Posts by Heather Carr

DPT, NTP, PRC, OCS, MTC

Grounding from an Electrical, Postural, Breathing, and Emotional Perspective

By Heather Carr, DPT, PRC, NTP

The concept of “being grounded” is becoming a common phrase that is being expressed these days. The connotations associated with “being grounded” are that it is a healthy and beneficial phenomenon. However, what exactly does it mean? The purpose of this article is to explore “grounding” from an electrical, postural, breathing, and emotional perspective.

The human body is constantly generating free radicals via oxidative reactions which if unchecked can contribute to immune and inflammatory stress. Anti-oxidants that serve to neutralize these reactive oxygen species do so by donating electrons. The earth’s surface has a net negative electrical charge characterized by an excess of electrons. Therefore, the earth is a natural repository of electrons to supply our bodies with anti-oxidants thus mitigating oxidative stress. However, this ultimately requires direct contact of our skin to the earth or the use of conductive sheets/pads/wrist bands (Earthing products) that are connected to the grounded component of an outlet.

Modern living subscribes to a plethora of toxins that we ingest and are exposed to through our foods and environment requiring significant anti-oxidant retaliation. Consider this relative to how the natural human electrical discharge mechanism between the ground and our bodies has become mostly obsolete. Until recently, throughout much of our human existence we walked barefoot and slept on the ground. Our shoes, particularly rubber soled, pose a barrier for this electrical conductance pathway. Furthermore, most of us are walking on artificial surfaces. There are many individuals who never or rarely experience barefoot contact on real earth. This is one of the reasons why walking barefoot on the beach is so enjoyable and relaxing for people. Not only are you experiencing wide open space (in contrast to the typical close-up, indoor, focal work we do on screens) and the natural multi-sensory rhythms of the ocean (as opposed to the artificial dissonance created by modern technological devices) but you are also absorbing electrons from the ground to neutralize free radicals in your body.

In the Journal of Environmental and Public Health, Chevalier et al (2012) describe in “Earthing: Health Implications of Reconnecting the Human Body to the Earth's Surface Electrons” the numerous health benefits of this phenomena. Such effects of “earthing” that have been demonstrated include beneficial changes related to sleep, pain, cortisol level, autonomic nervous system activity, immune function, osteoporosis, heart rate variability, hypercoagulable blood, and glucose regulation. In addition to personally sleeping on an earthing sheet, as a Physical Therapist I commonly recommend them to my patients, particularly those who are experiencing pain, inflammation, and have difficulty sleeping. Thus far, in addition to myself, my family, friends, and patients have reported significant improvements in these areas since incorporating earthing practices.

From a postural perspective, “being grounded” means your body is authentically aware of where the ground is and its positional and gravitational relationship to it. This is the responsibility of our postural system which is primarily comprised of our visual, auditory, vestibular, and sensory-motor systems. Our postural system and essentially all of the systems in our body, work in the realm of patterns. Our brain-body is a dynamic habit centered organism. Furthermore, our neuromuscular system works in patterned “chains.” This means that groups of linked muscles fire together in synergized mechanisms to accomplish our functional needs to be upright against gravity and move. Our primal human essence of movement is walking which is comprised of two polar phases-being on the left leg and being on the right leg. This has an accompanying predictable neuromuscular firing pattern from the foot all the way up to the head including the visual and vestibular systems.  Each side is essentially a conjugate of the other with opposite patterns occurring simultaneously.  When the left leg is on the ground it is in the “grounded” phase when the right leg is in mid-air, and thus ungrounded. The opposite occurs for the right stance phase of gait.

