Top 5 Fridays! 5 Ways PRI is Similar to MDT | Modern Manual Therapy Blog

Top 5 Fridays! 5 Ways PRI is Similar to MDT

Here we have an old fashioned compared (without the contrast - that's next week!) between MDT and PRI.
How are they similar? Let me count the ways... 5 for today.

The caveat for this post is this is based on my limited knowledge of PRI after taking only 2 home study courses. I will be ordering the 3rd in September and taking Advanced Integration live with Ron Hruska in December.

1) Both emphasize hands off techniques and home exercise programs

  • both are great for manual therapy adverse patients or those with higher fear avoidance
  • this is a plus and not a negative as many manually inclined clinicians believe as the patient is empowered to self treat
  • hands on techniques are instructed in both, but are simple and effective, but only to emphasize the HEP and enable the patient to continue to self treat

2) Both are systematic
  • both have classifications which are based on testing and not a diagnosis 
    • classifications lead to subgrouping which improves outcomes
  • MDT has repeated motions and loading strategies which make rapid changes
  • PRI has positional and movement based special tests which also improve rapidly after some not as simple home exercises
3) You can get rapid changes in ROM, pain, and function with both systems without touching the patient
  • the more I get into either system (and I've been getting into MDT for over a decade) the more other systems irritate me when I get an improvement with a technique that the patient basically thinks "Wow, that was great, now how the heck do I replicate that?"
  • both PRI's HEP and MDT's HEP enable the patient to do exactly what was done in the clinic to make rapid changes
4) Both are based on older school pathoanatomy
  • it has to be said that both disc derangement and reduction (mostly applicable to some lumbar conditions, but not really cervical and forget thoracic), as well as pelvic rotation most likely are not sole reasons for pain
  • these things like stuck facets, pinched nerves, etc... fall into mostly peripheral and pathoanatomical reason for pain
  • the rapid changes seen for both systems are most likely due to CNS and autonomic changes, but hey, who am I to call out other practitioners who are doing a great job
  • real bony and physical changes to structure occur, but NOT rapidly
5) Both have their limitations
  • you can absolutely restore full end range loading, and/or obtain neutrality and not have any change in the patient's pain perception
  • both systems sometimes change ROM rapidly but not pain levels
  • both have difficulty treating true dysfunction, as in the slow responders that need real tissue lengthening/loading
    • these are your true severe capsular dysfunctions
At this point, I have found PRI assessments to be quick and easily added to my exam, even if I do not plan on using their correctives immediately. I am using the balloon exercises for most of my patients, to some pretty amazing results with both pain and ROM.


  1. Dr. E,

    I just took the Postural Respiration course this past weekend and was curious as to your thoughts on their philosophy of a flexion based program only. They state that most people are already in an extended position and that we should all be working towards restoring flexion and placing people into flexion. He even commented and said that flexion and traction are healthier for the disc and this is probably more what McKenzie therapists are looking for.

  2. The problem with a blanket statement like that is that it ignores the literally hundreds (or more) of MDT trained clinicians out there who are using directional preference to centralize and abolish complaints. MDT even has research showing it reduces lumbar disc protrusions in some cases. Even when it does not, by the research it is a reliable system, valid for predicting outcomes with centralization, and is as you know, not just extension. You just can't critique a system if you do not have formal training or use it extensively. PRI has no research that I am aware of and probably should get some done into it's reliability then validity before critiquing other systems.

    What I normally tell my patients, if flexion was going to make you better, you would already be better by now - when they respond to extension, or if flexion makes them worse.