This advanced lecture and lab course explores the biomechanics of contralateral and ipsilateral myokinematic lumbo-pelvic-femoral dysfunction. Treatment emphasizes the restoration of pelvic-femoral alignment and recruitment of specific rotational muscles to reduce synergistic predictable patterns of pathomechanic asymmetry. Emphasis will be placed on restoration, recruitment, and retraining activities using internal and external rotators of the femur, pelvis, and lower trunk. Guidance will be provided on how to inhibit overactive musculature. This will enable the course participant to restore normal resting muscle position. Participants will be able to immediately apply PRI clinical assessment and management skills when treating diagnoses such as piriformis syndrome, ilio-sacral joint dysfunction, and low back strain.
Education Level: Advanced
Student Faculty Ratio 16:1
Instructional Methods: Lecture, demonstration & lab, clinical application, case studies, and Q&A
Live Stream courses will take place from 8am-5pm CT each day, and certificates of completion/CE credit will be awarded the following week after completion of the course evaluation survey and short post-test. For more information on whether your state/organization is approved for CE approval, please click on the “CE Approval” tab. Live Stream courses will be engaging, interactive and include demonstration of objective testing and/or non-manual techniques, in addition to course attendees being able to ask questions throughout the course. All that’s needed on your end is reliable internet access, a webcam, microphone and speaker (or a smart phone can be used if you do not have a computer or laptop with this capability) to utilize ZOOM for the live stream course. The ZOOM links for the live stream course will be included in the confirmation email. The course manual will be shipped directly to you 1-2 weeks before the course. *International registrants are discounted $30 since we do not ship manuals internationally, however you will be able to print the digital manual if you so choose. A digital version of the course manual will be added to your PRI account the week of the course. In addition, participants will receive access to the recording of the live stream course for 14 days to review the material, and re-watch any material that may have been missed due to connection issues. Those who attend in-person during a live streamed course will also receive access to the recording for 14 days. Extensions beyond this 14 day review are not available. ***Please note: In order to receive access to the recording for review, you must participate in person on the Live Stream course with your camera on for at least half of the course (7.5 hours). If you sign up for the course and do not participate in at least 7.5 hours of the live stream, you will not receive the recording and you will not be refunded. Also, once course manuals have been shipped (or the digital version has been added to your account), there will be no refunds for cancellations.***
Day One
| 7:30am – 8:00am | Registration and Light Breakfast |
| 8:00am – 9:00am | Left Anterior Interior Chain (AIC) Pattern and Pelvic Joint Dynamics |
| 9:00am – 10:00am | Lumbo-Pelvic-Femoral Capsuloligamentous Issues |
| 10:00am – 10:15am | Break |
| 10:15am – 12:00pm | Femoral Internal and External Rotators |
| 12:00pm – 1:00pm | Lunch (on your own) |
| 1:00pm – 2:00pm | Myokinematic Influences on the Pelvis and Femur |
| 2:00pm – 3:00pm | Examination Tests and Assessment:
|
| 3:00pm – 3:15pm | Break |
| 3:15pm – 4:15pm | Examination Tests and Assessment (Lab) |
| 4:15pm – 5:00pm | Repositioning Through Integrated Isolation (Demonstration/Lab) |
Day Two
| 7:45am – 8:00am | Sign-In and Light Breakfast |
| 8:00am – 9:00am | Myokinematic Functional Relationships |
| 9:00am – 10:00am | Examination Tests and Assessment
|
| 10:00am – 10:15am | Break |
| 10:15am – 11:00am | Examination Tests and Assessment (Lab)
|
| 11:00am – 12:00pm | Treatment Considerations and Myokinematic Hierarchy |
| 12:00pm – 1:00pm | Lunch (on your own) |
| 1:00pm – 3:00pm | Treatment Considerations Using the Hruska Adduction Lift Test (Demonstration and Lab) |
| 3:00pm – 3:15pm | Break |
| 3:15pm – 3:45pm | Case Studies |
| 3:45pm – 4:30pm | Myokinematic Restoration Inhibition Programs |
