Interview with John Iams
by Steve Cotter
It is not a question of if you will get injured as a serious athlete, but when. Fortunately, there are some amazing techniques out there such as active release technique and trigger point therapy. However, there is another technique that it is taking the athletic community by storm called Pain Reflex Release Technique, PRRT.
This revolutionary technique of pain relief, developed by John Iams, is providing injured athletes with a quicker return to the playing field, and improved performance in their game. In this interview with Steve Cotter, John Iams, PT, explains the science behind his system of treatment, and introduces the method that is changing the way athletes are rehabilitating injuries.
SC: John, you have developed a system of pain relief that has been very successful in treating all type of injuries. Do you have a particular name for your system?
JI: Steve, we call it the Pain Reflex Release Technique, PRRT.
SC: Could you tell us a little about what this system of medicine entails?
JI: This has evolved over almost 40 years of practice. It consists of looking for Primal Protective Reflexes that influence muscle function and in this case, the 2 major reflexes I'm looking for when I'm examining the body are the withdrawal reflex and the startle reflex.
SC: How has your practice brought you to working with athletes and athletic performance?
JI: Well, as you know, in the realm of athletics the return to competition is everything and consequently the search continues to look for the most effective and fastest method of treatment for athletic injuries so that athletes can be back to full level competition as soon as possible.
I think that's what's driven many athletes to my clinic for the physical therapy that we provide with the Pain Reflex Release Technique, because we're able to resolve most problems within just 1, 2, or 3 sessions. Seldom does it require more than that unless someone's had surgery. So that's probably what's driven this the most, is the speed with which the change occurs, even if other methods of treatment haven't been working.
SC: Have you had any mentors in the field of athletics that have influenced you to focus your work toward treating athletes?
JI: You know I think my influence in this probably has come more from my interest in athletics, rather than from any specific mentors. I played sports in high school and had injuries of my own, and was frustrated in not being able to continue to play, particularly football. I wanted to play college football, and was unable to even play high school football, because of knee injuries. That's what led me into the field of physical therapy and I continue today to love sports. So, rather than have a particular individual or individuals who've influenced this process, it's really more my passion for sports and enjoying seeing individuals perform at an optimum function where they're pain-free and able to apply the gifts that they've either genetically received or the skills they've developed through coaching.
SC: Can you give an example in sport where an athlete can utilize your Pain Reflex Release Technique to immediately benefit his or her performance?
JI: Yes, probably one of the easiest things that an athlete can do that would give them a sample of what this work is all about would be for them to be able to relax their hamstrings. This is particularly important for athletes who are involved in sports that involve running and jumping.
If the athlete were to sit in a chair and have their knees flexed at a right angle and they were to karate chop themselves over the patellar tendon, which is the tendon just below the kneecap, they would be able to elicit a reflex in the quadriceps muscle, not unlike when they go to see a doctor and he uses a little rubber hammer to test the reflexes. In this case the athlete would be eliciting their own reflexes, and they can initiate this just by karate chopping that tendon. That would then have a reciprocal inhibiting effect on the hamstring muscles, which of course are important because most sports performances are enhanced by some pre-stretching of the hamstring muscles, as well as other muscle groups, but the hamstrings seem to be one of the most important. So this done before the stretching allows an individual to have even more range to be able to stretch through than they would if they weren't performing that maneuver.
SC: So, there is a clear physiological benefit. There is a term in sports psychology "peak performance state" that is utilized quite often to describe the ideal mindset for successful performance in any sport. Is there any application for eliciting a peak performance state or the "zone" state that an athlete can enter into utilizing some of the techniques that you've developed?
