The Hruska Clinic Integrator
Posted on 05/12/2016
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 Postural Restoration Institute® (PRI) 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.