Science

A Recent Email question (from 2008) on understanding psoas relationships with the diaphragm in general: 

“In Myokinematic Restoration, James Anderson talks about how tightly woven anatomically the psoas major is into the right diaphragm leaflet.  Can we then assume that activation of the right psoas can be used and is advantageous to use as a method of activating the right diaphragm/pulling it down to enhance right intercostal expansion?”

Ron’s response: “The interesting thing about the psoas major and the diaphragm is that they have similar influence on the spine in the sagittal plane, but they have an opposite influence on the spine in the transverse plane.  In other words, in the transverse plane, the right psoas major compliments (is agonistic to) the left leaflet of the diaphragm; and the left psoas is agonistic to the right leaflet of the diaphragm.  They work with one another through their “tightly woven” attachments ipsilaterally in the sagittal plane to enhance the extension activity of an extended patient, but work with each other contralaterally across the anterior vertebral bodies in the transverse plane.  So, if you activate the right psoas, you are enhancing the sagittal influence of the right diaphragm leaflet and the transverse influence of the left leaflet (something that is desirable in both planes at both of these sites).  As far as using the right diaphragm to enhance right apical expansion is concerned, it’s incorrect to view it that way.  In fact, it is the torsional respiratory influence of the left diaphragm (not the right) that is primarily responsible for expansion of air into the right chest wall and mediastinum.”

Here are my initial thoughts on the email question: The R hemi-diaphragm doesn’t need help in its respiratory role.  It already has plenty of help in the form of a liver below, larger, thicker crura and central tendon, and better abdominal opposition to maintain its domed positon.  Its dominant respiratory activity contributes to chronic tension, not only of the abdominals, intercostals, and lats on the R side, but also of the muscles associated with the R brachial chain.  This is the crux of the reduced R intercostal and apical expansion.  So can activation of a R psoas change this, and can it improve R apical expansion?  Yes, indirectly, with a host of other muscles, but not by “activating a right diaphragm”.

Ron’s response was to acknowledge that a relationship does exist between the psoas and both the ipsilateral and contralateral hemi-diaphragm.  He states: “So, if you activate the right psoas, you are enhancing the sagittal influence of the right diaphragm leaflet and the transverse influence of the left leaflet (something that is desirable in both planes at both of these sites).”

However, it’s not as simple as flexing your R hip.  To clarify:

In our conversation about this email, Ron reminded me that occasionally a R psoas, not just a L psoas, can get hypertonic in a L AIC pattern. How?

Our brain simply wants fulfillment of L spinal rotation, and these 2 muscles may work together in an attempt in to satisfy the brain’s “request”. 

How is it that the R psoas and L diaphragm (and L psoas and R diaphragm) work harmoniously, if not through “tightly woven attachments”, as is the case ipsilaterally?

A vector force, through fascial connections overlying the anterior vertebral bodies, creates this contralateral influence.

Is this right psoas-left leaflet connection in the transverse plane significant?

No, they are ineffectual in achieving L lower spinal rotation. Why?  Because of the L side’s hyperinflated state and externally rotated ribs.  There is air in the way!

(another consideration:  Because of the orientation of the facets, minimal transverse rotation occurs through the lumbar spine.  That area moves more in the sagittal and frontal planes.  Therefore, it is the psoas’ frontal plane influence that is more significant when it comes to breathing and walking.)

Could a right psoas assist a L diaphragm with drawing air into the R apical chamber? 

Indirectly, yes, along with a host of other muscles.  However, certain conditions must first be met.

James Anderson states: “Limited influence of L crura in the transverse plane, lack of well-established L ZOA, and lack of L abdominal opposition, all complement R lumbar spine orientation.”

The R diaphragm partners with its abdominal wall to maintain its position as a powerful muscle of respiration and rib orientation.

If the R psoas becomes busy trying to rotate the lower spine to the L with a L hemi-diaphragm that has a smaller, shallower crura and with L ribs that are in ER, it will need L IOs/TAs to provide the needed pull on the L lower ribs for thoracic flexion and doming of the diaphragm.  Additionally, L abdominal wall opposition creates intra-abdominal pressure and, therefore, a counter-force to the descending diaphragm.   As long as those L ribs remain in ER, the L hemi-diaphragm will remain in a tonic state, influencing the tonicity so often seen in the L psoas.  In summary, when the L hemi-diaphragm contracts unopposed by the L abdominals, our upper body mass tends to shift to the L and, therefore, force us to compensate by spending more time and placing more weight on the R lower extremity in stance or L swing phases of gait, creating and perpetuating dysynchrony!

So while the R psoas can exert some degree of sagittal plane and L transverse plane motion, it serves us better in the frontal  plane, creating convexity at the lumbar spine to provide fulcrum from which L thoracic abduction can occur.   L thoracic abduction is a necessary movement pattern for maintenance of L ZOA and to provide the L hemi-diaphragm with a fulcrum (L hip) that is now situated directly below.  With an established L ZOA through L IO/TA activation, the L hemi-diaphragm can do its job of breathing – creating pressure differentials that allow us to manage gravity and walk, efficiently – with the least amount of force and torque.  This is how a R psoas indirectly enhances R apical expansion, along with many other muscles not mentioned in this orchestrated movement pattern.

