion, and to touch their knee to the mat. This represents a negative test.

A positive test is indicated by the inability of the active leg’s pelvic floor to ascend secondary to the left outlet’s inability to abduct.

Passive Abduction Raise Test (PART)

The patient lies on his or her side with their bottom knee and hip flexed at 70-90°. Their top knee and hip will remain straight (0-degrees). Passively stabilize the patient’s innominate with one hand as the other hand passively moves their leg into abduction. Standing behind the patient usually provides more examiner biomechanical comfort in lifting the leg. Patients with tight right intercostal walls and short and strong right adductors will demonstrate limited passive abduction when compared to the other side. Usually the examiner will feel lateral buttressing of the femoral head on the lateral superior acetabulum as the femur is abducted. When right thoracic abduction or sidebending occurs, discontinue the test.

A positive test is indicated by a restriction on one or both sides that does not allow sufficient abduction secondary to lack of outlet adduction. Usually seen on the right side especially if Left Adduction Drop Test is positive in a Left AIC oriented patient or a patient has a right Hruska Adduction Lift Test of less than a 3.

Functional Squat Test

LEVEL 1: Ability to initiate a squat by slightly bending knees while trunk remains in flexion. Inability reflects lack of posterior pelvic rotation and hyperactive back extensors.

LEVEL 2: Ability to begin squatting, moving bottom back and knees forward while trunk remains in flexion. Inability reflects lack of femoral adduction, hyperactive hip flexors, and overactive FA ER’s.

LEVEL 3: Ability to squat bringing bottom below knee level while keeping heels down and trunk flexed. Inability reflects tight intercostals and hyperactive anterior / posterior tibialis.

LEVEL 4: Ability to squat keeping heels down, trunk flexed and bottom to heels. Inability reflects hyperactive quads and gastroc-soleus.

LEVEL 5: Ability to maximally squat keeping heels down and trunk flexed while keeping center of gravity through heels. Inability reflects lack of maximal AF IR and synchronized mechanics of diaphragm and pelvic floor respiration.

Adduction Drop Test
See Myokinematic Restoration Review Guide

Hruska Adduction Lift Test
See Myokinematic Restoration Review Guide

Hruska Abduction Lift Test
See Myokinematic Restoration Review Guide

Licensed Physical Therapists and PT Assistants

Licensed Occupational Therapists and OT Assistants (Classification Codes)

Licensed Chiropractors

Certified Athletic Trainers

Certified Strength & Conditioning Coaches

Certified Personal Trainers

Licensed Massage Therapists

Other Healthcare and Fitness Professionals
PRI welcomes any licensed healthcare or certified fitness professional to attend our courses. You may be asked to submit your license to practice as a healthcare professional or qualified fitness or strength coach certification (though an organization that is recognized in the United States) to attend PRI courses. Students studying to become a healthcare or fitness professional at an accredited university are encouraged to enroll, and may be asked to provide enrollment status and program/degree information. If you have questions about whether you are eligible to complete PRI courses, please contact us. Attendees are responsible for following their state statutes regulating their professional practice. A certificate will be awarded to attendees upon completion of this course or any of the other PRI courses.

Accessible Learning Environments
All participants in Postural Restoration Institute™ (PRI) continuing education courses are entitled to an accessible, accommodating, and supportive teaching and learning environment. Participants have the right to request accommodations and the responsibility to provide disability documentation that supports those requests. PRI has the right to establish eligibility guidelines in accordance with both law and policy regarding disability and provide those accommodations that appropriately provide equal access to the programs and activities it sponsors.

A Certificate of Completion for 15 contact hours is awarded to attendees upon the successful completion of this course. Before attending a course, please verify CEU acceptance with your profession’s regulating body.

Physical Therapists and PT Assistants

In the states where PRI is sponsoring courses and where approval through state American Physical Therapy Association (APTA) or licensing agencies is required, PRI will apply for approval for CEUs for Physical Therapists and Physical Therapist Assistants.