| 4:30pm – 5:00pm | Left AIC Related Pathomechanics (Appendix)
|
Muscular Structures of the Pelvis
IC Adductor (Ischiocondylar portion of the adductor magnus)
Internal and External Femoral Rotators
Lower Half Pelvic Musculature (Gluteus Maximus, Levator Ani, Coccygeus, Pubococcygeus, Adductors, Obturators)
Upper Half Pelvic Musculature (Piriformis, Gluteus Maximus, TFL, Psoas)
Ligaments
Sacroiliac Ligaments (anterior/posterior) Anterior Ligaments: Iliolumbar, Sacrospinous Posterior Ligaments: Interosseous, Long Dorsal, Sacrotuberous
Femoral Acetabular Ligaments: Iliofemoral, Pubofemoral, Ischiofemoral
Anterior Interior Chain (AIC)
Muscles: Diaphragm, Psoas, Iliacus, TFL, Vastus Lateralis, Biceps Femoris
Opposition Muscles: Hamstrings, Gluteals, Internal Obliques
There are two anterior interior polyarticular muscular chains in the body that have a significant influence on respiration, rotation of the trunk, ribcage, spine and lower extremities. They are composed of muscles that attach to the costal cartilage and bone of rib seven through 12 to the lateral patella, head of the fibula and lateral condyle of the tibia. These two tracts of muscles, one on the left side of the interior thoraco-abdominal-pelvic cavity and one on the right, are composed of the diaphragm and the psoas muscle. With the iliacus, tensor fasciae latae, biceps femoris and vastus lateralis muscles this chain provides the support and anchor for abdominal counter force, trunk rotation and flexion movement.
FA = Femoral Acetabular (femur moving on the acetabulum)
AF = Acetabular Femoral (acetabulum moving on the femur)
Left AIC = Left Anterior Interior Chain
FA IR = Femoral Acetabular Internal Rotation
AF IR = Acetabular Femoral Internal Rotation
The patient lies on his or her side with the lower leg and hip flexed (90 degrees). Stand behind the patient and passively flex, abduct and extend the hip to neutral while maintaining 90 degrees of knee flexion. Passively stabilize the pelvis from falling backward and allowing femoral internal rotation to occur. Make sure the top innominate is positioned directly over the bottom innominate so the frontal plane starting position does not give any false positives (top innominate too cephaled) or false negatives (top innominate too caudal).
A positive test is indicated by a restriction from the anterior-inferior acetabular labral rim, transverse ligament, and piriformis muscle or impact of the posterior inferior femoral neck on posterior inferior rim of acetabulum that does not allow the femur to adduct; possibly secondary to an anteriorly rotated, forward hemipelvis. Usually seen on the left especially if left Extension Drop Test is positive in a Left AIC oriented patient.
The patient is positioned in supine with both thighs on the table. Both hips and knees are flexed to the chest. Passively lower one leg over the edge of the table while helping the patient hold the untested knee close enough to the chest to maintain the low back against the table. Do not allow hip abduction to occur past zero degrees on the tested extremity while passively dropping the FA joint into extension.
A positive test is indicated when the tested lower extremity (usually the left) is restricted in hip extension because of the forward orientation of the tested side compared to the other. If both femurs do not approach the edge of the mat or table the patient is tested on, the innominates are rotated forward bilaterally and the psoas muscles are on slack. Placing the femur in “neutral” is actually placing the patient’s femur in external rotation. This tightens the TFL and VL and restricts hip extension.
There is also a rotary component to this issue, especially seen with limitation in hip extension on one side. Since the forward, anteriorly rotated pelvis accompanies sacral rotation to the contralateral side (right rotation on a right oblique axis or left rotation on a left oblique axis) the iliofemoral ligament will also limit extension when the femur is externally rotated by the therapist, through testing with the femur in a “neutral” position.
The femur in this case will not approach the patient support surface without femoral internal rotation and or through luxation (i.e., “click”) of anterior superior femoral head moving forward under the superior anterior condyloid labral rim of acetabulum.
