PRI Illustrations

PRI illustrations are available in print. Artist, Elizabeth Noble, has taken the science of PRI and turned it into a visual masterpiece. Her dramatic illustration of asymmetrical patterns is one of a kind. Choose from one of the following unique illustrations specifically drawn for the Postural Restoration Institute to compliment your office or home.

Neglected
What's Included:

This illustration reflects the right mediastinum of the human chest wall.  The word “neglected” was chosen because this particular cavity is underutilized by many because of the lateralization issues that exist in our body.  Truthfully, the mechanics that drive this cavity’s function begin on the contralateral side.  Without good apposition on the left side of the rib cage generation of diaphragmatic influence opposition to the lobes on the right side is diminished.  Therefore, the underutilized activity on the right side results in not only biomechanical issues to the upper quadrant on the right side but also does not allow this quadrant to be fully utilized as it should be.

Abused
What's Included:

This cavity is often used wrongly or improperly because of the lack of diaphragmatic apposition and left thoracic opposition from the abdominal musculature.  This improper function results in improper breathing and anterior neck respiratory overuse.  It also contributes to the abuse of the spine resulting in curvature of the spine and the typical Right BC and Left AIC pattern that we so often see.

Deprived
What's Included:

This word was selected for this illustration because of the position that the temporal bones are in on the human cranium.  The temporomandibular fossa moves anterior laterally with temporal internal rotation on the right side which is what this illustration depicts.  This entraps the condyle and usually positions the condyle posteriorly on that side and produces a movement or positioning of the mandible to the left with underutilization of the left lateral pterygoid.  The retruded left mandible occurs because of temporal external rotation on the left.  The fossa moves posteriorly and medially when this happens and usually results in compression of the temporomandibular joint disc between the anterior lateral temporal fossa and the anterior mandibular condyle and that’s when you often see anterior disc displacements occurring on the left side.  Again, the reason “deprived” was chosen is because the left temporal bone usually is deprived of temporal internal rotation and the right one is deprived of temporal external rotation resulting in sidebending lesions of the cranium and rotational constraint through the temporomandibular joints.  This deprivation usually coincides and often precedes most TMJ dysfunctional patterns and pain.

Clandestine
What's Included:

What you see in this illustration is a very dominant right diaphragm leaflet that is working actively with the right quadratus lumborum muscle.  The illustrator has done a very good job in pulling out muscles of the lateral anterior wall of the abdominal pelvic cavity. These muscles including the diaphragm, quadratus lumborum and the left iliacus and psoas compliment what is going on in all human bodies.  This activity is kept in a “secret vault” (i.e. the abdominal pelvic cavity) and is something that is mysterious to many because we can’t palpate or visualize this on our patients.  Therefore, I like the word and I like the adjective describing this particular region of our body.  It’s a mysterious, secretive process that can be challenging for many of us to fully understand and appreciate.  The center of gravity is shifted over to the right side which is why the right thigh was kept on this particular image.  The right adductor magnus is a muscle that is allied with the above musculature listed.  It’s not a great picture that reflects the Left AIC musculature but it is a good picture that reflects the supportive or anti-gravitational muscle of a region that we can’t test or do research on.  It’s a great illustration, probably one of my favorites and it’s a good word that describes what I think eludes many of us in our teaching and basic reasoning on the influences of internal mechanisms that relate to the lateralization that we see in so many of our patients when they stand or walk.  We’ve spent so much time in our careers looking at the gluteus medius musculature, the abdominals and the quadriceps but we’ve done very little in discussing muscle that have greater impact and importance that we cannot actually observe or directly influence.  I believe PRI has a direct influence on the muscle in an indirect approach by understanding the normal mechanics of this asymmetrical view on typical asymmetrical patterns and positions that PRI therapists appreciate.

Loquacious
What's Included:

This word is derived from the Latin word “loqui” which means “to speak”. The tensor fascia latae is a muscle that is speaking loudly to us when patients with anterior knee pain, hip bursitis, SI joint strain, etc, come into the clinic and point to this overdeveloped muscle on the left side. It contributes to the forward inclination or anterior position of the left innominate. It has a very big impact on shifting the center of gravity to the right side and it often is considered a substitute muscle for gluteus medius abduction or gluteus medius type of activity when the gluteus medius and minimus on the left side are not in their correct position to properly support the body when the right leg is going through phases of swing through or push off. This muscle is a very important internal rotator of the femur on the acetabulum because its position often reduces good ability for acetabular internal rotation on the femur, especially at midstance. You see this overdeveloped and overused muscle on runners and individuals who stand and sit for long periods of time. Therefore, I chose the word because it’s very active, talkative, loud, and palpable and it vibrates a message to me every time I see someone come in with low back pain or difficulty with frontal plane movement.