 L IOs/TAs and a domed L hemi-diaphragm are the principle lower spinal/sacral/pelvic rotators to the L. 

Finally, why is it that the L hemi-diaphragm, not the R, expands the R intercostal and apical regions?

Rib position determines a hemi-diaphragm’s respiratory direction of flow.  When ribs are IRd on one side, they are ERd on the other.  IRd ribs assist the hemi-diaphragm with achieving and maintaining its ZOA to effectively draw air in.  Therefore, sufficient activity of the IOs/TAs, via their attachments to the ribs and their influence on intra-abdominal pressure, is a requirement for that hemi-diaphragm’s ZOA. 

IRd ribs don’t allow for much expansion. ERd ribs do. Therefore, once sufficient L IO/TA activity exists, creating L IRd ribs and a ZOA that is now effective for ventilation, the L hemi-diaphragm can draw air into the R apical chest wall, assisting with, and maintaining, its ERd ribs. Remember, when ribs are IRd on one side and ERd on the other, the thorax is positioned in ipsi-lateral abduction and contra-lateral rotation. Hence, it is “the torsional respiratory influence of the left diaphragm (not the right) that is primarily responsible for expansion of air into the right chest wall and mediastinum.”

We have 117 techniques in the standing integration section to teach us to get the R side to let go and to get the L side of rib cage to IR, highlighting the importance of L IO/TA activation to establish L hemi-diaphragm ZOA and restore its respiratory role.

Posted April 18, 2017 at 7:16PM
Categories: Website Courses Science

Our right triceps become very challenged if we can not sufficiently engage our left internal obliques and transverse abdominals during active late left lower extremity ‘push-off’ and concomitant active late right upper extremity ‘push-back’ (shoulder extension). Our bodies lose their ability to become centered over the left when our left abdominals, left hamstrings and right triceps disengage as a functional group. A few weeks ago Sy Abe-Hiraishi, a PRI faculty member, asked me about a non-manual technique called the ‘Supine Weighted Tricep Curl’ and the reasoning behind the two methods of instruction. I absolutely loved the question, the dialogue and the timing, since I will be presenting information on group function afferentation at this year’s Spring Symposium. Please read her summary and the response that is presented from a question that was initially asked by a course attendee that attended one of her courses in Japan. So awesome!   

Gratefully, Ron

アメリカの皆さんこんにちは!

Hello everyone!

日本講習担当、PRI講師の阿部さゆりです。昨年の12月に日本で初めてポスチュラル講習の開催をすることができたのですが、その際に参加者さんから出た質問とその答えを今日はここで共有したいと思っています。ロンが日本語と英語の両方でアップして!というので、両方でお届けしますですよ。

This is me, Sy writing this blog post – those of you who do not know me, I am one of the two PRI faculty members that are designated to teach courses in Japan. We hosted our very first Postural Respiration courses in Japan in December, and this interesting question came up from a participant. Today I am hoping to share the question and answer with y’all…(in case you cannot tell, I currently live in Texas). Ron specifically requested that I post this both in Japanese and English, so here it is – hope y’all enjoy!

ポスチュラル講習では左のハムストリングを使って骨盤を起こすように、右のトライセップスを使って右肩甲骨を起こすことがいかに重要か、という話をしますよね。その流れで講習中スーパイン・ウェイテッド・トライセップス・カールズの解説と実技ラボをおこなったのですが、このエクササイズにはやり方が二通り(ポジションA vs B)あり、「このエクササイズのポジションの違いは何?どういう状況の場合、どちらを選ぶのが正解なの?」という質問が日本人参加者さんから出たのです。

In Postural, we learn to use the Right Triceps to “get the scapular up” just like we learn use our Left Hamstring to “get the pelvis up” in the Myokin course.  One of the exercises we demonstrated and practiced in our Postural courses in Japan was “Supine Weighted Triceps Curls,” and that’s when this question was brought up – “I see, in the manual, that this exercise can be performed in two different positions – the original (Position A) and the alternate (Position B). What is the difference and what are some of the reasons we should pick one over the other?”

                           Position A                                                               Position B

What a great question! This got Ron super-excited because no one in the U.S. ever asked this question to him, and Ron and I had a great conversation about it over lunch the other day. So let me first share the short version of the answer – “You should always try Position A first. If it does not work, try Position B as this should be the “mechanically advantaged” version of the same exercise.”

