Course Notes: Cantrell’s Impingement and Instability, 2015 Edition

Third Time’s a Charm  A trip home and hearing Mike Cantrell preach the good PRI word? I was sold. Impingement and Instability is one of those courses that I could take yearly and still get so many gems. In fact, I probably will end up taking it yearly—it’s that good. I took I&I last year with Cantrell (and the year before that with James), and the IFAST rendition was a completely different course. Cantrell provided the most PRI clinical applications I have seen at any course, which is why he continues to be one of my favorite people to learn from. Basically, if you haven’t learned from Mike yet, I pity you. Get to it! I have way too many gems in my notes to discuss, so here are a few big takeaways.

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Manual Therapy Musings

When I think About You… Prompted by some mentee questions and blog comments, I wondered where manual therapy fits in the rehab process. To satisfy my curiosity, I calculated how much time I spend performing manual interventions. Looking at last month’s patient numbers to acquire data, I found these numbers based on billing one patient every 45 minutes (subtracting out evals and reassessments): Nonmanual (including exercise and education) = 80% Manual = 20% Modalities = 0%!!!!!!!!!!!! Delving a bit further, here’s my time spent using PRI manual techniques versus my other manual therapy skill-set: PRI manual = 14% Other manual = 6% As you can see, I use manual therapy a ridiculously low amount; skills that I used to employ liberally with decent success.   There’s a reason for the shift I want my patients to independently improve at all cost and as quickly as possible. The learning process is the critical piece needed to create necessary neuroplastic change; and consequently a successful rehab program. Rarely is learning involved in manual therapy.

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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

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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

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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

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