The patient is positioned supine with knees maximally flexed and together, and feet flat on the table. Passively rotate the legs to the trunk’s resting state with one hand, while stabilizing the trunk with the other hand (placing it on the anterior lower ribs and sternum). A yardstick may be used to measure the distance from the mat to the upper-most point of the superior knee, while maintaining the opposite posterior thorax contact with the mat. Repeat the test in the other direction.
A positive test is indicated when the legs do not rotate in one direction as compared to the other. For example, the legs are restricted in rotation to the left (i.e., the legs do not rotate to the left as they do to the right as measured through the use of an upright ruler). This means that trunk rotation is limited more to the right secondary to probable left hip anterior rotation and sacral-lumbar orientation of the spine to the right. Therefore, postural restoration should be initiated at the left lower extremity to address left mechanical instability and maintain proper restored pelvi-femoral neuromechanics.
This test is used as a Myokinematic measurement with each grade reflecting muscle position, strength, and neuromuscular ability. The test is named for the leg, which is placed on the examiner’s shoulder. (Patient is lying on their right side with left ankle placed on examiner’s shoulder – “Left” Hruska Adduction Lift Test.)
Position
Patient sidelying – back rounded
Uppermost lower extremity resting on therapists shoulder (neutral hip, extended knee)
Lower leg in flexed position
Maintain pelvis in a neutral position (do not allow upper pelvis to rotate forward or backward)
Mechanics
Step 1: ask patient to raise ankle of flexed lower leg to upper knee
Step 2: have patient raise flexed lower knee while keeping ankle to the knee
Step 3: patient will then raise lower hip while maintaining the above positions
Discontinue test at the step patient is unable to perform
Grading Criteria
LEVEL 0
Inability to raise lower ankle off mat or table.
Obturator weakness of flexed extremity.
LEVEL 1
Ability to raise lower ankle to upper knee.
Inability reflects either weakness of FA external rotators or AF stability of active extremity.
LEVEL 2
Ability to raise lower knee and ankle.
Inability reflects instability of AF and weakness of adductor magnus and obturators or an anterior tilted and forwardly rotated pelvis with accompanying FA IR weakness secondary to long position of ischiochondylar adductor and short position of gluteus minimus, medius and TFL.
LEVEL 3
Ability to maintain above position while lifting lower hip off table slightly.
Inability reflects weakness of FA stabilizers on extended extremity including the short head of the biceps femoris and adductor magnus and possibly bilateral AF stabilizers including muscles of the pelvic diaphragm and lower gluteus maximus.
LEVEL 4
Ability to raise hip completely off mat or table to level of patients shoulder and examiner’s shoulder.
Inability reflects lack of core lumbopelvic femoral strength and more than likely the internal obliques on side of extended leg and external obliques on side of flexed leg.
LEVEL 5
Ability to raise hip above level of the patients shoulder and equal to examiners shoulder.
Inability reflects patient’s strength and neuromotor proprioceptive skills to shift hips.
This test is used as a Myokinematic measurement with each grade reflecting muscle position, strength, kinesthetic awareness, and neuromuscular ability. The test is named for the leg, which is placed on the wall (Patient is lying on their left side with right foot placed on the wall – “Right” Hruska Abduction Lift Test).
Position
Patient sidelying with upper leg extended and aligned with hip and shoulder.
Adjust position of knees to wall, so that top knee is above the level of the ipsilateral shoulder.
Lower leg is flexed with lower toes positioned on the wall directly under the top foot and placed on 4 to 6” bolster.
Top palm should be placed flat on surface in front of chest and upper hand under head.
Mechanics (Discontinue test at the step the patient is unable to perform)
Step 1: ask patient to press bottom toes into wall to stabilize pelvis
Step 2: instruct patient to press bottom hip into the surface to engage lower abs and lower adductors
Step 3: ask patient to turn and raise bottom knee up or inwardly using lower ischiocondylar adductor and anterior gluteus medius, without moving top hip backwards.
Step 4: turn top heel up or top toes down without lowering bottom knee or moving top hip forward.
