Course Review: Postural Restoration Institute's Myokinematic Restoration Home Study | Modern Manual Therapy Blog

Course Review: Postural Restoration Institute's Myokinematic Restoration Home Study


After 3 weeks, at a leisurely pace, I finally finished PRI's home study, Myokinematic Restoration. Was it a triumphant return to pathoanatomy like I wanted? Read on to find out!

Having systems of evaluation like MDT and the SFMA really get you away from pathoanatomy and focused on movement. It's been years since I thought about muscle origin and insertions specifically and other muscles like the obturators and pelvic/SIJ ligaments. Such is the simplicity and power of looking at repeated motions and movement patterns. If regularly read this blog, you already knew that!

I first heard of PRI's approach when a former mentee of mine took their Myokinematic Restoration Course 6 years ago while she was doing OMPT Fellowship hours. She came back from a weekend, her mind on overload due to the tons of exercise variations and a message that manual therapy was not needed to restore movement. At the time, that seemed crazy to me, but here we are in 2013 almost 7 years later and I'm using OMPT to enhance a HEP, not the end all be all of Tx.

In my never ending quest to look for more tools, I was drawn to the flexibility of PRI's home studies, now offering 3 out of 4 of the core courses needed for a PRC certification. This was a huge plus for me as I am on the road more and need to balance time with my family, which is extremely important to me.

The basics of PRI's approach in this course is a systematic look at what is called the AIC or Anterior Interior Chain. This is a series of muscles that run along both the left and right sides of the body. The Left AIC Pattern, according to PRI may be responsible for Sx at the knee, hip, groin, SIJ, lumbar spine, top of shoulder, between the scapula, neck, face, or TMJ.

The Left AIC pattern occurs largely because of the natural asymmetries of our human body, such as the heart being on the left and the liver being on the right. When combined with repetitive postures like frequently leaning to the right in standing, lying, sitting, getting in and out of chairs, cars all the same way, this causes tendencies for the pelvis to shift to the right, causing predictable patterns of movement loss. The movement loss is often manifested as decreased trunk rotation to the right, with a left anteriorly rotated iliac crest and right posteriorly rotated iliac crest. The pelvic rotation changes the rib cage, and the focus of this course, the acetabulum on the femur. This appealed to me because PRI acknowledges that asymmetry is part of life and only needs to be corrected in the presence of pain and dysfunction.

It has been quite a while since I thought the SIJ was relevant in less than 10% of cases since that is what the research shows us. However, here I was coloring muscles that attach to different bones and learning, attachments and tri-planar actions all over again. The home study comes with a small box of crayons and the instructor asks you to color the attachments the same color on different bones. This was very helpful as I am a visual learner.

The advantages of the home course is that you have about 3 weeks to complete what is a lot of material to cover in 2 days. By the time I took the home exam, I found that I had time to absorb the concepts of the Left AIC pattern, how it relates to AF (acetabulofemoral) movement and how that limits what we normally measure FA (femoralacetabular) movement. If I had to do the exam on a Sunday after practicing this for 8 hours on both days, I would be fried, however in 3 weeks, I found the exam to be a fair test of my knowledge of these very new concepts.

I have already found several patients who I was able to apply PRI's lower quarter test re-test method
1) A chronic pain patient who started with pelvic and lumbar pain
2) A hypermobile runner
3) a hypermobile headache patient who is intolerance to manual therapy and MDT without getting migraines

In each case, they met the pattern of decreased left hip adduction (modified Ober's - OMG I'm doing a special test) and decreased trunk rotation to the right. I have not gotten around to doing the Hruska Adduction Lift Test, but will practice it this week. Doing very simple corrective exercises, for 3-5 minutes with correct breathing techniques, the tests changed and their symptoms were reduced. I do not have enough experience to comment whether or not these treatments will get a rapid response like with MDT, but some clinicians I know who use PRI's techniques daily tell me that is a possibility. PRI recommends 4-5 treatments with about 2 weeks in between treatments to learn the new motor patterns. I find this may be very difficult due to the multi-step nature of their exercise approach, which baffled most of my patients compared to the simple MDT based resets I often instruct.

