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New Technique of the Week!We have posted a brand new Technique of the Week! We realize that it is long overdue, however, we promise you won’t be disappointed! This technique is comprised of seven hand written pages and is said to be by the author, Ron Hruska, ”the best sidelying activity that incorporates the inhibitory processes needed to reduce Left AIC / Right BC tone in the upright individual”. To read about the Sidelying Hip Lift, click here!
Technique of the Week
It’s here! We have updated the Technique of the Week from several weeks ago! To access it, click here...or go to “Technique of the Week” under Resources!
Modified Retro Walking
Joan Hanson, MPT, PRC recently sent us this email: “I was working with a patient yesterday on retrowalking. She had sufficient adductor strength to be on her feet but she locked up during retrowalking. She was turning on her TFL each time she picked up her foot to move it backwards. I therefore had her slide her foot backwards along the carpet and she was able to hold a neutral pelvis. I now call this retroslide. I realize that this patient eventually must be able to pick up her foot and keep a neutral pelvis (gait) but the retroslide will just be a precursor to the retrowalking.”
Discussion with Ron Hruska - Part TwoWhat are your favorite activities to isolate the left abdominals and to inhibit the hip flexors? 60-60 Supine Twists 60-60 Sidelying Twists Sidelying Crossovers Right Sidelying Knee Toward Knee with Balloon Left Sidelying IO/TA Foot Toward Foot Sidelying Hip Lift Sidelying Trunk Lift Left Sidelying Supported Hip Lift “These are my favorite activities to give individuals with juvenile kyphosis, scoliosis, spondylolisthesis, PEC patterns, and runners”. What is the most consistent, reinforced, feed-forward integrated muscle group in PRI? What is the most common muscle group missed in a PRI integrated program? To learn more about PRI non-manual techniques, click here!
Discussion with Ron Hruska
The abdominals have been a popular area of discussion at PRI the last few weeks. When able to catch a moment of Ron’s “free” time, I asked him a couple of burning questions… What are your favorite activities to find and feel your left abdominals and achieve a left zone of apposition? Alternating Posterior Pelvic Rotation and Reciprocal Bilateral Wall Leg Lift 90-90 Crossovers 60-60 Sidelying Twists All Four Belly Lift Wall Short Seated Left Arm Reach with Balloon Seated Resisted Bilateral Arm Pull Down with Adduction #4 “These activities are activities I would give for individuals with left rib flairs, someone who has the inability to achieve a left ZOA, for swallowing dysfunction, for PEC patients, for left unilateral neglect, for right upper trap tension and for someone who has an overactive right quadratus lumborum.” Stay tuned for tommorrow’s question…What are your favorite activities to isolate the left abdominals and inhibit the hip flexors? To learn more about PRI non-manual techniques, click here!
New Technique
Because of the importance of this week’s Technique of the Week, we have created a new activity. The “Left Stance in Right AF IR Position from the Right AIC Pattern” is the second neuromuscular activity in the PRI integrated standing activities that allows the patient to experience proprioceptive right acetabular femoral internal rotation as he/she shifts their weight from their left non-dominant lower extremity to their right while keeping his/her right leg behind the left. Click here to get a copy of this new activity!
The Importance of the Abdominals
We have all been lectured and given the lecture on the importance of our core stabilizers, the abdominals. Although everyone needs their abdominals, one patient population in particular needs an abdominal program instructed on their first visit, the PEC patient. Someone who demonstrates a PEC pattern lacks the ability to “turn off” their hip flexors which positions their pelvis forward bilaterally. A typical abdominal program would probably increase their symptoms and increase the strength of their already overdevelped hip flexors if the abdominal program didn’t first focus on pelvic position! When using integrative non-manual techniques for treatment of a PEC pattern, one must always consider choosing an exercise that isolates the abdominals and minimizes hip flexor involvement!
