East Coast Physical Therapy Presents PRIMAL REFLEX RELEASE TECHNIQUE

1. East Coast Physical Therapy PresentsPRIMAL 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 Therapy

5. What is a reflex? East Coast Physical Therapy

6. Stretch reflex East Coast Physical Therapy

7. Sir Charles Sherrington East Coast Physical Therapy

8. 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and synapses • Painful stimulus detected • Ipsilateral extensors inhibited • Ipsilateral flexors excited • Limb is withdrawn • Contralateral extensors excited East Coast Physical Therapy

9. 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 East Coast Physical Therapy

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

11. Autonomic Nervous System East Coast Physical Therapy

12. 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

13. Up regulation of the ANS • Stress • Pain • Fatigue • Poor sleep • Hyperalgesia to sub nocioceptive stimulus 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

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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

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34. East Coast Physical Therapy