How did you become interested in PRI and when did you attend your first course?
This story begins in the late 1990’s. Kyndy Boyle was a member of our year long Maitland Joint Mobilization Training group. She took a class with a man who talked a lot about hamstrings and she found it interesting. She shared her thoughts with our group -although we were all about joints, not muscles – and she went on to present about this new idea to our local Triangle Orthopaedic Study Group. This was a very different approach to rehab! In 2002 or 3, Kyndy, now a professor with the new Elon University PT program, brought Ron Hruska to participate in an extracurricular Elon University program open to local PT’s. I attended the lecture he presented and recognized then that complicated and conception challenging as it was, this was the most comprehensive, bio mechanical and holistic methodology I had encountered in some 15 years of PT experience.
Our clinic, Advance Physical Therapy, became a certified PRI clinic in 2008 when Joe Belding, my colleague, and I both went through the PRI certification process. This exacting process gave a quantum leap in my understanding of and ability to apply PRI concepts. Now, 15 years later, I do not find any other rehabilitation approach which comes close to the breadth and depth and effectiveness of Postural Restoration. It provides a constant expansion of insight, of integration and of perception of the incredible complexity of our experience of living.
What would you say to other PTs who are considering taking a PRI class or becoming PRI Certified?
Postural Restoration is at the cutting edge within the medical field, and it will continue to evolve. Someday, this framework will be recognized for the reality it represents and asymmetry, right dominant patterned movement, and system integration will be widely accepted and utilized. The concepts are intricate, and it takes time to shift from a one to a three dimensional, integrative perspective. But it is worth the effort and time, and will enhance your practice and your thought processing in remarkable ways.
What is the typical patient you see in your clinic?
Advance Physical Therapy is a PT owned private practice. We treat a varied patient population: from infants to the elderly, having a wide range of concerns. Three of our therapists, me included, specialize in the treatment of scoliosis. About 65 percent of my current patient population has scoliosis as a primary concern or as a contributor to pain and dysfunction. The patients I treat typically range in age from preteen to elderly. A majority of our patients come to us by word of mouth. These folks tend to be interested in their health and wellbeing and motivated to work on challenging therapeutic activities.
What sparked your fire on the research and treatment of Scoliosis (Schroth, PRI, any other Info?)
The fourth and last day of the Advanced Integration course culminates in a discussion of scoliosis. My first experience of this conceptual coming together of triplanar lower body/upper body/ respiration and patterning was 2005. Each year at Advanced Integration, my interest in this complex, whole body, compensatory development became more acute.
In 2006, a 14 year old girl with scoliosis came to me for treatment. I knew at this age she was especially vulnerable for curve progression. I also knew that our work together would affect her entire life ahead of her and I was not wanting to make any mistakes! I sent her to Ron for consultation and followed his advice in progressing her. Her curve reduced from 40 degree Cobb angle to 27 degree Cobb angle. This was a heartening experience!
My German husband noticed this interest. He learned of the German Schroth Method for scoliosis rehab, practiced in Europe for nearly 80 years but practically unknown in the United States. He encouraged me to pursue this specially by taking one of the 2 trainings available in the United States. My colleague, Jean Massé and I attended a 10 day scoliosis specific training in the Schroth Methodology taught by Beth Janssen, PT and Patti Orthwein, PT. This course was developed by Dr. Manuel Rigo of the Barcelona Scoliosis Physical Therapy School who learned these techniques from Christa Lenhert-Schroth, the daughter of the originator of the work, Katharine Schroth.
The "3D" asymmetrical concepts we learned in this scoliosis specific course corresponded in many ways with the fundamental principles of Postural Restoration. Although PRI was more bio mechanically sophisticated, the Schroth Method added invaluable perspectives on evaluation of specific curvatures, clinical reasoning for treatment of these specific curve types, postural and movement precautions and an emphasis on kinesthetic self awareness of body position and breath.
Preparation for my presentation at the 2014 Interdisciplinary Symposium entitled: "The Influence of Position and Breath in Treatment of Curvatures of the Spine Utilizing PR and the Schroth methodologies" gave me an opportunity to delve deeply into these two approaches.
Shortly after this Symposium, I attended my first SOSORT meeting in Wiesbaden, Germany. SOSORT is an international organization of doctors, orthotists and PT’s interested in the conservative treatment of scoliosis. Each yearly conference is scheduled in a different country. Presenters share their research. My abstract was accepted for a poster presentation. I met many interesting people and heard many interesting presentations. The highlight of this event for me was meeting and visiting with Krista Lehnert-Schroth, daughter of the originator, Katharine Schroth, and author of the book, "Three Dimensional Treatment for Scoliosis". In 2016, I again attended the SOSORT meeting- this year in Banff, Canada. Here I met a PT educator, author and researcher, Dr. Josette Bettany-Saltikov, who expressed sincere interest in the PRI approach. In December of 2016, Dr. Bettany-Saltikov offered me the opportunity to write a chapter on the Postural Restoration approach for the book she was co-editing entitled, "Innovations in Spinal Deformities and Postural Disorders. My colleagues, Jean Massé and Lisa Mangino cooperated in this endeavor.
