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Right BC PRI Treatment Guidelines We received a great question the other day regarding the “Right BC PRI Treatment Guidelines” found in the Postural Respiration manual! “I have question concerning page 63 of the postural respiration manual. Written on the third row down is the term…All tests are - and sufficent right scapular-thoracic function and position exists. What is meant by this phrase and how do I know when the patient has obtained this”? The tests we are referring to are left horizontal abduction, left cervical axial rotation, left humeral glenoid flexion, right and left apical expansion, and right HG IR. If these tests are all negative and the patient has the ability to reach forward in supine, with arms extended, without losing position of the thorax (all previous tests would indicate that) then I would recommend standing right low trap and right tricep PRI activity. Standing places gravitational forces on the scapula and if good anti-gravitational support is offered by the right serratus anterior, middle and lower trapezius and atmospheric pressure then upright re-training and correct neuro-motor timing of upper extremity flexion should be able to occur without losing thoracic flexion. If it cannot then right low trap and right tricep co-activation using PRI non-manual techniques should take place in any of the previous non-standing or non-upright positions. We have also added this criteria on page 63 of the course manual. To get a replacement copy, click here! Posted July 7, 2009 at 7:11am by Bobbie Rappl. Categories: Courses Interdisciplinary Integration 2010 We have set the date for the Interdisciplinary Integration course in 2010! The course will be held Wednesday, April 14 - Saturday, April 17! All four days will be full of new and exciting information related to feet, dentistry, vision and our new topic….REST! The entire 4th day will be covering rest and sleep integration as it relates to PRI! Plan ahead for this course…you don’t want to miss it! You can register for all four days or each individual day by clicking here! Posted June 24, 2009 at 6:00am by Bobbie Rappl. Categories: Courses City of Syracuse If you have always wanted to explore Syracuse, New York...here is your chance! Ron Hruska will be in Syracuse on July 25-26 teaching Cervical-Cranio-Mandibular Restoration. Make a vacation out of it by attending a course while also enjoying the City of Syracuse! This will be your last opportunity to take the Cervical-Cranio-Mandibular Restoration course this summer because it’s FULL in August. This may also be one of the last opportunities for you to take this course before certification in December! If you register by June 24th...we will waive the late registration fee! To register, click here! Posted June 19, 2009 at 6:00am by Bobbie Rappl. Categories: Courses One Day Clinical Course Recently Karen Jiran, MPT, PRC taught at our one day clinical course in Crookston, Minnesota. Karen filled us in on how the course went: “I had a great time up in Crookston, MN! The group was really excited and asked great questions! First, we reviewed the mechanics of footwear and how correct placement of scaphoid pads can help move a patient out of a Left AIC pattern. There was a problem with understanding the need to support the right arch and yet allow the right great toe to contact the ground to assist with weight shift to the left. Second, we hit the ZOA. We went over what the ZOA is and how we functionally need to ensure the ZOA is supported in all three planes with each integrated exercise. We reviewed and performed exercises to help understand where mistakes can easily be made. We discussed clues to looking at hip lift scores and when a person really is a 3 or 4 by assessing true trunk abduction. Just because a person can lift doesn’t mean they are a true 3 to 4. I expect to see trunk abduction as a part of the movement. I encouraged them to be picky when evaluating the test! We also reviewed progressing with right vs. left lower trap exercises and to be careful with Right Superior T4 patients.” Here is what an attendee had to say about it: “This was an open conversation course! This was extremely helpful to address individual questions. The small group was conducive to understanding the deeper theories.” If you would like to learn more about our one day clinical course opportunities, contact us! Posted June 12, 2009 at 6:00am by Bobbie Rappl. Categories: Courses FULL COURSE The Cervical-Cranio-Mandibular Restoration course in Woodbury, Minnesota, August 8-9 is full! Posted June 11, 2009 at 6:00am by Bobbie Rappl. Categories: Courses NEW Course Location in October We are re-locating the October 3-4 Myokinematic Restoration course in Lincoln, Nebraska to Shakopee, Minnesota! The course will not be