Postural Restoration Integrative Multidisciplinary Engagement™ (PRIME)
Please see our new website dedicated for our PRIME program at
- What is Postural Restoration Integrative Multidisciplinary Engagement™ (PRIME)?
- Why Postural Restoration Integrative Multidisciplinary Engagement™ (PRIME)?
- How is Postural Restoration Integrative Multidisciplinary Engagement™ (PRIME) different? What is your mission?
- Am I a candidate for Postural Restoration Integrative Multidisciplinary Engagement™ (PRIME)?
- How do I start the process of Postural Restoration Integrative Multidisciplinary Engagement™ (PRIME)?
- What does a typical week of Postural Restoration Integrative Multidisciplinary Engagement™ (PRIME) look like?
- What happens after I leave Lincoln, NE?
- Meet the PRIME team
- Physical Therapy -- Hruska Clinic™ Restorative Physical Therapy
- Optometry - PRI Vision
- Postural Dentistry
- Postural Restoration and Orthodontics
What is Postural Restoration Integrative Multidisciplinary Engagement™ (PRIME)?
Postural Restoration Integrative Multidisciplinary Engagement™ (PRIME) is a unique treatment option to assist with treating chronic postural related issues, offered only through the Hruska Clinic in Lincoln, Nebraska, to engage patients with a collaborative, multidisciplinary treatment team. It is led by Postural Restoration® certified physical therapists who have integrated with experts at this time in the specialties of Optometry, Dentistry, and Podiatry. This engagement emphasizes multidisciplinary coordination of care to establish and maintain postural neutrality and upright balance both during activity and at rest. This is accomplished by regulating what you feel perceive and sense to improve efficiency of movement. Ultimately this will reduce imbalance and strain on the body that leads to chronic pain and difficult to manage symptoms.
Throughout the process each patient will engage with professionals from each discipline who will work together as a unified organization sharing the same treatment goals and philosophy. Each patient will have a case managing physical therapist at the Hruska Clinic™, who designs and provides ongoing input and coordination for the customized plan of care. Together the case manager and patient will engage with the other professionals within the PRIME team to provide a coordinated process with the patient at the center of this integrated approach. We believe this patient engagement during each step with each professional, rather than the patient passively receiving a program, is critical to maximizing successful outcomes.
Why Postural Restoration Integrative Multidisciplinary Engagement™ (PRIME)?
Our Collective Philosophy
The incredible human body….and its challenges
The human body is capable of amazing things. Just think of the myriad of activities that are done by everyone on a daily basis. Seemingly simple activities of chewing and swallowing food, balancing upright against gravity in a variety of positions, moving from one position to the other, walking, and even the automatic functions occurring during sleep are in actuality complex and amazing. The way we do these activities over and over creates patterns of movements that are easily repeated without having to think about them. For example you do not have to think about the complexities of each step when you walk or each chewing motion when you eat, you just do it.
The human body is not symmetrical. The neurological, respiratory, circulatory, muscular, visual, and all other sensory systems are not the same on the left side of the body as they are on the right. They have different responsibilities, functions, positions, and demands on them. This designed asymmetry is a good thing and amazing. It gives the brain information to helps us decide which leg stand on or to step with first, or which side of your mouth to chew with first, or which arm to open the door with or hand to write with. This asymmetrical position and function of the body will contribute strongly to those ingrained patterns of how you move.
Unfortunately, when some of these asymmetrical patterns become too overused and dominant the body loses its adaptability to change. For example when the muscle activity and pattern of standing on the right leg or reaching with the right arm become over-dominant compared to the same activity on the left side, the body will need to compensate to accommodate this over-dominant pattern when performing activities that require other patterns such as walking or running. Many negative consequences can be the result of these adaptations, including decreased muscle efficiency and use, increased pain, muscle aches and tension, increased susceptibility to injury, poor sleep, autonomic dysfunction and less than optimal athletic performance to name a few. Over time, these patterns and our suboptimal adaptations can become so ingrained into our brain as the norm that they are difficult to change. Due to our common asymmetrical body’s form and function, these patterned adaptations are predictable and evident to a professional who has studied these asymmetries and principles as taught by the Postural Restoration Institute®.
