PT Classroom - Primal Reflex Release Technique: Welcome to a Paradigm Shift- Part 1 of a 3 part series ׀ by Frank Fantazzi, PT, OCS, Amy Snyder, MPT, Mark Snyder, PT
Frank Fantazzi is a 1977 graduate of Marquette University. He is a board certified clinical specialist in orthopedic physical therapy and also has his manual therapy certification through Stanley Paris of the University of St. Augustine for Health Sciences. He is currently a physical therapist in practice and is the chief operating officer at PT plus. Frank is constantly striving to obtain maximal outcomes and results for his patients and has begun incorporating primal reflex release technique (PRRT) into his treatment plan. He has completed the advanced training for PRRT and is a certified instructor for teaching this method as well.
WHAT IS PRIMAL REFLEX RELEASE TECHNIQUE?
Primal Reflex Release Technique (PRRT) is a new treatment approach in the field of pain treatment and management that has the potential to radically alter the influence of the physical therapist in the health care model. PRRT will create the next paradigm shift in physical therapy.
John Iams, P.T. developed PRRT from nearly four decades of clinical experience and research. PRRT is a systematic approach to the evaluation and treatment of primal reflexes, which according to John Iams, P.T., are over stimulated. This over stimulation of the primal reflexes maintains pain and keeps painful patterns active. According to Iams, the treatment of these primal reflexes is effective in treating 80% of people that have painful conditions. The treatment of these reflexes may have an influence on other systems of the body playing a key role in health care.
The term paradigm shift was first used by Thomas Kuhn in 1962 in his book, The Structure of Scientific Revolutions. He used this term to describe a change in the basic assumptions within the ruling theory of science. The term has also been used in other contexts, such as to describe a shift in beliefs, thought patterns, or behavioral patterns. Paradigm shifts occur when unexplained anomalies in current paradigms initiate the search for answers. When new theories are developed, practiced and become accepted, the paradigm has shifted. The old paradigm is focused on the peripheral origin and treatment of pain. Pain is usually based on a fairly narrow medical model that assumes implicitly or explicitly that pain complaints can be accounted for by disease or anatomical abnormalities. The medical paradigm is relied on to provide the logic for clinical decision making. A basic premise of the medical model is that symptoms are the expression of anatomical, physiological, or biomechanical abnormalities indicative of disease. (Pain and Disability: Clinical, Behavioral, and Public Policy Perspectives (1987) Ch 10).
Currently, PRRT is being developed and practiced. The acceptance of this paradigm is the next step. Therefore, we are currently “in the shift”. PRRT will have an effect on scientific theory in the approach to the treatment of pain, rehabilitation, and the role of physical therapy in health care. As PRRT is accepted and adopted by the community, it will radically change the evaluation and treatment of painful medical disorders, as well as improve patient outcomes. Physical Therapy has the opportunity to lead the change.
THE THEORY BEHIND PRRT
The basic tenet of PRRT is that all painful experiences are controlled by a central source that biases the periphery. This challenges the old paradigm that there is a peripheral origin and treatment of painful conditions (PRRT does not discount or deny the peripheral origin and treatment of pain but only offers another theory to explain why the old way does not always work). According to John Iams, P.T., the primal reflexes such as the startle reflex, the withdrawal reflex and the protective joint reflexes are at the root of all sustained painful conditions. These reflexes are hardwired into the nervous system initially for the purpose of survival and/or the preservation of life. Therefore, when someone is in pain or is encountering a painful or startling experience, these reflexes are called upon to protect the body, stimulating a “fight or flight” response. These reflexes can be sustained in the state of hyper readiness described by John Iams, P.T. as being up regulated. This up regulation of the primal reflexes leads to patterns of pain that can be reproduced, duplicated and maintained.
The primal reflexes are linked to the “fight or flight” response and therefore the autonomic nervous system. This link to the “fight or flight” response is also associated with the human condition called stress. The AMA states that 80% of all illness and disease are associated with stress. Through this connection, John Iams, P.T. has developed a powerful new tool to treat a myriad of related medical conditions. This gives the physical therapist a very powerful new tool to both assess and treat clients. The effect that PRRT can potentially have on physical therapy and the medical profession could be profound.
PRRT is a paradigm shift on many levels. First of all, it challenges the scientific theory of pain and its treatment. Secondly, it is already changing the thought patterns, behaviors and attitudes to those few willing physical therapists utilizing this technology. Thirdly, it does not negate other paradigms, it only adds to them. Finally, it has the potential of having a far-reaching effect across all of medicine.
Physical therapy and the healthcare profession most likely is “in the shift” portion of a paradigm shift. Physical therapists should begin to ready themselves and start the process of embracing, studying, and using this technique to propel themselves into the next phase of development of health care delivery. In doing so the professionals for the sake of the profession need to ask all the appropriate questions and go through the process as described by Kuhn’s concepts. The process includes discovery, sharing, discussion, application, crisis and intellectual battle, and finally acceptance. History has observed the intellectual battles that ensued following the introduction to a new paradigm. This has been well documented in the physical therapy literature. The discussion is necessary, but should we waste a lot of time, energy, and hurt feelings as we process? It would do the PT profession well to embrace this new technology and quickly own it. If we wait for scientific studies to prove or disprove a technique based on empirical study or evidence based conclusions, the moment may be lost.
This is the first article of a three part series of articles on PRRT. The next two articles will give a more more complete description of PRRT and provide a description of the PRRT practitioners and the future. For more information on PRRT please contact Frank, Amy or Mark at www.ptplus.com or visit www.theprrt.com.
Last revised: May 7, 2008