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One Day Clinical Course - Woodbury, Minnesota

We have picked a date for our one day clinical course, Postural Restoration, in Woodbury, Minnesota!  Mark your calendars for March 28!  This one day review, demonstration, and lab course provides a number of PRI resources that are related to concepts covered in Myokinematic Restoration and Postural Respiration.  Space is limited, register early!

Posted November 14, 2008 at 3:35pm by Bobbie Ninneman.
Categories: Courses

Common Cervical-Cranio-Mandibular Restoration Dilemmas

Today brings an end to the discussion of System Integrational Dilemmas.  If you have been tuning in the last few days, we have been presenting common issues that arise with PRI programs and some things to think about when attempting to overcome these dilemmas.  Today we will feature common dilemmas that arise with a Cervial Cranio-Mandibular Restoration program:

1.  Can’t open mouth past 45mm - no click

• More than likely will need an appliance or see an orthopedic gnathologist oriented dentist.

2.  Can’t open mouth without a click

• Treat TMCC issues, free up cervical axial limitations, restore C3-C5 lordosis and if PRI stabilization effort maintains cervical neutrality a splint or TMD treatment may not be necessary, especially if there is no associated joint pain.  If joint pain, then refer to a dentist for an appropriate splint.

3.  Can’t passively rotate cervical spine to the left – axially with neutral brachial chains

• Treat left SCM, scalenes, upper trap, anterior and posterior capitus muscles to achieve right sidebending at OA and AA.
• Restore cranial flexion on the right manually.
• Re-check after placing tongue depressor between left molars; if cervical spine resumes neutrality – refer for intra-oral appliance.
• If all the above fail, consider neuro-optometric treatment.

4.  Can’t protrude without lateral trusion

• Treat left SCM, scalenes, upper trap, anterior and posterior capitus muscles to achieve right sidebending at OA and AA.
• Restore cranial flexion on the right manually.
• Re-check after placing tongue depressor between left molars; if cervical spine resumes neutrality – refer for intra-oral appliance.
• If all the above fail, consider neuro-optometric treatment.

5.  Can’t decrease a cant (bipupilar plane, otic plane, transverse occlusal plane)

• Will more than likely require palate expansion for system unlocking and possibly orthodontistry to ‘stabilize’ neutral cranium with proper occlusion.

Posted November 5, 2008 at 2:40pm by Bobbie Ninneman.
Categories: Courses

Common Postural Respiration Dilemmas

Yesterday I highlighted common problems that may occur when initiating a Myokinematic Restoration program.  Today I will cover common dilemmas in a Postural Respiration program:

1.  Can’t reduce left rib flare

• Open right low back – inhibit right quadratus lumborum.
• Right Superior T4 manual technique or two person Infraclavicular Pump with emphasis on proprioceptive integration of inhalation on right and exhalation on left.
• 90-90 abdominal integration without use of hip flexors.

2.  Can’t realize 70-80% of passive right HG IR

• Restore left horizontal abduction and cervical axial rotation to the left.  Guide right humeral internal rotation with hand placement on volar forearm to inhibit HG ER guarding.
• Supine Resisted Right HG IR with Left HG ER to fatigue right teres minor and infraspinatus, followed by Supine Resisted Right HG IR with Weighted Left HG ER.
• Two person Right Subclavius manual technique.

3.  Can’t achieve 45% of left upper extremity horizontal abduction

• Supine Hooklying T8 Extension
• Paraspinal Release
• Standing Hip Flexor Stretch
• Sternal Positional Stretch

4.  Can’t expand right chest with left chest wall resisted expansion

• Improve right thoracic rotation with technique that places a rolled towel along the left paraspinals when in supine.
• PRI Supine Weighted Punch (right serratus anterior) with Right Apical Expansion and (left latissimus dorsi) Left Resisted HG IR.
• Two person Superior T4 with right arm distraction from mid range flexion to full flexion (end range) during inhalation.

5.  Can’t blow up a balloon without pinching balloon neck

• Allow patient to blow balloon and pinch neck during inhalation at first.  Then practice tongue up during pinch. Then attempt again normal balloon process with epiglottis sealed by tongue.
• Can they perform Supine Hooklying Restorative Synchronized Resisted Glute without arching back?
• Consider blowing up a balloon correctly in seated position first to allow for posterior mediastinal expansion.  Then go back to supine hooklying position.