Step 5: attempt to raise top leg off wall while trunk and hips are stabilized in previous positions.
Grading Criteria:
LEVEL 0
Inability to position top leg in alignment with top shoulder and hip and with top knee above top shoulder without experiencing top hip impingement, sacral iliac pain or low back pain.
Malaligned pelvis and poor integration of adductors, abductors and FA rotators in frontal plane.
LEVEL 1
Ability to push bottom hip into surface.
Inability reflects weakness in bottom internal oblique and transverse abdominis or bottom quadratus lumborum or top external obliques.
LEVEL 2
Ability to raise or turn “in” bottom knee without moving top pelvis backwards.
Inability reflects poor strength or kinesthetic awareness of ischiocondylar adductor or anterior gluteus medius; or lax iliofemoral – pubofemoral ligament.
LEVEL 3
Ability to rotate top extremity inward (FA IR) without moving top pelvis forward.
Inability reflects poor strength or kinesthetic awareness of ipsilateral gluteus minimus and anterior gluteus medius, or impingement of medial femoral head on anterior medial cotyloid labral rim secondary to forward, anteriorly rotated contralateral pelvis.
LEVEL 4
Ability to raise top leg completely off the wall and hold without using lateral trunk muscle.
Inability reflects poor integration between contralateral hip adductors, and ipsilateral hip abductor (gluteus medius).
LEVEL 5
Ability to move correctly abducted top lower extremity into extension without extending low back or flexing knee or rotating leg externally (FA ER).
Inability reflects inability to extend leg with gluteus maximus during concomitant abduction and FA stabilization provided by adductors (IR’s) and anterior gluteus medius and TFL.
These references are attached below as PDF files. After clicking on them, you may have to “Allow Add On” if it pops up an error message at the top of the internet browser. You also may need to download a free version of PDF software, allowing you to view the articles below. Please contact us if you continue to have difficulty accessing the articles below.
Hruska, R. Pelvic stability influences lower extremity kinematics. Biomechanics. June 1998.
Dowling R, Hruska R. Hamstring injuries require triplanar assessment. Biomechanics, Feb 2003.
Licensed Physical Therapists and PT Assistants
Licensed Occupational Therapists and OT Assistants (Classification Codes)
Licensed Chiropractors
Certified Athletic Trainers
Certified Strength & Conditioning Coaches
Certified Personal Trainers
Licensed Massage Therapists
Other Healthcare and Fitness Professionals
PRI welcomes any licensed healthcare or certified fitness professional to attend our courses. You may be asked to submit your license to practice as a healthcare professional or qualified fitness or strength coach certification (though an organization that is recognized in the United States) to attend PRI courses. Students studying to become a healthcare or fitness professional at an accredited university are encouraged to enroll, and may be asked to provide enrollment status and program/degree information. If you have questions about whether you are eligible to complete PRI courses, please contact us. Attendees are responsible for following their state statutes regulating their professional practice. A certificate will be awarded to attendees upon completion of this course or any of the other PRI courses.
Accessible Learning Environments
All participants in Postural Restoration Institute™ (PRI) continuing education courses are entitled to an accessible, accommodating, and supportive teaching and learning environment. Participants have the right to request accommodations and the responsibility to provide disability documentation that supports those requests. PRI has the right to establish eligibility guidelines in accordance with both law and policy regarding disability and provide those accommodations that appropriately provide equal access to the programs and activities it sponsors.
A Certificate of Completion for 15 contact hours is awarded to attendees upon the successful completion of this course. Before attending a course, please verify CEU acceptance with your profession’s regulating body.
Physical Therapists and PT Assistants
In the states where PRI is sponsoring courses and where approval through state American Physical Therapy Association (APTA) or licensing agencies is required, PRI will apply for approval for CEUs for Physical Therapists and Physical Therapist Assistants.
Chiropractors
In the states where PRI is sponsoring courses and where approval through state licensing agencies is required, PRI will look into applying for CEUs for Chiropractors (upon request). Requests must be made at least 90 days prior to the course date.
