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,
Read MoreCourse Notes: PRI Vision Postural Visual Integration
Explosive I am still picking up the white matter that exploded all over the pavement as I left the PRI Vision course that was hosted in Grayslake, IL. It was an excellent experience interacting with Ron and Heidi, and believe it or not they are familiar with my blog…and the corresponding pictures. Therefore I was the butt of many jokes this past weekend, which definitely made me feel at home with the PRI family that I have so grown fond of. There is a reason it has taken me so long to put this work up. These notes have been the most challenging I have written yet, as the material was way out of what I have normally been studying. It is this class however, that solidifies PRI methodology as grounded in neurology. It was two days of brain, autonomics, vision, and optometry. I will do my best to show you what I learned in a semi-understandable manner. Seeing Visions Definition – “The deriving of meaning and the directing of action as a product of the processing of information triggered by a selected band of radiant energy.” – Robert Kraskin Vision is not just what we see, it is what drives us to make decisions. It is a skill that we develop as we age. It is the dominant sense in the brain, as 70% of the brains connections are related to vision. Vision can and does become lateralized. Sight is the clarity of our visual field, which is slightly
Read MorePain Language and other Jive Talk
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
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