最初に答えを書いてしまうと、どんな患者相手にもまず試すはポジションAです。このポジションでは、歩行時に左足で身体を前に押し出して、右手を前・上方に振り切った状態(=右立脚中期)からエクササイズが始まるんだ、とイメージするとわかりやすいかも知れません。ここからPropel (前進)するために次にすべきは右腕を振り下ろし、後方に振り切ることですよね。同時に左腕も前に振り上げれば、体幹の右回旋・骨盤の左回旋と一緒に右足のpush-offが起こり、左前方への体重移行が可能になります。

平たく言えば、トライセップス・カールズはこの右腕の「振り下ろし始め」を練習するエクササイズなのです。エクササイズ開始時のポジションでは右肘と右肩は共に屈曲位にあり、上腕三頭筋をisolate(隔離)するのに最適と言えます。肘と肩、両関節で伸長位に置かれたこの筋肉を、肘伸展を通じて収縮させることで「腕の振り始め」に真っ先に上腕三頭筋にスイッチを入れる感覚を体得できた人は、そのあとの「右腕の後方振り切り」はモーメンタムと広背筋らの協力を得て比較的楽に、自然とおこなえるんだということに気が付くかもしれません。

And here’s the longer-version of the answer. Everything we do can be applied into various phases of the gait – so please picture yourself being in the right mid-stance. Your L AIC pushed you over to the right, you are feeling the right heel and the right mid-foot, and you just finished swinging your right arm all the way forward. Now look at Position A – both right shoulder and elbow are flexed – doesn’t it look awfully similar? If you are thinking this position is mimicking the I-just-finished-swinging-my-right-arm-forward phase, you are absolutely right!

Now think what needs to happen next. You will need to begin swinging your right arm towards the back as you start to prepare yourself for the push-off phase, and eventually to shift your body weight to the left. The initiation of the right arm swing is essential because, without this, your right arm won’t be pulled all the way back, your right trunk won’t be pulled back, and the right trunk rotation won’t occur. Combined with L AF IR, the back-swing of the right arm is the key for the upper and lower body integration as shown in the picture below.

 (89) Left Stance Interrupted Swing

**改めて言及しますが、右の腕を後ろに引く、ということはロンがどの講習でも何度も繰り返し強調する、超超超超超重要事項です。右の腕を後方に振り切るということは右の体幹を後ろに引く、つまりは体幹が右に回旋するということでもあります(例: 下の写真参照)。体幹の右回旋は骨盤の左回旋(L AF IR)と対になるべきPRI介入には欠かせない要素です。ロン曰く、「左スタンス時(下写真)に荷重されていなければならない肢がふたつある。なんだかわかるかい?左足と、右腕だよ!」。歩行時に腕を荷重だなんて、その表現の仕方がまたロンらしいですけれど、つまるところ彼は空間把握や自我確立を導く神経的道具として、この状況では左足右腕が真価を発揮しているべきだと言いたいのです。

And hence the beauty of this exercise. Triceps curls in this position (Position A) is a great way for us to practice the initiation of the right arm swing. In this position, the triceps are elongated through the combination of shoulder flexion and elbow flexion and can be effectively isolated isolate.

しかし、このポジションで陥りやすいワナは「非常に矢状面に特化したエクササイズであり、上腕の屈曲には腰椎の伸展も伴いやすい」という点です。PRIの基本は適切なポジションで適切な筋肉を使う練習をするところですよね、ですから、患者さんがもしこのエクササイズで呼気(state of exhalation)のポジション、つまり胸郭の屈曲を保てなければ次はAlternate Position(代わりとなるポジション)であるポジションBを試すべきです。

However, here’s a pitfall of “Position A.” Because performing triceps curls in this position promotes sagittal movements, some patients just cannot help but extend their back. Those individuals weren’t quite ready to truly isolate the triceps and may need to take a step back – and try the alternate position, Position B.

ポジションBでは同じ歩行は歩行でも腕を縦ではなく横に振りながら、水平面で胴体を回旋させながら歩行してるイメージです。右の腕をぶん、と横にスイングし前に持ってきたようなこのポジションでは腰椎の伸展は格段に起こりにくいばかりでなく、体幹の左回旋が促進され、左腹壁の活性化と左後方縦郭の拡張、そして右肩甲骨の安定が起こりやすいのが特徴です。つまり、こちら(ポジションB)のほうが上腕三頭筋を単独で活性化させる(ポジションA)前に、腹壁・胸郭・肩甲骨と腕との統合をまずマスターしなければいけない患者に適したエクササイズなのです。

So now look at Position B. You also see the same gait phase in Position B, but the arm is swung to the side (on the transverse plane) instead of up to the front (on the sagittal plane). This arm position promotes the trunk rotation to the left, the better left abdominal engagement and the right scapular stabilization on the thorax, which further secures the right triceps. In this position, the patient will be given the mechanical advantage to remain in the state of exhalation (and thus not to extend the back) while activating the right triceps.

要約すると、「右上腕三頭筋の活性化にトライセップスカールを用いる場合、最初はポジションAで、もし腰椎の伸展がどうしても起こってしまう場合はポジションBでこのエクササイズをおこなう」ということです。こんな話をロンとしていたら、「こんな質問、アメリカでは受けたことないよ!」と非常にうれしがっていました。日本の方の思考力の助けを得ながら、これからも日本での講習でPRIコンセプトをこれでもかというほど切り刻んでいきたいと思います。アメリカの皆さんもこの回答を楽しんでいただければ幸いです。

Let me summarize it – “When using triceps curls to facilitate the activation of the right triceps, anyone should try Position A first. If the patient extends the back in this position, try the alternate position, Position B for the better abdominal integration.” I hope that this answer helps y’all, PRI families in both Japan and the U.S.!

