To All My Clinicians in the Struggle I struggle with patients. Those patients that I am having trouble with are who I study the most. It’s that whole learning from your failures thing. In studying these folks, I have noticed an interesting trend. It doesn’t involve movement. It doesn’t involve medical history It doesn’t involve stress (though it always involve stress) Instead it involves language. I have noticed a few commonalities in how those patients who are either not improving or have been in chronic pain for some time talk. There is one shift, however, that I notice more often than not. Disembodiment from Your Sports Team I don’t really watch a whole lot of sports; I’d rather play them. Sports fans however, interest me. It’s fascinating how much ownership a sports fan takes in his or her team. This ownership is especially noticeable when things are going well. Think of the language one may use during the following instances: Huge victory – “We finally beat the Packers.” Draft Picks – “Our team got some huge prospects.” Championship win – “We are the champions….my friends.” Notice though, how oftentimes language may shift when a team is not doing so well. Huge loss – “The Bears lost…Again.” Draft flops – “I can’t believe they chose Steve Urkel first round!.” Championship loss – “They blew our chance of winning.” Robert Cialdini discusses this concept in his book “Influence: The Psychology of Persuasion.” When our team is winning, we manipulate our association to
Read MoreCourse Notes: Postural Respiration
Another Course in the Books As an official Ron Hruska groupie, the tour continued to the Big Apple to learn a little Postural Respiration. And in NYC, everything is bigger. The biggest city I had prior been exposed to was Chicago. The cities feel similar, only NYC has twice as many people on the same size streets. I felt like this course was one of my less understood areas in the system, as Respiration was my first live PRI course. Taking this class the second time around really cleaned up a lot of things for me, and Ron was on point as always. So let’s dive into the cranium…I mean pelvis….I mean thorax. Oh sorry, wrong course. Laying the Foundation The three foundational courses aim to inhibit tone, twist, torque, and tension in the human system by various methods. In Myokinematic Restoration, mastering the frontal plane with both legs inhibits the system. In Pelvis Restoration, active leg adduction inhibits the system. In Postural Respiration, trunk rotation inhibits the system. When these powers combine, the goal is to simultaneously maximize phases of gait and respiration. This development allows for total-body freedom to move, breathe, live, and create amidst our incessant desire to run on our built-in right stance autopilot. There is nothing wrong with right stance, but it becomes wrong when it is all you know. “There is nothing wrong with half the gait cycle until it becomes the full gait cycle.” ~Ron Hruska. Make a Memory – The Zone of
Read MorePRI and Pain Science: Yes You Can Do It
Questions You may have noticed that my blogging frequency has been a little slower than the usual, and I would like to apologize for that. I am in the midst of creating my first course that I am presenting to my coworkers. It has been a very exciting yet time-consuming process. It makes me excited and more motivated to someday start teaching more on the reg. Ever since I started blogging people started asking me questions. These range from many topics regarding physical therapy, career advice, and the like. Some of the more frequent ones include: What courses should I look at? Any advice for a new grad? Seriously, Bane. What’s the deal? But the one I get asked more often then not is as follows: “Zac, how do you integrate PRI into a pain science model?” A great question indeed, especially to those who are relatively unfamiliar with PRI. With all the HG, GH, AF, FA, and FU’s, it’s easy to get lost in the anatomical explanations. Hell, the company even has the word (gasp) “posture” in the title. Surely they cannot think that posture and pain are correlated. I think there is a lot of misinformation regarding PRI’s methodology and framework. What needs to be understood is that PRI is a systematic, biopsychosocial approach that predominately (though not exclusively) deals with the autonomic nervous system. The ANS is very much linked into pain states, though not a causative factor. But of course, that may not be enough. Perhaps
Read MoreCourse Notes: Therapeutic Neuroscience Education
How’s Your Pain How’s Your Pain How’s Your Pain How’s Your Pain? To purge onward with developing some semblance of chronic pain mastery (ha), my employer had the pleasure of hosting a mentor and good friend Adriaan Louw. I first heard Adriaan speak in 2010 when I was in PT school. I was amazed at his speaking prowess and the subject matter. Unfortunately, my class could only stay for a little while in his course, and onward life went. I went on with my career focusing on structure and biomechanics and forgetting about pain. It wasn’t until I ran into Adriaan again two years later. He was teaching me Explain Pain (EP), and forever changed how I approached patient care. It’s funny how things have come full circle. Here we are, Adriaan teaching Therapeutic Neuroscience Education (TNE) through The International Spine and Pain Institute (ISPI), and me promoting his work to my colleagues. A lot has changed in two years. EP and TNE are quite different courses, and I learned so much this weekend that I continue to become more engrossed with what I do. So thank you, Adriaan, for playing a huge role shaping me into who I am today. I have now become very much more interested in what ISPI has to offer, and I think you should too. And no worries Adriaan, I will stay hungry 🙂 So without further ado, here is what I learned. The Power of Words It’s getting worse. One person out of