Command Central….THE BRAIN!
These patterns are established in the brain based on feedback it receives from multiple areas of the body. The sensory input the brain receives from the body is interpreted and used to make decisions of what to do and how to adapt. Examples of sensory input that your brain uses to make decisions on how to move or hold your posture include: Information from your teeth about the position of your head and neck, information from your eyes on where you are at in the room and what up and down is, and the sensation your feet are feeling about the floor underneath it. For example think about the feeling of having a very small piece of corn stuck between your teeth, or the feeling of putting on a new pair of glasses after which the floor or stairs don’t look “quite right”, or the feeling of your sock wrinkled inside your shoe. The input those things are telling your brain is that you need to change or adapt because they don’t feel right. These are examples of sensory awareness and information processing that your brain constantly uses to make decisions on how to move and maintain your upright balance and posture against gravity. Other examples may include information from the muscles in your neck and jaw, information from your inner ear, the sensation of the floor under your feet, the sound vibrations of your middle ear, and how you interpret the space between yourself and objects.
Each patient’s unique symptoms give us clues as to how the body has adapted to the demands placed on this predictable asymmetrical system. If you have adapted to poor patterns with faulty input over a long time it will be challenging to undo those habits without changing the input the brain is receiving. By engaging with our team of professionals we will change the way the brain interprets and processes information from these sensory systems, so that the body becomes better balanced or ‘neutral’. Then new activities and patterns of movement can be re-wired as normal as these changes are learned with specific activities and exercises. Over time we anticipate these new “normal” patterns will become the brain and body’s new habits. This is how symptoms are managed by looking at the cause rather than just the symptoms themselves. We feel strongly that this can only be accomplished through multidisciplinary integration.
How is Postural Restoration Integrative Multidisciplinary Engagement™ (PRIME) different? What is your mission?
PRIME: Our Mission
The Hruska Clinic, in conjunction with the other members of our multidisciplinary team, founded the PRIME (Postural Restoration Integrative Multidisciplinary EngagementTM) program to fill a need in the healthcare market that we felt was lacking. Patients in Lincoln, NE and across the country were not seeing results from traditional PT and even PRI (Postural Restoration InstituteTM) based programs. The number one reason they were not having success was the lack of coordination of care between disciplines, even when a multidisciplinary approach was being utilized. The only way to truly help these people was to gather a team of experts together to work hand in hand to fully engage with the patient and each other, to seamlessly come up with a comprehensive approach to management of their bodies. Over the last few years as we look back on the patients we have seen, helped, and yes even struggled with there are a few commonalities.
They have all not responded to treatments that should have helped them. Good people had worked with them and given them the best care and treatments that they knew how, yet for some reason they did not work. Most people had tried numerous different treatments from numerous providers, many of whom were even trained with the same theories utilized here at the Hruska Clinic, through the Postural Restoration Institute. So why did some of these patients not get better, and more importantly how are we going to help them?
In our humble opinion the reason that some of these patients didn’t respond to good treatments was due to their inability to change, perceive, or integrate the sensory input they receive on a continual basis to relearn new movement patterns and make lasting change. Our brain takes in a staggering amount of sensory input from a variety of sources and in a near instantaneous fashion must figure out what is important, filter it, give it meaning, and make decisions of what to do with that information just to sit, stand, balance, and do even the most simple of activities, much less complex things like walk, run or perform higher level movement tasks. If the input coming in is not perceived well, inaccurate, imprecise, or not filtered well, the output of movement and balance will be affected. The brain then becomes in a sense hyper-stimulated trying to keep up or catch up with a world that is continually changing. This hyper-stimulated state limits that person’s ability to make lasting change with general activities and exercises that should help.