追記ですが、ロンに日本のPRI講習で使っているスライドを見せたら「なにこれ!すごいねすごいね、これも一緒にアップしてよね!」と興奮して大騒ぎされてしまったので、私たちが日本ポスチュラル講習で使ったスライドの写真もおまけに付けておきます。アメリカの皆さんにも、PRIを日本語に訳すのがどれだけ大変だったか、これを見れば少しだけわかっていただけますでしょうか?

P.S. – I showed this (power point slides that we used in Japan) to Ron and he told me I HAVE to post this photo in this blog. I created some visuals and added them to the slide explaining the importance of the right low trap and right triceps…well, I am sure y’all can read the rest ;)  We will continue to strive to teach high-quality, full-of-fun PRI courses in Japan!

Circle Explanation: That's the cross-sectional view of the R BC-patterned chest....L lungs are more inflated than R, and the sternum tipped to the R. Orange semi-circles in this diagram represent SAs, and the light-blue lines are the lower traps. I use this diagram to explain how "L SA is rounded yet elongated (= challenged)" and "R SA is shortened yet flattened (= also challenged)" - sort of like obturator internus. Also, this diagram may help visualize how low traps are positioned in the transverse plane. For example, R low trap is shortened in the frontal plane (as shown in the image on the left...the back view), yet it is actually elongated in the transverse plane if you are to take a look at the image on the right (light-blue line)...the opposite is true for the L low trap... and therefore, again, both lower traps are challenged in its own way.

We are excited to announce that PRI will be featured throughout 2017 on public television networks' "Voices in America with James Earl Jones" educational segment. The video segment has been distrubuted to public television networks in all 50 states. While airing schedules are not available to us, you might hear from patients or clients who happen to see this educational segment on Postural Restoration®.

In addition to the educational segment that they will be airing on public television, two other segments: "PRI in 6 Minutes" and "PRI in 60 Seconds" were produced and made available to us, and will be on our home page soon (see below). You are welcome to embed these videos onto your personal or professional website to help educate patients, clients, and the general public on the history behind the science of Postural Restoration®.

The "PRI in 60 Seconds" commercial will also be airing nationally on CNBC on Friday, January 6th at 8:30pm Eastern, 7:30pm Central, 6:30pm Mountain and 5:30pm Pacific time. So, set your DVRs or tune in to CNBC tomorrow night! Please note the commercial airing could land anywhere within an hour of the above scheduled times. In the past, we have been told that they have typically aired within 15 minutes of the schedule. Following this national airing, it will continue to air on CNBC in several different regions across the country.

Posted January 5, 2017 at 3:08PM
Categories: Videos Science

On a sunny Sunday in June, the staff at Advance Physical Therapy in Chapel Hill, NC invited second year physical therapy students from UNC Chapel Hill to attend a screening for treating pain and dysfunction using Postural Restoration. The experience produced many and varied positive outcomes for all involved. We thought other PRI clinicians might like to know what we learned.

On the students: I teach PT students annually each spring. Inevitably this endeveour culminates in a line of young, high achieving, overworked, overstressed, mostly PEC’s at my door. Further, after years of attending courses within the institute, it seems the most dysfunctional and complex patients are often the PT’s sitting around me. We ourselves realize the profound benefits of PRI most when we feel the effects personally. As with PT practitioners, when PT students are offered plausible mechanisms for their chronic painful states, and more when they are changed by PRI, openness to the approach is enthusiastic. Working with students in this way seems powerful toward the PRI paradigm shift we would like to see within PT. The students also offered helpful feedback with regard to comparing different clinician handling for PRI tests.

On our clinicians: With 12 willing student subjects in the clinic, we couldn’t resist the temptation to try a bit of inter rater reliability among our clinicians for 3 basic PRI screening tests: Adduction Drop Test (ADT), Humeral Glenoid Internal Rotation (HGIR) and Cervical Axial Rotation (CAR).

In looking at our findings, it seems consistency among us was good for ADT and HGIR. Our values for CAR were frankly inconsistent, giving us an opportunity to discuss and problem solve on the utility and practice of CAR, as a group. Related topics entering later discussions included:

  • use of pillows and other forms of support during testing to accommodate clinicians capacity and patient comfort – perhaps changing patient tolerance for testing?,
  • anthropomorphics influencing decision-making (for example should a short femur on a wide pelvis drop as far as a long femur on a narrow pelvis?),
  • unique descriptions and measures during testing ranging from formally measured degrees, to estimates of %, or use of ++, each often with written distinctions for quality of motion and leading to diagnosis and treatment thinking,
  • pelvic/hip instability, frank hypermobility influencing test results, esp. false negatives?,
  • SI dysfunction perhaps influencing test results in strange patterns like + R ADT, - L ADT?,
  • repeated testing influencing test results?

On our clinic as a whole: All together at a follow up meeting, we watched each other do these same tests, this time on one subject, to discuss our individual thinking without the “blinding” we employed with the students. In the end we discovered we each employed unique positioning and preferences for support. Our collective descriptions, thinking and rationale for ratings were insightful and got us all looking more creatively about our own process with a greater likelihood of being in the same neighborhood, if not exactly the same page as our fellow PRI clinicians.

