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Impingement and Instability- It was an honor to present Impingement and Instability at the Professional Hockey Athletic Trainers Society Annual Meeting in Phoenix Arizona this year to a fantastic group of professionals. The group was primed and more than prepared for the transition to secondary level courses after having taken Myokinematic Restoration and Postural Respiration at 2 of the previous annual meetings, both taught by Mike Cantrell, MPT, PRC. I spoke to Matt Bain, ATC when I was in Vermont a few weeks ago and he said the PHATS organization was first class and that I would have a great experience presenting at their conference. Mike also told me that I couldn't find a better group of professionals anywhere to spend my time with, and after our interactions during Impingement and Instability I have to say you both were 100% accurate. This group was chalked full of first class professionals that made me feel like a member of the family as we learned together and talked shop. Thank you everyone for living up to your billing and making me feel so welcome.

On day one, we got into the power and significance of the frontal plane in athletic performance and got to analyze the gait cycle in terms of the frontal plane differences and demands seen in early stance vs the frontal plane differences and demands seen in late stance in the left AIC pattern. This included a detailed comparison of what happens on the right side vs what happens on the left side, because, well...thats what PRI does. And then we expanded this view of gait performance to the hockey athlete to help us better understand skating performance during starts, stops and turns when performing on the right leg and on the left leg. A big thanks to Matt Bain, ATC for helping us get the video footage of hockey performance in good old Gutterson Arena that allowed us to compare both right legged and left legged starts, stops and turns. The opportunity to review slow motion video as a group really helped us bring together the concepts as it related to performance tendencies on ice. If a picture is worth a thousand words, there's no telling what these slow motion videos did for the course attendees. Very helpful.

With a gait analysis mindset, a frontal plane mindset and also a hockey performance mindset, the group was able to move through the Impingement and Instability material with a central theme and focus. The calcaneal instability section was highlighted by a demonstration of gait and footwear that helped us appreciate the footwear recommendations and reference center training a hockey athlete may need when they are not in their skates. The mechanics of a compromised kinematic chain disrupted by poor performance of the calcaneus cannot be overlooked or ignored. Its always good to rethink conventional wisdom and outline the best practice for each individual athlete based on the objective findings of each individual athlete. The demonstration was a good experience for everyone in the group. The rest of day one consisted of discussions and demos on femoral instability. We spent a lot of time as a group analyzing the oriented or compensated rotational issues of the femur and the tibia as it related to knee function and pain. We looked closely at several of the attendees and were able to appreciate what was going on as we came to a group consensus of how their femurs and tibias contributed to their knee instabilities.

Day two consisted of detailed analysis of ilial instability and scapular instability issues. The ilial instability section included discussions around ischial tendinitis, hip instability and hip impingement. We analyzed the right legged vs left legged turns of a giant slalom skier and by this point in the course, we could all see the relationship to both gait and hockey skating. In fact, we even went back and reviewed the slow motion hockey videos after talking about the skiers and were able to connect the dots quite well. The scapular instability section included a comprehensive demo of all manual rib techniques merited for a scapular instability athlete. Thank you Tommy Alva, ATC for letting us use your rib cage for group teaching purposes. You were great. And lastly, it was great to take a deep look at scapular performance muscle issues like the difference between the lat and the subscapularis and the power of the low trap and the serratus anterior to offset overactity of the levator and the upper trap. Fun stuff that took on a new relevance for both the right and left handed hockey athlete. Thanks again PHATS for inviting PRI to your annual party. It was truly our pleasure to be there!

Posted June 23, 2017 at 2:34PM by
Categories: Courses

Josh Olinick emailed this document titled “Desired PRI Clinical Application for Integrated Gait Progression Activities: Facilitating Right Brachial Inhale and Left Brachial Exhale During Left Stance”. Ron and I had a chance to go through this with Josh, and we love what he has put together. Ron is looking forward to discussing this document further at the Advanced Integration course in December!

