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Lima, Ohio. Home of the KewPee Burger!

This weekend I travelled to Lima Ohio to teach my last course of 2019. It is not the easiest site to get to, but it was so worth the effort. This course had 18 attendees of varying backgrounds. It’s nice to teach to a group of professionals with different perspectives. There were PT’s, PTA’s, Chiropractic Physicians, Athletic Trainers, Strength Coaches and a Pilates Instructor.  

We spent the weekend discussing optimizing patterns, breathing and compensations of the Pelvic girdle as they relate to frontal plane control of Inlets and Outlets. Most of the attendees were new to the science so teaching this integrated introductory course allows us to explore the integration of thoracic diaphragmatic breathing with Pelvis respiration to balance posture and gait.  Pelvis Restoration is known for its complex acronyms. I tried to move away from overuse of acronyms, and discussed proper position of inlets and outlets during upright function. I think this helped the new learner shift their perspective from orthopeadic thinking to the neurologic ANS control of patterns.

On Sunday, “Treatment Day!”, we discussed a pathway for treatment of the L AIC, PEC and the  Patho PEC patterned individual. We explored the triplanar position of the iliacus as it relates to swing and stance and sacro-iliac dysfunction. This is always an awesome opportunity to bring concepts of inhibition and activation of the same muscle in different planes of movement. This course allows me to dive deep into rabbit roles of pelvic respiration and thoracic diaphragm position. We had a great time integrating breathing throughout the weekend. By Sunday afternoon, the light bulbs were going off as were the “Ah-Ha” moments.

I enjoyed the banter with both Jason Russell, DC and Nick Goins, DC throughout the weekend. They were my Glut Gait guys! Jason, be nicer to Nick!
Carri Baumback, PT took her first course 10 years ago with Ron and brought her co-worker and friend Cynthia Nieberding, PT. It was great having them in the front row, not afraid to ask questions! Next time we have dinner ladies!

Alex Maag and his staff took very good care of me and our class. The interest in PRI in that great state of Ohio is growing. I look forward to seeing these clinicians grow and develop their PRI knowledge.

“When you go to Lima, you eat a KewPee Burger and rub the babies belly” – James Anderson
Well, I ate the burger but couldn’t reach the belly. Next time…..

Robert Newhelfen, DC, founder of Motus Integrative Health, describes his clinic as “a full integrative health clinic bringing new and unique treatment options to the people of Northwest Indiana.” In keeping with this vision, his clinic hosted Postural Respiration, a unique and integrative approach to addressing postural influences of rib torsion, inconsistent breathing patterns, habitual use of accessory respiratory musculature, and a positionally-restricted diaphragm. As in most PRI courses, we had an interdisciplinary group of course attendees, comprised of PTs, chiropractors, ATCs, and strength and conditioning experts in professional baseball and soccer. Also in attendance was Ruth Hennessey, MM, a vocal specialist well-known in the world of singing. Thank you, Ruth, for your insights into how singers develop faulty breathing strategies and retain undesirable tension that can affect their voice.

From the get-go, we discussed human asymmetry, most notably of the right and left hemi-diaphragms, leading to predictable patterns of muscle activity and movement. Our inherent asymmetry gives us a starting point from which we  shift our bodies and rotate. It is what an infant relies on to make its way from the womb to the external world. This applies to every developmental milestone, from crawling to running. However, when patterned muscle activity "goes rogue", from too much sitting or engaging in the same, repetitive activities, day in and day out, the results are patterned restrictions, injury, and fatigue.  

Course attendees served as one another’s case studies as they compiled PRI objective data to assess for both lower and upper body neuromuscular dys-synchrony and to guide treatment. Thank you to Rebecca Custer, DPT, and Wynne Conklin, CPT, our templates for the entire class for right BC over-activity and its pathological sibling, superior T4 syndrome. We discussed how this syndrome limits first rib mobility. The first rib is the driver behind the mechanics of the entire thorax and, therefore, must remain mobile! This course was updated a year ago. It includes a new test for the brachial chain as well as where, when, and what inhibition techniques fit into the treatment scheme. If you haven’t taken Postural Respiration in a while, it’s time for a refresher!

 
Thank you everyone for your thoughtful questions. Nate Kloosterman, DPT, OCS, gets the prize for most questions asked, keeping this instructor on her toes. A special thank you goes to Adrian Gutierrez, DC, for handling the set-up, food, sign-in, etc.   You were a gracious host and helped make this weekend an enjoyable experience.