Read MoreCourse Notes: Explain Pain
A Whirlwind I finally had the opportunity to meet my personal Jesus, David Butler, and learn the way that he explains the pain experience to patients. It was an interesting weekend to say the least. The course started off with a smash…literally. We had the unfortunate experience of someone breaking into our car to start the trip off. Then once we arrived to the course, we were informed that Dave was going to be 2 hours late. He was staying in Philly (where I also experienced flight troubles last week) and a snowstorm with a name no one cares about stopped his flight. So Dave drives all the way from Philadelphia, “tilting his head back to rest” for 1 hour, and then what happens? He, along with the other instructors, drive to the wrong campus. So after all these crazy things happen, Dave finally makes it to the course, sets up his presentation, plays a little Bob Marley, and……………… Kills it. I mean, absolutely kills it. To see Dave present this topic under the above circumstances and be on the entire time is a testament to the type of speaker and professional he is. David Butler is one of, if not the best speaker I have ever heard. So I’d like to thank you, Dave, for making an otherwise stressful weekend memorable and exciting. I look forward to applying what I have learned. If you haven’t taken a course from the NOI Group, please do so yesterday! So what did
Read MoreCourse Notes: PRI Craniocervical Mandibular Restoration
“The Head and Neck Runs The Show.” ~Ron Hruska Hello, my name is Zac Cupples, and I have an addiction. I am addicted to attaining CEUs. But not just any CEUs, I want me some of that purple haze from the Postural Restoration Institute. I got my fix and then some. This past weekend I was at Endeavor Sports Performance in Pitman, NJ. I got to spend time learning about the neck and the cranium from none other then PRI founder, Ron Hruska. From the get-go, Ron was adamant in saying that this class was his baby. That this information is what started it all. And what I learned did not disappoint. When I took Advanced Integration this past winter, I understood that we were affecting a system, but it didn’t really settle in with me until now. What we are predominately using to affect the nervous system is not specific muscles, but namely triplanar muscle families. I am not trying to turn on the hamstrings, but I am trying remap the brain’s sagittal plane. I am not trying to turn on the IC adductor, but remapping frontal plane adduction to send me into left stance. Similarly, we can affect these movement planes with cervicocranial mandibular muscles. It is just another location in the system to which sensory input is applied. Though seeing what outputs resulted will leave you just as surprised as your patients and cleints. Watching Ron affect a person’s mobility throughout the entire body by manipulating a
Read MoreChapter 2.1: Dynamic Neuromuscular Stabilization: Developmental Kinesiology: Breathing Stereotypes and Postural Locomotion Function
This is a chapter 2.1 summary of “Recognizing and Treating Breathing Disorders” by Leon Chaitow. You’re Writing About DNS???!!??! Yes, I am. Pavel Kolar and crew actually contributed to quite a few chapters in this edition, and this one here was overall very well written. Believe it or not, it even had quite a few citations! Why they don’t cite many references in their classes is beyond me, but that’s another soapbox for another day. Onward to a rock-solid chapter. Developmental Diaphragm En utero, the diaphragm’s origin begins in the cervical region, which could possibly have been an extension of the rectus abdominis muscle. As development progresses, the diaphragm caudally descends and tilts forward. When the child is between 4-6 months old, the diaphragm reaches its final position. Throughout this period, the diaphragm initially is used for respiratory function only. As we progress through the neonatal period (28 days), we see the diaphragm progress postural and sphincter function. The diaphragm is integral for developing requisite stability to move. Achieving movement involves co-activation of the diaphragm, abdominal, back, and pelvic muscles. This connectivity assimilates breathing, posture, and movement. If this system develops properly, we see the highest potential for motor control. The largest developmental changes in this system occur at 3 months. Here we see the cervical and thoracic spine straighten and costal breathing initiate. 4.5 months show extremity function differentiation, indicating a stable axial skeleton to which movement may occur. Further progression occurs at 6 months. Here costal breathing is
Read MoreChapter 1: What are Breathing Pattern Disorders?