The following states accept other state approval and thus would honor this course as an approved course:
Alabama, Arizona, Colorado, Connecticut, Washington DC, Delaware, Georgia, Hawaii, Idaho, Indiana, Iowa, Kentucky, Maine, Massachusetts, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Oregon, Pennsylvania, Rhode Island, South Dakota, Utah, Vermont, Virginia, Washington, Wyoming.
Approved by the Arkansas State Board of Physical Therapy for 15 hours. Date of Approval 6/21/18. Approval does not expire, provided the course does not change.
This course has been approved by the Maryland Board of Physical Therapy Examiners for 1.5 CEUs. Approval expires September 30, 2027.
Approved by the New York State Education Department, Office of the Professions for 15 Hours. Approval valid February 18, 2022 – February 17, 2025.
Approved by the Texas Board of Physical Therapy Examiners for 15 CCUs for PTs and PTAs. Approval valid February 10, 2023 – February 10, 2025. Approval #7689TX.
Approved by the California Physical Therapy Association for 1.5 CEUs. CPTA #23-380. Approval valid October 13, 2023 – October 13, 2024.*Approval valid only for courses offered in the state of California and live streams. If you attend this course outside the state of California, you will need to submit an individual CEU approval application with the CPTA.
Approved by the Illinois Physical Therapy Association for 15 CE Hours.Course Approval #205-9091. Approval valid January 1, 2024 – January 1, 2025.

Occupational Therapists and OT Assistants

The American Occupational Therapy Association (AOTA) recognizes PRI as an Approved Provider of continuing education. AOTA Provider #6596. The assignment of AOTA CEUs does not imply endorsement of specific course content, products, or clinical procedures by AOTA or indicate AOTA approval of a certification or other professional recognition. This course awards 1.5 AOTA CEUs/15 Contact Hours.

Chiropractors

In the states where PRI is sponsoring courses and where approval through state licensing agencies is required, PRI will look into applying for CEUs for Chiropractors (upon request). Requests must be made at least 90 days prior to the course date.

Approved by the Minnesota Board of Chiropractic Examiners for 13 regular units of instruction for 2024. MBCE ID Number: 84105
Approved by the New York State Education Department, Office of the Professions. Approval valid February 18, 2022 – February 17, 2025.

Athletic Trainers

Postural Restoration Institute (BOC AP# P2376) is approved by the Board of Certification, Inc. to provide continuing education to Certified Athletic Trainers. This program is eligible for a maximum of 15 Category A hours/CEUs. ATs should claim only those hours actually spent in the educational program.

Strength and Conditioning Coaches

This course is approved by the Collegiate Strength and Conditioning Coaches Association (CSCCa) for 7.5 CEU’s.

Since continuing education courses are not required to have pre-approval through the National Strength and Conditioning Association (NSCA), this course is not currently approved through the NSCA. NSCA certificants interested in completing this course may contact the NSCA to inquire about CEU eligibility.

Massage Therapists

PRI is approved by the National Certification Board for Therapeutic Massage & Bodywork (NCBTMB) as a continuing education Approved Provider. Provider number 451877-12. *Approval applies to select live courses only. This live course is approved. **Approval not valid for New York licensed massage therapists.

Other Healthcare and Fitness Professionals
PRI welcomes any licensed healthcare or certified fitness professional to attend our courses. You may be asked to submit your license to practice as a healthcare professional or qualified fitness or strength coach certification (though an organization that is recognized in the United States) to attend PRI courses. Students studying to become a healthcare or fitness professional at an accredited universtity are encouraged to enroll, and may be asked to provide enrollment status and program/degree information. If you have questions about whether you are eligible to complete PRI courses, please contact us. Attendees are responsible for following their state statutes regulating their professional practice. A certificate will be awarded to attendees upon completion of this course or any of the other PRI courses.

PRI reserves the right to cancel and refund a course attendee’s registration if any concerns arise regarding the course attendee’s qualifications as a healthcare or fitness professional, copyright infringement, or any other illegal activity involving PRI copyrighted materials. International attendees may be required to review and sign a Copyright and Intellectual Property Recognition and Disclosure Contract prior to receiving access to course materials.