A priori
What's Included:

I chose the word “a priori” because I needed a word to justify my experience and a reference to my experience as a physical therapist testing for passive adduction ability. This word reflects issues concerning the proposition or claim that if your pelvis is in an anteriorly rotated state and you line the femur up with the body in a position that we often call the Ober’s Test you can justify the fact that the leg can’t adduct because of the osseous impingement components of the state the acetabulum is in. A priori is an argument that says you can see that it’s true just by laying a person on their side and you don’t have to necessarily rely on previous research or science because the a priori knowledge or justification is independent of my experience. It’s a word that is used as an adjective to modify the noun knowledge. It’s an adjective that can also modify other nouns such as truth. The word a priori is Latin and means “from what comes before”. In this case the activity that came before femur restriction in this position was acetabular orientation. My favorite description of this word comes from Wikipedia:

“Proponents of this explanation, a priori, claim to reduce dubious metaphysical faculty of pure reason to a legitimate linguistic notion of analyticity.”

Basically what it means is that I am using a word to describe a priori algorithm of a class of algorithms for learning association rules as they relate to femoral acetabular adduction when an individual is not first placed into a neutral position. If you had prior knowledge of the position the acetabulum is in when it’s in an anteriorly forwardly rotated or oriented state then you know that the position or the placement of the femur that you often see being carried out by testers by using over testing methodology, will result in a limited amount of adduction because of osseous orientation and impingement. So there is a known or assumed cause to a related effect that is objective. It’s a deductive word that is based on theory rather than experiment because of the argument that can be made prior to the experimentation. Again, this is one of my favorite Latin words and it reflects a lot of what I philosophically believe in and allows me to be open minded but yet be philosophically grounded. Our Institute is founded on the way you use knowledge and this word best describes the foundation of PRI.

Aprioricity
What's Included:

This is a word that is used to describe the quality of a concept being “a priori”. Therefore, it is a noun and it is being used for this illustration to demonstrate that it is necessary for you to internally rotate the femur and flex the hip in order to adduct the leg on an individual who has an anteriorly rotated and forwardly based ipsilateral innominate. It’s a contingent truth in that the “a priori” knowledge used to test this activity out analytically requires a necessary movement of these two bones in a pattern that reflects feed forward passive or active activity (in this case femoral internal rotation, adduction and flexion) as a result of “a priori” argument. I believe that the relationship between “aprioricity”, necessity, and analyticity is not easy to discern but real. There is a metaphysical distinction between the description of an “a priori” concept and the “aprioricity”. A priori is an analytical algorithm based relationship that has to take place prior to the testing in that position that resulted in the outcomes that were predictable. Aprioricity is the actual application of these prior truths and results in an actual position that is supported by prior knowledge of what it would take to adduct and internally rotate a femur that had to be in a flexed state. I analytically and philosophically believe in this metaphysical description and ones inability to metaphysically and linguistically think in this rational process. Presently many of us are influenced by the need for evidence based testing which diminishes our ability to take “a priori” concepts and apply them in an acceptable manner.

Laconic
What's Included:

This word is an adjective that reflects terseness or someone who uses few words and yet has a strong statement as a result of the word selected. Sometimes this word is used to reflect active activity that is being carried out in a very quiet manner and in this case I selected this word to reflect the activity that the left gluteus maximus muscle is generating on the human body on a continuum. The left gluteus maximus is a muscle that, we as humans, have a tendency to use to reposition ourselves to the right. Our neurological patterns that are created as a result of growth and development and our vestibular system and it’s adaptation to the demands placed on visual processing are all correlated and integrated with assistance from the gluteus maximus on the left side to generate necessary function for upright reciprocal asymmetrical form. It is a strong contributor to the development of the Left AIC polyarticular chain and although it is not part of this chain it is definitely a muscle that we use to acquire it, therefore, it is a very “laconic” type of activity that’s going on in almost every human being. Very rarely do you see the gluteus maximus muscle not respond during AF or FA ER testing.

