Posts by Robert George

Chiropractor

The first Postural Respiration course of the year was presented at Rehab2Perform in Frederick Maryland. This facility is a perfect blend of rehab and performance as stated in it's name! Physical therapy, functional training, group coaching provides the backdrop to the diverse group of attendees including PT's, CSCS's and even an M.D. Some of the topics that attendees, and usually all attendees have, is the difference and purpose of a right arm reach vs. a left arm reach. This issue can be vexing for even veterans of several courses. One way to remember this is a right arm reach first turns a diaphragm to the left taking a pelvis with it. Get and hold onto a left hamstring and left abdominal wall then with the help of left serratus and left low trap, a left arm reach then turns a ribcage above T-8 to the right. Caution with superior T-4's was a theme reinforced over the weekend and veterans that had some questions about the reasoning regarding which arm and when to reach with it came away more relaxed and settled with this issue. Strength and conditioning professionals got whatever you load you will reinforce so get neutral, stay neutral and then load, move and perform! All in all a great facility, hosts and especially curious students! Thanks to all that attended and Josh Funk, DPT, CSCS, PRC for providing this facility!

Posted January 26, 2017 at 2:43PM

The first thing any skier learns is how to stop!  The next is how to control speed coming down a hill and then turning skis to provide direction in what at first feels like a very awkward, sometimes out of control and for most ultimately exhilarating experience!

Positioning the skis in what is called a “snow plow” is what most beginners learn and both inside edges of the ski (medial under the arch of the foot) are used to slow, stop and turn the skis.  Essentially the feet need to evert to create resistance on the snow with the tips of the skis close to each other but not crossing and the tails of the skis wide apart.  This looks a little like a slice of pizza to most youngsters (and oldsters!) and we say “get into your pizza wedge”.  In this snow plow position, if a skier leans over to the right side, they will turn left and visa versa.

Learning how to parallel turn means both skis turn together everting and inverting at the ski boot.  Since the boot doesn’t allow for frontal plane movement of the ankle joint, frontal plane to evert and invert a ski will need to come from the hips and knees.  The feet and ankles sense frontal plane and actually determine direction of the ski. (Well the brain actually runs the whole show but needs feedback from the periphery!)   In fact, part of skiing well is termed “skiing in your boots” or having a good proprioceptive sense as to what your feet are doing, sensing and directing while sking.

Sagittal, frontal and transverse plane awareness, repositioning and training can enhance not only skiing technique and enjoyment but performance as well.

It doesn’t take much of a decline on a ski hill for a person to go faster than they are used to when walking or running.  The ability to manage and be controlled without falling even at high speeds is always a goal with skiing.  There is no shame in falling and even the best fall but the potential for injury increases without awareness and control of all three planes.

There are many ways to fall but one of the biggest culprits is leaning back or extending.  However, especially with many recreational skiers, if they come upon a steeper hill than they are used to, the tendency is to lean back out of fear of falling or inability to control speed on a steeper hill.  Training a person to push forward into their boots, bend their knees and reach forward with their arms helps to keep the center of gravity over their boots.

The standing wall reach is a prime example of a repositioning technique that trains a person to flex at the knees and the thorax, internally rotating ribs with exhalation and retracting a ribcage with inhalation.  Reaching forward is exactly what needs to occur in skiing to stay centered over your skis so you can anticipate changes in terrain and speed.

Another way to fall is while skiing on a steeper hill, instead of staying over the “down hill ski” with your weight, you lean into the hill, loose edge control and start to slide and fall.  Remember this can happen on a right turn more easily than a left because you need left inside edge control ( Left stance phase) that only comes from having a femur that can adduct and internally rotate.  You also need weight driven over into your left hemisphere or thorax so you can set that edge into the snow while your uphill leg (right leg) is inverting for outside edge contact and to some degree control.  The left leg needs to be in Left AFIR with FAIR to “crank that turn” and the right leg needs to be in Right AFER and FAER in a synchronized fashion.

