**Acknowledgement**

Morris Self-Report Low Back Pain Disability Questionnaire (RMDQ) was 9/24 or 37.5% self-

*Sagittal*: Treatment began with sagittal plane control of pelvis and thorax to improve critical respiratory core muscle control. JP started in hooklying and supine 90–90 postures to begin activities like supine 90–90 with balloon blowing versions (see **Figure 15**). Once postural test-

*Frontal*: For this patient, the left sidelying position was felt to be best to help her begin to control frontal and transverse plane forces particularly in the region of her left lower lumbar spine, which were the most likely source of her debilitating sciatica. As JP gained control of the left abdominal wall in left sidelying and to obtain a ZOA, she began to integrate that control with combined muscular efforts culminating in left acetabular femoral internal rotation as with *Left Sidelying Left Flexed Femoral Acetabular Adduction with Right Lowered Extended Femoral Acetabular Abduction* (see **Figure 17**). JP was severely challenged with kinesthetic awareness of muscle activation and "carry over" to alternative postures. In her case, it was very helpful to have her stand up after a left sidelying activity to try to reproduce the same movement pattern in upright—her most challenging posture. Adding activities like *Standing Supported Left Acetabular Femoral Internal Rotation with Right Femoral Acetabular Abduction* (see **Figure 19**)

*Transverse and alternating, reciprocating movement*: As JP demonstrated further capacity for trunk control with left acetabular femoral internal rotation, we added challenges to coordinate with right trunk rotation as with gait. The use of walking poles was tremendously helpful for this patient to help with her balance, core muscle activation, kinesthetic sense of the ground and weight shifting, as well as to offer additional support for spinal elongation, a critical element in scoliosis treatment. Activities depicted like Four Point Gait with Mediastinal

*Summary*: Over the course of her last few visits (21 visits total), JP was consistently reporting dramatic and steady improvement in her function. She was playing with her grandson more than 2 hours at a time and able to stand through 3-hour choir rehearsals. Her walking progression was up to 34 min. The last RMDQ score was 3/24 or 12.5% self-report disability. All physical therapy goals were met. She was highly compliant and motivated throughout the

The theoretical framework of PRI and its model of innate human asymmetry provides the clinician valuable insight into the development and progression of scoliosis and other spinal dysfunctions. This framework has the potential to redefine how clinicians evaluate and treat

ing indicated adequate sagittal plane control, she moved to a left sidelying program.

were, therefore, quite a good challenge for improved upright control.

course of her care, which no doubt, contributed to her strong outcomes.

Expansion were further developed (see **Figure 20**).

**6. Conclusion**

these conditions.

report disability.

*5.3.2. Treatment progression and clinical reasoning*

162 Innovations in Spinal Deformities and Postural Disorders

We are grateful to Ron Hruska MPA, PT, executive director of the Postural Restoration Institute, who formulated these concepts, developed this framework and continues to share his evolving insights.
