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


Amy Snyder, MPT, is a graduate of the University of Florida. Following graduation, Amy spent one year training with the National Centers for Facial Paralysis in Washington D.C., making her a specialist in the field of craniofacial pain and dysfunction. Amy has focused her continuing education on enhancing her manual therapy skills. She has attended numerous seminars. Her varied education includes Myofascial Release, Muscle Energy Technique, Strain-Counter Strain, Cranial-Sacral therapy, and Primal Reflex Release Technique. In her spare time she enjoys practicing Yoga and Pilates and incorporates these exercise philosophies into her daily treatments to enhance her patients overall health.


The first 2 parts of “PRRT: Welcome to the Paradigm Shift,” focused on the theory of John Iams’ Primal Reflex Release Technique, or PRRT. In the last part we will focus on the clinical application of PRRT and how it will affect the future of Physical Therapy.

As we have previously discussed, John Iams’ theory, Primal Reflex Release Technique, has had a profound effect on the evaluation and treatment of musculoskeletal injuries, orthopedic conditions, post orthopedic surgeries, and pain in our Physical Therapy Practice. It has altered our clinical beliefs and behaviors, including differential diagnosis, rationale for treatment and expectations for results-oriented patient outcomes. We have consistently found shorter treatment times with improved patient satisfaction. This has directly improved our relationship with patients and the medical community as a whole. From start to finish, PRRT has affected the way we practice. In turn, our vision for the profession of Physical Therapy and its potential benefits has also changed…that is until the next paradigm shift occurs.

Putting PRRT into Practice

A patient in our clinic will experience a typical Physical Therapy initial evaluation including Range of Motion/Goniometry Measurements, Manual Muscle Testing, Neurological Screening, Postural Assessment and Special Tests. The difference lies in the palpatory exam. While the traditional Physical Therapist will evaluate the soft tissue tension quality and assess the amount of tenderness of the musculature, when practicing PRRT, the examiner is assessing the existence of “Nociceptive Startle Reflexes” or NSRs as described by John Iams. This portion of the evaluation takes 1 to 2 minutes, depending upon the situation and the therapist’s discretion. These tenderpoints or NSRs are identified to determine the validity of PRRT as a treatment intervention, as well as identify the locations of PRRT treatment.

The initial treatment utilizing PRRT typically includes only 6 to 8 techniques. This usually takes approximately 5 minutes and is included in the same visit as the initial evaluation. These techniques are intended to “down-regulate” the areas that were identified as “up-regulted” by the presence of NSRs. In addition, the patient would be instructed in a few home exercises to further down-regulate of the treated reflexes.

Additional treatment sessions include more PRRT techniques as indicated by continued significantly up-regulated/painful areas. Daily re-evaluation of NSRs is performed to identify such areas. In the event that the patient’s primary cause of pain is the up-regulation of the primal reflexes, it has been the experience of these clinicians that following 6-8 treatment techniques and a home exercise program of 1 or 2 down regulation exercises, 80% of the tender areas were gone and the pain greatly diminished. In addition, many of the orthopedic conditions such as ROM and MMT also improve, further demonstrating the importance and influence of these reflexes.

In cases that there continues to be pain and dysfunction in the body, PRRT is still utilized, in addition to other procedures such as Myofascial Release, Soft Tissue Mobilization, Joint Mobilization, Muscle Energy Techniques, Cranio-Sacral Therapy and/or modalities such as electrical stim, ultrasound, and infrared. It has been our experience that after PRRT treatments, the areas of orthopedic dysfunction are more apparent and the traditional treatment techniques become more effective as well. This is especially helpful for patient’s with chronic and complicated pain patterns. In addition, follow up visits include more traditional orthopedic exercises for muscle groups that continue to demonstrate tightness or weakness.

An important component of PRRT is patient education. In order for the patient to maintain the benefits of this treatment, they must also understand the effects of stress on their body and the need to relax. Without this understanding, they are more likely to experience a relapse due to the underlying stresses that initiated the up-regulated pattern. By educating the patient to first identify what their stressors are, and then to perform simple, short exercises to self-down-regulate, they will be better equipped to handle their daily lives without experiencing physical pain.

When PRRT does not work and the patient does not improve, even after traditional physical therapy, John Iams provides practioners with a list of four dozen or more reasons to explain why. Therefore, within the PRRT model you are given a rationale of options to direct your clinical decision-making and assist you with your differential diagnosis. These reasons include unrecognized stress, emotional factors, medical conditions, and nutritional conditions. In this way, Iams is also clear with regards to the limits of this treatment technique.

PRRT and the Future of Physical Therapy

As we have demonstrated, there has been a fundamental change in our behaviors, opinions, and style of practice from our pre-PRRT days to our current style of practice. This change has been profound. We feel that it is signaling a paradigm shift within the profession of Physical Therapy. This shift has resulted in decreased treatment times, decreased number of visits per episode of care, and improved patient outcomes in all of our clinics, regardless of socioeconomic or health and wellness issues. These changes are paramount in our country as we face the challenges of our current healthcare system. In addition, as the profession of Physical Therapy moves forward in achieving a truly autonomous practice, we have gained confidence in declaring our limitations and referring with more certainty to other healthcare providers when working within this model. We are becoming an entry point into the medical model for our patients and are utilizing direct access more than we had in the past.

The difficulty that our profession will face in the future is wide spread acceptance of this shift. In the current environment of Evidence-Based Practice, there is resistance to new ideas based upon the lack of current evidence. As a group of professionals, we have observed the clinical results of this treatment technique and have determined it to be our best practice in the field of outpatient orthopedics. It is important to note that ethically, it is our duty first to “do no harm.” As a non-invasive technique, we do not risk harm to our patients by utilizing PRRT in the clinic before adequate research is complied. It is our belief that we also have an ethical responsibility to provide the best care possible within our knowledge base. To deny our patient’s the treatments that we have deemed clinically superior would be a disservice to them.

Rather than resist these changes, it would behoove our profession to combine our efforts. Academia possesses the resources, background and expertise to efficiently and effectively write research proposals, obtain grants and execute clinical studies. It is time for them to trust the skill level and expertise of clinicians and our recognition of the effects of PRRT. By working together, we can elevate the level of care that our patient’s receive as we speed the acceptance of this Paradigm Shift. For more information on PRRT please contact Frank, Amy or Mark at or visit


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

  Back to Part 2 of the article on Primal Reflex Release Technique  


Last revised: May 7, 2008
by Frank Fantazzi, PT, OCS, Amy Snyder, MPT, Mark Snyder, PT

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