Our postural system is intimately linked with our breathing (respiratory) system. Just like our alternating left/right walking, breathing also exhibits an oscillatory essence characterized by inhalation and exhalation. When we inhale the front of our rib cage elevates into external rotation as the diaphragm contracts and lowers. This is in contrast to exhalation where the front of the rib cage lowers. During exhalation the diaphragm relaxes as it returns to a upward domed position in apposition to the internal surface of the rib cage (referred to as the “zone of apposition”). Authentic and efficient breathing is characterized by being able to alternate between a full inhale when the diaphragm lowers and a full exhale where the diaphragm rises up into apposition with rib cage. This requires synchronized activity between the abdominal and pelvic floor musculature to control pressure and positional relationships throughout the trunk. These same muscular patterns are also involved in managing the process of walking. Therefore, how we breathe effects how we posture and move. Likewise, how we posture and move effects how we breathe.

Let’s take this a “step” further. When we walk our pelvis and rib cage rotate in opposite directions. This means when the pelvis is rotating to the right the rib cage is rotating to the left and vice versa. When the rib cage is rotating to one side it exhibits a twist in which the left and right sides are in opposite phases. For example, when we are on the left leg our rib cage is concurrently rotating to the right. This means that the front right side of the ribs are in an open, elevated, inhaled state while the left front ribs are in a closed, lowered, exhaled state. The best way to understand this is to place your hands on the front of your ribs and feel this opposing motion when you turn your torso to one side or the other. Likewise, when we are on the right leg our thorax is concurrently rotating to the left in conjunction with the left ribs being in a state of inhalation while the right is in exhalation.  This comprises a pattern of whatever leg is “grounded” the corresponding side of the rib cage is in an exhalation state.  This means that exhalation correlates to the postural phase of being “grounded.”

The current trend of postural and breathing dysfunction amongst our modern living society is characterized by being in a chronic state of inhalation. Many of us are functioning in a stressed out mode characterized by excessive sympathetic nervous system activity and holding our breath. Consider what we do when we are startled or experiencing fear-we gasp! This is in contrast to “a sigh of relief” when we exhale into a calm and relaxed state of being. Unfortunately, this inhalation pattern has become a chronic breathing behavioral habit vs an acute transient one (such as if we were startled by a predator as was the case in our paleo times). This means the rib cage is excessively elevated and open in the front, closed in the back, with the diaphragm locked down in a perpetual contracted state, preventing a full exhalation and thus relaxation to occur. This means poor breathing excursion and airflow. It also translates into excessive tension in the psoas, hip flexors, back extensors, and neck musculature as the diaphragm is fascially and functionally connected to these muscle chains. Positionally, this pattern is typically accompanied by an excessive anterior pelvic tilt, lumbar lordosis, protracted scapula, and forward head posture. This is ultimately an “ungrounded” posture.

Now it’s time to connect our emotional system to breathing and posture. A study done out of Northwestern University lead by Dr. Christina Zelano demonstrated that during inhalation people are more likely to learn fear based memories compared to the exhalation phase of breathing. Inhalation was shown to facilitate the amygdala and hippocampus in the brain (involved with emotional processing and memory) to encode and retain stressful events significantly more than during exhalation. This relationship can also work in reverse where emotional patterns incorporating fear and anxiety can impact how we breathe, our posture, and thus our “grounding.” Individuals who experience anxiety related disorders tend to function in an inhaled state of breathing and its correlational postural pattern. Therefore, anxiety and stress states are typically “ungrounded.”

In order to potentiate one’s ability to be “grounded,” one must consider the behavioral, postural, breathing, and emotional dimensions that ultimately create it. Behaviorally, we can increase our electrical contact with the ground either naturally and/or through the use of Earthing products. We can also attempt to reduce our free radical production in that we have some degree of control over the amount of toxins we ingest and are exposed to.  By restoring appropriate postural and breathing patterns one can improve their ability to authentically “ground.” The method of the Postural Restoration Institute (PRI) is heavily focused on creating these grounded relationships. An important component to this is to establish a full exhalation to allow the diaphragm to achieve a relaxed domed position in contact with the internal rib cage. Furthermore, because the diaphragm is part of a continuous chain of synergistic muscles from the foot all the way up through the head, a portion of or all of these chains may need to be re-educated to ultimately create this grounded pattern. This typically requires practicing specific postural restoration techniques so that the brain-body can learn a “grounded” pattern. Finally, by addressing fear based emotional patterns one can also influence their breathing, posture, and thus ability to “ground.” Likewise, one can positively influence anxiety and stress via better postural and breathing function. It’s all connected!