Any patient that is treated in our clinic, and hopefully in any clinic, is assessed, patterns of limitation are identified. Those predictable patterns are then ‘treated’ by identifying what the main issue is that is preventing balanced, efficient movement. Inefficient or imbalanced movement may lead to compensation, overuse, and potentially to pain patterns. For some people they just need to reengage a left hamstring and left inner thigh muscle to reorient a pelvis into a more neutral state. For some they need to find a better position of their left diaphragm leaflet so they can breathe with a more efficient manner and reduce accessory respiratory muscle use. Many patients get better with even these ‘simple’ focuses. But why doesn’t it work for some?
Albert Einstein described insanity as doing the same thing over and over and expecting different results. If as therapists or health professionals in general we continue to do the same thing over and over and expect different results aren’t we being a little insane? If they can’t figure out how to shift into their left hip easily, doing it more or on a bigger step, or with increased effort is not the answer. That could be considered insanity by some. Our PRIME program, wasn’t developed to be a program that gives people MORE of what they’ve already tried. If it was we’d be insane. The people who need a PRIME program are those who don’t need to work on more hamstring activity, or more hip shifting, or more abdominals. Someone who wants a more program (i.e more running, more lifting, more intensity) is not a good candidate for PRIME. The main issue to be addressed for people who need PRIME integration is their the ability to sense things differently so their brains are not hyper-stimulated just to stay alert so that their ability to perform a hamstring or abdominal program will be able to happen at some point without having to do more.
Therefore the mission of our PRIME program is not to do MORE, but to take away bad sensory input, give new sensory input to allow people to feel their ability to be neutral and then be able to live with it for normal daily activities. PRIME patients will get the tools needed to feel neutrality with sitting, sleeping and standing. When those things are accomplished and engrained and people can feel neutrality for those things throughout their day, then and only then does a movement program (i.e walking, running, weight lifting, elliptical) make sense. More demand, and more of anything will kill the program. We actually want our patients to do less initially with a PRIME program. If they do too much too quickly with the more mentality poor movement patterns will be utilized, reinforced and the program will struggle to succeed. Once they learn to do less and stay neutral with daily activities, then we can address movement and higher level function as a long term goal.
Am I a candidate for Postural Restoration Integrative Multidisciplinary Engagement™ (PRIME)?
Individuals who benefit the most from engaging with our PRIME team typically experience (but are not limited to) two or more of the following symptoms or diagnoses:
• Upper neck or shoulder pain
• Collar bone or chest pain
• Hip Impingement
• Shoulder impingement/tendonitis
• Clicking of popping TMJs
• Back extensor tightness
• Visual strain or fatigue
• Hip flexor muscle tightness
• Cervical instability or whiplash
• Ankle instability or fatigue
• Dizziness, lightheadedness or imbalance
• Anxiety or depression
• Dysautonomic symptoms (i.e. POTS)
• Ischial tendonitis
• SI or lateral back pain
• Knee pain
• Anterior shin splints
• Lateral foot, heel, or plantar pain
• Facial pain
• Head injury
• Chronic fatigue
How do I start the process of Postural Restoration Integrative Multidisciplinary Engagement™ (PRIME)?
• Candidates need to first apply to the program by filling out all multidisciplinary forms and submit them prior to scheduling. (See below for admission forms) We will then be in touch with you for collecting additional information and answering any questions you may have.
• Candidates must agree to all terms of program expense and payment methods.
• Candidates must accept program policy of engaging with ALL disciplines recommended by the PRIME team at each visit.
• The PRIME team recognizes that the patient’s recovery also affects and is affected by the patient’s family and/or significant others. Support is an integral part of the recovery process and we encourage both the patient to include a spouse, family member and/or close friend to be engaged with us you throughout the entire process.
Please contact the Postural Restoration Integrative Multidisciplinary Engagement™ (PRIME) Patient Care Coordinator, Megan, for more information on how to apply to engage with us.