Physical Therapists and PT Assistants

The following states accept other state approval and thus would honor this course as an approved course:
Alabama, Arizona, Colorado, Connecticut, Washington DC, Delaware, Georgia, Hawaii, Idaho, Indiana, Iowa, Kentucky, Maine, Massachusetts, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Oregon, Pennsylvania, Rhode Island, South Dakota, Utah, Vermont, Virginia, Washington, Wyoming.
Approved by the Arkansas State Board of Physical Therapy for 15 hours. Date of Approval 6/21/18. Approval does not expire, provided the course does not change.
This course has been approved by the Maryland Board of Physical Therapy Examiners for 1.5 CEUs. Approval expires September 30, 2027.
Approved by the New York State Education Department, Office of the Professions. Approval valid February 18, 2022 – February 17, 2025.
Approved by the Texas Board of Physical Therapy Examiners for 15 CCUs for PTs and PTAs. Approval valid February 10, 2023 – February 10, 2025. Approval #7689TX.
Approved by the California Physical Therapy Association for 1.5 CEUs. CPTA #23-380. Approval valid October 13, 2023 – October 13, 2024.*Approval valid only for courses offered in the state of California and live streams. If you attend this course outside the state of California, you will need to submit an individual CEU approval application with the CPTA.
Approved by the Illinois Physical Therapy Association for 15 CE Hours.Course Approval #205-9091. Approval valid January 1, 2024 – January 1, 2025.
Approved by the Minnesota Board of Physical Therapy for 15 hours. Course Approval #9648. Approval valid January 1, 2024 – December 31, 2024. *Approved for live stream courses only.

Occupational Therapists and OT Assistants

Chiropractors

Approved by the Minnesota Board of Chiropractic Examiners for 13 regular units of instruction for 2024. MBCE ID Number: 84105
Approved by the New York State Education Department, Office of the Professions. Approval valid February 18, 2022 – February 17, 2025.

Athletic Trainers

Strength and Conditioning Coaches

This course is approved by the Collegiate Strength and Conditioning Coaches Association (CSCCa) for 7.5 CEU’s.