Occupational Therapists and OT Assistants
PRI is no longer recognized as an Approved Provider through the American Occupational Therapy Association (AOTA). Many states do not require any sort of pre-approval process. And of the ones that do, most state licensure boards allow self-submission of CE programs. Please check with your state licensure board to determine if you will be able to submit PRI courses for CE hours.
Athletic Trainers
Postural Restoration Institute (BOC AP# P2376) is approved by the Board of Certification, Inc. to provide continuing education to Certified Athletic Trainers. This program is eligible for a maximum of 15 Category A hours/CEUs. ATs should claim only those hours actually spent in the educational program.
Strength and Conditioning Coaches
This course is approved by the Collegiate Strength and Conditioning Coaches Association (CSCCa) for 7.5 CEU’s.
Since continuing education courses are not required to have pre-approval through the National Strength and Conditioning Association (NSCA), this course is not currently approved through the NSCA. NSCA certificants interested in completing this course may contact the NSCA to inquire about CEU eligibility.
Massage Therapists
PRI is approved by the National Certification Board for Therapeutic Massage & Bodywork (NCBTMB) as a continuing education Approved Provider. Provider number 451877-12. *Approval applies to select live courses only. This live course is approved. **Approval not valid for New York licensed massage therapists.
Other Healthcare and Fitness Professionals
PRI welcomes any licensed healthcare or certified fitness professional to attend our courses. You may be asked to submit your license to practice as a healthcare professional or qualified fitness or strength coach certification (though an organization that is recognized in the United States) to attend PRI courses. Students studying to become a healthcare or fitness professional at an accredited university are encouraged to enroll, and may be asked to provide enrollment status and program/degree information. If you have questions about whether you are eligible to complete PRI courses, please contact us. Attendees are responsible for following their state statutes regulating their professional practice. A certificate will be awarded to attendees upon completion of this course or any of the other PRI courses.
PRI reserves the right to cancel and refund a course attendee’s registration if any concerns arise regarding the course attendee’s qualifications as a healthcare or fitness professional, copyright infringement, or any other illegal activity involving PRI copyrighted materials. International attendees may be required to review and sign a Copyright and Intellectual Property Recognition and Disclosure Contract prior to receiving access to course materials.
A Certificate of Completion for 15 contact hours is awarded to attendees upon the successful completion of this course. Before attending a course, please verify CEU acceptance with your profession’s regulating body.
Physical Therapists and PT Assistants
In the states where PRI is sponsoring courses and where approval through state American Physical Therapy Association (APTA) or licensing agencies is required, PRI will apply for approval for CEUs for Physical Therapists and Physical Therapist Assistants.
Chiropractors
In the states where PRI is sponsoring courses and where approval through state licensing agencies is required, PRI will look into applying for CEUs for Chiropractors (upon request). Requests must be made at least 90 days prior to the course date.
Occupational Therapists and OT Assistants
PRI is no longer recognized as an Approved Provider through the American Occupational Therapy Association (AOTA). Many states do not require any sort of pre-approval process. And of the ones that do, most state licensure boards allow self-submission of CE programs. Please check with your state licensure board to determine if you will be able to submit PRI courses for CE hours.
Athletic Trainers
Postural Restoration Institute (BOC AP# P2376) is approved by the Board of Certification, Inc. to provide continuing education to Certified Athletic Trainers. This program is eligible for a maximum of 15 Category A hours/CEUs. ATs should claim only those hours actually spent in the educational program.
Strength and Conditioning Coaches
This course is approved by the Collegiate Strength and Conditioning Coaches Association (CSCCa) for 7.5 CEU’s.
Since continuing education courses are not required to have pre-approval through the National Strength and Conditioning Association (NSCA), this course is not currently approved through the NSCA. NSCA certificants interested in completing this course may contact the NSCA to inquire about CEU eligibility.
Massage Therapists
PRI is approved by the National Certification Board for Therapeutic Massage & Bodywork (NCBTMB) as a continuing education Approved Provider. Provider number 451877-12. *Approval applies to select live courses only. This live course is approved. **Approval not valid for New York licensed massage therapists.