JI: Well, if we're talking about peak performance, then we've shifted in my mind a little bit, from the physical realm to the emotional, psychological, if you will spiritual side of sports. For that I typically incorporate the use of some of the techniques I've evolved which are under the realm of what I call "sports stress". One of the maneuvers I teach there is to teach an athlete how to position their head in such a way to minimize the effect that stress has on muscles in the neck, particularly the upper trapezius and the sternocliedalmastoid. The way they do this is by simply turning their head a small amount, usually it's about 15 to 20 degrees, usually to the right, but they could turn it to the left if they felt more comfortable.
So again, if they turn their heads slightly to the right and hold it there for a matter of 30 seconds to a minute, usually this will decrease the anxiety and the stress associated with the moment in which they're experiencing that. Often times that's just before a game is to start or if they have made a mistake. They've had a situation occur where they clearly did something they shouldn't have done-this is very hard for the athlete to recover and get back into the peak performance state. Often times they're going to be down on themselves and other people are down on them at that point and they can tell that they're in a kind of a funk. So this sometimes will let them ease back into that faster than they would if they had just tried to recover on their own.
SC: Wow, that offers exciting possibilities! I know if I mention the name of the physiologist Vladimir Janda that you are very familiar with whom that is and the work he contributed to the study of muscle physiology.
JI: Yes!
SC: In fact, many of our readers are aware of Janda's research as it applies to exercise. In particular, many readers practice the highly effective sit-up that is known as the Janda sit-up. What aspect of Janda's findings most interested you as a physical therapist?
JI: I think the most impressive part of Janda's work is the science behind what he's evolved. Many people in the field of sports rehab evolve methods basically just from their experience and not with a scientific model backing it. I think what makes Janda unique in many of the approaches that he's taken, is the fact that he has attempted to combine both experience and science. He's coupled with that the passion that he had from his own physical disability and from the sense of attempting to try to have other people benefit from what he was challenged with. You put those things together and that's pretty unique because this is a man who had dedicated his life, and of course, he just passed away about maybe 4 or 5 months ago, which is a real loss. But his work will survive because anyone who has made as much of an impact in the field of rehabilitation and sports enhancement and sports performance, I think that work is destined to be timeless.
SC: How would you compare your Pain Release Reflex Technique with something like chiropractic or massage?
JI: Well, many people ask me that and it's always a challenging question because when I talk about my work it sounds a little bit like it might be similar to those two, but really it's quite different than either of those. I guess to start with, chiropractic has a basic tenet or model that generally says that there's a theory that there is a vertebrae that is subluxed somewhere in the spine. The goal of the chiropractor is to identify at what level, or multiple levels, that vertebrae is out of alignment, and to in some way, shape, or form place that vertebrae back in its ideal position. So, right away, I do not agree with that, I do not believe in that, and I don't seek out that as a solution for the patient when I'm treating him. Right away we have a divergence of approach, that many chiropractic approaches use some form of force. Some are low force, some are high force, high velocity, manipulative techniques.
My work does not incorporate any of that, mine is either very gentle exercise movements or sometimes just isometric holding of a muscle, or it will be a tapping over a certain tendon, to elicit a certain reflex. So mine is very gentle, non-force, and it really is designed to influence learning in the nervous system. My goal is to try to encourage the nervous system to become engaged in the process of participating in the correction, whereas I would see chiropractic being something that is basically done to the body, and the hope is that the adjustment will hold. Some adjustments do and many don't. This is why many people go back to chiropractors many times, over and over again, because often times they get temporary, initial relief, but then they're back in again because the adjustment doesn't hold and they have to be readjusted again. The difference between my work is usually, if I can find the pattern that is involved and correct that, usually within 2 to 3 sessions, that pattern is no longer there and is holding, and the patient doesn't need to continue to come for more treatment.
