PRIMAL REFLEX RELEASE TECHNIQUE
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 www.ptplus.com or visit
www.theprrt.com.
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