Foreword from Josh:

I should start with the disclaimer that this was not my idea.  I was talking with James Anderson a few years back and he suggested that I try taking the article he wrote on left AIC inhibition/ delay and modify for the brachial chains.  I took a quick stab at it then, but wasn’t really happy with what I had come up with.  At that time, I was over loaded by opening a new clinic and couldn’t commit the time needed, but the idea kept running around in my head.  I had some time this year to write it out.  I think what makes the Myokin content more easily understandable is that a human is either in right stance or left stance, and they are either in a Left AIC pattern or a Right AIC pattern (without compensations like a PEC).  But the brachial chains seemed more complicated to me because they were more directly related to phase of respiration.  Bramble and Carrier showed that humans differ from other animals in that they can take up to 6 steps per breath while running.  This suggests that respiratory influence on the AIC and stance phase is more easily overridden than in the brachial chain.  So rather than focusing on individual chain inhibitory musculature like James did in his article, I decided to take a step back and consider what a patient in a right brachial chain pattern needs during Left stance in a Right AIC pattern.  Well, the easy answer that is taught in the Postural Respiration course is “Right Trunk Rotation”.  The thing I kept running into though is that position of the trunk is dynamic during stance phase and that respiratory phase is independent of that.  The more complete answer I came to is that in early left stance the right trunk needs to be more open (sooner) to reduce “listing” onto the left LE, thus the right chest wall needs to have a more inhaled state.  Whereas in late left stance, the left trunk needs to remain closed (longer) to allow a right heel contact without premature compression of the Right rib cage (i.e. keeping the left rib cage exhaled longer).  This idea is similar to James’ work on inhibition and delay in that the patient needs to get their left ZOA sooner (while the right upper trunk is rotated to the left) and keep it longer (while the right upper trunk is rotating towards the right – regardless of phase of breathing).  Hopefully this can help others in activity choice during different phases of their patients plan of care!

Read the article HERE.

Posted June 16, 2017 at 1:13PM by

The PRI Fitness and Movement Course continues to make progressive leaps and bounds in its development. This course is dedicated to the potential to advance PRI application in various settings related to fitness and movement, as well as help the discussions progress beyond just using PRI as correctives, warm ups, or cool downs.

I believe the strategic partnerships and interdisciplinary teams will most effectively meet today’s fitness, performance and healthcare challenges. Advanced PRI application is a key ingredient needed to conquer these challenges and its groups like we had this past weekend that will continue to progress the discussions involving PRI and keep us all moving forward. PRI really is not just another “tool” in a clinician, coach, or trainer’s toolbox. Its only a tool when you use or know parts and limited pieces of the system. When you understand all the pieces and parts, the PRI science provides us all a framework for which we can optimize various anatomical relationships to enhance human performance.

We devote a lot of time in this course to understanding the thorax and components of pillar core strength. Fitness and movement application has a lot of limitations in core strengthening if respiratory and neurological factors are not respected. We highlight those factors and teach people how to respect them in ways which are functional and easy to implement. For many high level performance athletes as well as any of your fitness clients with chronic pain, its not in strengthening and stretching that they will feel significant improvements in their stability; instead through strategic breath work and inhibiting hyperactive chains of muscles they will be able to synchronize the thoracic-acetabular abduction which is crucial for core stability and it’s that synchronized stability which must proceed the mobility that so many people crave. Let’s rethink mobilizing --- and start synchronizing.

Thanks to all that came out to Performance Gains in Palo Alto! PG Thank you for hosting and it was awesome to see the new beautiful facility! Caleb thank you for lab assisting and helping us out throughout the weekend!

Posted June 16, 2017 at 10:31AM by
Categories: Courses

It is always great to teach PRI at Northeastern University. The Sports Medicine Department has embraced the teachings of the Postural Restoration Institute and their entire staff does such an amazing job hosting courses for us. The facility is great having both a lecture room and an adjacent lab room for clinical testing and practicing techniques. Mike McKenney, ATC and Elizabeth Sheehan, ATC made sure we had everything we needed for a great weekend. The entire Northeastern staff in attendance were really starting to put this science together for their athletes! I enjoyed all of my "side bar" conversations with this group.

 It was also great for me to see some faces I had just seen in Providence, RI a few weeks ago back for more PRI! Matt Silvaggio, MSPT, Matt Medeiros, DPT, Chris Gomes, DPT CSCS and Jonathon Carroll CSCS were all at University Orthopedics Pelvis Course with me. That makes me so happy to see clinicians enthusiasm to learn more! The Ah Has were going off for this group!

