Following the Golden rules of PRI............A Must to succeed ! ! !

 I recently saw a patient who has had chronic left foot pain. Has tried traditional PT, orthotics(the hard, rigid ones that I hate), a steroid injection, everything he knew or was told in the traditional model. Had seen him few years ago for other issues ( successfully for a couple issues),  but knew even at the time that I was not quite finished as he was still not  always maintaining neutral alignment ( and always making his own modifications of the PRI exercises). Sure enough, he was back again with a " new " problem. Was I surprised ? Not, really. Just not too happy we did not prevent this " new " compensation from occurring. Upon evaluating him, I said to him, " You know what I'm going to say and where I am going to start working, right ? At the pelvis and the rib cage of course, because the evaluation tells me that you are not in the correct position, i.e. not symmetrical." His comment was, " I'll do whatever you say, because I've tried everything else they told me and its not better, which is why I'm here"  At the second visit, a week later after we worked his L hip and got his rib cage moving correctly, he was still a little skeptical and asked," We ARE doing this for my L foot pain, right ? " I assured him we were, just to be patient.   Well, 3 weeks and 3 visits later,  he reports that he is feeling the correct muscles in his hip working and his foot is indeed better. But, I am still not happy, because he comes in and the tests prove he is not yet neutral. Digging in further, trying to see what we were possibly missing, guess what we find is most likely getting in our way ? He was doing the exercises we had given him ( without his own modifications, for a change ! ), but along with these was also doing a lot of other " stretches" that were getting him out of position again and negating the effects of what we were trying to achieve. These so called "stretches" were something we PRI therapists never have our patients do, but are done regularly in the traditional training world. There was that missing link, which is why we were taking 2 steps forward and 1 back. My student spent the next half hour laying down some " Golden Rules " of PRI, drilling in the "Do's and Don'ts" and we hope to see faster progress from now on. Now guess what, we plan to have a hand out of the "Golden Rules " and give it to our patients on their first day, to help them on their road to success. Lesson learnt !