Phone: 402-975-8533 or
What does a typical week of Postural Restoration Integrative Multidisciplinary Engagement™ (PRIME) look like?
A patient engaging with us should plan on spending 3-4 days in Lincoln, NE. In general you should expect 4-5 hours of physical therapy instruction, 2 hours of consultation with the PRI Vision team to identify appropriate visual integration needs, 3-30 minute sessions with the dental team to fully assess your head and neck, assess your bite pattern, and take impressions and seat the oral appliance, one 30-60 minute session to assess your foot biomechanics in how it is related to your pattern with orthotic impressions taken or recommendations given, and a final discharge session to coordinate carryover and assist with continued progression and follow-up once you leave Lincoln. Each member of the PRIME team will be in communication with your case manager to facilitate coordination of care.
A *typical* weekly schedule is as follows:
* 30 minute Postural Dental appointment/intake which (includes x-rays, dental exam, and possibly dental impressions taken)
Late morning/ Early afternoon:
* 2 hour PRI Vision appointment
* 1 hour physical therapy appointment with Hruska Clinic PT/case manager
* 1 hour physical therapy appointment
* 30 minute Postural Dental appointment for bite registration
* 1 hour physical therapy appointment
* Podiatry appointment for foot orthotic assessment/ impressions
* 30 minute Postural Dental appointment for splint seating and dispensal
* 1-2 hour physical therapy appointment (possible discharge appointment)
• 1-2 hour PRIME appointment with case manager to finalize instructions for home
**Schedule is subject to change based on individual needs and with further assessement once on site**
What happens after I leave Lincoln, NE?
By the time each patient leaves Lincoln they will have received a comprehensive assessment and treatment by all necessary disciplines. This including prescription and fabrication of orthotics necessary to maintain postural neutrality, inhibit old patterns, and start to learn new patterns. Each patient will be instructed in and given specific activities to do, and not to do, including physical therapy exercises, as well as instruction on integration of orthotic use in daily life. Exercises and activities will be instructed, and progression guidelines given, to help with maximizing progression on your own once you leave Lincoln. We will continue to stay engaged with you to provide assistance to any referring professionals that can assist us in monitoring and progressing your activities. Most people will require at least one trip back to the PRIME clinic to progress and fine tune activities and orthotic use or receive other recommendations as needed. Your case manager is available to engage with you via e-mail or phone, if necessary, to discuss any questions or concerns you may have in regards to symptoms, progression of activity, timing of return trips, or to communicate with any referring practitioners. You are now interlocked with us as an integral part of the team, and we will assist you in taking control of your needs going forward.
Meet the PRIME team
Currently the PRIME team consists of professionals in the following areas:
Physical Therapy -- Hruska Clinic™ Restorative Physical Therapy
Postural Restoration Integrative Multidisciplinary Engagement™ (PRIME) Case Managers
Jason Masek, MSPT, CSCS, ATC, PRC
Lori Thomsen, MPT, PRC
David Drummer, DPT, PRC
Torin Berge, MPT, PRC
Caitlin Daubman, DPT, MHA
*For more information on the Hruska Clinic™ staff please visit: www.hruskaclinic.com
How does a Physical Therapist Engage in Postural Restoration Integrative Multidisciplinary Engagement™ (PRIME)?
• Works as case managers to assist with triage, intake and organizing and streamlining the plan of care
• Coordinates integration of team members during fabrication of sensory orthotics constantly assuring maintenance of postural neutrality.
• Establishes and instructs patient in activities to learn new patterns of movement once appropriate postitions are established with new sensory references/orthotics keeping PRI principles in mind.
• Offers consultation and recommendations to the patient, family members, significant others and various health care providers for improved carryover of the treatment plan.