Chevalier G, Sinatra ST, Oschman JL, Sokal K, Sokal P. Earthing: Health Implications of Reconnecting the Human Body to the Earth’s Surface Electrons. Journal of Environmental and Public Health. 2012;2012:291541. doi:10.1155/2012/291541.

Postural Restoration Institute: https://www.posturalrestoration.com/

Earthing Products: https://www.earthing.com

Posted May 22, 2017 at 2:01PM

Last weekend at the PRC/PRT conference I had the opportunity to speak about how to integrate Orofacial Myofunctional Therapy with PRI to create craniofacial resonance. I explain a "cranial ZOA," "facial hole control," and an "up and back swallow" through a discussion of circles, aliens, a sticky orthotic, and some silly yet simple and effective techniques. Because of my passion for this topic, I converted the presentation into an article which can be accessed by all by clicking here:  http://heathercarrdpt.com/uncategorized/integrating-orofacial-myofunctional-therapy-and-pri-to-achieve-craniofacial-resonance/

Greetings PRI Community,

I recently received an inquiry from a fellow PRI colleague who was unable to attend this past spring's symposium on the auditory system. The question related to the reasoning behind why one of his client's hearing improved despite a diagnosis of otosclerosis and accompanying prognosis that did not include the ability to get better. Below is my response that I thought was worth sharing with the rest of the PRI community. It was also posted on the Postural Restoration Google Group. If you are not yet a member of this group of practitioners where we have a forum to discuss PRI related topics please email me at HeatherCarrDPT@gmail.com to join. 

Our ability to "hear" is determined by a number of factors but here are the ones that are applicable to position and movement from a PRI perspective. 

The inner ear is composed of the cochlea (frequency/sound analyzer) and the vestibule (motion/position analyzer). Our cochlea receives auditory afferent sensory input via sound conduction through the air but also via our bones. The latter is particularly important in relaying the true fundamental tones of sound back to the nervous system. When our bones do not vibrate appropriately it is difficult for us to perceive authentic sound characteristics.  The vibrations created by the larynx are transferred to the spine and cranial bones providing important auditory afferentation.

Our middle ear is composed of 3 vibrating ossicles (hammer, anvil, stirrup in order from outer to inner) which transmit sound from the outer ear to the inner ear. Therefore, proper vibrational capability of these bones is important for sound conduction. There are two muscles within this complex. The tensor tympani is attached to the hammer and is a flexor. The stapedius is attached to the stirrup and is an extensor. Consistent with PRI's functional perspective of poly-articular chains of muscle, these muscles can also be included in these neuromuscular synergies. Therefore, if there is an excessive degree of extensor facilitation in the the body it will likely translate to the stapedius exhibiting hypertonicity. Likewise, stapedius hypertonicity can impact the rest of the postural extensor system. The same may apply with the tensor tympani. This could be extrapolated a step further when considering the asymmetrical tendencies of the cranial system (R typically more in extension and the L typically more in flexion). Therefore, when the system is not able to spend time in neutrality, it will likely have difficulty producing appropriate neuromuscular tone thus impacting position and vibrational capability of the skeletal system. 

The position of the larynx is important for sound generation and that forward head patterns, as described in Cervical Revolution, will negatively impact its ability to properly posture and thus vibrate appropriately. Furthermore, the length/tension relationships of the surrounding laryngeal musculature, ligaments, and tendons are concurrently providing additional somatosensory information also contributing to auditory perception. If these relationships are inefficient so will the corresponding sensory input.

Let's take this a step further and remember that a huge contributor to the position of the neck is the position and poly-articular patterning coming from the thorax/diaphragm and pelvis. Our diaphragm position exerts signficant control over the exhalation power behind the voice.