This past weekend I travelled up to Cranston Rhode Island to teach Myokinematics of the Hip and Pelvis. Elite Physical Therapy was hosting their first PRI course! They had several clinicians in attendance and Ryan Toher, DPT was a great host. They were all new to the science of PRI as were 90% of the course attendees. This was a larger class with  45 clinicians in the room. I was joined by Miguel Aragoncillo, CSCS, PRT and Tyler Tanaka, DPT PRC as my lab assistants. They did a great job offering help during labs and comments from their experiences during lecture. The class was made up of mostly rehab professionals and strength and conditioning specialists. It was super fun meeting Tyler’s college friend Daniel Gardner, DPT aka “Gator” and helping him begin his PRI journey!

As hard as it is to be away from family and friends on the weekends and the rigors of travel, I am always excited to see the light bulbs and Ah Ha moments that new clinicians experience learning about autonomics, breathing and polyarticular chains as it relates to concepts of lateralization, habit and movement dysfunction. I enjoyed meeting my front row newly inducted PRI front row Trisha Livemore, DPT, Steve( CSCS) and Amanda Zariello,DPT, Valerie Perron, LPTA, LMT, Elizabeth Johnson, MPT, ATC and Anne Ruffus, DPT, CSCS.

A very special shout out goes to Gustavo Woff, PT who flew 15 hours from Argentina to take his first PRI course this weekend. It is so inspiring to be part of the PRI Faculty and watch it grow and spread throughout the world.  I am truly honored to be a part of the process.

Alpine Physical Therapy has been the center of advanced PRI courses for over two years. The three amigos, Chris "Murph" Murphy, DPT, PRC, Jeremiah Ferguson, DPT, PRC and Eli Zygmuntowicz, DPT, PRC hosted Cervical Revolution at their facility this past weekend and it was a pleasure seeing the guys again and having their support hosting this course. Cervical Revolution has been evolving for the past two years with course manual changes, thanks in a large part to Jason Masek, MSPT, PRC, and his diagram of the atlas and occipital bone in the left and right TMCC pattern. One of the biggest learning challenges in any PRI course is to connect a pattern to position and have a tri-planer picture in mind from a two dimension drawing from a book. Jason’s description is a vital learning tool to understand position of atlas relative to occiput before the discussion of occiput on atlas in a patho-mechanical compensation called right torsion occurs.  

In addition, several revisions to the course manual have been made with the help of Ron Hruska and Mike Cantrell to make this course flow even better.   The emphasis has become even greater on the O/A junction being the driving factor for autonomics, cranial position and especially oscillatory lateralized function. The connection with the L AIC, R BC, R TMCC and LSB cranial position, and the need to alternate and reciprocate, was integrated deeply this past weekend with ample lab time and insightful clinical discussion.

Attendees in the course included six PRC’s as well as practitioners on the verge of becoming PRC’s with much PRI exposure and practice.  Along with the "veterans" there were practitioners with just a few PRI courses under their belts including PT’s, myofunctional speech therapists, and strength and conditioning personal with a strong emphasis on working with baseball players from little league to the pro’s.  Joseph Yousefian, DDS, an orthodontist, was in attendance for his first PRI course.  He was thrown right in the middle of PRI nation and was such a valuable voice when it came to occlusion and a dentist’s perspective.  In this course the discussion on occlusion is one that is interdisciplinary, and that more often than not, we need to work with a specific dentist to help with occlusion to "free up" a neck and let it revolve!

Thank you to all attendees and especially Murph, Jeremiah and Eli. I also want to thank Ron and Mike for their mentorship over the past two years. They have been so generous in their time and energy helping me understand the content and learn how to teach Cervical Revolution. This was my first solo Cervical Revolution as a faculty member and it was such a rewarding experience to be so well prepared with the help of Ron and Mike. Also, thank you to Jennifer Platt, MPT, PRC for all of your mentorship, emails and phone calls in this learning process!

If you have attended Myokinematic Restoration in the past, but not since the course received a make-over in 2016, I suggest you strongly consider attending. If you haven’t started your PRI journey, this course is one of the PRI introductory courses, and is a great way to begin that journey. A couple of changes that were made in 2016 that I appreciate compared to the version I first took in 2004 are that now we have a lot more time for lab, we are able to discuss and spend time in lab on both of the Hruska Lift tests, and we are discussing some ankle mechanics related to the L AIC pattern.

This most recent Myokin class is an excellent representative sample of these changes.  This class was nearly 40% lab.  So everyone was able to find, feel, and experience the muscles required to inhibit the L AIC pattern.  We were able to spend a solid amount of time on the Hruska ABD and ADD Lift tests with lab and explanation of both tests.  And we had a lively discussion about how calcaneal position and mechanics influence and are influenced by the L AIC pattern.