Massage Therapists

Jen is very patient and thoughtful when listening to and answering questions. | Baltimore, MD, October 2023
Jen is excellent to learn from. I really looked forward to being taught by her again. | Baltimore, MD, October 2023
Lori was an AMAZING speaker and EXTREMELY knowledgeable of the information being presented. | Live Stream, October 2023
Lori was an excellent coach for this course! I really enjoyed learning from her! | Live Stream, October 2023
Lori has amazing knowledge; she is the expert! | Boston, MA, June 2023
This course was amazing! It was my 2nd PRI course and I think my knowledge regarding the content was highly elevated and I am excited to utilize the new information with my athletic population! The instructor was awesome and provided many personal experiences as to what she sees in her practice and how it would help relate to the content and clinical pearls that are helpful! | Boston, MA, June 2023
I loved the way/ passion Lori Thomson presented the material! | Munich, Germany, May 2023
I think Lori’s knowledge and understanding of the subject matter is second-to-none. | Munich, Germany, May 2023
It is one of, if not my favorite course yet because of the explanation of the diaphragm and rib/pelvic positioning that I feel most teaching I have encountered to this point leaves out. | Columbia, MO, March 2023
Excellent instructor! Lori was easy to understand, explained concepts well and was very knowledgeable. In addition, she was very friendly and approachable. | Valencia, CA, February 2023
Lori was amazing! Her knowledge, passion for the science, understanding of the patterns, etc. was unparalleled and inspiring. | Valencia, CA, February 2023
Mind. Blown. Absolutely incredible.| Live Stream, February 2023
Lori was very knowledgeable about everything, and I loved the clinical pearls she sprinkled in throughout the course. The in-depth dive into the pelvis really made me think about how I treat my patients and gave me more clinical decision-making skills as to why and when a certain technique would be used. | Live Stream, February 2023
Lori made the material much more understandable than other teacher’s that I have had. I really appreciate the logical and clear presentation of this information. | Live Stream, February 2023
I thought Lori did an excellent job breaking concepts down and making sure any lost stragglers were able to pick back up. | New York, NY, November 2022
Lori’s teaching style was very effective, and I feel as if the information presented was able to be utilized immediately in the clinic with patients. | Live Stream, October 2022
I am very excited to continue learning this information and using it with my patients. This makes more sense to me than so many of the other courses that are out there. I greatly appreciate the recognition of the body being asymmetrical. The information that I am learning is applicable to so many of my current patients and myself. | Live Stream, October 2022
Lori was awesome. Inspiring. Her passion for the subject shows through her teaching. One of my favorite certs to date. Made real world application of the material natural. Great coach! | Warner Robins, GA, October 2022
Lori absolutely crushed this! The explanation of some of the intricate details of the various aspects was great! | Warner Robins, GA, October 2022
As a Chiropractor it was great to understand more of the muscular component to how specific patterns present and how the presentation effects the way respiration and gait are accomplished. It helped me understand how some of my patients are stuck in the same patterns every time they come into the office and opened my eyes to how to help through inhibiting and activating specific muscles to assist in treatment.|Charlotte, NC, September 2022
Lori was absolutely outstanding! Brilliant, excellent communicator, warm and engaging. | Bradenton, FL March 2022
Lori is one of the best speakers at the Institute. Very concise, explains it well to all levels. | Bradenton, FL March 2022
I cannot say how GREAT Lori was enough! Best PRI instructor I have had and I felt like she was standing in my home with me. Her ability to teach clinical reasoning vd. just explain exercises was superb…something that i feel is lacking in a lot of Con Ed. courses. | Live Stream April 2021
My 1st course with Jesse! Super helpful & his style helped facilitate my learning! Thank you Jesse! | Fort Collins, CO April 2021
Lori is the BEST instructor! Great examples of patient care; funny and engaging! | Lancaster, PA April 2019
Lori was an amazing instructor! I had some limited PRI experience prior to this course but was always confused. She really brought it together for me and I feel so much more confident employing these techniques with my patients! | Lancaster, PA April 2019
Keep expanding into the world! Mind-blowing. Too bad I didn’t know this 20 years ago. Jesse is an awesome presenter: funny (that helps to remember), very knowledgeable. | Albuquerque, NM March 2019
I really enjoy Jen’s teaching style and presentation. It’s clear she is a treating clinician, which is greatly appreciated. I feel comfortable and enthusiastic enough to try techniques tomorrow. | Southern Pines, NC February 2019
Jen did a wonderful job breaking down inlet/outlet position, as well as testing & treatment. I have taken this course before and recently sat for PRC, and I still learned so much. Thank you! | Southern Pines, NC February 2019
Wow!! Live and home study updates are fantastic. At this time I don’t know how to make it better. This course has evolved! | Dallas, TX August 2018
Enjoyed / learned a lot from being able to go through several of the facilitation/inhibition techniques. Thank you Lori!! | Dallas, TX August 2018
After taking the other two courses in the primary level – PRI is clicking for me, I can see how all three courses overlap and integrate for treatment of patients. I’m excited to apply it tomorrow in clinic. | Oakland, CA August 2018
Great course, well organized and presented. Great support from PRI staff from registration, during and after course. | Lincoln, NE October 2017
Excellent course! Highly relevant course content to daily clinical practice! Awesome job Jennifer! | Lincoln, NE October 2017
Jess was a phenomenal speaker at converging challenging information to participants with varying learning styles and professions. For me he gave me so many clinical pearls that I have a PRI pearl necklace to treat my patients with. Thank you. | Seattle, WA May 2017
Lori was amazing. This is my 3^rd PRI course and my FAVORITE. Lori broke everything down and repeated things in different ways. She answered ALL questions fully. | Phoenix, AZ January 2017
Lori provided new information on pelvic floor mechanics that enhanced my understanding of L AIC and PEC Patterns. | Anchorage, AK November 2015
I wanted to let PRI know that Jesse Ham did a wonderful job! Jesse did great when explaining and demonstrating concepts in the course! He was very patient. I appreciated his ability to find different ways to explain the point he was trying to make which allowed us to obtain a better understanding. As always, PRI courses are amazing and I am grateful for the chance to continue to grow and learn! Kudos! This was the best PRI course I have taken. I think Lori would be great teaching Myokin and Postural Respiration. I like the structure of the course and how she follows the manual so we can use it later as a reference. This was the best course for learning how to treat using PRI. | Phoenix, AZ, March 2015
