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 MoreTag: neuromuscular
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.
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: 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 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 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: 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
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