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 MoreAuthor: Zac Cupples
Course 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
Read MoreCourse Notes: PRI Integration for the Home
The Pilgramage One of the many reasons I was drawn to make the trek to Lincoln was to experience my man James Anderson’s original affiliate course. I always enjoy hearing James’ perspective on PRI, and he did not disappoint here. The course felt like an Impingement and Instability with a bias towards the geriatric/chronic pain populations. Some might argue that James is the king at implementing PRI here. I really admired James saying throughout the course that the Geriatric population houses his favorite athletes, and they really are. High performance at any task, be it sprinting 100 meters or walking to pick up the mail, require similar alternating and reciprocal components. We still go after the same pieces to achieve different goals along a continuum. So let’s dive into this high performance course for some high performing individuals. PRI 101…or at Least the Pieces You Didn’t Get from My Other Reads The affiliate courses have a huge introduction that gives an overview of PRI principles, namely the Left AIC and Right BC patterns. I’m not going to go through all the nitty gritty as this course did, but instead I’ll review concepts that James cleaned up for me. Think of this post as an in-depth FAQ. If you want to learn more about the left AIC, you might want to read the course notes on Myokinematic Restoration and Pelvis Restoration. If you want to learn more about the Right BC, then read my Postural Respiration notes. The Overviewing Overview The big keys
Read MoreTreatment at the Hruska Clinic: PRI Dentistry and Vision
For part 1, click here For part 3, click here Jaws will Drop I’m in the dentist chair, The room slowly get darker and darker. I feel my mouth open, and I wasn’t sure what would happen next. Then Dr. Schnell places the necessary goup in my mouth to get an impression for my splint. I bite, and out comes the finish product. Before the impression was taken, Ron came in and explained what he was hoping to accomplish. He wanted to fit me for a gelb splint to give my tongue some space to move in my crowded mouth. This splint would also help bring my mandible forward. Dr. Schnell: “Is he neutral right now?” Ron: [throws a towel over my eyes and sets my neck in a lordosis] “Now he is.” And with that, the above sequence occurred and I was ready for vision. I couldn’t leave the room without that overarching reminder Ron gave me: Ron: “Margo, if this was your son, what would you do with those wisdom teeth?” Dr. Schnell: “I’d have them pulled.” Yikes! An Eye Opening Experience It was so much fun watching Ron and Heidi teach together, that I could only imagine what it was like seeing them treat. They did not disappoint. My session was getting videotaped for their marketing department, so I again told them my story. It ought to end up on the Internet sometime, so stay tuned for that! They began the session by showing some of my
Read MoreTreatment at the Hruska Clinic – Initial Evaluation
For part 2, click here. For part 3, click here. “Do you produce enough saliva?” That was the first interview question Ron Hruska asked me; something I will never forget. I went to Lincoln, NE for almost a week to take a course, get treated, and observe PRI in it’s purest form. I wanted to see Ron out of curiosity and because I cannot achieve neutrality on my own. I have done most every exercise that could be thought of and been “worked on” by my fellow comrades and a couple PRI instructors in courses; nothing could budge. I knew I needed some type of orthotic to get somewhere; the question was which one? Subjective Complaints I do not have any pain really. My only complaints are a tight neck and I can’t seem to deadlift without feeling most of the effort in my back. I don’t see this deadlifting problem as a form issue necessarily. Interning with Bill Hartman at IFAST cleaned that up, and for a long time I could feel glutes and hamstrings all day when I deadlift. But not now. Other “issues” I have Left TMJ clicks; nonpainful. Clench jaw at night. Eye strain after reading on a computer too long (duh). By PRI standards, I am a classic PEC. I have no pathology anywhere, but I am limited in almost every motion. I knew this and so did Ron. Objective Exam First Ron had me walk and was pointing out some things to my student-to-be Trevor,
Read MoreCourse Notes: Dermoneuromodulation
What? You Mean You Have to Touch Someone???!!?!? My gluttony for punishment continues. This time, I had the pleasure of learning Diane Jacobs’ manual therapy approach called Dermoneuromodulation (DNM). My travels took me to Entropy Physiotherapy and Wellness in the Windy City. These folks were arguably the best course hosts I have ever had. We had lunch!!!! Both days!!!!! That is unheard of, so a big thanks to Sandy and Sarah for putting the course together. I took DNM out of curiosity. I have been lurking around Somasimple on and off for the past couple years, and wanted to learn more about the methods championed there. Believe it or not, I have yet to take a pure manual therapy course, DNM seemed like a great way to get my hands dirty. That darn PRI has lessened the hand representation in my somatosensory homunculus! One reason I haven’t taken a manual course is due to the explanatory models many classes are presenting. It seems as though few are approaching things with a neurological mindset, but I was pleased to hear Diane’s model. It is the best explanation I have heard yet. I know that I usually list my favorite quotes at the end of the blog, but I wanted to share the best quote of the weekend right off the bat: “I don’t know why.” I heard this phrase so much throughout the course and it was quite refreshing. Diane made few claims about her technique, admitted who she “stole” from,
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