Clear, organized and methodical. Makes learning very easy. Clinical Pearls and lessons learned truly assist in practice integration of ideas. Thank you very much! | Phoenix, AZ, March 2015
Lori was great. Her teaching was very thorough, objective and summative. Really appreciated her repeating concepts to have us nail them home. | Indianapolis, IN, March, 2015
Outstanding primary course! I can use techniques immediately and I am excited for future integration. | Fort Collins, CO, February 2015
Jesse – Great job! I really enjoyed the course. Thank you! | Fort Collins, CO, February 2015
Very relevant to my patient population. Lori related the material to be easily applied in our clinic/patients. | Frederick, MD, February 2014
Amazing class that really pulls Myokin/Postural classes together. | Loveland, Colorado, February 2013
Lori is awesome. This stuff is hard – but worth all the work! | Rapid City, South Dakota, January 2013
Thank you so much for being authentic, clear, and purposeful, Lori. Total package! | Rapid City, South Dakota, January 2013
Lori was excellent and authentic | Pasadena, Maryland, January 2013
I really enjoyed Lori’s teaching technique and her ability to connect content to other PRI courses. | Pasadena, Maryland, January 2013
This course will help me apply info from previous PRI courses better – provided another piece to the puzzle. | Lincoln, Nebraska, October 2012
Lori- thanks for all your hard work to make this course so clinically relevant. Awesome job! | Lincoln, Nebraska, October 2012
Lori was great. I haven’t been to a course since Integration 5 years ago and it makes me want to retake them all!! | Lincoln, Nebraska, October 2012
Great job – very passionate. | Lincoln, Nebraska, October 2012
Jennifer did a great job making a complex subject simplified. | Shelby Township, Michigan, October 2012
Excellent course. Knowledgeable and pleasant speaker. | Arlington, Virginia, September 2012
Jen was great! Fabulous presentation! | Arlington, Virginia, September 2012
Jennifer Poulin was very knowledgeable, answered questions thoroughly, was entertaining and kept things light as well. Excellent. | Arlington, Virginia, September 2012
Thank you for a very informative course! | Seattle, Washington, August 2012
What a great “connect-the-dots” course after Myokin and Postural Respiration. | Seattle, Washington, August 2012
This has been the best PRI course I’ve taken because of Lori’s organization, manual organization and her specific instruction in creating treatment protocol, integrating testing and treatment exercises. | Seattle, Washington, August 2012
Thank you! I look forward to continuing learning. | Monterey, California, April 2012
Excellent. Helped to understand all the rest of the courses much better. | Monterey, California, April 2012
Awesome and informational! I will so use all the info. | Monterey, California, April 2012
Thanks Jen & Lori! Many “aha” moments this weekend | Wilmette, Illinois, March 2012
Great info, great instructors. Wonderful enthusiasm; Really liked the case studies. | Wilmette, Illinois, March 2012
Very good course. Lori does a good job explaining and putting ideas together. | Wilmette, Illinois, March 2012
Very impressive – I’m never disappointed by high quality of A/V, manual and instructor ability. | Wilmette, Illinois, March 2012
Excellent info and it’s relationship to pelvic floor. | Wilmette, Illinois, March 2012
It was great – can’t wait to take more. | Wilmette, Illinois, March 2012
Lori is a great instructor! Thank you so much! | Salem, Oregon, March 2012
This is my 3rd course, and I remain excited to apply the knowledge. | Salem, Oregon, March 2012
I will need a lot of review and practice but I’m looking forward to it – it is not overwhelming. | Phoenix, Arizona, February 2012
Put a lot of things into a clearer light. More objectivity! | Minneapolis, Minnesota, January 2012
Enjoyed tremendously and thank the institution for their commitment to our profession. | Minneapolis, Minnesota, January 2012
LOVE LOVE LOVE my pelvis model. Could not have understood content as well without it. I will use the model extensively with my patients. My favorite PRI course so far! | Minneapolis, Minnesota, January 2012
Excellent presentation – presented logically, able to move step by step to PT resolution – we hope! | Minneapolis, Minnesota, January 2012
Can’t wait to see how it evolves! | Minneapolis, Minnesota, January 2012
Thank you for correlating Myokin and Postural Respiration info to understand full trunk mechanics with PRI technique. | Minneapolis, Minnesota, January 2012
Absolutely the best PRI course I’ve attended (6 in all!) | Chapel Hill, North Carolina, October 2011
Thank you, it has finally clicked with me! | Chapel Hill, North Carolina, October 2011
Lori was amazing! What a great instructor!!! Thank you so much, I love the course! | Chapel Hill, North Carolina, October 2011
I was very impressed with this course. Not what I expected. I’m going to be able to use this information way more than I anticipated. | Essex Junction, Vermont, September 2011
Another great PRI course, amazing, enlightening, exciting. | Essex Junction, Vermont, September 2011
This is a great addition to the process! It helped fill in more gaps for me especially for treatment with PEC patients! Lori did an excellent job. She is an amazing presenter/teacher. | Essex Junction, Vermont, September 2011
This course had a the best explanation of HEP of all PRI classes I’ve taken! I walked away with a better understanding of what exercises to choose and how to perform them. | Alabama
Amazing manual and excellent presentation! Hugely helpful to further apply PRI to my patients. Thank you for the repetition of key principles! | Minneapolis, Minnesota, August 2011
Great material and great instructor! A lot of new things to consider with patient treatment. | Minneapolis, Minnesota, August 2011
Excellent presentation of course content and tying it into other PRI material. I have a much better understanding of why we are doing specific steps of exercises. | Minneapolis, Minnesota, August 2011
I gained a greater appreciation of normal gait with this course. This course really “tied together” all the other courses. | Lincoln, Nebraska, January 2011
I feel confident and excited to apply the knowledge and techniques that I gained this weekend with patients this week! | Lincoln, Nebraska, January 2011
Great introductory course! Excited to implement with patient treatment. | Lincoln, Nebraska, January 2011
Very well done! Explained very clearly and concisely. My first PRI course, will definitely take more! | Lincoln, Nebraska, January 2011
Lori & Heather are both excellent. Lori’s presentation style is TERRIFIC – easy to follow, handles questions really well, approachable, good pace. Although I find the material challenging and overwhelming at times, I am really pleased to have taken this class with Lori – she helped me “get” several things that were totally confusing from my Myokinematic Restoration class. | Falls Church, Virginia, March 2011
Enjoyed the course and thought it was taught well with great organization and challenging the thought process. Already have several patients I am excited about evaluating to see if they are appropriate. | Falls Church, Virginia, March 2011
Great course! I am so excited to ‘play’! This course really made the Myokinematic Restoration course that I took last Jan or Feb make more sense! Integration of pelvic floor is necessary for the lumbo-pelvic-pelvic floor patient population that I treat. I should be able to immediately apply to my patients. | Falls Church, Virginia, March 2011