Tommorrow we will end this series on Common Dilemmas with a Cervical-Cranio-Mandibular Restoration program!

Posted November 4, 2008 at 3:31pm by Bobbie Ninneman.
Categories: Courses

Common Myokinematic Restoration Dilemmas

For those of you tuning in the last few days, we have been discussing common dilemmas that occur with a PRI program.  Today we will highlight dilemmas that occur when instructing a Myokinematic Restoration program and offer suggestions on how to correct the dilemma:

1.  Can’t find and feel left hamstring

• In a 90-90 position use the isotrainer ledge or similar set up to disengage paravertebrals
• Blow up a balloon in a 90-90 position with right arm reach and toes off the wall
• Protonics

2.  Can’t find and feel left adductor

• Allow the patient to ‘roll’ entire torso and hip back upon Right Sidelying Left Adductor Pull Back during inhalation.  Upon exhalation, contract the left abdominals - left knee into right thigh or ball
• Right Sidelying Knee to Knee – we often forget about this co-contraction adductor technique
• Left Sidelying Knee Toward Knee with Left Trunk Rotation – move knee with left abs on and during state of inhalation

3.  Can’t find and feel right glute max

• Single Leg Wall Left AF IR with Right Glute Max
• Standing Supported Right AF ER with Right Glute Max
• Left Retro Stairs with left AF IR Stance, left foot one step higher than the right.  Focus on right AF ER / glute max facilitation

4.  Can’t abduct right leg without right low back activity

• Un-Resisted Single Leg Lateral Dip - emphasis on simultaneous right cervical and left thoracic abduction
• Sidelying Swiss Ball with Passive Apical Expansion - focus on contracting left IO/TA’s upon inhalation, hold and then attempt to raise right leg with hip abductors
• Standing Resisted Adductor Pull in -left leg in left thoracic abduction

5.  Can’t inhibit left TFL or left hip flexors

• Single Left Leg Kneeling with right hip flexion
• Right Sidelying Left Glute Med in Hip Extension - push left knee into the wall above
• Right Sidelying Left Anterior Glute Med with TFL Inhibition - push left thigh into post

Tommorrow we will highlight common dilemmas that take place with a Postural Respiration program!

Posted November 3, 2008 at 11:21am by Bobbie Ninneman.
Categories: Courses

System Integrational Dilemmas - Part Two

If you caught yesterday’s blog...here are the other five reasons PRI dilemmas are reduced or resolved:

6. Leading with left hand and right leg to encourage right arm extension (right thoracic rotation).

7. Achieving a reverse squat from a PRI level 4 Squat Test.

8. Occasionally focusing on a target with left eye during upright (standing or seated) diaphragmatic breathing.
9.  Keeping tongue up with right upper extremity demands.
10. Walking counterclockwise periodically throughout the day with calcaneal stabilization footwear and mid arch contact.

Next week we will discuss common Myokinematic Restoration, Postural Respiration, and Cervical-Cranio-Mandibular Restoration dilemmas.

Posted October 30, 2008 at 1:31pm by Bobbie Ninneman.
Categories: Courses

System Integrational Dilemmas

“System Integrational Dilemmas” was the title of the presentation Ron Hruska gave to the PRC therapists this past weekend.  Over the next few days, I will share with you topics highlighted during this presentation. 

To help you better understand the information presented in this talk you should appreciate the difference between a system and a dilemma:

System – The human body regarded as a functional physiological unit

Dilemma – A situation that requires a choice between options, usually equally unfavorable or mutually exclusive

Most PRI dilemmas are reduced or resolved (albeit temporarily) by:

1. Not approaching the dilemma as ‘head on feet’ or ‘feet influences on head’ issues.
2. Focusing more on frontal plane muscle that is not integrating with it’s ‘family’.
3. Co-contracting left IO’s and TA’s during inhalation in a lumbar-thoracic flexion state.
4. Facilitating ‘Left Stance in Right AF IR Position from the Right AIC Pattern’ or by delaying ‘Left Stance in Left AF IR Position from the Left AIC Pattern’ (see previous Techniques of the Week).
5. Reinforcing proprioceptive and mechanoreceptor ‘feel’ and movement of right apical expansion in a left thoracic abducted state.