Course +'s

  • James, the course instructor was very thorough, and a good speaker
  • the manual is well done with good illustrations and a great appendix of exercises
  • the price is fair for 8 DVDs (which you return), a course manual, a study guide and exam
  • test-retest method that relies on a few special tests according to asymmetrical patterns that present in many individuals according to their concepts
  • no reliance on palpation
  • exercises make immediate change in testing
  • the instructor states correcting the asymmetry is not only moving bones but facilitating what is inhibited and inhibiting what is facilitated 
    • this was a big plus for me, because I'm not really convinced we can reposition bones with some simple muscle contractions
Course -'s (or approach)
  • too many option for exercises - really the manual is overwhelming similar to most traditional OMPT courses
  • not sure at the end whether or not to correct the asymmetry if the patient is asymptomatic, instructor said not to, but there was no degree of asymmetry discussed that should be a warning sign
  • did I say the exercise manual is overwhelming, because IT IS!
  • the exercises often have several steps, we're talking on average 5-7, too much even for some athletes to perform correctly
    • they do make sense why they are performed that way, for example to active the right glut maximus and left hip adductors to correct for the pelvic rotation
In the end, I was very pleased with the home course and found it to be a great option for those who cannot travel to the courses. I absolutely plan on taking the other 2 home courses and the Advanced Integration at PRI in December - if I can get the approach down! At this point, I see it as a tertiary in my current Eclectic Approach second to MDT and the SFMA. I did need more exercises in my approach as well as information on breathing and the diaphragm, so this was a great start. I am ordering Postural Respiration soon and will be sure to give my thoughts on it.

The final word, if you are a visual learner, go for it! There are no manual techniques in this course so it will just take practice anyway to master the tests and the exercise prescription. 

Anyone with PRI Experience and other systems want to chime in on how you integrate it?

5 comments:

  1. "The movement loss is often manifested as decreased trunk rotation to the right, with a left anteriorly rotated iliac crest and right posteriorly rotated iliac crest. The pelvic rotation changes the rib cage, and the focus of this course, the acetabulum on the femur. This appealed to me because PRI acknowledges that asymmetry is part of life and only needs to be corrected in the presence of pain and dysfunction."

    - I have the most trouble with this reasoning process. It would seem to me that if you are then correcting these asymmetries as you think that they have pain and dysfunction, then wouldn't it make sense to correct them prior to pain and dysfunction to prevent it? Seems like this is a gateway drug back to lots of special testing, landmark palpation, and alignment explanations.

    How does PRI go about explaining what they are working on in regards to the person's problem? How do you explain testing Ober's and then current treatment in the case of the person with the migraine?

    What would happen if you used the Right AIC techniques for someone with a diagnosed Left AIC problem? Is the benefit only from specific corrective exercise or just movement and the explanation?

    Would you classify this not as much as PRI but more along the line of NRI (Neurophysiological Restoration Institute)? Is it much like the SFMA where you work the non painful dysfunction to restore movement? The improvement in movement decreases threat to the CNS.

    - Ben Swinehart

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  2. Ben, I am interested to hear Erson's opinion on this, because my understanding of PRI is that we are asymmetrical via anatomy (heart, lungs, diaphragm, liver, also including our neurological system) which are either single in nature or not symmetrical themselves, however PRI does not teach that moving asymmetrical is ok. Rather that we should work to be as symmetrical as possible when at rest and able to move as symmetrical as possible as well. Obviously Peyton Manning should not be a left handed QB, but because he is a right handed QB he needs to work creating symmetry in other ways to reduce risk of pathological asymmetries.

    As for SFMA, going after the DN only is not what they teach. Erson may have a different take but I just read an article on this topic but I can't remember if it was Charlie W. or even G. Cook that wrote it. You still should address the DP region, but SFMA shows us that the DN should be addressed as well to maximize our outcomes. If a runner comes in with back pain, but you find DN ankle dorsiflexion, you will still be treating that back but can include the ankle as well for when they return to running.

    With PRI, a patient might have hip bursitis, but you recognize that without correcting the overall positioning of the pelvis with respect to the femurs or vice versa that your results could be transient. By addressing these asymmetries, the muscle fiber orientation is optimized, movement is more symmetrical and results in improved recruitment and reduced lateral hip stress. A

    As for how PRI goes about explaining what you are working on, well that can be tricky. I wouldn't put on an assessment that because the patients pelvis and lower lumbar spine are oriented to the right is why they are having migraines. However, they are also tests for the trunk, upper extremities, and cervical spine as well as the TMJ movement. I am pretty sure you could find a way to appropriately explain your findings outside of patient has FHP and is tender along suboccipitals as your assessment.

    I am not sure about your question on the right AIC for the L AIC problem though. The idea is that everyone has the underlying L AIC presentation, if we take out pathological issues, and this is due to the fact that our anatomy is asymmetrical in a very consistent pattern, and that moving into a R AIC pattern is actually optimal initially for your patient. L AIC pattern shows inability to adduct on the L side, well we want to achieve L adduction and R abduction which is R AIC posture. However we eventually want to be able to move in and out of both which we would simply call symmetrical movement.

