east coast physical therapy1 east coast physical therapy presents primal reflex release technique...
Post on 19-Dec-2015
222 views
TRANSCRIPT
East Coast Physical Therapy 1
East Coast Physical Therapy Presents
PRIMAL REFLEX RELEASE TECHNIQUE
Darren J. Weidenman, PT, MA, OCS
East Coast Physical Therapy 2
Darren J. Weidenman, PT, MA, OCS
East Coast Physical Therapy 3
Who developed PRRT?
East Coast Physical Therapy 4
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.
East Coast Physical TherapyEast Coast Physical Therapy 55
What is a reflex?
East Coast Physical TherapyEast Coast Physical Therapy 66
Stretch reflexStretch reflex
East Coast Physical TherapyEast Coast Physical Therapy 77
Sir Charles SherringtonSir Charles Sherrington
East Coast Physical TherapyEast Coast Physical Therapy 88
The Withdrawal ReflexThe Withdrawal Reflex
• Previously known as the Flexor Reflex• Involves multiple levels and synapses
1.Painful stimulus detected2.Ipsilateral extensors inhibited3.Ipsilateral flexors excited4.Limb is withdrawn5. Contralateral extensors excited
East Coast Physical TherapyEast Coast Physical Therapy 99
The Startle ReflexThe Startle Reflex
•Known as the Moro Reflex in infants• Is associated with withdrawal in the pain reflex•Frequently involved in PTSD as a hyper-arousalresponse to stimuli• Likely to upregulate the ANS
East Coast Physical TherapyEast Coast Physical Therapy 1010
Autonomic Nervous SystemAutonomic Nervous System
2 Parts:2 Parts:
SympatheticSympathetic
Fight or Flight Fight or Flight
ParasympatheticParasympathetic
RelaxationRelaxation
East Coast Physical TherapyEast Coast Physical Therapy 1111
Autonomic Nervous Autonomic Nervous SystemSystem
East Coast Physical TherapyEast Coast Physical Therapy 1212
Small StartlesSmall Startles
• Expletives said when something Expletives said when something shocks or upsets usshocks or upsets us
• Likely to upregulate the ANS by Likely to upregulate the ANS by Pavlovian conditioning of the upset Pavlovian conditioning of the upset feeling to situations we can’t or don’t feeling to situations we can’t or don’t controlcontrol
• Probably facilitate the Dura through Probably facilitate the Dura through Vagus Vagus
East Coast Physical TherapyEast Coast Physical Therapy 1313
Up regulation of the ANSUp regulation of the ANS
• StressStress
• PainPain
• FatigueFatigue
• Poor sleepPoor sleep
• Hyperalgesia to sub nocioceptive Hyperalgesia to sub nocioceptive stimulusstimulus
East Coast Physical Therapy 14
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 15
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 16
How can PRRT affect the Central Nervous system?
East Coast Physical Therapy 17
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
East Coast Physical Therapy 18
East Coast Physical Therapy 19
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 20
Dural Drivers
• Rectus Capitus Posterior Minor
• Ligementum Nuchae
• Masseter
• Upper Trapezius
• Sternocleidomastoid
East Coast Physical Therapy 21
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 22
The sub occipital muscles
East Coast Physical Therapy 23
Ligamentum Nuchae
East Coast Physical Therapy 24
Rectus Capitis Posterior Minor
East Coast Physical Therapy 25
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 26
Sternocleidomastoid
East Coast Physical Therapy 27
East Coast Physical Therapy 28
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 29
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 30
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 31
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 32
Demonstration
• 1 Minute exam to find areas of NSR
• Treatment
• Reassessment
East Coast Physical Therapy 33
East Coast Physical Therapy 34