Now, in the case of massage, there are many, many types of massage, much like there are many types of chiropractic treatments. The difference there usually is, the massage is generally geared to being able to influence and attempt to relax muscles that are tight, to work knots out of muscles that are present, which are often times called trigger points, or to release fascia, which are the envelopes that surround muscles. My goal is not that. Again I'm back to looking at how reflexes influence the nervous system and then ultimately how reflexes up-regulate, or arouse, or make muscles hyper-vigilant, when in fact muscles, when they're not supposed to be working, should be at rest, should not be tender and should be relaxed so that if they were palpated that wouldn't cause that person to jump and have a reaction to that digital palpation. So, I'm not attempting to work out anything that is at the muscle-fascia level. Mine is a neural influence, and that again is a divergence from where most massage and soft tissue mobilization philosophies are going.
SC: That makes it very, very unique it seems.
JI: Well, I think so in that I've yet to find anyone that I think is even close to what I am doing. I mean people attempt to compare and contrast the Pain Reflex Release Technique with other methods that are out there. I've studied everything that I can find in all the different fields and I can't find anything thus far that I've been able to identify, that is a similar form of work that is attempting to address the body at this same level, either by exam or by treatment. I have developed an exam called the 1 minute nocioceptive exam. Nocioception means pain, that's the term that is used in the pain literature; nocioceptors are the pain receptors in the body.
I have a way in 1 minute of going through and screening the entire body for the areas that I typically find are involved, and there are certain patterns that we find these in. So as I go through it takes me about a minute to find what's there, and then usually within another 5 to 10 minutes I've gone through and made the corrections and then go back and reexamine, reassess, and most of those, if not all of those, have been resolved and they are no longer tender. So, that system of both exam and treatment I have not found anyone even close to replicating that. In that sense I think at this point, until I find someone who is doing something similar, I'd say it's unique.
SC: John, I know that you regularly lecture to medical doctors. Tell us about that.
JI: Well, I lecture throughout the country to people of various disciplines, not just to medical doctors. I have medical doctors who have attended my seminars, I have chiropractors, I have physical therapists, athletic trainers, massage therapists, personal trainers, osteopaths, acupuncturists, naturopaths, so it runs the gamut of people who are interested in and treat musculoskeletal pain. This seminar I have coming up in another 2 weeks, I have two MDs who will be attending, and my goal is to eventually be able to have a forum of practitioners in all of these related fields, who would be interested in finding out a faster way to resolve the musculoskeletal pain challenges that they face.
SC: Do you find that doctors are generally receptive to your findings, and what type of questions do they generally ask about PRRT?
JI: I don't know that they're receptive any more than anyone else is receptive when they first hear about what I'm doing. Because as with anything new, and I do believe this is truly a new, revolutionary approach to assessment and treatment, there is always skepticism. I mean, I remember when Janda was first starting his work. He ran into tremendous skepticism, I mean he had the language barrier to deal with obviously, which made it even more difficult, but you know, he was trying to make claims about tonic and phasic muscle activity at a time when those concepts were really being applied primarily, in the United States, to conditions that involved problems like cerebral palsy, where there was a neurological pathology underlying the nervous system. Those terms were not typically being used; those concepts were not being bantered about in terms of either sports or orthopedic kinds of influences. So, I mean he's a good example of somebody who was a pioneer in, you know the definition of a pioneer is somebody that has arrows sticking in him. You know because that's what happens when you're out there where other people haven't been. You tend to get shot at a lot.
So that's typically a tough thing to sell when I'm talking to people about my work, because reflexes are not something people understand well, be they at the spinal cord level or visceral reflexes. In other words, whatever the level we're talking about, of reflexes in the body, they're not really well understood. There's not a lot written about them. There's not a lot of time and energy in research being spent to analyze how these might influence pain. Consequently, when I'm demonstrating this on physicians, as I did the other day when I had lunch with a physician, an internist; she was absolutely amazed at what I found on her because she thought she was in pretty good shape. Then she was even more amazed when she felt the changes, within 5 minutes time of going through and making some corrections.
