East Coast Physical Therapy Presents PRIMAL REFLEX RELEASE TECHNIQUE My name is Darren Weidenman, I am a physical therapist and I am here today to talk about and demonstrate a physical therapy technique called primal reflex release technique (PRRT). My intention is to tell you a little bit about the technique, how it came to be, how it works, what types of conditions it is good for and then show you a little bit so you may get a feeling for what treatment is like. I would like to thank Diane Ruenes for setting this afternoon up for me and allowing me to come and share this with you all. Darren J. Weidenman, PT, MA, OCS East Coast Physical Therapy

East Coast Physical Therapy Darren J. Weidenman, PT, MA, OCS I graduated from Touro College in 1995. I spent my first year of practice out at Saint Charles hospital working in the adult rehabilitation department treating mostly a neurologic population: Mainly people who had strokes and some traumatic brain injured patients. My interest lay in orthopedics so I took apart time job in 1996 in Huntington in an out patient clinic where manual therapy was the preferred technique. Later that year I went to full time orthopedics where I spent significant time in continuing education classes honing my skills as a manual therapist. In 2001 I started my own practice in Melville and sat for the orthopedic specialty certification in 2004. East Coast Physical Therapy

East Coast Physical Therapy Who developed PRRT? I read in a PT publication that a fellow named John Iams , a physical therapist from Poway California invented a treatment technique called prrt. It sounded interesting so I called and spoke with John. He knew all the techniques I had learned and knew all the professors I had taken classes from. I felt he was on to something I wanted to learn. PRRT sounded like it fit in very well with the way I was practicing physical therapy. Unfortunately his next class was full. I called several times in a span of two days to see if a spot had opened or if somehow I could get in to the next class. Finally,John said he would add a spot for the pushy New Yorker. That was in November of 2004 and in 2005 I went back to San Diego for the intermediate class and finally the advance class in fall of 05. East Coast Physical Therapy

PRRT (Primal Reflex Release Technique) Manual therapy technique using reflexes as treatment to reduce pain. Takes advantage of the body’s wiring system. Reduces stress. Releases endorphins. Quiets the central nervous system. Primal reflex release technique is a manual therapy technique using the body’s reflex system to treat pain. This is done by reducing neural input into structures that affect the CNS. By relaxing muscle that have been tense, the patient experiences stress reduction and deeper relaxation. Endorphins are released when a patient has a positive result. East Coast Physical Therapy

East Coast Physical Therapy What is a reflex? A reflex is an involuntary and relatively stereotyped response to a specific sensory stimulus. Two features of the sensory stimulus are particularly important in shaping the reflex response. First, the precise location of the stimulus determines in a fixed way the particular muscle that contract to produce the reflex response. Second the strength of the stimulus determines the amplitude of the response. Reflex therefore are graded behaviors. East Coast Physical Therapy

East Coast Physical Therapy Stretch reflex First let's examine the neural circuitry of one spinal reflex: the stretch reflex. This is the simplest reflex known; it depends only in the monosynaptic connection between primary afferent fibers from muscle spindles and motor neurons innervating the same muscle. The muscle spindle contains specialized elements that sense muscle length and velocity of length change. The spindle is innervated by large myelinated afferent fibers known as type Ia afferent fibers. The cell bodies of these neurons are clustered near the spinal cord in the dorsal root ganglia. They are an example of a bipolar cell: one branch of the cell's axon goes out to the muscle and the other runs into the spinal cord. In the spinal cord the Ia afferent fibers make monosynaptic excitatory connections to alpha motor neurons innervating the same muscle from which they arise and motor neurons innervating synergistic muscles . They also inhibits motor neurons controlling antagonistic muscles through an inhibitory interneuron. Half the neurons in the brain are inhibitory. They release neurotransmitters that hyperpolarize the membrane potential of the postsynaptic cell, thus reducing the likelihood of firing. The muscle spindle is sensitive to stretch so that when the muscle is stretched the Ia afferent fibers increase the firing rate. This leads to the contraction of the same muscle and its synergists and relaxation of the antagonist muscle. The reflex therefore tends to counteract the stretch, enhancing the spring like properties of the muscles. East Coast Physical Therapy

Sir Charles Sherrington Sir Charles Sherrington, a British scientist was born in 1857 and was one of the first people to talk about reflexes. His experiments led to many discoveries about the nervous system and reflexes. Circa 1901 Sherrington's law of reciprocal innervation was developed. This law stated that for every neural activation of a muscle or muscle group, there is a corresponding inhibition of the antagonistic muscle or muscle group. East Coast Physical Therapy

