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Timing is a tricky thing, isn’t it? Difficult to measure. Tough to describe. Hard to master. But once you find timing, or timing finds you, it can dramatically change any outcome. Aren’t we all searching for that nebulous and elusive thing called "timing"? One of the main overall goals of PRI is to improve neuromuscular timing to reduce patterned behavior. Timing is kind of like a unicorn with a majestic, golden mane; you know it when you see it.   

Last weekend it was my distinct pleasure to teach Myokinematic Restoration to 68 movement specialists, 45 of which were new to the science of PRI. We had 10 individuals in person, and two of them were my good friends Craig Depperschmidt, DPT, PRC and Jason Miller, PT, PRC, both of whom are new additions to our PRI faculty. We are lucky to have them. We had a group of 18 co-workers attending the live-stream together. It was daylight savings, which means we got an extra hour of sleep Saturday night. And we had a unicorn in our midst. We were fortunate to have had several unique events occur this weekend that I feel blessed to have all been able to share the experience with 68 friends, old and new.

One of our objectives in this course is to learn how to correctly interpret the tests and let them lead us into our treatment approach. Another objective is to understand how and when to use ligamentous muscle to stabilize an unstable hip capsule. For those of you who have taken this course before, you’ve experienced the lab portion on the second day, and we usually are able to get to around 7 or so PRI non-manual techniques. On this unique weekend, we were able to get to 15 techniques in lab. Part of it was the small class size during lab, but Craig and Jason were an enormous reason we were able to get to so many activities. It was just a unique experience afforded to those in attendance in-person and on the live stream. This extensive lab time allowed us to dive into the algorithms on pages 49 and 52, as well as the inhibition section of the appendix.  We used page 48 as a treatment flow chart, and proceeded through that page as a decision-making tree to help the attendees solidify examples of how to apply the science of PRI upon returning to their clients and patients. Do what the tests tell you to do. Reposition. Do page 39. Retest. Do what the tests tell you to do.

One of the best teaching examples for this course is an example of someone who fits the description of the algorithm on page 49, and the algorithm on page 52. Ron did this for me in my very first Myokin class in 2004, and it helped me remember how different these patients can present. It is pretty easy to find someone in the course during lab who presents with testing representative of page 52; however, finding someone who fits the description on page 49 is kind of like finding a majestic unicorn with a flowing golden mane. In 6 years of teaching this course I had only met one unicorn, until this weekend. Our unicorn’s name was Brett, and he provided us with an exceptional example of how and why testing matters, and how testing helps drive the treatment decision-making tree on page 48.  

My thanks to all of those who attended on live-stream. Your questions clearly indicate you were engaged and were thinking ahead to future courses. Your questions were spot-on and I am looking forward to seeing many, many of you in future PRI courses.
 
My sincere thanks to Brett Shulte, Alison Janky, Savannah DeVault, and Angie Nixon. Your willingness to be our models for demonstration provided all of us with an exceptional learning experience. My thanks to RJ for his excellent production of our live stream, and to Jason and Craig for keeping me honest and helping us get through as much lab as we did.  

So, to recap……
Fantastic in-person and live stream audience. Excellent questions all around. Unbelievable lab. A splendid unicorn. An extra hour of sleep.
Timing is everything.  

Thank you to Impact Physical Medicine and Aquatic Center for hosting Pelvis Restoration this past weekend. It was a wonderful weekend of integration and learning with fellow colleagues as we dissected the pelvic inlet and outlet. Our goals were to Reposition (inhibit), Re-train (facilitate) and Restore (alternate, oscillate, resonate, vibrate).  Participants were energized with open minds with 7 new course attendees to PRI, 3 PRC’s, and the rest attending another PRI course with various backgrounds. I feel the attendees gained a better understanding with the Pelvic Ascension Drop Test (frontal plane stance phase) and Passive Abduction Raise Test (frontal plane swing phase) with application of the Hruska Abduction Lift test to assist with the pelvic inlet or outlet restoration. From Shirley’s purple highlighted hair reminding of us of internal rotation/inhalation, to Lindsey’s awesome questions, to Mylan’s “light bulb” moments—it gave me energy and found me grateful. Mike, Mara and Christie (PRC’s and lab assistancts) thank you for supporting the Institute and for your passion for the science of PRI.

