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 MoreTag: brain
Course 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: 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 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 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 MoreThe Post Wonderful Time of the Year: Top Posts of 2013
The Best…Around Time is fun when you are having flies. It seems like just yesterday that I started up this blog, and I am excited and humbled by the response I have gotten. Hearing praise from my audience keeps me hungry to learn and educate more. I am always curious to see which pages you enjoyed, and which were not so enjoyable; as it helps me tailor my writing a little bit more. And I’d have to say, I have a bunch of readers who like the nervous system 🙂 I am not sure what the next year will bring in terms of content, as I think the first year anyone starts a blog it is more about the writing process and finding your voice. Regardless of what is written, I hope to spread information that I think will benefit those of you who read my stuff. The more I can help you, the better off all our patients and clients will be. So without further ado, let’s review which posts were the top dogs for this year (and some of my favorite pics of course). 10. Lessons from a Student: The Interaction This was probably one of my favorite posts to write this year, as I think this area is sooooooo under-discussed. Expect to be hearing more on patient interaction from me in the future. 9) Clinical Neurodynamics Chapter 1: General Neurodynamics Shacklock was an excellent technical read. In this post we lay out some nervous system basics, and
Read MoreAdvanced Integration: Day 2 (Triplanar Activity)
For day 2 we discuss more and more the areas that help support ZOA establishment. Read on comrades. For day 1, click here Neutral Neutral can be described as a position in which certain muscles are disengaged; those that make up chains in the human system (i.e. left AIC, Right BC, right TMCC). It is neutrality that allows us to function out of an unbiased non-lateralized position. We will never be fully symmetrical because we are neither built as such nor function cortically as such. But being able to be as symmetrical as possible may allow our bodies to function favorably. Achieving neutrality is only step one in the process. It allows for someone to accept triplanar movement. Once one can reach neutral, then you may teach them how to move with the left and right sides of the body. Is it possible to be too neutral? The answer is it depends. Mike Cantrell, one of PRI’s instructors, discussed a sprinter he was treating. Mike was able to get him neutral, but once this occurred his times worsened. This result goes back to part 1’s discussion regarding variability. In this case, being neutral, being too parasympathetic, made him slower. We could akin this to almost parasympathetic overtraining. The crazy thing? This sprinter’s sister had died earlier in a week he was scheduled to see Mike. The guy came in as neutral as could be. His nervous system shifted him towards this state as a way to disengage, thus leading him
Read MoreChapter 5: Interaction of Psychological and Emotional Effects with Breathing Dysfunction
This is a chapter 5 summary of “Multidisciplinary Approaches to Breathing Pattern Disorders” by Leon Chaitow. The second edition will be coming out this December, and you can preorder it by clicking on the link or the photo below. Intro This chapter is dedicated to showing the connection between the body and consciousness; how our psyche is influenced by breathing and vice versa. This chapter was easily my favorite out of the entire book. Breathing Strategies Optimal breathing involves moderate abdominal expansion, some intercostal involvement, and minimal involvement of accessory muscles. Conversely, chest breathing is dominated by accessory muscle use. These two breathing styles are merely end points on a continuum rather than discrete categories. In terms of which strategy is used, chest breathing is often the preferred route for consciously mediated intentional breathing; whereas abdominal breathing is the main route for relaxed, automatic breathing. One reason you would want to override automatic breathing is to prepare for sudden action. At the onset of exercise, ventilation immediately jumps. This change occurs via three phases, with the first phase occurring independent of exercise load. This phase is a conscious exercise preparatory action. The other increases occur as exercise demands increase. When we are in an emergency situation, these breathing phases change. Prior to the initial pre-action deep breath comes a breath holding phase, which helps increase sensory organ stability. These preparatory breathing changes are great for imminent danger or action, but problematic when threats are non-physical and in the future. While
Read MoreCourse Notes: PRI Impingement and Instability
Soooooooooo Dense It has been a long, busy, and great few weeks for me. After attending a cluster of courses, playing around with some new jobs, moving, and working, I got some time to settle down and review PRI’s I&I material. I traveled to Phoenix to take this course. My man James Anderson taught and several good friends attended. James did not disappoint. I&I was easily one of, if not the best course I have ever taken. You did it again PRI! The only real disappointment was leaving Arizona. The temperature was in the 80’s and the sun was shining. Now here I am in the Midwest with the temp in the mid-20’s. Why did I stay here again? 🙂 This course combined and fleshed out the concepts of respiration and myokin, and added so many more layers onto what we previously learned. I&I was what DNS C should have been. I left the course with many answers, but double the questions. You truly cannot appreciate how complex the nervous system is, and how the total body responds to perceived threat until you delve into this material. I am so excited to learn more. This course had so much information regarding the entire body that there is no way I could post all the relevant info and do it justice. It really was a 4 day course done in 2. So here are a few of the gems I got from this weekend. The PRI Basis The course started off
Read MoreCourse Notes: PRI Myokinematic Restoration
What a Class Wow. That’s all that really needs to be said. I have had a great deal of exposure to PRI in the past, but I have only had one formal class under my belt. Needless to say, I was looking forward to learning more. James Anderson and the PRI folks did not disappoint. Myokinematic Restoration was easily the best class I have taken all year. It also helped having another like-minded group attending. You learn so much more when you are surrounded by friends. Here is the course low-down. Disclaimer for the Uninitiated I know there are a lot of misconceptions about PRI on the interwebz. Even though posture is in the name, PRI has little to do with posture in the traditional sense. We know posture does not cause pain, and PRI agrees with this notion. But it’s not like they can change the name of the organization now. What? Do you think Ron Hruska is Diddy or something? After discussions with James and his mentioning this aloud in class, the target of PRI is the autonomic nervous system. Not posture, not pain, not pathoanatomy, but the brain. Essentially, they have figured out a window into the autonomic nervous system via peripheral assessment. Moreover, PRI is not in the pain business, though many think this is the case. Hell, even in the home studies they mention pain quite a bit. But realize those were done in 2005. Would you like me to hold you to things you have
Read MoreChapter 7: Standard Neurodynamic Testing
This is a Chapter 7 summary of “Clinical Neurodynamics” by Michael Shacklock. Passive Neck Flexion With this test, the upper cervical tissues slide caudad, and the lower cephalid. The thoracic spine moves in a cephalid direction as well. Normal responses ought to be upper thoracic pulling at end-range. Abnormal symptoms would include low back pain, headache, or lower limb symptoms. Median Neurodynamic Test 1 (MNT1) This test, also known as the base test, moves almost all nerves between the neck and hand. Normal responses include symptoms distributed along the median nerve; to include anterior elbow pulling that extends to the first three digits. These symptoms change with contralateral lateral flexion and less often ipsilateral lateral flexion. Anterior shoulder stretching can also occur. Ulnar Neurodynamic Test (UNT) This test biases the ulnar nerve, brachial plexus, and potentially the lower cervical nerve roots. Normal responses include stretching sensations along the entire limb, but most often in the ulnar nerve’s field. Median Neurodynamic Test 2 (MNT2) This version biases the lower cervical nerve roots, spinal nerves, brachial plexus, and median nerve. Normal responses would be similar to MNT1. Radial Neurodynamic Test (RNT) This test looks predominately at radial nerve, as well as the nerve roots. It is uncertain if this test biases any particular nerve root. Normal responses include lateral elbow/forearm pulling, stretch in the dorsal wrist. Axillary Neurodynamic Test (ANT) This test tenses the axillary nerve, though may not be specific. Normal responses include posterolateral shoulder pulling with about 45-90 degrees of
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