And That’s a Wrap It’s that time of the year that we get to look back and reflect and what posts killed it (and which bombed). It seems as though my fine fans be on a pain science kick this year, and rightfully so. It’s some of the best stuff on the PT market right now. It’s definitely a topic I hope to write about more in the coming year, and one I will be speaking on at this year’s PRC conference. But without further ado, here are the top 10 posts of 2014. 10. Treatment at the Hruska Clinic: PRI Dentistry and Vision Going through the treatment process as a patient has really upped my game in terms of knowing when to integrate with my patients. It has also been a life-changing experience for my health and well-being. Learn how they did it for me. 9. Course Notes: THE Jen Poulin’s Myokinematic Restoration So much fine tuning occured the second time around. I love how Jen acknowledged the primitive reflex origin of the patterns, as well as fine tuning both lift tests. She’s an excellent instructor (and fun to party with)! 8. Treatment at the Hruska Clinic: Initial Evaluation The start of my alternating and reciprocal saga. Made for one of the most fascinating evaluations I have ever experienced. Ron Hruska is otherworldly. 7. Course Notes: PRI Postural Respiration I love a good foundational course taught by the Ronimal. You always get a few easter eggs that allude to
Read MoreAuthor: Zac Cupples
Hruska Clinic II: The Follow-up
Six Months Later I have come pretty far in my journey since initially being treated at the Hruska Clinic (see day one, two, and three). I have developed a beautiful squat, am noticing less back issues when I lift, and just generally feel mo’ betta. I also have zero fatigue when reading or on a computer screen. That said, I was still getting some right neck tension and felt that my reading comprehension was not as good as it was. I was accommodating to both my orthotics, so I thought my next trip to Lincoln would be a good time to follow-up. If Youz Ain’t Assessin’ You Guessin’ Came through the door after a long flight and minimal sleep, and surprised even myself. Without any orthotics, I was neutral at my pelvis and thorax, but still had some left cervical axial rotation and right OA sidebending restrictions. I was also lacking the capacity to perform mandibular lateral trusion without kicking in my SCMs. The reason why I don’t have access to my pterygoids for this movement? Those DAMN wisdom teeth. My wisdom teeth essentially alter pterygoid position and reduce my mandible’s capacity to move. When I protrude, I have to extend my OA joint and utilize a forward head posture to complete the movement. The same thing occurs with lateral trusion. When I attempt the movement, the bony block limits my pterygoids from performing the action. SCMs, in particular the right, try to pick up the slack. From a
Read MoreCourse Notes: PRI Integration for Baseball
Another Course in the Books Back in November I had the pleasure of attending a new Baseball PRI affiliate course, taught by my homies Allen Gruver and James Anderson. I really enjoyed this course because it was such a high-level affiliate and great prep for my PRC. We went into great deal regarding position, throwing mechanics, and treatment. A…lot…of…stuff. One of the most amazing pieces of the course was Allen’s ability to breakdown complex baseball movements into their basic biomechanical bits, And from that point show what compensatory things could occur if limitations are present. His eye for these things is unreal. That piece of the course is a post or two on its own, so I won’t touch it here. In fact, I probably won’t touch it at all. Go to this great class and be wowed by Allen. You will be motivated to become a better clinician. I know I was. Here are some of the big takeaways. PRI 101 v 3.0 I’ve heard this overview three times this year now, and it is amazing that I still pick up things from it. James really outdid himself here. The big piece this time around was space. We want space maximized. In the vision course we discussed maximizing left peripheral visual space because the pattern reduces this quality. The pattern in general reduces our ability to move through triplanar space. There are a few other reasons that we would be unable to shift into our left side. Overactive muscles
Read MoreCourse Notes: PRI Vision Integration for the Baseball Player
The first Section Where I Usually Say Something Like Whew or This Was the Best Course Ever! Phoenix has yet to disappoint on the CEU front, especially if the Dbacks are hosting. What a facility! After the baseball course that my homies Allen Gruver and James Anderson taught, Ron and Heidi put together a small vision course that one could apply on baseball athletes. Only it was so much more than advertised. Whether it was intended or not, the dynamic duo demonstrated just how extensive the PRI principles are, and spoke to many of the neuroscience foundations to which it was founded on. PRI Vision Integration for the Baseball Player was the Batman Begins of PRI. I am going to tell you right now, you must take this course yesterday. The foundational science alone is worth the price of admission, but adding in the visual training and corresponding life lessons, you get way beyond what you expect. Here were the major nuggets that I picked up. GGGGGG-rav…a…ty (Said as though 50 Cent read the title) Two major forces are acting upon a body at all times: gravity and ground. When one is able to manage and be aware of these forces, alternating and reciprocal triplanar activity can be realized. This reason is why PRI emphasizes finding the floor and feeling grounded so much. When these forces go unrecognized within a human system, extension is needed to maintain uprightedness. For example, do you ever notice that some individuals look at the
Read MorePost 100: Sexifying Upper Quadrant Post-Op