Essex Physical Therapy near Burlington provided a warm welcome to students and PRI faculty that matched the fall colors of a Vermont fall season. This facility is a dream location for learning PRI principles and provided a perfect learning environment for all of the students in attendance.

Cervical Revolution is the secondary course that introduces "top-down" and autonomic function guiding movement that is reciprocal and alternating. The heart and soul of this course is the atlas and occipital articulation which is autonomic in nature given the location to the brainstem anatomically. From that articulation the course builds into normal cervical spine coupling, compensatory coupling, occipital influences on a sphenoid, sphenoid to temporal bone, temporal bone influences on the entire system including mandibular/occlusal position and finally to right torsion as a pathologic compensation of the cranium that originates at the O/A joint.  This course integrates sense from top down and ground up including pressure sense generated by respiration, autonomic nervous system regulation of balance, sight, occlusion and especially alignment, position and dynamic tone and tension of the cervical spine.

In addition to PT’s in attendance, there were athletic trainers, strength professionals, massage therapists and two doctors of chiropractic in attendance with one of them also being a PT. Our discussion on Saturday morning included speaking of the atlas and that chiropractors have always held this articulation with high reverence observing it’s role in overall wellbeing and neurologic function. Ron Hruska also has seen this relationship for years, and as a chiropractic physician, I appreciate Cervical Revolution so much as it brings our knowledge of the cervical spine, and how it specifically relates to overall function of every system in the human body, to a practical clinical application combining objective testing with powerful and effective treatment.

Fellow PRI faculty member Louise Kelly, DPT, who is training to teach this course, was our lab assistant and my sidekick during the weekend and courses always are easier to teach with her energetic input, insights as a masterful clinician and ability to break down PRI Non-manual techniques. Many thanks to her and many, many thanks to Estelle La Clair and the entire Essex Physical Therapy staff for their support, organization, food, set-up, clean-up and overall spirit of learning this past weekend!

One of the main objectives of this inaugural course was to help the participant gain an understanding on how the development of the human vocal tract resonance and articulation of speech is influenced by air pressure, and controlled through entrained exhalatory patterned function. Patterned exhalatory function, or voice, is most influenced by the position of the larynx, the trachea, and the esophagus, and through the available freedom the hypopharyngeal region of the neck offers.

Over adduction of the vocal cords severely impedes normal modes of vocal cord vibration and accentuates cervical tension from the accessory muscles of respiration, from the “lifting” muscles of the larynx and neck, and smooth muscles of the airway. Two of the most visible outward signs of over adduction of the vocal cords, is a prominent right sternocleidomastoid (extended, posteriorly rotated, and internally rotated right temporal bone) and a protruding left ear (flexed, anteriorly rotated, and externally rotated left temporal bone).

These two outward signs reflect the ongoing entrainment of deteriorative phonatory pitch effort (more than likely from the left temporal orientation) and disturbing auditory high pitch continuum (more than likely from the right temporal bone orientation). This intrinsic stricture, influencing both how we speak and hear ourselves speak, is the reflection of air pressure production, that is incapable of unrestricting temporal resonance entrained patterned function, that we have become accustomed to and rely on for identification of who we are as a physiologic, psychologic, and physical machine.

I feel honored to have had the emphatic opportunity to present to so many PRTs and PRCs. Thank you for showing interest and for your attendance.

Out of all the courses that I have written, out of all of the objectives in those courses that have been written and out of all the corollaries made, I feel so grateful to have had this opportunity to share this written work, for the first time. One of the most important attributes, that reflect most my course and objective effort, is that ‘brainwave entrainment revolves around patterned exhalatory function’, and this course allowed me to emphasis this concept through a review of research and literature from the world of “voice”, through a reflection of this Institute’s respect for pressure management, and through a strong case presentation.

I especially want to thank Ruth Hennessy, Hennessy Breath and BodyWork, and Ann Marie Pollard, Voice Realized, for sharing their insights and thoughts on subject matter that is dear to their heart and soul. They helped me discuss the role of the hypopharynx, that is not often associated with the inhibition effort of a right femoral adductor magnus, right internal and external obliques, left gluteus maximus, left psoas major, left pectoralis major, left anterior temporalis, and most important a right sternocleidomastoid muscle.

