Postural restoration institute – Page 2

June 15, 2015 Zac Cupples

Course Notes: PRI Cervical Revolution REMIX

Note: I made some errors on the first rendition of this blog that were corrected after speaking with Eric Oetter. Courtesy to him, Lori Thomsen, and Ron Hruska for cleaning up some concepts. Four Months Later When the Lori Thomsen says to come to Cervical Revolution, you kinda have to listen. I was slightly hesitant to attend since I had taken this course back in January. I mean, it was only the 3rd course rendition. How much could have changed? Holy schnikes! It is simply amazing what four months of polishing can do. It was as though I attended a completely different course. Did I get it all figured out? No. But the clarity gained this weekend left me feeling a lot better about this very complex material. This is a course that will only continue to get better with time; if you have a chance to attend please do. Let’s now have a moment of clarity. Biomechanics 101 The craniocervical region is the most mobile section of the vertebral column. This mobility allows regional sensorimotor receptors to provide the brain accurate information on occipital position and movement. The neck moves with particular biomechanics. Fryette’s laws suggest that the cervical spine produces ipsilateral spinal coupling in rotation and sidebending. The OA joint, on the other hand, couples contralaterally. C2 is the regulator of cervical spine motion; much like the first rib regulates rib cage movement. C2 is also important for the mandible, as it balances the cervical spine during mandibular

May 11, 2015 Zac Cupples

Course Notes: PRI Interdisciplinary Integration 2015

A Stellar Symposium Back in April I had the pleasure of finally attending PRI’s annual symposium, and what an excellent learning experience. The theme this year was working with high-powered, extension-driven individuals. The amount of interdisciplinary overlap in each presentation made for a seamless symposium. Common themes included the brain, stress response, HRV, resilience, and drive. These are things altered in individuals who are highly successful, but may come at a cost to body systems. If you work with business owners, CEOs, high-level athletes and coaches, high level positions, straight-A students, special forces, and supermoms, this symposium was for you. And let’s face it; we are both in this category! There were so many pearls in each presentation that I wish I could write, but let’s view the course a-ha’s. The Wise Words of Ron Ron Hruska gave four excellent talks at this symposium regarding high performers and occlusion. Let’s dive into the master’s mind. People, PRI does not think extension is bad. Extension is a gift that drives us to excel. Individuals who have high self-efficacy must often “over-extend” themselves. This drive often requires system extension. Extension is a consequence, and probably a necessary adaptation, of success. If this drive must be reduced to increase function and/or alter symptoms in these individuals, we have to turn down the volume knob. How can we power down these individuals? Limit alternate choices – These folks take a wide view of a task Set boundaries – These folks attribute failure to external factors Making initial

April 6, 2015 Zac Cupples

Course Notes: Pelvis Restoration Reflections

Pelvises Were Restored It was another great PRI weekend and I was fortunate enough to host the hilarious Lori Thomsen to teach her baby, Pelvis Restoration. Lori is a very good friend of mine, and we happened to have two of our mentees at the course as well. Needless to say it was a fun family get-together. Lori was absolutely on fire this weekend clearing up concepts for me and she aptly applied the PRI principles on multiple levels. She has a very systematic approach to the course, and is a great person to learn from, especially if you are a PRI noob. Here were some of the big concepts I shall reflect on. If you want the entire course lowdown, read the first time I took the course here. Extension = Closing Multiple Systems This right here is for you nerve heads. It turns out the pelvis is an incredibly neurologically rich area. What happens if a drive my pelvis into a position of extension for a prolonged period of time? I’ve written a lot about how Shacklock teaches closing and opening dysfunctions with the nervous system. An extended position here over time would increase tension brought along the pelvic nerves. Increased tension = decreased bloodflow = sensitivity. We can’t just limit it to nerves however, the same would occur in the vasculature and lymphatic system. We get stagnation of many vessels. Perhaps we need to think of extension as system closure; a system closing problem. Flexion will be

March 16, 2015 Zac Cupples

The Road to an Alternating and Reciprocal Warrior: Wisdom Teeth Extraction

This spans an entire treatment over a year’s time. Here’s part 1 Part 2 Part 3 The Saga Continues I’ve been through vision, I’ve had dental integration, I’ve put in the PRI activity homework, maximized my PRI testing, and feel a new man. Yet neutrality eludes me. It is a state of mind I could once feel by the power of glasses and splints, but the nervous system learns and accommodates. I topped out. But of course, I knew that would be the case from my very first session with Ron. “You gotta get those wisdom teeth pulled.” ~Ron Hruska By virtue of the dentist I integrate with, the time came. And here are the results. Zac B.E. (Before Extraction) So at this point in my life the large HRV gains I initially had were dropping and I was still having some neck tension. Training was feeling so-so. Test-wise, the videos below show what I look like. Here’s my squat And my toe touch. Upper quadrant tests And lower quadrant tests Mandibular movements And some cervical movements My pelvis is consistently neutral and I can shift and squat with the best of ‘em. But I still present with restrictions in my thorax, neck, and mandible (BBC/RTMCC). These limitations are likely present because of a bony block called wisdom teeth. As you can see, the maxillary (top side) wisdom teeth limit the excurision of my lateral pterygoids for lateral trusive movements. My hope is by removing these guys I will get