I Wrote a Lot It’s interesting to think how much this blog has changed since I started writing in February 2013. We’ve gone from cliff notes of books, to cliff notes of courses, to the occasional self-musing. While I still plan on reviewing and assimilating courses I take, my hope is to expand and reflect upon whatever is in my brain a smidge more. It makes sense to start this trend with post 100. And today, postoperative care is piquing my interest. Yes, post-op intervention is a guilty pleasure of mine. And it’s not because it’s easy. Far from easy. Post op treatment gives you a license to create under various constraints. Meaning you have to dig a little deeper to achieve desired goals. I think it can be way sexier, and effective, than your typical post-op protocol BS. So let’s create some successful post-op fun. The First Constraint Before we even talk about specific patients, we have to first look at the largest constraint yet: available tools. At my current digs, I don’t have much of anything in terms of heavyweights. So here is what I have at my disposal that I can implement: 1-on-1 care for 60 minutes Kettlebells: 10, 15, 25 pounds Therabands and theratubes of various sizes Cook bands of various resistances PRI trial orthotics (mouth splints, arch supports, reading glasses, yada) Steps Tape IPAD 3D stretch cage (aka very expensive equipment to tie therabands to) Access to higher level brain centers Heart of gold
Read MoreCourse Notes: The Last Craniocervical Mandibular Restoration Evahhhhh
You’d Think I’d Learn it the First Time Around You’d think, but CCM is one of the hardest PRI courses to conceptualize. It didn’t hurt that my work was hosting the Ron’s last time teaching this course, as next year we will see Cervical Revolution instead. I took this course last February, and it’s amazing how different the two courses were. We had a room filled with PRI vets, and the Ronimal went into so much more depth this time around. It was such a great course that I would love to share with you some of the clarified concepts. If you want a course overview, take a look here. The TMCC The right TMCC pattern consists of the following muscles with the following actions: Cranial retruders/mandibular protruders Right anterior temporalis Right Masseter Right medial pterygoid Sphenobasilar flexors Left rectus capitis posteror major Left obliquus capitis OA flexors that maintain appropriate cervical lordosis Right rectus capitis anterior Right longus capitis Right longus colli If this chain stays tonically active, then there is better accessory muscle respiratory capacity present. These muscles provide the fixed point needed for an apical breathing pattern. We want the muscles on the other side, the left TMCC, to be active. Their activity will allow alternating reciprocal cranial function to be possible. We also call this gait. Keep Ya Sphenoid Flexed One cranial goal we have is to achieve sphenobasilar flexion, but what does this mean? In the RTMCC pattern, the sphenoid is in an extended position.
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Course Notes: PRI Impingement and Instability – Cantrell Edition
A Quick Trip Home I made my first trip back to my roots since moving out west to watch Mike Cantrell’s version of one of my favorite courses: Impingement and Instability. Yes, if you are wondering, my family does hate me for not being able to visit them. Mike absolutely killed all of the various topics we covered, and his ability to coach some of the advanced PRI activities is second to none. I had a blast learning from him. I won’t go over all the nitty gritty like I did here, but here were some of my favorite concepts that we covered. Learn on. The I&I Conundrum Impingement occurs due to the human system’s conflicting demands. We face a battle between instability and stability. Flexion allows for movement variability, which is desirable in the human system. Variable movement reduces threat perception. However, system flexion leads to increased instability and the risk of falling forward. To combat this risk, impingement may occur by compensatory extension. Extension begets joint and system stability, yet system variability is minimized. Increased stability is desirable when under threat, but not for long term. The “goal” then, would be to build control within flexed instability so the system can stay variable; to remain upright without extension. As Charlie Weingroff would say, we want “control within the presence of change.” That is alternating and reciprocal movement. That doesn’t mean you have to do silly little PRI exercises for the rest of your life. PRI activities are simply neuromuscular training
Read MoreThe End of Pain
I’m Done Treating Pain. Yes. You read that correctly. I’m over it. Several different thoughts have crept into to my mind sparked by what I have read and conversations I have had. I would like to share these insights with you. I remember when I was visiting Bill Hartman Dad a few months ago and we were talking about a specific treatment that is quite controversial in therapy today. He said something that really resonated with me: “Maybe they measured the wrong thing.” This sentiment was echoed in “Topical Issues in Pain 1” by Louis Gifford. Check out this fantastic excerpt: “Thus, pain can be viewed as a single perceptual component of the stress response whose prime adaptive purpose is to powerfully motivate the organism to alter behavior in order to aid recovery and survive.” Notice what I bolded there. Pain is a single component of the stress response. Not the stress response. Not a necessary component of the stress response. Just one possibility. Why do we place so much importance on pain? Many proponents of modern pain science (myself included) often use this statement against individuals who are over-biomedically inclined: “Nociception is neither necessary nor sufficient for a pain experience.” Agreed, pain is not always the occurring output when nociception is present. That said, pain is only one of several outputs that may occur when a tissue is injured. Just because pain is absent does not mean other outputs are also absent. Many different outputs can occur when an individual is