Peroration
What's Included:

This illustration is displayed with the pubis inferiorly positioned, the sacrum superiorly positioned, and the coccyx forwardly positioned so that the presentation is of the pelvic floor outlet. One can see the sacral base oriented to the right reflecting ischial sacral internal rotation on the right and ischial sacral external rotation on the left. One can also see the torsion going through the pubic symphysis with left ischial pubic external rotation and corresponding right ischial pubic internal rotation. I believe that this particular illustration reflects where the Institute has come from and where it has gone over the last decade. It also reflects the last course that has been put together by the Institute on the pelvic floor by looking at the myokinematics of the inlet and outlet, neuro-oriented respiration through the inlet and outlet and soft tissue malalignment. The word “peroration” reflects rhetoric. It’s often referred to as ‘the conclusion of a speech or discourse in which the points made previously are summed up or recapitulated with greater emphasis than was made in the body of the speech’. This section of our body speaks to us loudly and lets us know when things are not being regulated correctly. Everything from pubic pain, SI joint pain, and pelvic floor pain reflect this oration and final remarks that the body can make with respect to imbalance. Many of our ascending problems do not necessarily start at the feet but actually in this pelvic floor region and therefore, I think the word “peroration” best recapitulates the principle points of PRI and urges those who use PRI to use greater effort and earnestness in reducing these poorly managed and irregular forces that are generated because of poor pelvic floor symmetry.

Omniscience
What's Included:

This is a word that is projected in the noun form with a Latin background that describes having total knowledge or knowledge about everything. I don’t think there is a more appropriate word than “omniscience” in the description of what’s going on between the cranial and the sacral movement patterns that need to take place for normal human function. The sacrum is one of three bones that have this powerful knowledge of orientation, position, and neurological control whether it’s autonomic or somatic. The other two bones, sternum and sphenoid, are in the same position and have the same type of demands placed on them. Flexion and extension of these three bones directs and controls, not only movement patterns, but also activities like respiration, state of anxiety, cognitive ability, and so much more. It’s a very important illustration because it reflects true uniplanar movement patterns that are non-threatening when working correctly and very menacing or “omniscience” when not working correctly because of poor rest position and accompanying limited function.

Insidious
What's Included:

If you look at the pelvic inlet from above you will often see the left pelvic inlet forwardly rotated and anteriorly tipped in a flexed state. The ilium and pubis are externally rotated, abducted, forwardly rotated, and anteriorly tipped. This left IP ER results in left AF ER and results in an individual working or spreading themselves in a harmful way, in a subtle way and a stealthy way. It’s a treacherous position for many of us because it’s a position that does not allow us to restore our left IP IR and our left AF IR function. The ilium, pubic and acetabular femoral IR that is lost because of the state the innominate is in entraps us and places “insidious” demands on our daily activity.

Commencement
What's Included:

I think this word best reflects the beginning of PRI concepts. The hamstring was the first muscle that I felt individuals needed to grasp and understand better for one to fully appreciate the lateralization that is taking place in our bodies using an orthopedic mentality. We have become products of our professional reading materials and if you cannot palpate a muscle, grasp onto the concept of its movement activity or have a good appreciation for origin, insertion, two joint mechanical activity, etc. the orthopedic mind will not allow one to integrate with families of muscles or polyarticular activity that result in chained limitation. This particular illustration is the beginning of that conceptual, philosophical approach to looking at the neural mechanical system that we all possess. The Supine 90-90 Hemibridge comes to mind when I think about the days I tried to facilitate this particular unilateral muscle. The results were magical, mysterious and fun to talk about but we’ve come a long way since then and the days of application of isotonic resistance to a muscle that is moving independently of speed, gravity, or position (i.e. Protonics) are no longer novelty to many of us. It’s important to understand the human body needs to be able to extend the sacrum, sphenoid and sternum without extending the appendicular structure or the back so that other PRI applications and algorithms can follow. When I look at “commencement” of establishing pelvic neutrality or system neutrality I think of this particular muscle, this particular illustration and my 30 years of studying and outlining the road for PRI instruction and teaching.

Capricious
What's Included:

This is a picture of the anterior pelvic region and the viewer will see that the femoral acetabular position is different on the right and left side reflecting the Left AIC orientation of the pelvis and the accompanying compensation that’s so often seen through the femur in the left acetabulum. This picture depicts a femur that is externally oriented and the femoral acetabular activity is, therefore, unstable because of the high compressive forces being distributed through the anterior superior labrum of the capsule itself and the accommodation of the femoral head being moved forwardly as the iliofemoral and pubefemoral ligaments are being lengthened. This “capricious” state is impulsive, unpredictable and unstable.  It’s a very difficult position to manage, control, regulate and guide. I like using this word to describe left acetabular femoral joint activity when the acetabulum is in a position that places demands on the femur that are not appropriate for normal kinetic or kinematic function. This is a “capricious” state and a joint that is going through “capricious” activity in a manner that is unpredictable from individual to individual.