offered in Lincoln this fall so if you were interested in taking this course in Nebraska there are still spaces available next weekend in Omaha. If you are interested in the course in Shakopee, Minnesota you can register here! Posted June 3, 2009 at 12:51pm by Bobbie Rappl. Categories: Courses A Friendly Note… If any of you have read the book, The Last Lecture, by Randy Pausch you probably remember the section on “handwritten thank you notes”. This note was sent to us by a course attendee of the four day Interdisciplinary Integration course. It’s notes like these that keep us moving… I would like to commend you on the presentation of such a wonderful course, Interdisciplinary Integration! With each PRI course that I attend, I leave knowing that I have made such a great career choice! I cannot even imagine what life would be like after graduation if I would not have been introduced to your work in Postural Restoration! Thank you so much for continuing to share your knowledge. The organization of the course and welcoming environment, in addition to the overwhelming knowledge of the presentors, made for a very educational and enjoyable four days! Thanks! Posted April 22, 2009 at 6:00am by Bobbie Rappl. Categories: Courses 2009 Course Date Additions You’ll find that we’ve recently added a few more course dates to our schedule for this year: Myokinematic Restoration June 6-7 Syracuse, NY (Speaker - Mike Cantrell) June 13-14 Omaha, NE (Speaker - James Anderson) June 27-28 Sioux Falls, SD (Speaker - James Anderson) Postural Respiration October 10-11 Omaha, NE (Speaker - James Anderson) Posted April 14, 2009 at 6:00am by Janie Ebmeier. Categories: Courses PRI in Poland Michal Niedzielski and Gregory Parfianowicz recently returned from their trip to Poland. On March 20th through the 23rd Michal and Gregory taught Myokinematic Restoration in both Warszawa and Olsztyn. This year marked a new chapter for PRI as this was the first time PRI has been presented in Poland. Michal and Gregory put in months of preparation for this course and we are honored to have both of them represent PRI! Here are some photos from their trip… Warszawa Olsztyn Posted April 8, 2009 at 8:08am by Bobbie Rappl. Categories: Courses Course Notes - Pelvic Floor Dysfunction If patient can’t maintain re-positioning… Breathing Are they diaphragmatically breathing? Quality of respiration? Symmetry of respiration? Decreased diaphragmatic motion, increased descent of pelvic floor, altered breathing patterns associated with pelvic pain. Diaphragmatic and TA muscle activity reduced with hypercapnea. Pelvic floor depression associated with breath holding/Valsalva maneuver. Abdominals Can they isolate IO / TA? Symmetrical or Asymmetical? Palpate approximately 2 cm medial and inferior to ASIS. Slowly & gently draw in your abdominals away from your fingers. Sub maximal contraction. Change positions (supine, side lying). Monitor for substitutions. Is IO / TA activity sustained with breathing? Can they maintain IO / TA contraction with upright static & dynamic control? Pelvic Floor Can they isolate their pelvic floor muscles? Can they actively contract and relax the pelvic floor? Do they feel an up & in contraction? Are they substituting (glute squeeze, breath holding, adductor squeeze, bearing down)? Is there symmetry? Is there appropriate motor planning? Voluntary contraction of the abdominal muscles stimulates pelvic floor contraction. TA and IO recruited during all pelvic floor muscle contractions. Relaxed abdominals resulted in only 25% of maximum pelvic floor contraction. Women with stress incontinence have increased OE activity (increased OE increases IAP). Back pain more common in women with incontinence , increased probability of LBP if have symptoms of incontinence. Pelvic floor muscles are part of preprogrammed response to postural adjustment. Decreased pelvic floor strength, endurance and thickness noted in women with incontinence. Increased pelvic floor activity with postural perturbations noted with women with incontinence. Pelvic floor tonic activity at rest, with cough automatic phasic response, in women incontinence unsustained tonic pattern with asymmetrical recruitment. Timing deficit of muscle recruitment lost with women with incontinence. Higher resting tone of pelvic floor with dysfunction, need to teach down training. High resting tone does not always mean a strong pelvic floor. The pelvic floor needs to relearn how to function within a neutral pelvis. Feel the pelvic floor contract and relax. Reported cure rate of pelvic for urinary incontinence ranges between 44-69%. 