Posted August 31, 2016 at 2:35PM
Categories: Clinicians Science

Can I use PRI materials when presenting an inservice, on my blog, or in an article, etc? This is a question that we are asked nearly every week.

All techniques, materials, and content created by the Postural Restoration Institute® (PRI) its employees and staff, and displayed or presented in any manner or format including but not limited to manuals, brochures, electronic presentations, CDs and DVDs, photographs, and web sites, are the proprietary intellectual property of Postural Restoration Institute, LLC and its founder Ron Hruska.  This content is protected by the copyright laws of the United States and by the 172 countries who are a signatory to the Berne Convention which established and provides copyright protection globally. 

This content may not be duplicated, published, displayed, or otherwise communicated or distributed in any country and in any language, without prior written permission from the Postural Restoration Institute, LLC.  

Permission to use this content can be obtained by contacting the Postural Restoration Institute, LLC. Permission requests are reviewed in a timely manner and in most cases, there is no fee for obtaining permission to use PRI content. Permission inquiries can be submitted using our new online PRI Copyright Permission Request Form.

The non-manual techniques provided in your appendix are intended for use with patients or clients and may be photocopied and distributed without written permission. Be sure to use the techniques without modification while including the copyright information found on the bottom of the page. Modification of any technique is prohibited. Digital copies of all PRI non-manual techniques are available on CD and can be purchased via our website.

For more information about correct use of PRI Copyrighted Materials and FAQ's, please read our "PRI Guide to Use of Copyrighted Materials".

Posted August 1, 2016 at 2:11PM
Categories: Science

There's a change coming...

The storm of change has blown across our conference table at the Institute (as evidenced by the sea of journal articles strewn in its wake). Jen Platt, Jen Poulin and I are on a mission, and with the help of our other faculty members, we are revising and updating the Myokinematic Restoration manual, power point and class. So....hunker down and brace yourselves and when the storm passes, enjoy the blue skies, tranquil calm and fresh smells of the new and improved Myokinematic Restoration class!

Posted June 27, 2016 at 3:14PM
Categories: Courses Science

The following article was inspired by the book, The Brain’s Sense of Movement by Alain Berthoz and the concepts taught by the Postural Restoration Institute (PRI). The purpose of this narrative is to explore the multisensory nature of PRI.

Traditionally, we presume that the goal of our PRI interventions is to create postural changes and thus function via first repositioning to achieve positional and neuromuscular neutrality by decreasing the dominant L AIC/R BC/R TMCC lateralized pattern, followed by retraining the body to be able to fully appreciate the submissive R AIC/L BC/L TMCC pattern, and finally restoring authentic reciprocal alternation between the two. This ultimately means the ability to walk and breathe utilizing all 3 planes of motion as well as have the movement variability capacity to experience other potential functional strategies of these synergistic patterns such as sports performance activities or simply carrying an object while walking.

Within this paradigm, we tend to think about inhibiting specific chains of muscle (members of the L AIC/R BC/R TMCC) while facilitating the opposing R AIC/L BC/L TMCC neuromuscular synergistic pattern. More details of these chains and their composition can be found at https://www.posturalrestoration.com/the-science. Depending on an individual’s specific patterns and where they are in their restorative process, some of these chains and plane of function (meaning sagittal, frontal, and transverse) may need to be emphasized more than others. However, the bottom line is that PRI practitioners are mainly considering within their treatment rationales which chain(s) of these synergistic patterns of neuromuscular function need to be inhibited/facilitated and the corresponding plane of emphasis. Again, this is all for the goal of efficient and effective movement.

In my recent previous article (http://www.posturalrestoration.com/community/post/2633/biasing-bilateralism-with-unilateral-sensory-and-manual-integration-by-heather-carr?id=2633), I discussed the interrelated somatosensory nature of neuromuscular function. This means that the brain is programmed not only to simply facilitate or inhibit various agonistic and antagonistic chains of muscle but that this mechanism is accompanied by the ability to also sense and feel these contractions, accompanying body segment positions, and movement relative to each other. To be more specific, our somatosensors (such as tactile, proprioceptive, and kinesthetic receptors) are feeding the brain information regarding position, velocity, and acceleration. In PRI, we refer to these as reference centers. PRI teaches 6 key ones (as described in the Impingement and Instability course) that when one has the ability to sense they most likely can also simultaneously engage the corresponding desired neuromuscular chains and hence movement patterns for better function and performance. The brain does not aim to separate motor from tactile, proprioceptive, and kinesthetic processing but needs all of this information for proper motion. In cases where there is impairment here, such as with a stroke or peripheral neuropathy, movement capability can become significantly dysfunctional.

