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.
- 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?