In summary, our bodies need to have the ability to vibrate. If one is locked into asymmetrical or bilateral patterns that do not allow appropriate range of movement, one's resonance is dampened. This will reduce important sensory input to the system further contributing stress as sensory deficits are ultimately stressors. 

Posted November 28, 2016 at 2:36AM

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

Last week I had the opportunity to take Advanced Integration for the 2nd time followed by 2 days of PRC testing. I found the experience to be extremely beneficial in enhancing my PRI philosophy and skills while also further engraining my connection to our special community. I highly recommend going through this process to those who believe in continuing to expand their PRI methodology and horizon. The journey of taking the required classes, completing the application, preparing for certification, and finally going through testing is a huge learning experience. Completing this endeavor not only demonstrates a certain level of competence of PRI but further develops your relationship with the institute and peers who will always be a significant pillar of support for you. I regard us as a family.

Because I care so much about PRI and its valuable clinical application I thought it would be helpful to my fellow PRI practitioners to share a couple important take home messages that I gleaned from last week’s experience coupled with my 2 years of PRI based clinical practice (not sure if I can count the prior 12 years….) I hope that this knowledge will help others to have more efficient and effective outcomes utilizing PRI’s powerful and unique approach to system integration.  Please let my struggles become your success.

Let’s start with the concept of “Biasing Bilateralism.” I can remember back to when I first took Pelvis Restoration and learned about the “PEC.” This is the individual who has both AIC chains locked up coupled with excessively facilitated back extensors (usually R>L). This pattern may also parallel a bilateral BC and/or bilateral TMCC. At the time, I was really excited to learn about this bilateral phenomenon because it seemed like the majority of my patients presented this way. Most of my patients had both legs that would not adduct, arms that would not internally rotate and horizontally abduct, and posterior mediastinums that would not expand. Thus, I readily complied with the PEC algorithm and began doling out a lot of Modified All 4 Belly Lifts, Squat and Reaches, 90/90 Hip Lifts, Short Seated Balloon Blowing, etc. The problem with this was that many of these individuals were still not transitioning into a L AIC/R BC/R TMCC (unilateral) pattern despite my persistence at inhibiting their bilateral posterior mediastinums and posterior outlets while facilitating their left and right zones of apposition in the sagittal plane.   

After I took Advanced Integration last year and listened to Ron speak about the necessity of our system to serve as a pump (to push gas, solids, and liquids) I decided to try to apply this concept to my PEC patients. I figured out that if I had my PECs pump their rib cage during bilateral flexion based exercises I got better results. Pumping means I had them do alternating reaching coupled with inhalation and exhalation (R/exhale and L/inhale seemed to work best and is consistent with PRI’s breathing/reaching patterns). I used short seated, all four, 90/90, supine hooklying, and squat positions for the pump activities. I was going rogue in terms of the PRI algorithm and having non-neutral individuals do alternating frontal and transverse plane rib cage movement to reduce extension tone. Even though this alternating motion was not truly authentic (meaning the performing individual did not yet have true full reciprocal motion in all planes) it helped many of my “stuck” PECs to get out of their bilateral sagittal world to either a L AIC/R BC/R TMCC pattern or in some cases actual neutrality.  Once they achieved either of these patterns I would then return to the traditional PRI algorithm for further progression. 