Let’s take this a step further. When processing somatosensory signaling, the brain concurrently needs other sensory signals that are crucial for desired movement goals. This includes vestibular, visual, and auditory reception and thus perception. The vestibular receptors provide critical information to the brain such as where the head is oriented with respect to gravity, its velocity and acceleration, as well as the plane of its motion. In fact, the semicircular canals are organized in 3 perpendicular planes with one another which enables the differentiation between sagittal, transverse, and frontal vectors of head movement. This triplanar architecture is reflected in the subcortical areas where the 3 dimensional directional information is retained and further integrated with visual, auditory, and somatosensory signals. Furthermore, muscles are represented in the brain by their “eigenvectors”, their own virtual vectors that convey the amplitude of force exerted by each muscle and its corresponding plane of action. There seems to exist patterns of redundancy with the orientation of the planes of the semicircular canals to how the brain processes 3 dimensional movement and position to enable more consistent sensory processing. For example, the three pairs of extraocular muscles are approximately parallel to the planes of the semicircular canals likely making it easier for the brain to reconcile triplanar multisensory information.

What is important to understand is that without the merging of ALL the sensory information, the brain will not be able to completely know its position and movement with respect to itself, the ground, and other objects. For example, without synchronized signals from both the visual the vestibular systems, the brain wouldn’t be able to tell whether the body and/or the environment is moving. Without appropriate integrated tactile, proprioceptive, and kinesthetic signaling, the brain has no idea where its body segments are positioned relative to the head and the ground. Without proper visual processing, the body loses information regarding orientation of the position of self with relation to the environment coupled with reduced direction, speed, and acceleration of movement signaling. Furthermore, the auditory system also provides information regarding environmental space as patterns of sound are detected and contribute to an individual’s orientation relative to their surroundings. In sum, postural positioning and movement with respect to the self, ground, and other objects is dependent on all of these sensory signals.

Not only do we need authentic sensory signaling from the vestibular, visual, auditory, and sensorimotor systems but this information must be perceived by the brain in a coherent manner. Thus the term, “neurosensory coherence,” describes this phenomenon. There are certain parts of the brain such as the superior colliculus, cerebellum, and lateral geniculate nucleus of the thalamus that are especially important for merging these signals together and communicating with around 20 other brain structures. In fact, these sensory pathways are so intertwined that some neurons can respond to different types of sensory receptor signals. For example, 2nd order vestibular neurons fire from both oculomotor and neck efferent signals as well as incoming afferent vestibular, visual, and proprioceptive signals. Some bimodal neurons can be fired with either visual or tactile input and thus can create the same perception. The visual stimulus of a finger moving to touch one’s face can be perceived as actually touching the face without real contact due to the overlapping tactile and visual receptor field function. Some cases of hemi neglect have shown that injection of cold water into the ear and thus stimulating the vestibular system can temporarily alleviate symptoms of neglect including hemianopsia (seeing only ½ of a visual field) and/or hemianethesia (reduced sensation on ½ of the body). Likewise, somatosensory stimuli (example of transcutaneous electrical-stimulation) as well as visual stimuli (such as prism glasses) can also reduce symptoms of neglect. What this means is that a somatosensory stimulus can simultaneously be perceived as a somatosensory, vestibular, or visual stimulus and vice versa. The somatosensory primary cortex seems to have no preference for the various sensory inputs. There are a variety of neurosensory patterns in the brain that can all contribute to neurosensory perception and body schema. Therefore, movement ultimately creates and requires a symphony of somatosensory, visual, vestibular, and auditory sensory signaling that must be properly synchronized, merged, and modulated together with other cortical and subcortical discharge. When this neurosensory coherence occurs, desired and efficient movement is permitted. Therefore, in cases where this is not occurring the clinical dilemma involves figuring out which sensory system(s) to manipulate to achieve the desired functional outcome.

Within the paradigm of PRI, we assume an inherent asymmetry and lateralization of the postural system. However, based on the information presented in this article, I hope you are now also assuming this includes an asymmetrical and lateralized sensory system. Once again, the brain merges all of this information together for processing posture and movement modulation. The brain is actually constantly checking to see if how it predicted position and motion was indeed perceived as accurate. Furthermore, this information is not just being used to only put us in certain positions and permit movement but also is concurrently telling us where we are located in space relative to the ground and peripheral environment. Movement is orientation and orientation is movement. For example, the brain regulates the firing threshold of a motor neuron. This threshold (meaning how easy or difficult it is to fire) is influenced by the position of the body part and thus also has a spatial dimension within it. Considering both the agonist and antagonist facilitation or inhibition tendencies (think PRI patterns), these thresholds convey spatial information because of their correlation to different body segment angles. This is one of the main principles that PRI non-manual techniques are based on.  We are attempting to encode new threshold relationships between agonists and antagonists in synergistic patterns in specific positions which concurrently encode new spatial patterns with vestibular, visual, and auditory frames of reference. 

To help understand this concept even more, wherever you are right now pause to do the following: Acknowledge the position you are in and how this feels. For example, if you are sitting where do you and don’t feel pressure? What angles are your body segments at? Can you sense whether your body is leaning or rotated in a particular direction? Are you moving? Are you on an object that is moving (car) or are you moving on an object (walking on the ground)? Are objects moving around you (cars or people)? What sounds do hear? Are they coming from far or near? Now for the punchline: ALL of what you just experienced, including what you see and hear is YOU. Not only is your body but also what you perceive beyond your personal space is YOU. It is YOUR NEUROSENSORY WORLD. The question then becomes: is your neurosensory world coherent on both sides of not only your body but also SPACE which includes the visual and sound fields?