Stay tuned to learn the other five reasons PRI dilemmas are reduced or resolved…

Posted October 30, 2008 at 1:19pm by Bobbie Ninneman.
Categories: Courses

Cervical-Cranio-Mandibular Restoration course in Lincoln, NE

If you are registered to attend the Cervical Cranio Mandibular Restoration course in Lincoln, Nebraska on November 15-16...book your hotel reservations now!  The hotel room block will end this Friday the 31st!  To contact Chase Suites, click here! To receive our discounted rate, ask for Roxanne!  See you in November!

Posted October 29, 2008 at 1:35pm by Bobbie Ninneman.
Categories: Courses

“Pitfalls to Stabilization Rehabilitation” - Impingement & Instability

• Failure to address pain and hypomobility
• Failure to follow progression steps
• Failure to ensure proper patterns of movement
• Failure to ensure proper muscle firing sequences
• Allowing incorrect movement patterns
• Failure to understand the mechanics of selected movements
• Failure to understand demands of patient’s functional activities
• Failure to involve the whole kinetic chain
• Failure to rehabilitate deceleration and acceleration components of movement

Scientific foundations and principles of practice in musculoskeletal rehabilitation. Magee, Zachazewski, Quillen. 2007

Posted October 28, 2008 at 10:13am by Bobbie Ninneman.
Categories: Courses

Impingement and Instability Course Notes

For those that attended the Impingement and Instability course in Minneapolis, Minnesota this past weekend and would like the information on Cervical Afferent Reflexes, click here! To obtain the information on Type I treatment guidelines, click here!

Posted October 25, 2008 at 12:36pm by Bobbie Ninneman.
Categories: Courses

Course Vacancy

We recently re-opened two courses that we’re previously listed as “full”. Our Impingement & Instability course this weekend in Minneapolis now has one opening. Also, our Advanced Integration course scheduled for December 4-7 has 6 openings. Please register at your earliest convenience as space is limited. We hope to see you soon! Thanks.

Posted October 24, 2008 at 7:42am by Janie Ebmeier.
Categories: Courses

Pattern vs. Position

In the last several weeks the issue of “Left AIC Position” vs. “Left AIC Pattern” has come up.  Although similar, there is a distinct difference between the two.  Once we started discussing the differences between the two, we also realized that there is an additional element...PRI Stance!  Now that we have it all clear, we have updated and added material to the Myokinematic Restoration manual.  To check out the updates...click here! Also, take a look at the Technique of the Week for additional text referring to this issue!

Posted October 13, 2008 at 9:27am by Bobbie Ninneman.
Categories: Courses

„Miokinematyczna odbudowa wzorców zespołu lędźwiowo – miednicznego”

Today it is with much excitement and pride that we unveil our first international web pages. If you’re like me, the words themselves make little sense but the overall picture of PRI concepts and courses spreading further outside our national borders is very satisfying. We have much work ahead of us but the great deal that has already been accomplished could not have been at all possible without our Polish colleagues, Michal Niedzielski and Gregory Parfianowicz. Michal and Gregory will travel to Poland in March 2009 to present two courses covering material from our Myokinematic Restoration course. This endeavor has been a commitment of their time, expertise and energy and for that we are grateful. So, be sure to forward this link to all your friends in Poland! 

Posted October 2, 2008 at 1:17pm by Janie Ebmeier.
Categories: Courses

Please make your hotel reservations today!

For those planning to attend our Impingement & Instability course in Minneapolis...October 10th will be the last day to reserve a hotel room at our discounted rate. Please call the hotel at (952) 854-1000 and ask to reserve your room in the block for “Impingement Course”. To make reservations on-line, click here!

See you in Minneapolis!

Posted September 30, 2008 at 1:37pm by Janie Ebmeier.
Categories: Courses

Update from the TMCC Course in Chandler, AZ

For those of you that attended the Cervical-Cranio-Mandibular Restoration course in Chandler, Arizona, last weekend there was some confusion on the correct guidelines for a patient with a Right TMCC pattern.  To obtain the updated handout that corresponds with the course, click here!

Posted September 30, 2008 at 8:06am by Bobbie Ninneman.
Categories: Courses

Postural Restoration in Sioux City, Iowa

October 4th is the date for our one day clinical course, Postural Restoration, in Sioux City, Iowa.  Please join us at Sioux City Physical Therapy to discuss concepts covered in Myokinematic Restoration.  Topics of interest include but are not limited to, objective tests and measurements, manual and non-manual techniques, exercise progression and patient populations including AIC, BC and PEC patients. To register, please click here!

Posted September 17, 2008 at 12:54pm by Bobbie Ninneman.
Categories: Courses