Another way to fall is turning from the left to the right.  If an individual has the inability to have a neutral left oriented pelvis, go into left AFIR, drop a left shoulder over their ski with abdominal control and achieve a ZOA so they can reach forward with a left hand and right counter trunk rotation, then the transition from a left to right turn can be an issue.  Oh and don’t forget, their posterior mediastinum  still needs inhibition while the lower trap on the left needs to help with left frontal plane control of a left hemisphere! Whew!  So,  they are stuck in an extension moment as they attempt to get onto their left leg to turn right and as they do so they lean back and have a tendency for an extension rotation fall.

There are about as many ways to fall as there are types of snow and skiing conditions!  These three are not an exclusive list for sure.

In PRI we all know that sagittal plane control and maintaining position is key to our rehab and performance goals.  Without a neutral pelvis we are inhibited in achieving adduction of a femur especially on the left with Left AFIR and the ability to turn right as well.  Without a neutral pelvis, a ZOA is not possible especially on the left.  Without a ZOA you soon run into the painful limitations of end range loading and excessive torque in the spine, hips and knees.

If you watch an advanced or expert skier they are almost always reaching down hill with flexed knees and a rounded back.  Are they neutral in their pelvis and thorax?  Well, no, if they haven’t been introduced to PRI!  But I do know that  some of the really good skiers I’ve skied with over the years and learned from, tend to fight nagging back and knee issues. (Excluding knee injuries!)  

Performance skiing for recreational skiers who just want to have some fun to the more serious competitor or expert skier could combine PRI principles through a strong foundation of a pelvic floor for starters.  A strong pelvic floor and a neutral pelvis drive the femurs and knees forward into the feet and ski boots to flatten that arch shaped ski for edge control and the ability to turn at will.  A neutral pelvis with equal AFIR/FAIR of a provides right turns as well as left turn ability and strength.  Being able to counter rotate a ribcage over a right or left oriented pelvis allows for efficient transfer of weight right to left side for edge control and quick turn transitioning.  Reaching forward down the hill engages the abdominal wall,  serratus anteriors, lower traps all in a harmony to provide a neutral thoracic curve with a retracted ribcage maintaining center of gravity with bent knees right on top of your feet a driving forward through the shins into the ski boots.

It is my humble opinion that PRI principles can help any skier of any ability, especially turning right as well as turning left!  See you all on the slopes.  We have a great winter just starting!      

Posted January 19, 2017 at 10:57PM
Posted January 19, 2017 at 3:33PM

Management of position, posture and weight distribution are key elements to skiing.  In the “pattern”, our weight is over the right leg driven in part by a dominate right antero-lateral abdominal wall.  This works in our favor with a left turn.  The pelvis is oriented to the right, we have Right AFIR, right shoulder is down with left trunk rotation and a right arm forward. 

Weight distribution over the right ski, or downhill ski, in a left turn is pretty important especially with the ability to adduct and internally rotate on the right.  The inside portion of the ski, or the inside edge, is necessary so that we don’t slide or fall straight down the hill.  This is called edge control and the ability to evert the downhill ski while we invert the uphill ski gives us direction and control. This is also called a parallel turn.

 The ankles in a ski boot are fixed and move very little so frontal plane control has got to come from the hips and knees.  But the feet and ankles have an important role with sensing the ground and signaling the brain and rest of the kinetic chain the position of the skis and helping to control shifting of weight side to side, forward and backwards. 

Tri-planer thinking starts with sagittal plane and having a neutral pelvis is necessary to transfer load from right to left side, left turn to right turn.  Without sagittal plane control and maintaining it, frontal plane control will suffer since adducting a femur then internally rotating it will be limited at best. Without sagittal and frontal plane management, a ZOA on the left will also be compromised and limit the ability to turn a pelvis to the left to stay effectively in left stance with right trunk counter rotation.  As a side note, this directional separation of pelvis and rib cage is another critical component to performance. Trying to teach someone to just “get better” at right turns without a tri-planer position awareness will be a limiting factor at best.      

Posted January 13, 2017 at 4:25PM

Dominant neurologic patterns and natural human asymmetries drive every form of breathing, position and movement.  The inability to manage patterns, asymmetries and breathing shows up in performance from simply walking to every sport or physical activity. 