So much of my clinical and academic life has been centered around our need to express, explain, and explode alternation, through the regulation of intrinsic, biased patterned pressure, for the improvement of outward, unbiased positional performance. Our exploration in and of life depends on the re-reference and re-interference, offered through this plosive vocal ‘sounding’ and explosive plantar ‘pounding’.

My maternal grandmother, Lucy, raised pedigree Saint Bernard dogs. Some of my best memories were traveling with her and her prized show dogs to “dog shows”. My brother and I would ‘dog-sit’ the dogs she was not showing on the runway. They were big dogs, with big mouths, to her 8 and 9  year old grandsons. But they were so lovable, slobbery, tongue friendly and gentle. They also had the cleanest teeth of any of the other dogs being shown. Grandma Lucy would say that clean, healthy, teeth on her Saint Bernards were one of the secrets to keeping their coats of hair beautiful and shiny, their overall social disposition, and their extended longevity.  She would often tell us that she believed a dog that could “keep” all its teeth, for as long as possible, would be a happy dog, and “to some degree” would generate better “pedigrees”.  I am not sure I believed her then, especially when I was given the responsibility of brushing slobbery dog teeth before they walked on a runway. None the less, I will always appreciate her for so many reasons, including responsibilities she gave me, like brushing canine teeth. She introduced the concept of  ‘epigenetics’ without ever talking to people like Dr. Singh. I will always be reminded of her phrase,  “to some degree”, when tying to make a point about something she believed had a corollary; which to grandma Lucy, was everything in life.

After many years of discussing material, presenting my thoughts, teaching concepts and writing on occlusal-cervical  and cervical-occlusal corollaries, I am beginning to see, hear and read inter-disciplinary discussion on patterned airway and occlusal cervical malfunction relationships, that contribute to and lead to pathology. It is exciting for me to watch and nurture these pedagogical moments, on many disciplinary fronts and confronts.

After presenting the Occlusal Cervical Restoration course on October 8th and 9th, I have received many emails and notes from course attendees, including dentists, who were so appreciative. The course was strengthened by Dr. James Carlson, a dentist who has written so much on the stomatognathic system, physiologic occlusion and orthocranial force, presence, input and confirmation. One dentist wrote, “to see your interactions with Dr. Carlson will never be forgotten”. This comment, followed by other comments from other participants, reinforce our mission, our intent and our desire to help create and foster communities of interdisciplinary minded providers. A community that appreciates the health of occlusion and oral alignment.

Dr. Carlson, in his 2005 publication on Physiologic Occlusion (a book that is now titled “Orthocranial Occlusion and Dentition Design”) wrote, “With the advancement of integrated health care it is becoming apparent that dentistry, osteopathy, chiropractic, medicine, optometry, physical therapy, massage therapy, and craniopathy have overlapping areas of concern: the head, neck, and face. The concept that the structural alignment of the maxilla, the position of the mandible, and dental occlusion affect the craniosacral mechanism, orbital bones of the skull, neuromuscular system, and the position of the cervical vertebra may be new to many dentists. However, with more dentists cognizant of the interdisciplinary approach to treating patients, the awareness of the concept is growing.” His presence at this course was such a gift, a privilege for all of those in attendance, including the 14 dentists and the other health care providers, that were also in attendance, some of whom work directly together. We will again be honored with his presence and presentations at next Springs PRI Interdisciplinary Integration Symposium (The Stomatognathic System: An Interdisciplinary Approach In The Management of Spatial Navigation and Structural Strength) next year on April 21-22nd. Because of his, and my, strong belief in integrating different disciplines, the health and happiness of the patients being served by an integrative team, should improve; ‘to some degree’.

Malta, New York’s colorful foliage and Capital Area Physical Therapy and Wellness welcomed Postural Respiration into its PT-owned clinic. Course attendees had expertise across multiple disciplines — physical therapy, strength and conditioning, internal medicine — and patient populations, from pediatrics, geriatrics, basal ganglia and other movement disorders, and high school through professional athletics. Most expressed gratitude and satisfaction with getting back to a live course following the covid sequester. With so much of the weekend devoted to hands-on lab time, Postural Respiration is better experienced live.