This class had a lot of great participation, as every single participant asked a question, which helps everyone learn. My thanks to Ken Guzzardo for hosting our course. My thanks to Amy Corbin, Amanda McDevitt, Jaclyn Marino, Ivan Salazar, Kristian Flores, Aidan Scotland, and Jamil Skakoor for their excellent questions and re-states. Really, my thanks to all the course attendees for their interest and many awesome questions.  

It was a true pleasure to have Neal Hallinan as the lab assistant. He’s a PRI Black Belt, and he’s speaking at Interdisciplinary Integration in April 2020. He’s going to kill it! 

As one attends conferences organized by various boards and professional groups of education, it becomes apparent that many of them, no matter which organization is of the primary focus, are alike. This is now our second time attending the AAPMD Airway Summit, and it again was distinguishable from any other conference in the past. I believe it is important to understand the truly collaborative effort of all the organizations involved as the level of discussion was already set high because of the many disciplines present during these four days.

We were proud to join a long list of sponsors which included; The American College for Advancement in Medicine, The American Academy of Physiological Medicine & Dentistry, The Academy of Applied Myofunctional Sciences, The American Academy for Oral Systemic Health, The Institute of Physical Art, The Foundation for Airway Health, The North American Association of Facial Orthotropics, The International Academy of Oral Medicine & Toxicology and the American Academy of Craniofacial Pain.If you made it through the list above, it may be easier to understand the vastness of conversations had, professions in attendance, speaker topics presented and overall interest in integration. As I spent four days discussing and fielding various questions related to the relevance and strong presence of our Institute at this event, we immediately became aware of the potential and power that this science of Postural Restoration can have on a collaborative group of minds which we were surrounded by. After having these conversations between various Dentists, Oral Facial Myologists, Hygienists, Speech & Language Pathologists, Craniofacial Pain Physicians, and many other systemic health and physiology professionals, their desire for integrative and collaborative care was at an all-time high.

Many of them however were curious and sometimes cautious about where to begin, who to reach out to, and how those other professionals may benefit their patients overall plan of care and most importantly their treatment outcomes. Then comes “The Important Collaborative Role of PT and Airway Health” which was presented by Ron Hruska, Gregg Johnson and Brad Gilden. Which in and of itself was a milestone in the collaborative effort to introduce the important role PT’s have in viewing and treating airway and all other forms of dysfunction. Not only is the role of the physical therapist becoming more apparent but the roles of ALL individual professionals involved are becoming more appreciated. We were fortunate to have the presence of PRC, Steve Cuddy who has been practicing PRI and integrating with other disciplines in the Austin area for many years. Steve, it was truly an absolute gift to have you there as a representative of our credentialed providers across the country and abroad as these other professions look to you and others like you, who have become a PRI provider. The professionals mentioned above will be reaching out to all of you in the days, months and years to come, as a resource for integration of the science of PRI within their approaches of treating Airway Dysfunction and overall health!

“Attending the Collaboration Cures Airway Conference was an eye-opening, yet reassuring experience.  Eye-opening in the sense that the collection of airway-related issues is more complex and prevalent than, I believe, anyone truly understands.  Reassuring because I’m more confident than ever that we as PRI practitioners are uniquely positioned to play an integral role in the detection and treatment of obstructive airway conditions. Returning back to our homes, I’m sure that all attendees are more hopeful after listening to and meeting a wide range of passionate practitioners. This would include Ron who gave a few very insightful presentations.  I’m here to tell everyone in PRI Land that airway obstruction and the anterior neck are areas that we understand, thanks in very large part to the information that Ron has put together for us. My hope is that we make that clear to all allied airway health professions in our communities as we continue our own Postural Restoration journeys.”
– Steve Cuddy

A huge thank you to Dr. Howard Hindin, and the AAPMD Organization for once again including us in this effort. Dr. Hindin was awarded the “Howard G. Hindin, Breath of Life Award” for his dedication and role in this collaborative movement and because of his efforts Airway Health has been brought to the forefront of Healthcare. Thank you again and we look forward to continuing our involvement with and alongside you all. Next year’s Collaboration Cures conference will be held in Seattle, on November 12-14th! See you there.

On page 16 of the Cranial Resolution manual, there is a bullet I wrote that states ‘If we don’t balance rotational events through hemispheric oscillation, occipital alternation or lateralized rhythm, we remain resolved to compensate for our rewarded over-reaction and autonomic drive to repeat.’ 