Seated Adductor Pull Back
When treating the geriatric population or someone with acute pain, we modify our testing and treatment all the time. You can take several of the sidelying activities and modify them to a seated position. This is an example of a modified Sidelying Adductor Pull Back. Because of the patients inability to get on and off the floor, the therapist has instructed this activity in a seated position. What’s even more beneficial to this modified seated position is the ability for the patient to isolate just the left adductors by placing her right hand medially to the left knee. With verbal cues for the patient to “press their left knee into their right hand”, they isolate just the left adductors without right adductor involvement. To access the complete handout, click here!
PRI Recommended TMJ Proprioceptive Occlusal Splints
We have updated the page discussing Recommended TMJ Splints. This handout provides a great reference for mandibular and maxillary splints and the benefits of both. We have now added discussion regarding permissive and directive splints and the considerations that need to take place before using both. To access our updated handout on PRI Recommended TMJ Proprioceptive Occlusal Splints, click here!
Moving Forward
In today’s weekly meeting between PRI and the Hruska Clinic, we discussed the importance of the PRI Left AIC Stance technique. This activity is the first activity in the standing integration section of our 2nd Edition Non-Manual Techniques CD-Rom. This activity is the beginning to all of our activities that incorporate standing left AF IR. Some patients may have Adduction Lift Test and Abduction Lift Test scores of 3 or better but still be challenged during daily gait. By placing them first in a Left AIC position, it allows you the capability to teach them how to get out of right AF IR and into left AF IR before their right foot leaves the ground. Although stair activity is a great activity to gain left AF IR during midstance, this activity helps teach the patient how to get out of right AF IR during late stance. Consider the PRI Left AIC Stance technique to transition from active right AF IR to left AF IR by transferring 50% of the patients weight through the left leg before moving forward. Many patients appreciate this activity because it gives them a good understanding of what left AF IR really is. To access the complete technique, please click here!
In Case You Missed It
These last few weeks have been filled with discussion on shoes. Now that you’ve been guided on which shoe to buy, let’s put them into use. Alternating Gait Recommendations is a handout found on PRI’s website educating patient’s on appropriate gait sequence complimenting a Right AIC pattern. This handout is a great way to incorporate PRI activity into an upright dynamic program! To access this handout, please click here!
Top 10 Recommendations for the Office
Lori Thomsen, PRC has given several community talks around Lincoln, Nebraska. One popular topic of interest is office ergonomics. In the world of Physical Therapy, office ergonomics, is a trendy topic covered by many clinics and organizations. Here at PRI, we have taken your typical office recommendations and applied PRI related concepts to them. Along with a list providing you with the top ten recommendations, there is also a coordinating image. To access the Top Ten Office Recommendations, please click here!
Standing Right AF ER with Right Glute Max
While working with a patient who lacked right glute max activity in a standing right AF ER position, we came up with a new activity. This new activity not only places the patient in standing right AF ER, activating the right glute max, it also provides resisted right FA ER. This is a great activity to promote left AF IR with concomitant right AF ER / FA ER activity. To access the complete exercise, please
Class is always in session
Providing patient care is not only a learning experience for the patient but also for the therapist. Each patient has taught a lesson, sent a message and left an imprint that has helped develop our approach to treatment. This week Ron Hruska was working with a patient who had seen another therapist at the Hruska Clinic prior to this visit. She mentioned that a specific cue from Lori Thomsen made all the difference in her ability to breathe into her right chest. Lori asked her to “breathe into the heel of my right hand” during an Infraclavicular Pump and Subclavius technique. Ron brought a couple of us into the treatment room to feel the upper right ribs externally rotate upon inhalation using this particular cue. The next time you perform these PRI Manual Techniques consider using this instruction to maximize your patient’s ability to achieve right apical expansion. Contact us to share your own patient-directed discoveries!
Functional Squat Test
In addition to the Hruska Adduction Lift Test and the Hruska Abduction Lift Test, we have created the Functional Squat Test. Similar to the tests mentioned previously, The Functional Squat test is graded by levels. Level 1 is the inability to perform the test and level 5 represents maximal performance. This test helps the clinician determine whether the patient demonstrates hyperactive hip flexors, back extensors, and femoral rotators. It also helps establish whether or not the patient has the ability to perform a posterior pelvic tilt and if they can achieve maximal AF IR. To view the complete Functional Squat Test, please click here!
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