PT Classroom - Primal Reflex Release Technique: Welcome to a Paradigm Shift- Part 2 of a 3 part series ׀ by Frank Fantazzi, PT, OCS, Amy Snyder, MPT, Mark Snyder, PT

PRIMAL REFLEX RELEASE TECHNIQUE

Primal Reflex Release Technique (PRRT™) is a systematic approach to the evaluation and treatment of pain patterns based on primal reflexes. John Iams, P.T. developed PRRT from many years of experience and extensive research. It advances our use and understanding of basic physiology and anatomy, bringing about a paradigm shift for Physical Therapy and Healthcare.

REFLEXES
Primitive or Newborn Reflexes are present in-utero and during the first year of life. They originate from the brain stem and are used to sustain or preserve life. Traditional medicine uses such reflexes to diagnose neurological disorders at birth. In the event of neurological injury later in life, they may return. It has been traditionally thought that they are inhibited by the frontal lobe. Iams proposes instead they persist as a primal form of protection for the human body. He specifically refers to the Palmar, Plantar, Moro or Startle, Rooting and Withdrawal Reflexes. In addition, he describes a protective Joint Reflex. In the adult human, he suggests that dysfunctional activation of these reflexes may be at the root of most painful conditions.
 

Stimulating these reflexes demands a motor response and therefore the neuromuscular system is activated. Activation of this motor response is widespread in the skeletal muscles. According to Iams, the whole body will respond to activation of these reflexes. These primal reflexes lead to patterns of pain that can be reproduced and duplicated. Dysfunction occurs when these reflexes are repeatedly stimulated and maintained. Is this the “splinting and/or guarding” observed in our patients? Is this the “hard ropey muscles” we feel or palpate that never goes away? Iams says “yes,” and believes they are maintained for a variety of reasons from physiological to emotional states of being.

AUTONOMIC NERVOUS SYSTEM
In conjunction with these reflexes, Iams further attributes the role of the Autonomic Nervous System (ANS) in painful conditions. The fight or flight response is the commonly described motor component of the autonomic nervous system, putting “thought into action.” Iams’ goal is to achieve a balance between the two halves of the ANS, the parasympathetic and the sympathetic systems. When balance is achieved and the ANS is quieted, then muscle tone, tenderness, and pain are significantly decreased.

Iams describes over-stimulation of the ANS and primal reflexes, causing the entire body to be “up-regulated.”  The purpose of PRRT is to identify this state and to “down-regulate” the motor component of the ANS and the reflexes.  This “down-regulation” means that there is a “quieting” of the nervous system and hence, a relaxation of the musculoskeletal system as well. Down regulation therefore is a term for neuromodulation resulting in decreased guarding, splinting, muscle tone, and pain.

For the sake of brevity, there is a neuroanatomical connection between the musculoskeletal system and the ANS. Not all the intricate wiring has been defined and is open to further research and discussion. However, common sense tells us that there needs to be a wiring of the whole body from the autonomic nervous system to the musculoskeletal system to achieve a fight or flight response. The PRRT seminars further discuss the relationship between the musculoskeletal system and the autonomic nervous system and their practicality for use in the clinical environment.
 

In addition, this connection of the techniques of PRRT to the ANS opens up a Pandora’s Box of possibilities in the evaluation and treatment of all individuals. The potential uses of PRRT in medicine are enormous and that is what you would call a paradigm shift.

A DISCLAIMER
Iams says “that only 80% of my patients respond to PRRT” and he says “When I fail, I fail quickly,” therefore PRRT may not work for everyone, but it can be used to rule out conditions and give further direction to the plan of care. He also provides practioners with a list of reasons why his techniques will not be effective.

WHAT HAPPENS
The cornerstone of PRRT is the palpatory exam. The exam is quick and can be completed in 1-2 minutes. The PRRT exam identifies tender points, as many manual therapy techniques do. Iams refers to the tender points that he has identified as, “nociceptive startle of reflex regions” or NSR’s. The practitioner begins each exam with the identification of these NSRs. This will dictate the treatment sessions based upon the pattern observed. This pattern is easily reduced or not reduced secondary to the PRRT techniques employed and an indicator of the efficacy of PRRT as a treatment modality. The intimate relationship of the palpatory exam and result is consistent and reproducible.
 

Once the NSRs are identified, PRRT techniques are used to “down-regulate” these tender regions. The PRRT techniques use several means to decrease the influences of primal reflexes. Most of the techniques are limited to a brief treatment of 12-30 seconds. Multiple techniques are used to achieve the desired result. The treatment session using only PRRT is brief. Occasionally, techniques must be repeated to achieve a maximum result.

Unlike other soft tissue techniques, treatment may not occur directly at the location of tenderness. As the purpose is to globally “down-regulate” the body, techniques performed at the head and neck may influence tenderness in the lower extremities. In this way, the practioners can determine the effectiveness of this technique and diagnose the cause of pain as “up-regulation” versus direct soft tissue injury. A skilled practitioner should be able to discern within 4 to 5 treatment sessions whether PRRT will be effective or ineffective in the treatment and reduction of pain. The practitioner then decides in which direction the care of the individual will proceed.

After the initial visit other orthopedic manual therapy techniques and/or exercises are blended into PRRT to achieve a desired result. “PRRT ONLY ENHANCES OTHER TECHNIQUES AND MAKES THEM MORE EFFECTIVE.” Both the exam and treatment are fast. Remember “When I fail, I fail quickly”.

Clinically we use PRRT with all of our patients. We utilize PRRT almost exclusively on the initial visit. The follow up visits are a blend of PRRT and other orthopedic manual therapy techniques, therapeutic exercise programs and a home exercise program for the patient. Stay tuned for our third article which we will go into more detail about integrating PRRT into one’s daily practice and the future of Physical Therapy. For more information on PRRT please contact Frank, Amy or Mark at www.ptplus.com or visit www.theprrt.com.

Go to Part 3 of the article on Primal Reflex Release Technique

Back to Part 1 of the article on Primal Reflex Release Technique