March 9, 2015 Zac Cupples

9 weeks with Bane, I mean Zac…Oops Sorry Wrong CI

Note from Zac: This is my first guest post, and to start things up is the one and only Trevor Rappa. Trevor was my intern for the past 9 weeks and he absolutely killed it. Here is his story. It’s very exciting for me to get to write a guest post for Zac’s blog that I have read so many times and learned so much from. The experience I have had with him over these past 9 weeks has been incredible and I hope to share some of it with all of you that read this. He challenged me to think critically in every aspect of patient interaction: how I first greet them, which side of them I sit on, the words I use, and how I explain to the patient why I chose the exercises they’ll go home with. All of this was to create a non-threatening environment to help to patient achieve the best results they can. He also taught me how to educate patients with a TNE approach, incorporate other interventions such as mirror therapy into a PRI based treatment model, and deepened my understanding of the neurologic concepts behind performance. Therapeutic Neuroscience Education Perception of threat can lead to a painful experience which will cause a change in behavior. It’s the PT’s role to introduce a salient stimulus to attenuate the perception of threat in order to cause a positive change in experience and behavior (Zac and I came up with that, I really like it). Pain

February 23, 2015 Zac Cupples

Favorable Inputs: A Model for Achieving Outcomes

One Hot Model Louis Gifford’s Topical Issues in Pain has an amazing amount of quality information, and has really inspired many thoughts. I’ve only read book 1 thus far, but this book can generate material to expand upon much like Supertraining does for fitness writers. I’m sure many of you folks have seen this picture before. Gifford called this schematic the “Mature Organism Model” (MOM) to illustrate how pain works. Inputs from the tissues and the environment travel up the spinal cord to the brain. The brain processes these inputs and samples information from itself to generate a corresponding output. These outputs are perceived as new inputs which reset the cycle. MOM was of course used to illustrate the three pain types (read here and here), but it is so much more than that. The MOM is a schematic for how the nervous system works. Any input that is processed by the brain may or may not lead to outputs of altered physiology and/or behavior. Viewing (your) MOM (ha) made me think a lot about working with individuals who are dealing with a threat response. How exactly are we helping these folks? I’ve come to believe that we do not treat outputs. At best we can only provide inputs that we hope are exchanged for new, desirable outputs. In patient care, we are hoping to alter perceived threat. We attenuate threat by giving an individual favorable inputs, which we hope leads to favorable behavior and physiological changes. Let’s look at what these

February 19, 2015 Zac Cupples

Come Hang With Me: Courses At My Clinic

Dear Readership We are hosting several courses at my clinic this year, and we would love to have you, the readers, attend. The three courses that East Valley Spine and Sports will be hosting are all excellent courses. I have taken two of these classes prior, and the third I have taken a prior rendition of. And let me tell you, these courses are boss. Aside from us bringing some excellent content, you will also have the opportunity to hang out with a good group of people, and imbibe in some good beverages with me. Here is what we are bringing. PRI Pelvis Restoration: March 28th-29th I took this course a little over a year ago (read the review here) and I am very excited to be learning from Lori again. She presents this very complex material in a systematic and understandable fashion. Most importantly, she’s funny! Signup for the course here. ISPI Therapeutic Neuroscience Education: Educating Patients about Pain: June 6th-7th Adriaan Louw is one of the best speakers I have heard, and the material is priceless (read my review here). This course gives several practical insights as well as easy-to-learn neuroscience education that will help you become adept and educating patients on pain. Signup for the course here. ISPI Neurodynamics: The Bodies Living Alarm: October 17th-18th I took a version of this class when Adriaan spoke for the NOI group, and I am excited to see what tweaks have been made since. This time we are bring Louie

February 16, 2015 Zac Cupples

Course Notes: PRI Cervical Revolution

Where are all the People? I recently made the trek to Vermont for the first rendition of PRI’s Cervical Revolution course; a course in which the attendees doubled the population of the entire state. It was nice to go to the class with a bunch of old friends. You always learn better that way, and I couldn’t have been more excited to get the band back together. And even more so, I got to meet a lot of good folks for the first time. It was a real treat. This course was meant to update the former craniocervical mandibular restoration course (which I reviewed here and here), with extra emphasis on the cervical spine and OA joint. In this blog however, I will not touch much on the cervical spine positioning. I still have several questions regarding the mechanics. Some spots within the manual seemed to be conflicting; the blessing and curse of a first run-through. I will update this piece once I get these points figured out. That said, the revolution helped fine tune the dental integration process for me. I have been working a bit with a dentist, and I have a bit more insight in terms of what devices they are using for whom. Let’s go through my big a-ha moments. Smudging 901 The human body is symmetrically asymmetrical. When we have capacity to alternate and reciprocate, we are able to separate the body into parts to form a whole. If you lack integration, then there are