My lab assistants were a real power house. This was a large class so having 2 PRC's Donna Behr and Anita Furbush along with PRT's Miguel Aragoncillo and Navin Hettiarachchi was hugely supportive. This class size of 55 students was almost an equal split of rehab professionals and wellness professionals. So having support from both PRCs and PRTs was great!

38/55 students were what we call PRI newbies! The energy was positive and the depth of knowledge in this group was vast. Recently I have been teaching the Pelvis course a lot, so it was fun to switch gears into discussion of Hole Control and AF vs. FA control of a hip and pelvis! Personally I had the pleasure of teaching Kirsten Bombardier, DPT her first PRI course. Her parents and I have been friends for years and Kirsten used to babysit my girls when they were babies. How great it was to bring her into the PRINation! She left excited to sign up for her next PRI course.

Thanks again to all who attended and I appreciate all of the Twitter love that was sent out during and following the course. I teach for the love of PRI and I always learn from my course attendees!

A Big shout out to Queen B for her song Irreplaceable for giving me the quote of the weekend "to the left to the left". See you in the fall PRINation!

Posted June 14, 2017 at 10:57AM by

Impingement and Instability- Great visit to Northwest Vermont to teach Impingement and Instability at the University of Vermont, or UVM, meaning the latin Universitas Veridis Montis (University of the Green Mountains). If you've been to Burlington Vermont, you know why they chose to call it the "University of the Green Mountains", because they are spectacular. I'm from Utah and quite familiar with mountains, but these beautiful Green Mountains rolling into the shoreline of Lake Champlain are something to see. I always enjoy visiting Vermont and this trip was no exception. It was also a neat opportunity to catch up with my nephew Josh, who is currently an engineering student at UVM. I can see why he chose to go to college here and be a Catamount.

Thank you to the Athletic Training staff for hosting and helping to get everything coordinated and set up, especially point man, Matt Bain. Michele Bliss, Lisa Hardy, Neal Sand and Emily Snyder, you were all great as well and made me feel like a welcome guest in your department. I can appreciate the cultural mantra "Catamounts All In" after spending a couple of days with you guys. Loved it. And thank you to Kathy Metzger, Cory Healy and Oliver Hall, three certified PRI Professionals who really did a great job helping the group elevate their understanding of these advanced concepts. The class was better because you three were with us. And Olly, I loved what you took the time to do on the second day, together with Ali Spencer, in helping the group to understand the mechanics of alpine skiing and especially the mechanics of the Giant Slalom high speed turns. Your willingness to share helped us all bring some things together that we may have otherwise missed. As it turns out, just about every athletic performance function can be tied back to the mechanics of gait and postural patterns. Fun stuff. I look forward to future collaborations on the topic and furthering my own understanding of alpine skiing. Thank you Olly and Ali for your contribution.

As far as the class was concerned, we had a great time moving into the realm of PRI advanced assessment and treatment in an effort to expand on the information presented in the introductory courses. During the first day, we had a powerful discussion of how frontal plane dysfunction contributes to lateralization and early stance vs late stance bias during the gait cycle. We discussed the contributing factors behind human lateralization and ways that we could intervene to influence the situation to reverse the tendencies during performance. We discussed neurological reference centers as it related to the gait cycle and of course applied the mechanics of breathing to all of this. We took a good look at calcaneal instability, femoral instability, ilial instability and scapular instability with a gait, frontal plane and reference center perspective.

Lastly, I wanted to thank Matt Bain and Eliana Leddy for sharing your insights on hockey skating and figure skating, respectively. I loved how the two of you took the things I was explaining as it related to right vs left sided gait performance and applied what you knew and personally experienced as ice skate athletes. It was a helpful application of the material that made the experience better for all of us. I'm excited to collaborate further with you Matt to put some of our thoughts down on paper as it relates to the hockey athlete. Thanks for your willingness to learn together with me. And thank you to everybody. Great weekend. Great class.

Posted June 12, 2017 at 4:54PM by

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