If you exist in a lateralized body and world, you therefore not only posture and move differently on each side but you also perceive space such as the ground, gravity, objects, and sound asymmetrically as well. PRI practitioners are typically trying to teach our patients and clients to position and move in new ways to become less lateralized. However, in reality we are also simultaneously teaching them a new orientation and perception of space. Therefore, when you are working with your patient or client, try to imagine their entire neurosensory world (as you just practiced) and perceived reality. This “imagination” of neurosensory perception is what Ron Hruska bases his neurosensory decision making recommendations on.  He interacts with patients to figure out how best to modulate their neurosensory world to achieve authentic reciprocal alternating body and space coherence.

In conclusion, the L AIC/R BC/R TMCC dominant pattern promotes a neurosensory illusion of being half lost in space and body. Therefore, when you are instructing your patients and clients in a PRI technique, consider not just the specific muscles and plane you are trying to inhibit or facilitate but also the corresponding sensory pieces to them. Many of these aspects are already in the techniques whether you realized it or not. Basically, any time you reposition the postural system you are concurrently reorienting its perceived space. Consider what other sensory mediums you can use to achieve this. This is why the Postural-Visual Integration course is so powerful because it emphasizes the visual aspect of our space which is a huge piece of our neurosensory world. I am really looking forward to learning how the auditory system can be engaged to instill coherent space and body function at this spring’s annual symposium…….

Posted January 22, 2016 at 11:15PM
Categories: Clinicians Science

This year we are offering an optional Interdisciplinary Integration evening series on Thursday, Friday, and Saturday of Advanced Integration. You must be signed up for Advanced Integration to attend these sessions. They will be offered from 5:15-6:30pm each night if you would like to attend. 
Thursday-Dr. Rebecca Hohl and Ron Hruska will present on Dental Occlusion. 


Friday- Dr. Heidi Wise will present on PRI Vision


Saturday- Dr. Paul Coffin will present on Podiatry.

Posted September 17, 2015 at 6:48PM
Categories: Science PRI Vision

Two weeks ago, we travelled to St. Louis, MO for the 66th Annual NATA Clinical Symposia & Expo. Matt and I had a great time meeting nearly 600 Athletic Trainers at our PRI booth. There is a lot of excitement for PRI in the Athletic Training field, especially having Evidence Based Practice (EBP) CEUs for Myokinematic Restoration, and more courses to come!

I also had the opportunity to present at this conference for the first time. The topic of my presentation, "The Influence of Pelvis Position on Hamstring Injuries: To Stretch or To Strengthen" drew around 450 people into the room, with standing room only. For those who were unable to get into my presentation, they will have the opportunity to listen to it on the NATA Online CEU Center in the near future. I have also attached my presentation handouts HERE!

Dan Houglum, MSPT, ATC/L, PRC also presented at this year's conference. The title of Dan's presentation was "Asymmetrical Posture and Common Pain Related Syndromes". He also had a nearly full room, with Athletic Trainer's eager to learn more about PRI. Dan is also willing to share his presentation handouts, which I have attached HERE!

Posted July 9, 2015 at 7:59PM
Categories: Athletics Science

There is a “silver-lining” to nearly every negative situation in which you find yourself.  If you open yourself up, you can find the positives and then use your experience and knowledge gained to help others…hopefully, creating a “greater good” in the universe.  I hope the following story, lessons learned, perspective, and insight are informative.

The aftermath of a very personal health situation brought me in to see Lori Thomsen at the Hruska Clinic.  She took me on as a patient one year ago.   Realizing quickly that I was a candidate for PRI Vision intervention, I was assessed by Ron Hruska and Heidi Wise the same day and prescribed a specific pair of PRI lenses.  I filled the prescription and followed up with Lori the next day. 

Lori guided me through a program consisting of upright exercises.  (Exercises in the Vision program are primarily upright activities, because you are learning how to use the floor to propel yourself forward through all phases of the gait cycle, using the PRI Vision lenses as a tool.)  Coincidentally, at this same time, I was beginning to more fully appreciate the need to get my own clients “on their feet”.  Admittedly, I was designing exercise programming primarily for the supine, side-lying, and all-fours positions.  Having received Lori’s instruction for my own upright activities, I was able to more adeptly implement upright activities with my own clientele, especially when it came to teaching L mid-stance.  I believe I have been able to avoid major pitfalls/setbacks and progress my clients more quickly than I might have, if I had not been a patient of Lori’s.

[Side Note:  It is important to make a distinction between assessing one’s ability to center themselves in L or R mid-stance (as is part of the PRI Vision assessment) versus teaching L mid-stance and other phases of the gait cycle at the appropriate time in one’s rehab/training program.  Assessment does not involve cueing; teaching does.]