So, if they have a personal experience with the work, either they or a family member, and I have many of them who have their family treated by me, those individuals are very receptive to this because they've seen it or they've experienced it personally. But other members of other professions, as well as physicians, sometimes have trouble getting the concept of how these primal protective reflexes, like the startle reflex and the withdrawal reflex, might truly be influencing motor behavior. So their questions typically are, you know, "what's the basis to this" or "what's this like?", "This looks a little bit like this or that". So they're trying to compare it to something else, and that's the basis of their questions, and then of course they want to know what physiologically is happening. And that's easily explained by just referring to the fact that the startle and the withdrawal reflex are 2 reflexes that are hard wired into our nervous system and present at birth, and both are tested early in life.
Within a matter of days they make sure that the infant is neurologically intact. So they're that critical to determining that the nervous system is normal. Those reflexes continue to be there in the background, much like how an operating system on a computer runs in the background. You really don't see it on a day-to-day basis when you're operating your computer, but it better be working, because otherwise your computer won't work right. So you have to count on an operating system to be functioning as it's supposed to, so that whatever platform of software you're running will be appropriate in allowing you to perform the tasks you want. Much the same way these reflexes that are there to help us. They are literally life-saving at times, if we reach out and touch something hot or sharp or electrical, thank goodness we pull back from it as quickly as we do, otherwise we might have more damage than we otherwise do. So that's the withdrawal reflex. And the startle reflex is the difference between life and death at times, if something happens and you don't react quickly enough when you're startled, you can be dead!
So, those are 2 very primal reflexes that are very protective in nature, but they should not be influencing motor behavior on a routine basis. Yet they are, and that has not been identified and that's what I've identified. Once the medical profession understands this and other professionals who treat musculoskeletal pain, are going to understand why we've been so slow in getting results with many people who have this pattern. Not all, but many, and once we establish that they have this pattern and we correct it then within a couple of sessions we'll see the changes occurring.
SC: Wow, you're taking something complex and really simplifying it! Talking again about treating athletes, is there a particular injury that is most common among the athletes that you see?
JI: It depends on the sport, because in say throwing sports, I see a lot of professional baseball players, and of course the most common injury with them is their shoulder, and secondly, their elbow. If it's football it's the knee and the ankle, so it's kind of sports-dependent. But in terms of the patterns that I see, more commonly than not, in most athletes, there is an awful lot of problems in their pelvis, particularly their sacroiliac joint, because many of these athletes are jarred, many times by falling. Many sports of course involve the athlete being off their feet, coming down, and landing on their pelvis. So, many of them have restricted motion in their SI joint. Many of them have injuries to their diaphragm, literally where their breath gets knocked out of them, they're sometimes unconscious for a matter of a few seconds, and there is a diaphragm injury associated with that. So many times we're treating the diaphragm.
Often times we find that they have a great deal of tension in the rotator cuff muscles, particularly on the right side, that's a common pattern we see. Even if they're not involved in a throwing sport, but for sure if they are involved in a throwing sport on the side of their dominant arm, we're going to see some up-regulated muscle activity in the rotator cuff muscles, at rest. Then up into the cervical spine, particularly at the base of the skull, into the muscles at the base of the skull, the sub-occipital muscles.
And the last thing we see commonly, because of the stress involved in sports, is muscles of the jaw, TM joint muscles, are often times very tense. These athletes are sometimes clenching their teeth at night, if not during the day; many of them chew gum for hours at a time. So they're constantly stressing these muscles. There is a big difference in using those muscles with chewing food, versus using them when you are stressed, chewing sunflower seeds, chewing tobacco, chewing gum when you're in a high anxiety, high stressed mode. So those are probably the most common patterns
SC: John, you truly are a pioneer in the human potential movement and in physical therapy. From personal experience, I know absolutely that your system of healing is incredibly effective and I am grateful for the value that your work has added to my general health and well-being and also to my athletic performance. I know that this work is going to have a huge impact in the field of athletics, and I really appreciate your sharing with us.
JI: Thank you for your comments and I'm glad I had an opportunity to present the work to your readers.