Yet there were 14 PRCs, 1 PRT and the rest of the class who have taken a minimum of 7 PRI courses. Needless to say, they were “repeaters”. Their drive to continue to learn how to balance rotation with frontal oscillation is on a continuum. The host couple emulates this drive. Thank you Josh and Katie Olinick for hosting another PRI course in the manner you did. (The coffee was just a tad bit cold. Just kidding. I did not need the sugar. Your sweetness diffused into my body before my first sip.) Your hospitality and reception is truly reflective of “home”. Sangini Rane PT, PRC thank you for bringing a patient for all of us to evaluate and make suggestions reflecting autonomics and the course material. Everything about this course I love. The material has been strengthened over my last 30 years of clinical practice. And the messages are being delivered to a body of people who now can appreciate what my autonomic and somatic nervous systems were integrating 30 years ago, with a platform, called ‘PRI’. Any time I get a hug from Susan Henning PT, PRC I feel better than a cold cup of coffee. 

Thank you Forward Fitness (Mike) for hosting Pelvis Restoration this past weekend. Fourteen healthcare and fitness practitioners were attending their FIRST PRI course. Seasoned PRI course attendees were also present and helpful for our newbies. I am more convinced than ever getting a sound foundation and understanding of the three primary PRI courses helps us the most clinically to assist our patients, athletes and clients.

Appreciation of PRI objective tests and how they demonstrate PRI neutrality, need for clinical inhibition of muscle, frontal plane integration, and restoring the human gait pattern for a reciprocal and alternating pelvis were capitalized this past weekend. Most importantly, hitting home how the respiratory and pelvic diaphragm and synchronization of the left and the right side for integration of all the above to occur.

I truly appreciate all that attended and sacrificed a weekend away from family and friends to learn. It was a beautiful fall weekend, but we rocked it inside learning and developing our skills.

A shout out to Jon, Tim, and Nancy who brought treatment tables. Nancy Hammond my amazing lab assistant, your passion for PRI is inspiring. Again, thank you Mike for hosting your first PRI course. It was truly humbling to teach you all.

This past weekend, I visited one of my favorite places to teach PRI courses. The energy of  "the City that never sleeps" always seems to match the energy and enthusiasm for the science of PRI. This was my third trip back to New York to teach a class. On a personal note, it was great to bring my husband Chris and daughter Devon along again this weekend. We basically ate our way through the city and thankfully were able to walk most of what we indulged on off over the course of the 4 days! A friend and future PRT Kyle Langworthy’s brother Brandon Langworthy, DPT was attending his first PRI class. Brandon lives close to me in NC, so I look forward to seeing him again as well as the other attendees that were taking their first or second PRI course. I was also honored to be part of Kasey Aiken’s mentorship as she prepares to teach this course next year. I will let Kasey share her thoughts and experiences from the weekend. 

– Jen Poulin

From Kasey: "The class brought the energy from the city into the two full packed days of learning Myokinematic Restoration. With 80% of the class being their first PRI course ever, the questions and ability to learn and regurgitate the material was very impressive. We even had a DO that lives in Belgium fly over to learn the science of PRI. The combination of strength and conditioning specialists, PTs, and even PT students in the course is what keeps PRI applicable and beneficial to all different disciplines. They mastered exercises in lab to reposition the pelvis as well as strengthen the pelvis in the new neutral state. The attendees began to understand the correlation between the infamous Hruska ADDuction and ABDuction lift scores in regards to the gait cycle. Being able to tag team teaching with Jen Poulin was an absolute honor and appropriate considering she was the first faculty member to present Myokinematic Restoration to me several years back. A thanks to Brad Gillen, for assisting in lab, we couldn’t have done it without your help and expertise to hit home for such a large group of attendees."

“I have several cases I can apply this to already.”

“The course met the objectives to the full extent. Loved the course!”

“I am so glad I finally got to do a PRI course!”

“I learned a tremendous amount of information that my client base can benefit from.”

The physical therapy team of Charles George VA Medical Center hosted the most recent Postural Respiration course. This facility is considered among the top VA hospitals in the country, noted for its clinicians’ care and expertise. Surrounded by the splendor of the Blue Ridge Mountains, the 40 attendees, comprising PTs, OTs, PTAs, ATCs, DCs, and one student contemplated the asymmetrical diaphragm and its influence on pelvic-femoral and rib cage position and function. Movement starts with diaphragm, driving our lower half to one side while our upper half counter-rotates to the other. It’s a neurological concept, and it’s what allows humans to be adept at things like throwing a ball, dancing, and doing flips and twists mid-air. Rib cages come in all shapes and sizes, formed not just by genetics but also by the activities a person engages in, positions they hold themselves in, and his or her unique responses to physical and emotional stress. However, regardless of rib morphology, every cage is under the influence of a powerful diaphragm that pulls it to the right, driving predictable patterns of air flow and movement. When not countered, and if skewed too far for too long, the result is pain, rib deformity, poor physiology, shortness of breath, anxiety, etc.