Megrim
What's Included:

This is an illustration of the cranium and cervical complex that is positioned in a supine state. It illustrates an individual who has a limited amount of ability to establish an oral airway because of the position of the tongue, mandible and cranium when normal cervical lordosis is lost. This cervical cranial reflection generates a case of the “megrims”. Megrim and migraine share the same meaning etymologically. The Greek’s afflicted with pain on one side of the head called this ailment hemi-cranium which means half of the cranium. Nowadays, the word “megrim” and migraine are still used interchangeably but the word “megrim” can also refer to much less severe and painful departures from normal health whereas migraine is more catastrophic. Anything associated with this position, vertigo, cranial pain, dizziness or depression would refer to the word “megrim”. When I see limited oral airway, forward posturing, excessive cervical lordosis, and poor cervical opposition from the cervical flexors I think of “megrim”.

Ameliorated
What's Included:

This is a picture of an individual who is laying in a supine state with a normal cervical lordotic spine and a normal airway with good mandibular position and cranial cervical alignment. This illustration reflects someone who has improved their alignment when lying down by working posturally using activities that recognize the strong overuse of the right anterior and lateral neck musculature and have become better at breathing at night because of uniform and symmetrical temporal fossa orientation and mandibular position. The tongue is in a state where security, comfort and control do not have to be offered through it. Its relaxed state allows the glottis, hyoid bone and the neck itself to direct airflow in a normal respiratory manner using the diaphragm as a primary source of respiration. I call this an “ameliorated” state or a person who has done a good job with amelioration. Therefore, the word “ameliorate” is a verb and it means to make or become better and to improve one’s self. I think this illustration clearly defines what’s necessary for good rest and improved sleep habits as well as what is considered good cranial and stomatognathic function.

Prodromal
What's Included:

This illustration demonstrates the type of scapula you would see on a Right BC patient. The right scapula is abducted, depressed and upwardly rotated on the thorax. Its internal rotation or orientation makes it look like it’s winging at the vertebral border around a vertical axis. It’s resting in a protracted state and often compliments the rib hump on the posterior thoracic wall on this type of a patterned patient. The subclavius is having a direct impact on its forward pull at the distal spine and at the acromion junction. On the left side you will see an abducted or elevated orientated scapula on the thorax. Its downward rotation results in an overactive and shortened pectoralis muscle on the left side that is active because of the limited amount of sternal rotation to the left. It’s externally rotated and resting on a rib cage that is more posteriorly positioned with respect to the right, therefore, appearing to be in a retracted state. I like the word “prodromal” because it’s a word that describes precursory function. It relates to pre-activity that is associated with the Right BC pattern that precedes symptoms and dysfunctional discomfort that is often described as shoulder bursitis, upper trapezius hypertonicity, levator scapula strain, T4 pain, and snapping scapular syndrome, and curvature of the spine. Prodromal is an early situation that is indicating possible or early onset of an attack of the above mentioned symptoms or by dictionary definition “a disease state”. I like the word because it reminds us of premonition, precursory, and pre-position.

Indubitable
What's Included:

This illustration is a reflection of the Right BC chain in a Left AIC pattern as one would observe it on a human being in the upright state without a zone of apposition on the left side. This is a very common pattern seen in the human body and reflects both the respiratory and neuromechanical lateralization issues that the human is gifted with. It’s a reflection of normal asymmetry when looking at rib cage position and balance. It’s to apparent to doubt it because of the consistency you see with respiratory function, the definitive strength, size and power of the right diaphragm in comparison to the left, and the organ and visceral imbalances between the right and left torso. It’s unquestionably one of the most fascinating asymmetries of our body and has generated the most discussion in PRI in that very few look at this region from an asymmetrical view point or from a patterned outlook. Many biomechanical or kinesiology studies don’t recognize it and although most pulmonologist’s understand the internal relationships of the left mediastinum to that on the right very few relate it to posture or imbalances placed on the musculature for alignment or for spinal support. I like the word “indubitable” to describe this illustration because of the apparent pattern that we as humans have and because of the unquestionable rotational torque placed on the rib cage because of that pattern. The loss of apposition or the reduction of apposition on the left side because of this “indubitable” pattern is why the manual techniques that have been outlined in PRI exist.