Primal Reflex Release Therapy (PRRT)- Making the News

The link to this story came across my desk this morning (courtesy of EIM’s Evidence Express) and thought you ought to see this "little used, unusual form of physical therapy" guaranteed to relieve chronic pain.  Yes, thats right: a silver bullet that immediately relieves chronic pain.  The reason is because it actually treats the cause of pain……tension (of course everyone should know that by now).

I have seen PTs in exhibit halls at various professional meetings literally flock to see this "break-through" treatment.  But, as we see and hear in the video, the only way you know it works is to try it yourself.

Now, there may be something to this.  However, at this point I still don’t know what conditions or syndromes it is indicated for, who is said to benefit, and whether or not it is effective (I haven’t tried it yet).  A nice  start would be to at least be able to read a case study in a reputable journal describing the intervention and associated outcomes (seriously, let me know if one is available).  Right now all I can tell is that there is a "whole lot of shaking going on".  Despite that, I bet you will still see some PTs flocking to demonstrations,  jumping on the PRRT bandwagon and patients paying out of pocket for it.  However, I wonder if insurers are really paying for this (as stated).

We have a long way to go.

 

Rob

13 responses to “Primal Reflex Release Therapy (PRRT)- Making the News

  1. Louie Puentedura says:

    “However, I wonder if insurers are really paying for this (as stated).”
    This is a great question, Rob, and unfortunately the answer is probably yes because insurers do not know what they are paying for. The procedure is probably billed under the manual therapy or neuromuscular re-education CPT codes, and it would certainly be VERY interesting to see what sort of progress notes are documented to support the intervention. There may well be some confusing phraseology.
    I subjected myself to a PRRT technique at CSM in San Diego, to ‘try it myself and see’, and to be honest, it didn’t feel like much at all. Some tapping here and tapping there, and lots of leading questions and suggestive remarks about ‘tension’ that I apparently had despite not knowing about it.
    Until there are some case series, a case study or any kind of research to support this stuff, I think we do ourselves (the PT profession) a disservice by embracing stuff like this.

  2. Peter Wahl says:

    I have known John Iams for over twenty years and myself and members of my family have been treated by him and I have referred many of my physical therapy friends and customers to his course work. I would recommend John’s work to anyone without any reservations. I’m an informed consumer of pt services, past provider of PT continuing education services and pt equipment supplier and have recommended John’s course(s) to many PT friends and customers. Peter Wahl

  3. Peter Wahl says:

    PS
    A follow up comment. If the PT profession continues to be guided by “what insurance is going to pay for”–it is in deep trouble.

  4. Selena Horner says:

    Peter, aren’t you proposing 2 contradictory statements? You agree that it probably isn’t a great idea to be guided by what insurance will pay but in the same breath will recommend John Iams and PRRT which has zero evidence other than possibly placebo at this point in time?
    Just because you are friends with someone or know someone for many years does not equate that the person you know as being effective because the treatment strategy employed by that particular person “worked” in your situation. I’m confused as to exactly what you are informed. You haven’t provided me a reasonable argument to convince me that I just have to attend one of his courses.
    And since you are a long time friend of John Iams, well, maybe you could point him in this direction so he can share his evidence and enlighten all of us! :)

  5. Louie Puentedura says:

    Selena:
    Mr. Wahl doesn’t clearly state this directly, but it is obvious that he is not a physical therapist. He describes himself as a ‘comsumer of consumer of pt services’ (i.e. he has been a patient in the past), ‘past provider of PT continuing education services’ (i.e. he has probably promoted and profitted from John Iams and ‘the like’ courses) and ‘pt equipment supplier’ (i.e. he probably sold John Iams’ world famous Backerciser and Pivotal Therapy System) see really old, old posting http://blog.evidenceinmotion.com/evidence/files/JohnIamsCrap.pdf
    What evidence does Mr. Wahl provide for us to consider the value of PRRT? ……..