Read MoreCourse Notes: PRI Integration for Yoga
Portland is Cool The PRI road show continued on to Portland. This time I learned how PRI integrates with Yoga from the masters—Emily Soiney and James Anderson. Coming into the course I was incredibly biased against Yoga. I’m not a huge fan of crazy mobility expression, which in PRI-land could potentially lead to pathology. Moreover, the crowd that is typically attracted to yoga is of the more flexible variety. Bad news bears. That being said, Emily pleasantly surprised me. With the way Emily teaches Yoga, I see it more now as an expression of moving within your limits; not going beyond those limits like many poses attempt to do. Yoga can be done right, and when it is it’s fahkin’ haad! The goal for PRI-inspired Yoga is to keep the zone of apposition (ZOA) while expressing how far you can move. If you lose the ZOA, then movement integrity is diminished. Let’s find out how we can do that. Yoga Overview…Yogarview???? Whatever I came into this course knowing piddly diddly about yoga. Which being around several yoga practitioners was a big mistake. There was a lot of Yoga terminology and posing that was discussed nonchalantly, which more than a few times had me lost. I now know how those who are not familiar with PRI feel taking a course for the first time. I only blame myself though. Make sure you are prepped when you go and at least have basic familiarity with basic yoga poses, verbiage, and tenets. There is
Read MoreCourse Notes: THE Jen Poulin’s PRI Myokinematic Restoration
Intro Another retake course is in the books to prep for my PRC testing. This time, it was Myokinematic Restoration with THE Jen Poulin held at Indianapolis Fitness and Sports Training. This class was my Midwest going away present to myself. IFAST has become a second home to me, and any time I can spend with the folks from there I cherish. Plus ma and pa wouldn’t be too happy with me if I didn’t 🙂 I also had yet to take a course instructed by Jen, so I was very curious to hear her perspective on the PRI science. I won’t go into the Myokin nitty-gritty like I did here, but what I will do is go into concepts that were cleaned up for me this time around. Want to know what I learned? Let’s do it! PRI Patterns = Primitive Reflexes Ron Hruska just doesn’t make shit up. Right off the bat Jen stated that the patterns were based off of primitive reflexes that can be elicited in everyone. And for you EBP folks, this is demonstrated here and here. The left AIC has its origins from the asymmetrical tonic neck reflex, and the PEC from tonic labyrinthine reflex. and the PEC from the tonic labyrinthine reflex Jen was the first person to state this claim outright, and to hear it in the basic of basic courses…It made my heart melt. You Down with Several P’s? Yeah You Know Me. Another big thing Jen discussed was
Read MoreA Fly on the Wall of the Hruska Clinic
The Saga Continues This post is way overdue, but a lot has been going on in life. I have just moved to Arizona to start anew, and the change is bittersweet. The Midwest is all that I have known for the past 27 years. I’m leaving a lot of loved ones behind that I will miss dearly. However, getting out of the Midwest to a warmer place has always been a dream for me, and I finally got that opportunity. I also get to work at an awesome clinic alongside like-minded clinicians. One of my good friends will even be there. Plus, summer forevaaaaaaaaaaaahhhhh!!!!!! So with this transition in my life marks a good time to reflect on one of my many experiences at the Hruska Clinic. This time, I will show you how the clinic itself operates. And their operation is a beautiful thing. The General Feel You walk in the door and can immediately shift into your left hip. That’s what this place is like upon entering. With various shades of purple and tan, you just feel at ease being there. It screams parasympathetic. This build was no accident of course. Purple is a calming color, giving those at the clinic a huge home-field advantage. I bet there is also a reason why you walk left to check-in at the front desk. The clinic is an interdisciplinary dream. The staff includes 5 physical therapists, an optometrist, a dentist, and a podiatrist. This setup allows for great communication among
Read MoreTreatment at the Hruska Clinic: The Finishing Touches
For part 1, click here. For part 2, click here. A Low Key Day 3 Day three consisted mostly of putting the finishing touches on my quest toward neutrality. The morning began by tweaking my gelb splint so I was getting even contact on both sides. This way I would be ensured to not have an asymmetrical bite. I put a pair of trial lenses that fit my PRI prescription, and grinding commenced. We finished with this: Once the splint was done, I had a final meeting with Ron to go over my exercise program. I was placed into phase one visual training with two pairs of glasses. My training glasses were to be used when I lift weights, perform my exercises, walk around, etc. I could wear these for up to 30 minutes at a time; making sure I maximize my visual awareness of the environment. While I was wearing these glasses, I was to be keen on finding and feeling my heels; especially when I turn my head. The glasses would help me find the floor, as well as help my eyes work together and independently from my neck. My second pair of glasses was to be used while performing any activities within arms reach. This pair helps my eyes converge better and promote less eye fatigue. Ron gave me several phase I vision activities as well as a few others. His main objectives were to get my eyes to move independent of my neck. We also
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