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East Coast Physical Therapy 1

East Coast Physical Therapy Presents

PRIMAL REFLEX RELEASE TECHNIQUE

Darren J. Weidenman, PT, MA, OCS

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Darren J. Weidenman, PT, MA, OCS

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Who developed PRRT?

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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.

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What is a reflex?

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Stretch reflexStretch reflex

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Sir Charles SherringtonSir Charles Sherrington

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The Withdrawal ReflexThe Withdrawal Reflex

• Previously known as the Flexor Reflex• Involves multiple levels and synapses

1.Painful stimulus detected2.Ipsilateral extensors inhibited3.Ipsilateral flexors excited4.Limb is withdrawn5. Contralateral extensors excited

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The Startle ReflexThe Startle Reflex

•Known as the Moro Reflex in infants• Is associated with withdrawal in the pain reflex•Frequently involved in PTSD as a hyper-arousalresponse to stimuli• Likely to upregulate the ANS

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Autonomic Nervous SystemAutonomic Nervous System

2 Parts:2 Parts:

SympatheticSympathetic

Fight or Flight Fight or Flight

ParasympatheticParasympathetic

RelaxationRelaxation

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Autonomic Nervous Autonomic Nervous SystemSystem

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Small StartlesSmall Startles

• Expletives said when something Expletives said when something shocks or upsets usshocks or upsets us

• Likely to upregulate the ANS by Likely to upregulate the ANS by Pavlovian conditioning of the upset Pavlovian conditioning of the upset feeling to situations we can’t or don’t feeling to situations we can’t or don’t controlcontrol

• Probably facilitate the Dura through Probably facilitate the Dura through Vagus Vagus

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Up regulation of the ANSUp regulation of the ANS

• StressStress

• PainPain

• FatigueFatigue

• Poor sleepPoor sleep

• Hyperalgesia to sub nocioceptive Hyperalgesia to sub nocioceptive stimulusstimulus

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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

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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

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How can PRRT affect the Central Nervous system?

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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

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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

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Dural Drivers

• Rectus Capitus Posterior Minor

• Ligementum Nuchae

• Masseter

• Upper Trapezius

• Sternocleidomastoid

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Direct Dural Drivers

• Ligamentum Nuchae through the arthrodural bridge at C1-C2 level.

• Rectus Capitus Posterior Minor through the myodural bridge

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The sub occipital muscles

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Ligamentum Nuchae

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Rectus Capitis Posterior Minor

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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

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Sternocleidomastoid

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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

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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

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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

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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

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Demonstration

• 1 Minute exam to find areas of NSR

• Treatment

• Reassessment

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