  6. John Ware says:

    Iams is the poster boy for “shrewd healthcare fad marketer.” He knows that the way to sell your “widgets” in the healthcare market is through the gullible media, not through research- that might actually show that anxiety and stress are NOT the ultimate cause of musculoskeletal pain.
    Also, I love how guys like Iams say you can incorporate this stuff “seamlessly” (one of their favorite words) into what you already do, but then go on about how you can see so many more pts because you won’t have to spend as much time treating them. So, I can do my joint/soft tissue work, teach exercises and ADLs AND tap on someone’s masseter, and I’m somehow going to be able to do all that in 15 minutes! Something here doesn’t compute- nor pass the smell test.
    John

  7. Jean says:

    Hi,
    I currently work in a clinic where the owner is a hard lined subscriber to the practice of PRRT. While I myself am skeptical, it does seem to work for some patients. Whether or not it is a placebo effect I cannot say (similar arguments can be made for ultrasound use depite contrary evidence). On some patients it does seem to work, specifically those with chronic pain or “fibromyalagia”. Whether or not insurance it is billable is a different story, but we’re in this to get people better. I’m all for another weapon in the tool box for those pesky patient problems, and if they get better then I don’t see a problem with people using it (not everything in other medical professions is evidenced based either). Some evidence based stuff would be great to support it, and I wish John Iams would follow through on this. Thanks for letting me post.

  8. John Ware says:

    Jean,
    Thanks for posting here on this growingly contentious issue in physical therapy.
    I suggest you go back and read one of the great editorial classics from the late Jules Rothstein, PT, PhD “When Thoughtfulness Dies” from PT Journal. (http://www.ptjournal.org/cgi/reprint/76/4/342?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&author1=rothstein&title=thoughtfulness&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT.
    In this essay, Dr.
    Rothstein can more eloquently explain exactly why it’s critically important that we know why (not just whether or not) our treatment interventions work.
    PRRT has been around for some 10 years or more, and yet not so much as a case study has been published in any health, medical or rehabilitation journal that I’m aware of. Why do you suppose the purveyors of PRRT would be reluctant to hold this treatment approach up to scrutiny in a journal? I don’t think the they’re lazy- Iams himself has got more patents than Edison. Are they concerned that scrutiny within a formal scientific format may damage the credibility of the approach, and then hurt seminar sales?
    I don’t know. The PRRT folks seem to prefer talking to reporters who will say interesting and nice things about their approach or to PTs who pay them for their seminars.

  9. Sebastian says:

    One thing I have to say about Mr. Iams – at least he doesn’t sue any detractor of him or PRRT immediately!
    I fully agree with John here – Jules Rothstein has made a very strong case for knowing the “why” of effectiveness – not just the “yes, it works” type of evidence.

  10. ron says:

    I would like to say to all the people who are very negative regarding PRRT.
    If you have not used the treatment or have seen it used by a trained PRRT practioner you should not judge.
    It is a very effective treatment form for many diagnosis. It works very fast or fail fast. For all the evidence based PT’S Go ahead and keep mobelizing/massage people.PRRT practioners can accomplish the same or even better results in a fraction of your time.

  11. Sebastian says:

    Um, thanks ron.
    You should not forget to try bloodletting – I bet you haven’t tried it yet, so you can’t really judge it yet.
    It is just like PRRT, it works very fast or fails very fast.
    All fun aside, have you even READ the stuff above? What is being posted relates mainly to the “Why” of the supposed/assumed effectiveness of PRRT. And here you go, telling us about the effectiveness again…..

  12. Chris says:

    As a patient I tried this. Didn’t work at all and I’m angry that the PT wasted my time and money with a “voodoo” technique. It’s a bunch of hooey and I’m amazed that educated PTs would just start using this without any research evidence that it works.

  13. pam Cammisa says:

    It works, I am a PTA who works with a PT that is certified PRRT and I see it helping reduce pain and increase strength everyday !!! He taught us the 10 starting protocols and we get results. It maybe more anecdotal than evidence based but you cant deny patients requested and feedback as well as your own. It is based in science, you can research primitive and primal reflexes and how they get up regulated and shut things down, there is also an element of muscle energy.

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