Other Healthcare and Fitness Professionals
PRI welcomes any licensed healthcare or certified fitness professional to attend our courses. You may be asked to submit your license to practice as a healthcare professional or qualified fitness or strength coach certification (though an organization that is recognized in the United States) to attend PRI courses. Students studying to become a healthcare or fitness professional at an accredited universtity are encouraged to enroll, and may be asked to provide enrollment status and program/degree information. If you have questions about whether you are eligible to complete PRI courses, please contact us. Attendees are responsible for following their state statutes regulating their professional practice. A certificate will be awarded to attendees upon completion of this course or any of the other PRI courses.
PRI reserves the right to cancel and refund a course attendee’s registration if any concerns arise regarding the course attendee’s qualifications as a healthcare or fitness professional, copyright infringement, or any other illegal activity involving PRI copyrighted materials. International attendees may be required to review and sign a Copyright and Intellectual Property Recognition and Disclosure Contract prior to receiving access to course materials.
Thoroughly enjoyed Kasey Ratliff as an instructor!! | Scottsdale, AZ, November 2024
Course
| Date | Location | Faculty | Register |
|---|---|---|---|
Feb 15-16, 2025
(Sat-Sun) | EVO Health+Performance Freehold, NJ |  Kasey Ratliff | |
Mar 1-2, 2025
(Sat-Sun) | Untapped PLLC Louisville, KY |  Jennifer Poulin | |
Mar 7-8, 2025
(Fri-Sat) | Postural Restoration Institute Lincoln, NE |  Craig Depperschmidt | |
Mar 29-30, 2025
(Sat-Sun) | Team Rehabilitation Madison Heights, MI |  Jason Miller | |
Jun 21-22, 2025
(Sat-Sun) | Northeastern University Boston, MA | Kasey Ratliff | |
Jun 28-29, 2025
(Sat-Sun) | Spooner Uptown Chandler Chandler, AZ | Jason Miller | |
Sep 13-14, 2025
(Sat-Sun) | Cantrell Center for Physical Therapy Warner Robins, GA | Jason Miller | |
Sep 27-28, 2025
(Sat-Sun) | EA Therapeutic Health Rochester, MN | Craig Depperschmidt | |
Oct 10-11, 2025
(Fri-Sat) | Postural Restoration Institute Lincoln, NE | Kasey Ratliff | |
Oct 18-19, 2025
(Sat-Sun) | Spine and Sport Annapolis Annapolis, MD | Jennifer Poulin | |
Nov 15-16, 2025
(Sat-Sun) | St. Louis City Fitness Brentwood, MO | Craig Depperschmidt |
Registration is limited to ensure a low faculty to student ratio. Please register early. Courses will be canceled or rescheduled if fewer than 15 participants have registered by the early registration deadline of four weeks prior to the scheduled course date.
Special Needs Requests
If you have a disability and require accommodation in order to fully participate in this course, please contact us at least two weeks prior to the course date or prior to purchasing any online home study course so that arrangements can be made.
Course Completion
The course must be attended in full, and an online course evaluation summary and short post-test (with a passing score of 70% or higher) must be completed in order to receive a certificate of completion. Certificates of completion will be emailed after the online course evaluation summary and post-test have been completed If you arrive late, or leave early, your certificate of completion will be adjusted for the number of CE hours you were in attendance. *For live stream courses, if you have your camera turned off (or you are not visible on camera) at any time for greater than 15 minutes, this time will be deducted from your total hours on your certificate of completion.
Cancellation and Refund Policy
Tuition is refundable less $50 if cancelled 14 days before the course date. Tuition is not refundable for registrations or cancellations within 14 days of the course. However, you may have someone attend in your place or attend on another date. If you choose to attend on another date, a $50 fee applies to transfer your registration. If you are a no show and we have no communication with you before the course you will forfeit your course tuition. PRI reserves the right to cancel a course and will refund the tuition fee only. *Please note: For Live Stream Courses, once course manuals have been shipped (or emailed to international attendees), there will be no refunds for cancellations.
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