Lab time was generous to allow proficiency in PRI techniques, both manual and non-manual, and objective tests that indicate an individual’s neurological patterning and presence of pathology. Attendees experienced the power and swiftness of PRI’s neurological techniques — inhibition and facilitation – to create changes to pathology-producing patterns. There isn’t a patient population out there that wouldn’t benefit from the PRI approach. Thank you to lab assistants Josh Owen, ATC, PRT, and Tracy-Lynn “I am SO ready to get my PRC” Schuster, DPT, whose guidance and clinical expertise provided clarity throughout the weekend. Great to see PRC clinics well-represented: Josh Olinick’s Steps for Recovery, Jen and Chris Poulin’s Sandhills Sports Performance, Advance PT, and Tracy Lynn’s Schuster Physical Therapy. Thank you to our avatars Debra Albrecht, PT; Nathan Crosby, DPT; Charles Fairbanks, PTA; Anthony Figuera, DPT; Linda Gutowski, DPT; Carl Heldman, DPT; Megan Humpal, PT; Caroline Lounsbury, ATC; Christiana Marron, DPT; and Pete West, DPT. Also thank you to our reader, Onyeamaechi Arinze, PT (my apologies again for botching your name all weekend. If we meet again, I’ll need to shorten it to “O”!). Finally, thank you so much to our hosts, who made the weekend go smoothly: Nathan, Anthony, Carol Harty, Deanna Mihok, Monica Sety, Keith Silcox, Pete, and Sharon Wisner. It was a pleasure to meet you all! Charles George VA will be hosting Pelvis Restoration in 2020. I highly recommend a visit to Asheville for this course. Be sure to treat yourself to a few days before or after the course to enjoy the gorgeous hikes and all that Asheville has to offer.

It was another great PRI weekend in Santa Barbara, CA. Thank you Peter for hosting this past weekend. The breakfast burritos and fruit and your hospitality were amazing. The theme of the weekend was applying the science and concepts of PRI at the pelvis with patients with simplicity. Understanding these concepts and tests assist with making PRI non-manual techniques much easier with better patient outcomes. It was a great group of practitioners with a passion for PRI and learning. Many were attending their 3rd or 4th PRI course and we had three newbies in the group. Thank you for a wonderful weekend. I was humbled to be your "coach" for the weekend.

Rosencutter Ultra Fitness, also known as Rosen-Cutting Edge Fitness, was the location of their second hosted PRI course this past weekend. Nick Rosencutter is always looking for a way to help his clients improve whether it is thru strength and conditioning, nutrition, the latest in soft tissue workand especially PRI as it applies to performance and rehabilitation. Rosencutter Ultra Fitness had six of their trainers in attendance including Nick and they have a team approach integrating PRI into client programming. Position prep is part of their programming to provide sense awareness for neutrality before, during and after workouts. We discussed this weekend that PRI loves extension for power and performance–we just don’t want you to stay in extension. Equally, and perhaps more important, is the issue of rest and neutrality via flexing into neutral with adequate rib internal rotation.

The job of strength and conditioning professionals is to help clients and athletes become stronger, faster, more skilled at movement and especially durable whether you are a grandmother picking up grand kids or an olympic speed skater. Since this class was attended by so many strength and conditioning individuals, the issue of "saggitalization" was explored as well as the ability or inability to maintain or achieve competent transverse plane-ability in rotational sports. Since all sports require rotation for power and performance, the ability to orient a pelvis fully left and right then have adequate and full counter rotation of a ribcage is a must for what is known as separation of torso and pelvis.

Testing and non-manual techniques are always "ah ha" moments as they relate to position pelvis, femur, ribcage, scapulae and even neck. What is driving these positions in this course and the best answer when a student is called upon? The diaphragm of course! Manual techniques included the big three that we cover in Postural Respiration as well as a two person infra-clavicular pump that is often needed for a person that loves to stay in extension even after the best efforts via non-manual techniques to get them neutral. Also in attendance were physical therapists, a massage therapist and an ATC from Alaska who was travelling locally with the hockey team he works with. Shout out to Nick and all of his staff for their support and enthusiasm this weekend.