This is a chapter 1 summary of “Recognizing and Treating Breathing Disorders” by Leon Chaitow. It’s Been A While I know it has been a while for some Therapy Notes (©™®#zacistheshizzy), but I decided to revisit some Chaitow as I read his new edition. The chapters have changed quite a bit so far, and many new things have been added. Here is the updated chapter one. A Lotta History Hyperventilation disorders have been through the ringer, and to this day are hardly diagnosed. Some of the biggest classifications in my eyes arrived in 1908-09 from phsyiologists Haldane, Poulton, and Vernon. These fellows classified symptoms of overbreathing to include: Numbness Tingling Dizziness Muscular hypertonicity. This symptom cluster occurred with respiratory alkalosis. In 1977, Lum, Innocenti, and Cluff developed assessment and treatment programs for breathing disorders in the UK, which spearheaded breathing disorder literature. Despite these scientific advancements, many physicians do not diagnose hyperventilation as a legitimate problem. Some of these patients even go so far as to being accused as malingering. Hearing this problem is quite unsettling, as I am seeing more and more people who overbreathe; and possibility correlating, more and more people with chronic pain. A future post is in order to show how I think the two are connected. Breathing Pattern Disorders (BPD) and Symptoms So many symptoms could occur with BPDs. The most extreme of these symptoms is hyperventilation syndrome, defined by the following: Breathing in excess of metabolic requirements. Reducing CO2 concentrations in the blood below
Read MoreCourse Notes: PRI Pelvis Restoration
Just recently attended another excellent PRI course taught by Lori Thomsen and new instructor Jesse Ham called Pelvis Restoration. The weekend was filled with great discussion about inlets, outlets, shoes, and many other pearls that helped solidify my PRI understanding. So without further ado, let’s summarize. If this is your first reading on a PRI course, it may be beneficial to review my post on Myokinematic Restoration. PRI 101 Jesse started off the class discussing some PRI basic philosophical tenets. In PRI, we talk a great deal about position, which will be defined as a stance or posture at one point in time. Or as Jesse defined it, a position one can maintain for an extended period of time without pain. With this operational definition, our goal as a PRI clinician or trainer is to organize activities in the following order: Reposition – inhibit muscle chains. Retrain – Facilitate muscle chains Restore – Create reciprocal alternating activity (using all muscle chains when it is desired). Reciprocal activity is defined as going from one end-range to another (extension to flexion) and alternating activity is switching from one side of the body to another (right to left stance). When we alternate, the joint on one side of the body ought to do the exact opposite at the other side. With the above treatment hierarchy, we are working on allowing positional freedom within the person being treated. We call this movement in multiple planes. Now the Pelvis This part is where things can
Read MoreThe Year of the Nervous System: 2014 Preview
It’s All Part of the Plan And if you see my course schedule this year, the plan is indeed horrifying. I wanted to write a post today to somewhat compose my thoughts and plans for this year, as well as what I am hoping to achieve from the below listed courses. Because of the course load and some of my goals for the year, I am not sure what my blogging frequency will look like. I have begun to pick up some extra work so I am able to attend as much con ed as I do. The Amazon affiliate links that I don’t get money for because I live in Illinois simply cannot pay for classes :). I am just putting these links up here because I want to encourage you to read these books on your own. Use my site as a guide through them. Big Goals My biggest goal for this year is to successfully become Postural Restoration Certified (PRC), and my course schedule below supports this goal. The amount that I use this material and the successes that have come along with it simply compel me to become a PRI Jedi. I see the PRC as a means to achieving this goal. The application thus far has been quite time-consuming. There are a total of 3 case studies, 5 journal article reviews, and tons of other writing that has to be done. Couple that with studying the material, and I have had a very busy
Read MoreCourse Notes: Advanced Integration Day 4 – Curvature of the Spine
Today we get wild and crazy and talk about scoliosis and the like; the last day of AI. For day 1, click here For day 2, click here For day 3, click here Scoliosis Variations The entire day focused predominately on treating scoliosis, which oftentimes amounts to exaggerations of the common patterns PRI discusses. Because scoliosis is an exaggerated PRI pattern, one must beget the question if the pattern or scoliosis came first? This question obviously cannot be answered, but for our intents and purposes we ought to assume pattern precedes curve. That way we may be able to alter the impairment. The scoliosis we can alter is often functional aka rotational. These types are ones that everyone has; the question is to what degree. Nonpathological Curve The nonpatho curve is an exaggerated version of the LAIC/RBC pattern, oftentimes with superior T4 syndrome involved. In this pattern the left ribs are externally rotated and right internally rotated. This reason is why 98% of scoliosis has right sided rib humps. A rib hump is akin to excessive rib internal rotation. In this case, the spine looks like so… Here we can see how the spine excessively right orients up to T8-T9, then rotates left superior to that. These patients will present with typical Left AIC and Right BC test results along with typical right lateralization. One difference may be the right shoulder is not as low as typical with most patterned individuals. This change is due to compensating for the excessive curve. When
Read MoreAdvanced Integration Day 3: Thoracic-Scapula Integration
Day 3 was all thorax and scapula. Here we go! For day 1, click here For day 2, click here A Philosophical Ron Intro Since the day began talking thoracic-scapula, Ron started us off by showing all the T-S connections in the body. Temporal——-sphenoid Thoracic———sternum Thoracic———scapula Tri-os coxae—-Sacrum You will notice that the thorax is very connected to many of these areas. Therefore, it is very important to control this area early on; especially if one’s problem is in the cervical spine. The “pattern” dictates the thorax governing the cervical spine because the neck follows suit with the rotated left thoracic spine. Thus, if we restore position to the thorax, oftentimes neck position will clear up. From here, my man James Anderson was introduced, and we started off the discussion with a bang. Brain, Brain, and a Little More Brain The first hour was spent talking about a subject much needing discussion: PRI’s cortical foundation. James really hammered the fact that our brains are what drive us to the right. None of the previous mentioned material matters. Zones don’t matter, left AFIR, right shoulder internal rotation, nothing, if you can’t get the brain to change out of a left hemispheric dominance. How do we do this? Per James, let’s get a zone of apposition (ZOA) in a right lateralized pattern. Say what? All the talk you have been hearing involves getting out of this right-sided dominance. But think of PRI activity in this fashion. We are most comfortable with performing right-sided activities. So why not use graded exposure to slowly
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