East Coast Physical Therapy The Withdrawal Reflex Previously known as the Flexor Reflex Involves multiple levels and synapses Painful stimulus detected Ipsilateral extensors inhibited Ipsilateral flexors excited Limb is withdrawn Contralateral extensors excited Typical example is touching a hot stove or stepping on a tack you get a withdrawal reflex East Coast Physical Therapy

East Coast Physical Therapy The Startle Reflex Known as the Moro Reflex in infants Is associated with withdrawal in the pain reflex Frequently involved in PTSD as a hyper-arousal response to stimuli Likely to upregulate the ANS Typical example walking down the street and run into someone coming around a corner and become startled. East Coast Physical Therapy

Autonomic Nervous System 2 Parts: Sympathetic Fight or Flight Parasympathetic Relaxation East Coast Physical Therapy

Autonomic Nervous System East Coast Physical Therapy

East Coast Physical Therapy Small Startles Expletives said when something shocks or upsets us Likely to upregulate the ANS by Pavlovian conditioning of the upset feeling to situations we can’t or don’t control Probably facilitate the Dura through Vagus East Coast Physical Therapy

Up regulation of the ANS Stress Pain Fatigue Poor sleep Hyperalgesia to sub nocioceptive stimulus East Coast Physical Therapy

The Pain ReflexTM a.k.a. Nocioceptive Startle ReflexTM Combination of a withdrawal and startle response Elicited over TriggeRegionsTM Found in many areas of the body that are not trigger points East Coast Physical Therapy

TriggeRegionsTM VS. Trigger points Areas not points Locations of hyperalgesia do not correspond with typical trigger points Do not typically refer pain like a trigger point can TriggeregionsTM do not need much compression to elicit a response East Coast Physical Therapy

How can PRRT affect the Central Nervous system? East Coast Physical Therapy

East Coast Physical Therapy The Dura Mater The Cover of our nervous system Has bony attachments in the neck and low back Has one muscular attachment in the neck Innervated by cranial nerves V, X, XII, VII The Dura is a key structure in treating the body using PRRT. It becomes a doorway to the CNS through which we can help to down regulate the CNS. Some interesting coincedences that the dura attatches in two spots in our backs where we get lots of complaints of pain and lots of stress is held. East Coast Physical Therapy

East Coast Physical Therapy

East Coast Physical Therapy Dural Drivers Any structure that directly or indirectly affects the dura Very important for PRRT These are the muscles and structures that continue to maintain an upregulated CNS East Coast Physical Therapy

East Coast Physical Therapy Dural Drivers Rectus Capitus Posterior Minor Ligementum Nuchae Masseter Upper Trapezius Sternocleidomastoid East Coast Physical Therapy

East Coast Physical Therapy Direct Dural Drivers Ligamentum Nuchae through the arthrodural bridge at C1-C2 level. Rectus Capitus Posterior Minor through the myodural bridge East Coast Physical Therapy

The sub occipital muscles East Coast Physical Therapy

East Coast Physical Therapy Ligamentum Nuchae East Coast Physical Therapy

Rectus Capitis Posterior Minor East Coast Physical Therapy

Indirect Dural Drivers SCM excites the dura through its scalp attachment to Ligamentum Nuchae TMJ muscles excite the Trigeminal nerve which innervates the Dura Mater East Coast Physical Therapy

East Coast Physical Therapy Sternocleidomastoid East Coast Physical Therapy

East Coast Physical Therapy

Who can benefit from PRRT? People with Sports injuries or MVA injuries Any trauma patient Most musculoskeletal conditions Over Stressed patients Fibromyalgia patients Chronic pain patients East Coast Physical Therapy

What I look for in the patient Pain reflex (NSR) elicited without compression Found in many areas (Trigger Areas) of the body Looking for the series of “G’s: Groan Grasp Grimace Gasp Global lower extremity response East Coast Physical Therapy

East Coast Physical Therapy What I look for Barrier to entry Patient’s effort to pull away from pressure Thickened, boggy, tight, full feeling in the tissue Difficulty palpating a bony contour East Coast Physical Therapy

East Coast Physical Therapy Positive response Decrease in pain reflex found in the body on reexamination Feeling of calm and relaxation Lightheadedness, slight tipsy feeling, sleepy feeling Reduction in pain complaint East Coast Physical Therapy

East Coast Physical Therapy Demonstration 1 Minute exam to find areas of NSR Treatment Reassessment East Coast Physical Therapy

East Coast Physical Therapy

East Coast Physical Therapy