Course

Schedule

Date	Location	Faculty	Register

Course Registration

Registration is limited to ensure a low faculty to student ratio. Please register early. Courses will be canceled or rescheduled if fewer than 15 participants have registered by the early registration deadline of four weeks prior to the scheduled course date.

Special Needs Requests

If you have a disability and require accommodation in order to fully participate in this course, please contact us at least two weeks prior to the course date or prior to purchasing any online home study course so that arrangements can be made.

Course Completion

The course must be attended in full, and an online course evaluation summary and short post-test (with a passing score of 70% or higher) must be completed in order to receive a certificate of completion. Certificates of completion will be emailed after the online course evaluation summary and post-test have been completed If you arrive late, or leave early, your certificate of completion will be adjusted for the number of CE hours you were in attendance. *For live stream courses, if you have your camera turned off (or you are not visible on camera) at any time for greater than 15 minutes, this time will be deducted from your total hours on your certificate of completion.

Cancellation and Refund Policy

Tuition is refundable less $50 if cancelled 14 days before the course date. Tuition is not refundable for registrations or cancellations within 14 days of the course. However, you may have someone attend in your place or attend on another date. If you choose to attend on another date, a $50 fee applies to transfer your registration. If you are a no show and we have no communication with you before the course you will forfeit your course tuition. PRI reserves the right to cancel a course and will refund the tuition fee only. *Please note: For Live Stream Courses, once course manuals have been shipped (or emailed to international attendees), there will be no refunds for cancellations.