Abundant research exists that describes the role of the diaphragm in facilitating physiologic processes and homeostasis. Less understood and studied is its role in regulating pressure within the chambers of the body to produce integrated and coordinated movement. When the diaphragm’s shape is altered from patterned postural positions, movements, and behavior, the result is asymmetrical air flow patterns that become ever more patterned. Practitioners encounter this phenomenon every day in our patients/clients and witness its influence on autonomic variability, a concept fundamental to the Postural Restoration Institute.  

Throughout the weekend, we considered questions such as:  
-    How do the left and right diaphragm position and function influence rest, recovery, and performance?  
–     Why are the right triceps, left internal obliques and transverse abdominus, and bilateral low traps and serratus anterior so crucial in establishing and maintaining effective length-tension properties of the thoracic diaphragm? And how do they influence new, unfamiliar, yet optimal, patterns of movement in our patients’/clients’ day-to-day lives?
–      When and why do the scalenes, notably on the right, conspire with the subclavius and pec minor, to produce unrelenting activity and the pathological respiratory syndrome known as superior T4?
-     How does the PRI paradigm fit within a clinician’s current approach to evaluation and treatment?  
–      If you have only thirty minutes with a patient, how do you prioritize?  
-     Why/how do patients/clients benefit from reaching activities? Balloon blowing?

It was a treat to be reunited with Kathy Metzger, PT, PRC, a fellow member of the PRC squad of 2011. Kathy applied her experienced hands on many rib cages to teach the nuances of objective tests and treatment techniques.  Thank you for all your help!  

We greatly appreciate our models:  Christopher Denio, DPT, Mike DeMille, DPT, PRC, Andrew Gaetano, DPT, Ken Jin, DPT, and Trisha Livermore, DPT.  Your willingness to participate allowed all of us to gain a deeper understanding of the tests, interpretations, and techniques.

A special thank you to Evan Marsh, DPT, and Andrew Gaetano, of Capital Area Physical Therapy and Wellness, for opening your doors and welcoming this wonderful group of clinicians! 

Hey PRI family!

I recently returned from Tualatin, Oregon  where I enjoyed a weekend teaching Pelvis Restoration to a widely diverse group of movement professionals. Positioned adjacent to a majestic wetland, I was awestruck by the Active Edge PT clinic setting. Thank you Micah, Annie and Kindra for hosting and making the accommodations quite inviting!  

This instructor enjoyed sharing the science of PRI with exercise science professionals like Chris Hathaway, PT’s like Kindra Fish, Anthony Book and Heather Jenny, as well as integrative practitioners like Liz Williams, LCSW and DC’s like Brett Darrington and John “Branden” Garland.  

Pelvis inlet and outlet position as it pertained to asymmetry, and polyarticular chains of muscle were discussed and described. Class participants were interested and involved in discussions and demonstrations of neuromechanics of techniques aimed at synchronizing thoracic and pelvic diaphragms for optimizing function in prospective clients. Thank you Brian Coleman, Kindra Fish, Chris Hathaway, Eva Bilo and others for your help in lab demonstrations and discussions. Thank you Anthony Book, Liz Williams and a host of others for great questions, spurring discussions about how to integrate Pelvis Restoration coursework, manual and non-manual, into the content of this weekend.  

I thoroughly enjoyed my time in the great Northwest, capped by a Mahi sandwich.  Thank you all again for the hospitality and eager learners!

As we first announced a couple months ago, we are excited to now offer a PRI Mini Residency Program, a 6-week formal program of post-professional education and mentorship for PRI-minded healthcare and movement professionals that is designed to enhance one’s understanding and application of PRI concepts, objective testing, and patient/client management. The foundational science from the Postural Restoration Institute’s three primary courses will be strongly emphasized by all PRI Mini Residency Centers, however each PRI Mini Residency Center offers a unique environment and experience, and many residency centers will also include exposure to interdisciplinary integration with other healthcare or movement professionals.  

This PRI Mini Residency Program is designed for healthcare or movement professionals who are self-directed learners, have completed the required PRI coursework, and would like to enhance their clinical reasoning, interpersonal communication and dialogue using PRI terminology with other professionals as well as patients or clients, and application skills of the science of Postural Restoration® through one-on-one clinical education and mentorship with a PRC or PRT professional at a PRI Mini Residency Center.