Even though the pumping was helpful at getting a lot of my bilaterally patterned patients to shift into a unilateral pattern or even neutrality I was still having trouble getting others to change. Thus my first take home message from this past week of PRI extravaganza: Bias your bilaterals! What this means is that when you are doing your bilateral posterior mediastinum/outlet/capsule inhibition and zone of apposition facilitation activities put a twist into the mix. For example, get them to flex and sidebend more on the left compared to the right (thoracic flexion and L abduction), bias them more into L AF IR, have them be more aware of their left periphery, and/or see if they can find their left canines, etc. If you are already choosing a platform activity that puts them into flexion they are less likely to kick in their extension tone when performing the activity. These techniques are still addressing the bilateral extension problem but are also tailored to the underlying asymmetrical extension pattern. Because these individuals are existing in a sagittal reality and are deprived of tri-planar movement variability what they really need is a stimulus to allow them to sense a change to bring them out of their one dimensional existence. They need to experience something different to get their system to shift. They also have to want and see a purpose for making this change but that’s another story… Furthermore, if while performing a unilaterally biased flexion based activity and they do indeed end up undesirably compensating you always have your PRI tests to fall back onto. That way even if you don’t see any extension while they are performing the technique you can always rely on your tests to tell you what really happened.  

We now come to the next part of my take home message: Use unilateral sensory integration to bias your bilaterals! As was just explained, we can position our patients when performing their exercises to simultaneously address both the bilateral and underlying unilateral extension pattern. However, when actually executing these techniques to get certain chains of muscles to become more active and others less active you can’t forget about the sensory component to these sensory-motor techniques. In other words, you cannot separate motor from sensory. The brain needs both! What this means is that even though you may be setting them up to perform the exercise perfectly from a biomechanical perspective (which enhances the proprioceptive aspect) you also have to make sure they can actually feel what you are trying to get them to do. For example, do they feel their left basal anterior ribs move down, in, and back? Do they feel their right anterior apical ribs and left posterior apical ribs expand? This concept of sensory “reference centers” is discussed in depth in the Impingement and Instability course but focuses more on the extremity reference centers such as the left heel, right arch, left glut med, etc. This past week, it became even more crucial to me of not only the need for tri-planar rib cage movement but for this motion to be coupled with a parallel sensory awareness of it.

From a clinical perspective, if someone is having difficulty moving and feeling their rib cage with a non-manual activity that is biased towards unilateralism the next step would be to incorporate a manual technique. Similarly to what was explained in the previous paragraph, the purpose of a manual technique is not just to provide increased mobility capacity of connective tissue but also to develop increased sensory awareness of that tissue. Therefore, consider PRI manual techniques to really be motor (breathing component utilizing the diaphragm and abdominals) as well as sensory (manual sensory contact coupled with the kinesthetic perception of rib cage movement and muscle activation). Once again, you cannot separate motor from sensory. Therefore, while performing your manual techniques I suggest cueing your patient to engage with you from a kinesthetic perspective. Can they sense their ribs moving in a particular direction? Are they aware of their internal obliques/transverse abdominus (with a left bias) activating? This brings us to my final concluding point which is to regard manual techniques as both a sensory and motor application to bias your bilaterals as well as integrate your unilaterals. When we consider the core PRI manual techniques they are inherently asymmetrical in nature to reflect this natural human phenomenon. They are already unilaterally biased and thus designed for our asymmetrical design. Thank you Ron Hruska!

Posted December 14, 2015 at 3:57PM
Categories: Clinicians

This past weekend I had the pleasure of taking Cervical Revolution for the 2nd time. My first go around was the class debut in January of this year. I had also taken the original TMCC course as well a year before that. Based on my cervical-cranio-mandibular ride thus far with its most recent stop in NYC last weekend, I must say that Ron (and Mike Cantrell) have done an excellent job of re-synthesizing this material for clearer comprehension and practical application. 
 
I believe that the concepts covered in Cervical Revolution are an essential piece of the PRI chain. In order to truly integrate the body, one needs to know not only what is occurring below the neck, but at the neck and above as well. The following case study supports the importance of learning how to engage with the cervical-cranio-mandibular system:
 
A 40 y/o gentleman who is a competitive underwater hockey player presented with R shoulder pain over the past 5 months. His history was unremarkable except that he finished up Invisalign 2-3 years ago but still wore his top appliance at all times during the day and night. He reported the reason behind wearing the retainer was because his teeth would shift without it.