Skiing is no exception and it is especially true with the ability to ski-turn to the right as well as to the left.  Ask most skiers which turn is easier and invariably they will mention their left turn going downhill is easier that their right.  Knowing the PRI definition of “AFIR” and “AFER” can help even the non-skier understand the mechanics and problems facing a skier attempting to get into left stance or Left AFIR as well as their right stance or Right AFIR.

For most people in the “pattern” (Left AIC, Right BC), they get into Right AFIR more easily than their left.  They can get so good at it that they are stuck in it.  For some in what we refer to a PEC pattern, they really don’t do right or left stance very well but they tend towards right stance easier.

The point is to do both well especially on the left and that means getting the socket over the ball (acetabulum over femur) as well as the femur turning internally in the socket (femur under socket).

For an effective right turn, the pelvis has to orient from the right to the left for Left AFIR.  Being able to position a left inominate bone from flexion towards extension into neutral is the job of the left hamstring and glute.  Then having the ability to put that ball joint into the socket depends on an anterior lateral abdominal wall, an anterior glute medius and a distal left adductor that has an internal rotation component to it. 

None of this will happen without getting a hemi-diaphragm to “dome” or create a “Zone of Apposition” (ZOA) and help to inhibit a left psoas muscle that contributes to the inability to put the pelvis in a position so a femur can adduct.  With sport performance, not only do both femurs need to be able to adduct in stance phase, but they need to be able to adduct with strength and power.

Adduction of a femur is critical for a ski turn along with internal rotation of a femur driving the knee medially for frontal plane control of the “inside edge” of the ski, left and right side, but especially left since this is the side most of us have difficulty with.  Many skiers are great compensators, like many athletes, and they find a way to have decent turns to the right even without the ability to adduct or get into Left AFIR fully.  But this comes at a cost with extension of a spine and compensatory torque into a knee that often can lead to reliance of end ranges for stability. 

Skiing, like walking, requires that our brains sense the ground or in this case the snow under a ski.  Getting into left stance is critical for this process proprioceptively so the brain can trust being on the left side for a right turn.  Without the ability to get into Left AFIR, dominate patterns will prevail and most skiers will fight with a right turn to some degree regardless of their ability. 

         

Posted January 10, 2017 at 3:58PM

Hosts Joy Backstrum PT, PRC and Katie Piraino, PT made this weekend a most rewarding one to teach Postural Respiration. There was a lively discussion throughout the weekend with intelligent questions always on point supported with a curious attitude to understand the concepts and application of PRI principles. In addition to numerous P.T.'s there was an ATC, two CSCS strength professionals, a cranial/sacral therapist, one dentist and an optometrist! The dentist is most interested in sleep apnea, airway management and how PRI principles can be applied to her holistic approach to dentistry. Several attendees had been PRI patients and were hungry to learn more and share their personal experience of PRI with their patients. For several students this was their third primary course that connected the pelvis with the thorax and connecting the dots that femurs need to adduct and a thorax needs to flex with ribs that can internally rotate for reciprocal and alternating function. The topic of "separation" of a pelvis and thorax was explored as well as a discussion that not only to feet often need an orthotic, but the optometrist and dentist appreciated that eyes and a TMJ or the teeth need an orthotic as well. It was such an addition to have these two professionals and their enthusiasm. Thank you to The Physical Therapy Place for being such a great host site!

Posted November 10, 2016 at 2:23PM

California Dreamin' was a common response to Water Sports and Physical Therapy hosting another Postural Respiration at their facility integrated with Exos of La Jolla. This was another great mix of professions including PT's, ATC's and strength and conditioning professionals. There were four chiropractors who have attended other courses, an RN and a dentist from San Diego who specializes in TMD and facial pain. He wanted to understand the relationship of the diaphragm and orientation of the neck and head as it relates to the TMJ! This is such a great venue and we hope to keep coming back. Yours truly was grateful to be a local and drive 15 minutes to the location! Attendees came from as far as Virginia, Texas and Colorado! Over half of the class was new to PRI! Many thanks to Matt Uohara and Matt Varca for assisting. They make the weekend a rewarding experience for students and faculty!