The PRI Mini Residency Program website page is now up and running, and applications are being accepted! CLICK HERE to learn more about the PRI Mini Residency Centers that are currently accepting residents, application details, along with answers to questions that you might have. If after visiting this page, you still have questions about this program, please don’t hesitate to contact me! Or, if you have questions for a PRI Mini Residency Center that you are interested in, you will find the contact information for each residency center on the "Residency Centers" tab of this page.

The Cervical Revolution Course last weekend was taken to a new level in it’s development of being the course that introduces " top down" concepts and the neurologic connection of the body with the brain and cranium.  What made this cervical-cranial-occlusal course extraordinary had many components. The technology provided by an international audience online revealed a growing international hunger for PRI. From the Western Pacific, Australia, Japan, Hong Kong, New Zealand and Singapore were represented. On the other side of the world students from Canada, Iceland, Belarus, Malta, Ireland, Poland and the UK were present as well as all over the USA. There was a great local representation from Nebraska in the live audience that provided energy and interest with questions, feedback and lab demonstration that all in attendance benefitted from.

One of the best questions, and one that is central to this course, is how is it that the occipital bone can move into A/O flexion on one side and A/O extension on the other if it is one bone? During tri-planer movement of this highly neurologic joint a sliding or gliding of the condyles of the occiput in the fossa of the atlas provides a rocking motion the looks like a bowl (occiput) rolling in a tri-planer motion side to side with one side going up and forward as the other side is coming back and down in a balanced alternating fashion. If this alternating/oscillating movement ceases to occur driving the occiput down into the atlas coming up on the ride side, torsions that are torque-like scoliosis patterns occur in the cranium. Hence, in this regard, the neck runs the neurologic and cranial/occlusal system.

What really made this course is not only the student participation and international diversity, but Dr. James Carlson, a world renown dentist, was in attendance. As the course got deeper into the cervical-cranial-occlusal subjects, this instructor went to student mode personally and asked Dr. Carlson for his input. I’m not sure if new students realize what a special opportunity it was to have Dr. Carlson describe occlusal issues as it applies to this course and a holistic approach it provides to all healthcare disciplines in attendance.

What then added to this course was to have PRI faculty members Louise Kelly and Dan Hoglum in attendance. Big "wow" factor for the entire weekend. Louise broke down the Standing Stomatonathic Squat in such detail that described a bottom up and top down integration of ground, vision, occlusion. She will be teaching Cervical Revolution soon and not to be missed!  Dan Hoglum is the Impingement and Instability "rock" in PRI and provided a powerful, concise description of one of the main concepts of this course being "Top Down"!  Both Louise and Dan brought "extra credit" and value along with Dr. Carlson to all our learning experience.

There is no way this weekend could have been pulled off without Jennifer Platt getting to the institute early and the last one to leave the building to facilitate the entire weekend and make it a successful learning environment for all. None of this could happen without her. Not only that, but Jen has so much experience in these courses as well as PRIVY and her knowledge and sharing what she knows gave this weekend so much more depth and color. To my "co-instructors", Dr. Carlson, Louise, Dan and Jen thank you all. And to everyone in attendance thank you for being such a great group!

The greatest part of being a part of the Postural Restoration community is the people. It always has been and always will be. The people within this community are open minded, passionate, eager to learn and not afraid to push the envelope. They care for their patients and client’s well-being sometimes greater than their own. And, what amazes me daily is the global reach this community has. On a daily basis I find myself in contact with like minded individuals in places like Egypt, Iran, Spain, Italy, Germany, Poland, South Korea, Hong Kong, Japan, and so many others. Attending this years AAPMD Collaboration Cures conference in Atlanta, our 4th meeting to date, seemed to me as wide reaching as our expanding global community. Especially after 2 years of diminished in person contact. Meeting people and reuniting with past collaborators and friends in person is more important now than ever, and it was sorely missed.

This community of integrated minded professionals allows us to present an introduction of PRI concepts to Dentists, Dental Hygienists, Myofunctional Therapists, Myologists, Speech Pathologists, Occupational Therapists, Medical Doctors, Neuro Optometrists, and others. To many the introduction of neck neutrality, body position, grounding (whether through the floor of your mouth or the floor under your feet), or arm wing among other common concepts we strive to teach and grow, are often welcomed and already being looked at and discussed but in different ways through different models. And sometimes individuals have never considered these things at all, and often times prefer to not go there. This dichotomy of professions coming together to agree and disagree from numerous perspectives on numerous subjects, is truly fun to be a part of.