Optometry - PRI Vision
Heidi Wise, OD, FCOVD
Ron Hruska, MPA, PT
Stacy Masek, PRI Vision/PRIME Patient Care Coordinator
*For more information on the PRI Vision staff please visit: www.privisioncenter.com
How does PRI Vision Engage in Postural Restoration Integrative Multidisciplinary Engagement™ (PRIME)?
In PRI Vision, Dr. Heidi Wise, an optometrist, and Ron Hruska, a physical therapist, will evaluate the patient together. This results in the following:
• Finding a specific eyeglass prescription to change the visual input to the brain that will assist the patient in achieving a new postural position by changing the messages the brain sends to the body to respond to that input. This will inhibit overactive patterns that restrict the body’s ability to learn new patterns. This is a successful way to change the activity of muscles even when other methods have been unsuccessful.
• One or more prescriptions for training eyewear to accomplish this goal will be given.
• Recommendations and guidance for visual clarity needs that are integrated with the physical needs of the individual patient.
• Overall treatments guidelines for the anticipated sequence, level, and type of integrated activity needed to eliminate visual and neurological interferences to physical progress will be shared with all the disciplines working directly with the patient.
Dr. Rebecca Hohl, DDS,MS
Dr. Christine Campbell, DDS
Dr. Mark Vanicek, DDS
*For more information on our dental staff please visit: www.hohlorthodontics.com for information on Dr Hohl, www.smileinnovationsdentistry.com for information on Dr Christine Campbell or www.vanicekdds.com for information on Dr. Mark Vanicek.
How does the Postural Dental Specialist engage in Postural Restoration Integrative Multidisciplinary Engagement™ (PRIME)?
• The Postural Dental Specialist identifies any occlusal or dental related issues that are contributing to cervical and postural painful patterns.
• Specific mouth appliances are fabricated while the patient is in a neutral position, as assessed by the case managing PT, to establish appropriate occlusal reference and guidance for head and neck position and movement. This will allow increased carryover of neutrality, during a period of time where new movement patterns are being learned and experienced.
• Appropriate reference and sensory input from a joint call the temporo-mandibular joint (TMJ), is respected and maximized in a state called “neutrality” while occlusion is assessed and stabilized.
• Airway management, to allow one to sleep, and work without losing diaphragmatic function may also be addressed.
• The Postural Dental Specialist will make referrals and recommendations, when necessary, to other health care and dental specialists, so that all goals of the patient and team members can be met.
Click"Postural Restoration and Orthodontics" above to read more from Dr Rebecca Hohl on how they integrate their practice with us for PRIME and other Hruska Clinic patients that require integrative care.
Dr. Paul Coffin, DPM
*For more information on Dr. Coffin please visit: www.drpcoffin.com
How does a Podiatrist Engage in Postural Restoration Integrative Multidisciplinary Engagement™ (PRIME)?
• Provides appropriate sensory reference, through biomechanically correct, custom-fit orthotics and/or shoe recommendations, from the floor up during upright weighted activity to assist in maintaining appropriate upright position of neutrality that matches and compliments the other sensory input the patient is now receiving.
• Analyzes the impact their feet and gait have on the patient’s overall postural health
• Consults with the PRIME team to ensure the orthotics compliment the patient’s ongoing therapy program.
How do YOU Engage in Postural Restoration Integrative Multidisciplinary Engagement™ (PRIME)?
• We expect each patient to consider this as an engagement with us rather than a program designed for you
• Each patient will be responsible for engaging with the PRIME team prior to coming to Lincoln by facilitating information release to us to allow us to help you in the most efficient way possible.
• Each patient will be encouraged to engage with each professional while in Lincoln, and once you go home, asking any and all questions needed to ensure you are informed and educated in what and why things are done the way they are
• Each patient will be expected to engage with the program by following through with recommended activities and orthotic use to maximize outcomes
• We encourage each patient to have a support person such as spouse, family member or close friend whenever possible attend PRIME activities to be able to engage with you to facilitate improved outcomes
A map of where people have come to Lincoln for our PRIME program