The most enlightening piece of information Lori taught me was the use of the quad during mid-stance.  As a member of the PRI faculty, Lori teaches the Pelvis Restoration course.  She frequently refers to her “3 Amigos”: L abdominal wall, L quad, and L hip.  It wasn’t until I was a patient, when she actually took me through the integration of the “3 Amigos” on MY body, that I fully appreciated the quad in L mid-stance.

I think perhaps that the quad is overlooked when teaching L mid-stance, due to overemphasis on the L heel.  Let me try to explain in an admittedly round-about way J 

In L mid-stance you should feel 75-80% of your body weight traveling down into the back half of your foot (mid-arch to center of heel). Your left foot should be firmly planted on the ground without the toes lifting up in front.  I have witnessed individuals lifting their toes or entire forefoot into dorsiflexion when cued to: “find your left heel” or “press down through your left heel” .  I have inadvertently used these types of cues and seen those little toes wiggling around in the shoe, trying to lift up.  Sometimes it helps to have the client go barefoot, so you can see if they are “cheating” with their toes.  “Cheating” with the toes IS cheating, because it is extension. Toe extension kicks on dorsiflexors…kicks on hip flexors…kicks on low back, etc. etc.  (There are certainly those who walk as “heel-diggers”, pulling themselves forward through this entire list of muscles. These are very extended individuals who tend to use their pecs as their abdominals and present with significant FHP.) 

PRI programming accentuates “sensing” or “feeling” your left heel making contact with the ground in mid-stance, because those in LAIC patterns tend to bypass the L heel altogether during the gait cycle.  Their L foot tends to be in constant plantar flexion, so the first part of the foot that hits the ground on heel-strike is the arch or the ball of the foot (late mid-stance to early toe-off phase).  Maybe we take the client/patient through proper heel-strike phase, but in mid-stance, we should be teaching them to merely “sense” or “feel” their left heel vs. “press” or “dig” their left heel.

Back to the quad…  In L mid-stance, the quads should be in an eccentric contraction phase around the knee joint, counter-balancing the eccentric contraction of the hamstrings.  Because the knee is slightly flexed in mid-stance, the quad is on a slight stretch but holding tension, getting prepared for the propulsion phase where the concentric action of the quad takes over (stretch-shortening).  There is a “springiness” to the quad, unless the L foot is not firmly planted or the L hemi-pelvis is anteriorly tilted.   In either of these cases, the quad is acting more concentrically. 

I like the word “springiness”, because it reflects my most recent reflections on mid-stance.  “The first modal peak [of the vertical component of ground reaction forces (GRF)] occurs during the first half of support and characterizes the portion of support when the total body is lowered after foot contact.” (Hamill and Knutzen, Biomechanical Basis of Human Movement).  This is mid-stance. 

When I ask my clients if they “feel” the floor under their feet, sometimes they look at me like I am crazy.  When teaching L mid-stance, I have begun asking them if can “drop” their bodyweight (75-80%) into the L foot and “allow” the L left leg to “accept” that weight.  Now, maybe they can sense some weight, actually the GRF pushing up into their left foot (through the “springy” eccentric quad).  Now they have a point of contact from which to propel forward.  They are not in a constant state of  “pulling” or “lifting” themselves off the floor with vision, jaw, neck, shoulder, low back, and/or gastroc muscles.  [Side note in regards to Cervical Revolution:  all of this “lifting” and “pulling” through the kinetic chain, bottom-up, is to no avail, because ultimately there is gravity crushing down on all of those lifting forces, meeting at the skull and generating cranial compression.]

When you really think about this, walking is hard stuff!!  Each leg has to be able to “accept” 75-80% of your body weight in able to propel forward and not evade this difficult task with the above-listed extensor and pulling muscles. 

Again, back to the quad…  “If you can feel your L quad, Lilla, your L abs should automatically be kicking on”, Lori says during our session.  The quad is one of the markers for integration from the ribcage to the pelvic inlet through the pelvic outlet to the femur. 

I’m in L stance with pelvis rotated left, L foot flat on ground, upper body rotated right, reaching out and down with left arm to facilitate both trunk rotation and thoracic flexion, a bit of thoracic abduction to help find L abs.  I’m doing everything right, but still no abs.  When I “press” down into the ground, as suggested, I am concentrically activating my quad, and it is difficult to posteriorly tilt my pelvis and reach the knees forward.  However, when I think of “dropping” my weight onto my L leg (feeling those GRFs and a “springy” eccentric quad), I can reach my knees forward with posterior pelvic tilt, effectively bringing my pelvis under my ribcage so that they are in a position to access the side abs.  YEAH and whew!

I didn’t mention the third amigo, the L hip (Glute Med), which comes into play in the frontal plane, balancing the forces of the IC Adductor.  I am certainly not downplaying the role of this amigo in L mid-stance!  I only wanted to emphasize the important role of the quad (a muscle that is not given as much “press” in teaching L mid-stance), because Lori’s instruction certainly helped me, both personally and professionally.

Attached are 2 short video demonstrations.

Toe Extension MCS

Quad MCS

Lilla Marhefka, PhD, HFS, CSCS, PRT

Posted April 28, 2015 at 2:11PM
Categories: Videos Clinicians Science
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