Thanks to Brad Gilden, who has been instrumental in our involvement over the years, Ron Hruska was given the opportunity to teach twice over the course of the three-day PT Track and meeting. His talks included “Malposition of Airway Axial Alignment and Stomatognathic Common Compensatory Conflict” and “Peripheral Visual Cortical Influence on Central Ventilation”. And for the first time we were joined by faculty member Louise Kelley who has become involved in the AAPMD through her recent webinar and presentation of “Connecting Ground Sense and the Airway Through Arm Swing”. It was such an honor to have her presence, alongside ours, to not only present things through her own light but to strengthen our mission of collaboration as an institute with many of the individuals and organizations in attendance. If you have the chance to join Louise for a PRI course, her didactic yet easily understood ability to present material will not go unappreciated.

I recently had the pleasure of joining Tassie Cantrell and some of the accommodating Cantrell Center staff for a course in Myokinematic Restoration course in Warner Robins, Georgia.

An energetic group of learners ranging in PRI experience from PRC’s Samantha Anderson, Jamie Lochner and Cindy Rice, to anticipatory new learners like Kaitlin “not Katie” Blankenship and Sunshine Walton took to the task of learning PRI introductory concepts, theory, rationale, special tests and treatment algorithms. This group flourished during lab demonstrations with tests and according lab practice on various techniques designed to treat specific special test findings.

This instructor especially appreciated the attention to detailed questions about designing treatments to oppose FA and AF compensatory movement strategies inherent in human movement as well as the effort of all students during lab applications. One of my favorite things is watching clinicians bring the science of PRI to life during labs and case studies when applying didactic concepts, and this group excelled!

Thank you each for joining me in Georgia to perpetuate the science of PRI Myokinematic Restoration, I thoroughly enjoyed my time teaching this course!

Nestled among the hemlocks and Douglas firs, with Olympic National Park beckoning in the distance, IRG Physical and Hand Therapy in picturesque Mill Creek, WA, opened their doors to host Postural Respiration.

The clinicians in attendance were energetic, collaborative, and engaging, hailing from the worlds of physical therapy, massage, athletic training, and chiropractic. One attendee, Samarpan Buchalter, DC, plans to return to, of all places, the Amazon Rainforest in Brazil and the indigenous Yanomami Tribe to introduce the Postural Respiration concepts and techniques. PRI keeps expanding its reach!

The theme of the weekend was that of the twisted diaphragm, created by its left and right-sided differences in girth and abdominal support. Coupled with a preference for right stance, this twist creates on-going and un-relenting asymmetrical air flow patterns and a tendency toward hyperinflation. Individuals don’t recognize they’re in this state and don’t know how to resolve it. Through non-manual and manual techniques, we learned to help our patient-client by first guiding them to sense and maintain left abdominal functional concentric and eccentric activity, or a left zone of apposition (ZOA). Lung and rib cage regions that, in the pattern, are restricted, can now expand with a left diaphragm that is more respiratory, and less postural, in its role. We learned the importance of “reach”, a huge PRI concept, since it promotes diaphragm ZOA, normal thoracic kyphosis, rib cage internal and external rotation, and spinal rotation. Furthermore, reaching inhibits overactivity of the over-worked and over-trained pecs, lats, and paraspinals. The net result is alternating, reciprocal airflow for efficient breathing and effortless forward locomotion.

Thank you to models Samarpan, Christa Byler, LMT, Jonette Ford, PT, Christopher Gant, PT, and Joshua Schwartz, PT, who graciously allowed me to demonstrate objective tests and techniques. With their help, we were able to identify various patterns of overactivity and learn of their injury histories that supported the findings. Erin Rajca, PT, PRC, was instrumental in providing clinical pearls from her many years of experience, offering one-on-one expertise in lab, and acting as my human GPS Sunday morning when my Waze app was stymied by the clouds! Finally, a huge thank you to Jennifer Wright, PTA, ATC, our host site coordinator, for all the work you put into making the weekend run smoothly. Your generosity and effort were much-appreciated!