January 19, 2015 Zac Cupples

Course Notes: Cantrell’s Myokin Reflections

Third Time’s a Charm Mike Cantrell was in my neighborhood to teach Myokinematic Restoration by the folks at PRI. And I couldn’t resist. This is the third time I have taken this course, a course I feel I know like the back of my hand, yet Mike gave me several clinical gems that I want to share with y’all. This post is going to be a quick one. If you want a little more depth, take a look at my previous myokin posts (See James Anderson and Jen Poulin). Or better yet, take a PRI course for cryin’ out loud. Hip Extension, We Need That Yo. Sagittal plane is your first piece needed to create triplanar activity. Since this is a lumbopelvic course, we look at getting hip extension as high priority. If I am unable to extend my hip, here’s what I could try to use to do it: Back SI joint compression Anterior hip laxity Gastrocnemius and soleus. We use two tests to see if we have hip extension: adduction drop (modified ober’s test) and extension drop (Thomas test). The adduction drop will look at your capacity to get into the sagittal and frontal plane, and the extension drop test will look at your anterior hip ligamentous integrity. A positive extension drop is a good thing if you are in the LAIC pattern. It means you didn’t overstretch your iliofemoral and pubofemoral ligaments. Well done! The reason why this test is not a hip flexor length test has to

January 13, 2015 Zac Cupples

Course Notes: Advanced Integration and PRC Reflections

I Passed I officially became a Jedi this past December after retaking Advanced Integration and going through the Postural Restoration Certified (PRC) testing. Both were a wonderful experience in terms of learning new concepts and fine-tuning old ones. Since I have retaken this course, I will not go into huge detail in terms of the material covered (if you want detail, read last year’s AI notes here, here, here, and here). Instead, I will reflect on a few concepts that really hit home for me (No, i’m not saying what we did at the PRC)! Enjoy. Extension is Evolution Extension is what allowed our brains to develop because it brought us to two legs. The big extenders: psoas, paravertebrals, lat, QL, capitis Extension given us more but comes with a cost. As we continue to extend, we increase system demands. Extension will likely be a necessary adaptation to live in the world we are creating. I’m scared to see what the future looks like. Position Refers to triplanar position of the body. Neutrality is the state of rest and transition zone from one side to the other. We want this most of the day, but can’t expect this to occur all day. We want to establish a rhythm in and out of neutrality in alternating and reciprocal function. The alternating and reciprocal rhythm has alternate appendages on either side of the body. When the left leg is in front, the right leg should be back. In right stance, the appendages take

December 29, 2014 Zac Cupples

The Post Wonderful Time of the Year: 2014 Edition

And That’s a Wrap It’s that time of the year that we get to look back and reflect and what posts killed it (and which bombed). It seems as though my fine fans be on a pain science kick this year, and rightfully so. It’s some of the best stuff on the PT market right now. It’s definitely a topic I hope to write about more in the coming year, and one I will be speaking on at this year’s PRC conference. But without further ado, here are the top 10 posts of 2014. 10. Treatment at the Hruska Clinic: PRI Dentistry and Vision Going through the treatment process as a patient has really upped my game in terms of knowing when to integrate with my patients. It has also been a life-changing experience for my health and well-being. Learn how they did it for me. 9. Course Notes: THE Jen Poulin’s Myokinematic Restoration So much fine tuning occured the second time around. I love how Jen acknowledged the primitive reflex origin of the patterns, as well as fine tuning both lift tests. She’s an excellent instructor (and fun to party with)! 8. Treatment at the Hruska Clinic: Initial Evaluation The start of my alternating and reciprocal saga. Made for one of the most fascinating evaluations I have ever experienced. Ron Hruska is otherworldly. 7. Course Notes: PRI Postural Respiration I love a good foundational course taught by the Ronimal. You always get a few easter eggs that allude to

December 22, 2014 Zac Cupples

Hruska Clinic II: The Follow-up

Six Months Later I have come pretty far in my journey since initially being treated at the Hruska Clinic (see day one, two, and three). I have developed a beautiful squat, am noticing less back issues when I lift, and just generally feel mo’ betta. I also have zero fatigue when reading or on a computer screen. That said, I was still getting some right neck tension and felt that my reading comprehension was not as good as it was. I was accommodating to both my orthotics, so I thought my next trip to Lincoln would be a good time to follow-up. If Youz Ain’t Assessin’ You Guessin’ Came through the door after a long flight and minimal sleep, and surprised even myself. Without any orthotics, I was neutral at my pelvis and thorax, but still had some left cervical axial rotation and right OA sidebending restrictions. I was also lacking the capacity to perform mandibular lateral trusion without kicking in my SCMs. The reason why I don’t have access to my pterygoids for this movement? Those DAMN wisdom teeth. My wisdom teeth essentially alter pterygoid position and reduce my mandible’s capacity to move. When I protrude, I have to extend my OA joint and utilize a forward head posture to complete the movement. The same thing occurs with lateral trusion. When I attempt the movement, the bony block limits my pterygoids from performing the action. SCMs, in particular the right, try to pick up the slack. From a