    Did any of that make sense? I have been exposed to PRI for a long time and have only recently decided to give it a go and start applying it to my patients, therfore I am sure there are others that can better explain PRI than myself. The hardest parts are the number of exercises they provide you with initially, sequencing and specificity of exercises (its for a reason) which takes longer to teach and can sometimes be frustrating for patients. That keeps your HEP down to 2-3 exercises tops and a few daily posture cues to perform.

    One thing I would recommend is that if interested, take a course and just start testing patients and check your results and see if they are consistent. One simple one is, if you find a + Ober's on your patients R hip, then they will have a + L unless there is somekind of pathology. However you will find + L and - R all the time.

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  3. First let me say that I do not have any training, other than some reading, in PRI or SFMA. I am just dangerous enough to talk about it. I am fully open minded to anything that is going to help someone achieve their goals, which would include taking a PRI course and adding it to the evaluation.

    Yes, your comments made a lot of sense. I still have a lot questions regarding the how and why, and think that I would even if I took the courses and implemented them into an evaluation. For instance, if our organs, nervous system, appearance, handedness pattern and even some limb lengths are asymmetrical, then why would certain movement patterns also not be symmetrical? Does that truly predispose use to injury? If this is the case then why are we using PRI to pre-screen individuals, like with the FMS, and work on correcting asymmetries to prevent the problem in the first place? Erson stated that the course he took did not recommend treatment towards the asymmetries unless there was pain or dysfunction.

    Dan John did talked about trying to correct his own asymmetries due to always throwing the discuss right handed. He said that would go to the gym and work out his left arm and his right leg (if I remember correctly). Is there something to this, I can see it, but might it just have been a perceived imbalance? I don't know. Did working his asymmetries keep him from additional injuries and pain, again we might not know.

    I think that the test and re-test method combined with patient response is the best way to hash this out. If correcting found asymmetries with the PRI system makes a difference in the concordant sign, then use it and you can make all the theoretical deductions from there. This might then also hash out if it is movement or the specific corrective exercise that makes a difference. If you treat someone with typical Left AIC asymmetries with corrections for a Right AIC presentation, and they feel better (their concordant sign improves) then the theory does not seem to match.

    I also worry about how we word these things to the patient as to not make them dependent on someone else to, "fix" them or to perpetuate a sense of their bodies are against them wanting to go our or become asymmetrical. The benefit over typical OMPT stuff is that it is exercise based which takes away the, "Put me back in place," stuff the can be a pitfall of hands on manual therapy, especially if used with the typical biomedical/theoretical terminology.

    I think that with the SFMA the therapist would work on the DP area, but it is my understanding that the patient is sent home with home treatments focusing on the DN. Since PRI is exercise based I wrote this with the home treatment in mind. Sorry if I was not clear on this point.

    The Ober test in your comments above, what is that actually testing? Are we testing fasica, muscle length, capsular/ligamentous tightness or adverse neural tension? As long as the treatment has a positive effect on the concordant sign, then I can except the treatment that has a corrective effect on the positive Ober. I can't see basing a treatment just on a positive special test, which we might be making soft tissue restrictions and theoretical assumptions off of.



    I have officially passed the amount that I can write and keep a coherent thought a long time ago. Hope that I made sense.

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  4. Stephen, I agree with you on the DN/DP SFMA questions. Gray in his IFOMPT Keynote (and probably Movement as well) states going after the distal most DN is necessary, and also safe, as you're unlikely to flare up a proximal DP. I never said do NOT go after the DP, it's just that it is more difficult using a SFMA/FMS based approach. For me, that is where MDT comes in, great at putting out the fire, which would be a proximal DP, and the SFMA helps clean up little burning embers or piles of dried leaves that may catch fire in the future.


    In terms of the PRI, I am obviously very much a novice in this approach, however, I am a fan of patterns. It does seem that almost every patient I tested so far regardless of upper/lower quarter complaint has consistent + adductor drop, limited trunk rotation, and asymmetries with the adduction lift test.


    Ben, what that means in PRI is not "length" of tissues, but rather imbalances in pelvic and rib alignment which the patient by pattern falls into after repeated dysfunctional movement or habitual postures.


    What I am not a fan of is "repositioning" bones with muscle contractions. I do like how they state breathing can affect the autonomic nervous system and how the asymmetries are not only in position, but in certain muscle imbalances that result in facilitation and inhibition that are also predictable based on the normal asymmetries of the internal organs.


    That is something I do not like explaining to patients, but it does make sense to everyone I explained it to. I am careful to not to say the exercises are repositioning, but rather tell them it helps restore balance to certain muscles that are not functioning well, and those that are overfunctioning so to speak.

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  5. It has been and I am getting some rapid responses in movement, no s much in Sx presentation, at least not as fast as MDT, but it seems like a useful tool if the patient can figure out how to do the correctives at home without you.

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