Can you tell us something more about the chapter you authored on scoliosis.
I believe the framework provided by PRI would help many patients the world over to achieve better system balance and function. The hope for this chapter is that it will inform practitioners interested in spinal issues, including scoliosis, of a more accurate, asymmetrical model of human biomechanics than the current common assumption of human symmetry. Basic concepts addressed in this chapter include: innate human asymmetry, the concept of neutral posture within an asymmetrical system, the power of respiratory influences, right side dominance as a result of innate human asymmetry, muscle chain activity and the left AIC, right BC pattern and the perspective ofbio mechanical dysfunction beginning in the Sagittal plane. These concepts are related to scoliosis issues throughout the chapter.
What areas of patient care excite you the most?
What I love most is working with others in the realm of breath and sensation. When a patient achieves the ability to allow a diaphragmatic breath, the room becomes quiet and calm. When a patient begins to experience movement flow/ integration – often in a "static" position, we share a feeling of satisfaction. I am grateful that as this patient is processing their sensations, I too can process my sensations. We breathe together.
Human asymmetry predisposes all humans to have right side dominance. Scoliosis is an extreme progression of their pattern. In PRI, we all work with scoliosis to some degree with every patient. What is compelling to me about working with patients with diagnosed scoliosis ( greater than 10 degrees Cobb angle) is the process of their coming to understand their pattern, and finding new sensations to guide them to greater balance. It is a total body process and breathing is a key component.
Who have been your mentors in your career?
I have many years behind me in which I learned important lessons from many people. I consider this question an opportunity for me to remember and thank my guides:
Charlotte Selver gave me embodiment and reshaped my life through her Sensory Awareness work.
Among countless gifts, John G. Bennett awakened my conscience and gave me a sense of purpose.
Irmis B. Popoff trained me to be able to meet unexpected circumstances and to serve.
Andrew McDonough at NYU communicated a love of human biomechanics.
Joy Devins and Tracy Holtzman helped me navigate hospital PT in my early days at UCSF.
Krista Clark mentored me in Maitland, gave me manual expertise and helped me start my private practice.
Kyndy Boyle led me to Postural Restoration.
My husband, Hans, has endlessly supported me and urged me to take on new challenges.
My son, Max, has repeatedly helped me formulate my thoughts and ideas.
Beth Janssen opened the doorway for me to appreciate and apply the Schroth method.
My colleagues, Joe Belding, Jean Massé, Lisa Mangino, Nancy Toole, Beth Elder, Shella LoBianco and Deana McCollum are a constant source of learning and growth, sharing and goodwill.
My patients keep my mind agile and my skills growing with their concerns and questions.
Who have been your mentors within PRI?
Despite the challenges of trying to follow the thoughts of a brilliant, integrative thinker, I am so grateful to Ron Hruska for sharing his understandings and insights. I have attended nearly every Advanced Integration course since 2005 in order to follow his evolution. Every year has been unique and revelatory. As the Institute courses continue to evolve, these extraordinary concepts continue to expand in depth and breadth. Ron continues to push our boundaries yearly at the Interdisciplinary Symposium and through his explorations of neuro-sensory and visual realms.
How do you go about mentoring others in your profession?
I have encouraged all of my colleagues, current and past, to take on the PRI certification challenge. We encourage all PTs who express interest in our practice to take PRI courses. We expose volunteers at our practice to Postural Restoration treatment and encourage these potential PTs to remember the power of this methodology. I also feel that presenting about PRI and writing about PRI are forms of mentoring.
What advice would you give to other private practice owners who want to integrate PRI at their clinic?
I have already said it multiple times: this is the most effective evaluation and treatment modality I know of in Physical Therapy. It is well worth the investment of course work. As the clinicians understanding grows so do effective interventions. Patient success rates increase, so do word of mouth referrals. It is a good business decision to begin the process of becoming a certified clinic.
What types of activities do you enjoy doing in your free time?
Before I started PT school (age 34), my early experience was shaped by the work of Charlotte Selver, J.G.Bennett, and Irmis B. Popoff. I learned deep sensing of fundamental forces in myself: gravity, support, energy; how one could relate to others, to the environment, how to listen. I learned about self-study, meditation, movement practices, how to work with others for a greater good. I was exposed to big ideas of the world and our place in it. These teachers and experiences were transformative on all levels and continue to be my touchstone.