30% of contractions are performed incorrectly; 50% of contraction are strong enough to increase urethral pressure. Pelvic floor muscle activity alone does not predict UI, activity related to UI needs to be considered. Isolated contraction of pelvic floor produces greatest displacement of pelvic floor. Hypermobility - But Still Have Symptoms Is there global hypermobility? There is a high correlation of pelvic dysfunction with a reduction in tissue collegan concentration. Referral Has there been trauma? Consider referral early on if patient not progressing appropriately. Patient can reposition but they still have symptoms- are they able to relax their pelvic floor? Is there psyco-social issues? Referral To If symptoms have not subsided consider referral to OB GYN/Urologists/Primary MD PT with pelvic floor specific training (biofeedback, internal evaluation, condition specific integration) Podiatry (correlation of foot flexibility and SUI) Dentist Neuro - Optometrist Posted April 7, 2009 at 6:00am by Bobbie Rappl. Categories: Courses Feedback from the Postural Restoration course in Woodbury, Minnesota Karen Jiran, MPT, PRC was the instructor last weekend for our one day clinical course called Postural Restoration. For those of you unaware of what this course is, this course is an individualized, one day class, that covers concepts requested by the attendees. In short, the entire day is spent reviewing concepts taught in one of our two day courses. This course happened to be organized by PRI but we often schedule the courses on request. Here is some feedback from the attendees: “Great course, Karen did an excellent job! I would recommend this class to everyone. It was a fun, dynamic learning experience!” “Excellent course, please offer more of them! It’s nice to have a small class size to have practice time!” “Very, very good! The case studies and small group discussion made the problem solving effective!” “It’s nice to have a source to get questions answered.” If you are interested in having a one day clinical course at your office, please contact us! This is a great opportunity for more advanced, hands on clinical application for you and your colleagues! Posted April 3, 2009 at 6:00am by Bobbie Rappl. Categories: Courses For those of you that couldn’t make it… to our first Interdisciplinary Integration course, you missed out on a fantastic weekend! Let me give you a quick overview on each day… Day one which covered Podiatric Integration started out with information covering gait analysis and it’s relevance to PRI related treatment. It was a great overview of the reciprocal process that takes place as our body moves through the motion of gait and what PRI considerations we should keep in mind as we are treating different phases of gait. The afternoon carried on with information regarding orthotics and what purpose a PRI orthotic serves in reducing neuromotor pathomechanics provided by Dr. Paul Coffin. The day couldn’t have ended better than with Ann Ringlein, from the Lincoln Running Company, covering proper shoe wear. Here are some comments from attendees of day one: “Excellent clinical application I can use immediately.” “Fantastic, fascinating guy; we could learn a lot more from him!” “Excellent information and application for our clinic.” “The videos and pictures of those walking was so helpful!” Day two was devoted to Dental Integration provided by Dr. Mike Hoefs. The entire day was spent by a passionate, enthusiastic dentist talking about the importance of position and maintaining cranial symmetry. Dr. Hoefs is one of the few dentists in our country treating craniofacial pain and dental discrepancies through gnathic orthopedic positioning. The highlight of the day was when he took our very own, Lisa Bartels, DPT, PRC, and placed a twin block ALF appliance in her mouth in front of the whole class. It was incredible to see the postural changes that took place immediately following the application of this appliance! Here is what others had to say about the day… “Interesting, informative and very helpful for understanding when and how to refer to an appropriate dentist!” “This was such an eye opener; I really appreciate all the information given!” “The demonstrations used during this course were very applicable for use in the clinic.” “Wow, Dr. Hoefs is the Ron Hruska of dentistry! He is such an innovator!” Day three was spent on Vision Vestibular Integration. The first part of the day covered optokinetic learning taught by Ron Hruska, MPT, PT. We learned all about vision and its influence on balance and the vestibular system. The morning provided an excellent overview on how to integrate and communicate with optometrists. Dr. James Nedrow discussed his expertise in neuro-optometry and the treatment of visual midline shift and post traumatic visual dysfunction. Here is what others had to say: “I have a better idea of when to request optometry and neuro optometry.” “Both the morning and the afternoon came together for me and showed me where to look to study and begin tying