Posted October 26, 2016 at 6:11PM

Jen Poulin, one of PRI's veteran faculty members, told me that this group of attendees would be great to present to. She was spot on and this group assisted by Carolyn Weber, PT, PRC and Holly Spence, PT, PRC was most engaging and enthusiastic . There were physical therapists that either worked in a hospital setting, private practice or with local ski teams. Former ski racers, now turned physical therapists and mentors that were new to PRI got the concepts immediately and could see applications for their athletes as well as general populations. As always, the questions asked were intelligent and challenging backed by a strong drive to learn and explore new concepts and practical applications of a previously unknown science to many in the room. Also in attendance was a DC/PT, athletic trainers and strength and conditioning professionals. Vermont has a great audience and already has another PRI course scheduled for next year. Many thanks to the staff at Northwestern including Karen Staniels and Christy Cushing. Thanks again to Carolyn and Holly for your help!

Posted October 4, 2016 at 4:33PM

Postural Respiration was taught at the Detroit Medical Center in the Rehabilitation Institute of Michigan building September 10-11, 2016. This course was 2/3 full of new students to PRI and many other first timers to Postural Respiration. This group was enthusiastic from the start and responded well to learning the basics of PRI from providing a foundation with a neutral pelvis then addressing ribcage management of tri-planer air flow. Some of the big hits for new time attendees were that the left hamstring is an essential muscle for pelvic repositioning and is necessary to achieve an agonistic relationship with a left abdominal wall. This basic but essential concept was a huge revelation to even the most seasoned practitioners attending. During lab the concept became very real as femurs started adducting after a non-manual repositioning technique. Of note was one of the PT's in the course had taken a Protonics course by Ron Hruska in 2000! During this course there was time to really correlate PRI testing with position of the diaphragm as it relates to the axial skeleton. Then being that this course has manual techniques, one and two person manual techniques were described and demonstrated numerous times with reasoning when and why a manual vs. non-manual technique would be used. Detroit is a great city and this was a great venue! The feedback was Michigan doesn't get enough PRI courses and they want more!

Posted September 15, 2016 at 7:17PM

I was invited by Chris Poirier of Perform Better to present an introduction of PRI principles in Long Beach, CA for the 2016 Perform Better Functional Training Summit.  This was the first time “PRI Nation” was represented at a Perform Bettter Summit on the West Coast.  Among the presenters pictured were Dan John, Stu McGill, Chris Mohr, Todd Durkin, Jason Glass, Greg Rose, Brandon Marcello, Brian Nguyen, Martin Rooney, Mark Toomey, Josh Henkin, Ben Bruno and Alwyn Cosgrove and yours truly with the white polo shirt! (Center front).  I was asked to join the Saturday afternoon panel for questions and answers and  was able to provide a  compelling lead-in for the  Sunday morning lecture and hands on.  Both hands on and lecture segments were extremely well attended and received.  The buzz heard in the room from the attendees was “we have been waiting to hear about PRI, now we want to take courses and learn about PRI principles for rehab and performance especially managing human asymmetries and rotational performance!”  Thanks much to Michael Mullin who provided support in this first time appearance and who speaks for Perform Better on a regular basis.  And Thanks much to Chris Poirier for allowing me the opportunity to present!   This past weekend, August 13-14, I was invited by Chris Poirier of Perform Better to present an introduction of PRI principles in Long Beach, CA for the 2016 Perform Better Functional Training Summit.  This was the first time “PRI Nation” was represented on the West Coast.  Among the presenters pictured were Dan John, Stu McGill, Chris Mohr, Todd Durkin, Jason Glass, Greg Rose, Brandon Marcello, Brian Nguyen, Martin Rooney, Mark Toomey, Josh Henkin, Ben Bruno and Alwyn Cosgrove and yours truly with the white polo shirt! (Center front).  I was asked to join the Saturday afternoon panel for questions and answers and  was able to provide a  compelling lead-in for the  Sunday morning lecture and hands on.  Both hands on and lecture segments were extremely well attended and received.  The buzz heard in the room from the attendees was “we have been waiting to hear about PRI, now we want to take courses and learn about PRI principles for rehab and performance especially managing human asymmetries and rotational performance!”  Thanks much to Michael Mullin who provided support in this first time appearance and who speaks for Perform Better on a regular basis.  And Thanks much to Chris Poirier for allowing me the opportunity to present!   

Posted August 22, 2016 at 3:54PM
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