things together. The whole day was fascinating!” “This course opened my eyes to the importance of treating the entire system.” “Wow, this course definitely helped clarify the relationship of the vision-vestibular system and posture. Ron and Dr. Nedrow did a great job of presenting this information and demonstrating the importance of interdisciplinary integration.” And finally, day four! Pelvic Floor Dysfunction was the topic of this day given by Heather Engelbert, PT, PRC and Lori Thomsen, PT, PRC. What an incredible day covering the importance of establishing a positioned pelvic floor, before addressing pelvic floor dysfunction. Not only was pelvic asymmetry discussed but also covered was the importance of the respiratory system and its influences on the pelvic floor! The afternoon was spent on treatment techniques for pelvic floor dysfunction and we were given several new activities to use with our patients. Here is what other attendees had to say about it… “Great explanation of the Left AIC pattern and how it affects pelvic floor dysfunction. I loved the “egg”, pelvic floor and diaphragm diagrams; it helped me to understand position of the pelvic floor and the pelvic diaphragm.” “The clinical application with treatment strategy and reasoning behind these strategies was one of the best discussions I have ever heard!” “This was a wonderful way of improving my understanding of how to fit the pelvic floor in the PRI picture.” “This course exceeded my expectations; I now know what is going on at the bottom of the egg and what to do about it!” Posted April 1, 2009 at 9:35am by Bobbie Rappl. Categories: Courses Course Notes - Pelvic Floor Dysfunction Abdominal Discord Abdominal weakness- dorsal stabilizers become tight and static, exhalation becomes passive and rate of inhalation increases. Belly breathing associated with increased lordosis. Unilateral or bilateral rib flare. Rotation dysfunction increases with internal oblique weakness on side toward which the body is rotated, external obliques weakness on opposite side. Strains sacral iliac ligaments. Posted March 29, 2009 at 1:07pm by Bobbie Rappl. Categories: Courses Course Notes - Pelvic Floor Dysfunction Common Compensatory Pattern 1. Pope, R. The common compensatory pattern: it’s origin and relationship to the postural model. AAOJ 14(4):19-40. 2. Zink G, Lawson W. An osteopathic structural examination and functional interpretation of the soma. Osteopathic Annals, 1979 Dec 7(12):433-440. Posted March 29, 2009 at 1:05pm by Bobbie Rappl. Categories: Courses Course Notes - Podiatric Integration PRI Gait Analysis of the Accelerated “Asymmetrical” American 1. The left foot goes through a toe-out gait pattern at early push-off compared to the right. Secondary to poor abductor co-contraction of adductors and anterior gluteus medius. 2. The right lower extremity externally rotates more overall than the left. During swing because of overactive iliacus and during stance because of innominate orientation of legs and trunk to the right. 3. The right heel lifts early at mid-stance compared to the left and at push-off. Secondary to longer interval of right weight acceptance and trunk glide and longer shorter swing and ‘stride’ with left leg. 4. The femurs significantly internally rotate at push-off. At late mid stance and trunk glide phases innominates are forwardly rotated too much contributing to FA IR orientation or position. Especially seen in hyperextended individuals. 5. There appears to be a higher ‘active’ mid foot arch on the right at mid stance. Secondary to overactive, shortened strong right adductor influence on foot and ankle. 6. No sufficient resupination of the left foot occurs after midstance to stabilize or “lock” the tarsus in the sagittal plane and allow for efficient propulsion. Contributed by weak right acetabular femoral external rotational strength. 7. The right 1st metatarsal is not secure in plantar-flexion against the ground during forefoot loading. Contributed by C.O.G. over-distributed to the right and overactive left TFL during swing. 8. The right 1st MTP joint does not dorsiflex freely for forward gait progression without compensatory dorsiflexion from smaller toes and shifting of COG to the right. Secondary to forefoot and possibly rearfoot varus and overactive posterior gluteus medius and iliacus. 9. The right arm does not move forward upon right toe-off. Secondary to poor left lateral abdominal integration and overactive right thoracic abductors reinforcing right arm adduction. 10. The left shoulder does not drop upon left toe-off. Contributed by weak left gluteus medius and left lateral abdominals at late mid stance or trunk glide. Posted March 26, 2009 at 9:39am by Bobbie Rappl. Categories: Courses Page 3 of 7 pages < 1 2 3 4 5 > Last » More blog entries can be found in the archives...