He initially tested positive bilaterally for restricted humeral glenoid internal rotation, abduction (pain on the R), flexion (pain on the R), toe touch, straight leg raise, adduction drop test, cervical lateral flexion, and cervical axial rotation putting him in a pattern of a PEC, B BC, B TMCC. He also was weak and painful with the R "full can" test for rotator cuff strength. 
I started out treatment with Standing Supported Wall Squat and Reach and Modified All Four Belly Lift which resulted in about a 50% improvement in his testing. I then had him remove his Invisalign retainer and his testing went to neutral. However, he was unable to reciprocally find his bite. This means he was unable to make contact on one side of his molars without contact on the other side. Regarding his cranio-mandibular positioning, his mandible was centered and his cant seemed fairly even (it may have been being marginally higher on the right). His right temporal bone was observed to be in a little more external rotation/flexion compared to his left. For those that have taken Cervical Revolution, this indicates he may be in a right torsion cranial pattern but it appeared mild. His bite was Class 1 with canine guidance during full laterotrusion and no interferences bilaterally. This means he had good occlusion and range of motion.

Based on these findings, I conjectured that by wearing his Invisalign retainer for so long he essentially locked up his cranium which had a parallel impact on this thorax and pelvis. I then gave him Standing Alternating Cranial Expansion (a Cervical Revolution exercise), taught him how to properly position his tongue to prevent undesirable teeth shifting while encouraging movement in the cranial complex, and instructed him how to practice finding his bite in a reciprocal manner. This will not only get his cranium moving but his neck, thorax, and pelvis as well. 

By the end of the treatment, he was able to move his shoulder in the directions that previously were restricted and painful with full range of motion and no pain. Furthermore, he was able to hold his arm in a "full can" test position without pain and improved strength.
 

The ability to manage this patient is owed to the concepts I learned from Cervical Revolution. Even if one doesn’t directly treat head, neck, and jaw conditions you will gain incredibly powerful tools that apply to not only this region but below it. After all, our bodies are ultimately connected from the foot all the way up through the head and vice versa. If we want to keep evolving our abilities to help our clients and patients, consideration of integrating the cervical-cranio-mandibular system is essential. Furthermore, this complex supports crucial neurological and sensory matter that impacts system wide regulatory function. Getting the head and neck to properly re-position and synchronize with the thorax and pelvis can not only impact how we move but how our entire neurological system functions. I can’t wait to find out how this relates to the auditory system and vice versa at the spring Interdisciplinary Integration Symposium next year!
 

Posted September 30, 2015 at 7:19PM
Categories: Courses

In PRI, we are typically focusing on creating a reciprocal and alternating neuromuscular system. However, our neuromuscular system is connected with all the other systems in our body. There appears to be a coupling between autonomic, central, endocrine, and gastrointestinal systems which, in parallel with our neuromuscular system, are also asymmetrical and rhythmically shifting. “Asymmetry, Lateralization, and Alternating Rhythms of the Human Body” has been broken up into 5 parts describing this phenomenon in addition to the story of how and why our asymmetry came to be. It can also be accessed at on my website where I have written on other various topics that relate to PRI. 

CLICK HERE to read Part 5: "Connecting Ultraradian and Neuromuscular Rhythms of the Human Body"

CLICK HERE to read Part 4: "How Does One Reconcile an Asymmetrical Neuromuscular System?"

CLICK HERE to read Part 3: "How Did Humans Become Asymmetric?"

CLICK HERE to read Part 2: "What Does Asymmetry Provide for a Human Being?” 

CLICK HERE to read Part 1: "The Prevalence of Human Asymmetry and Lateralization"

Posted April 14, 2015 at 1:32PM
Categories: Articles Science

In PRI, we are typically focusing on creating a reciprocal and alternating neuromuscular system. However, our neuromuscular system is connected with all the other systems in our body. There appears to be a coupling between autonomic, central, endocrine, and gastrointestinal systems which, in parallel with our neuromuscular system, are also asymmetrical and rhythmically shifting. “Asymmetry, Lateralization, and Alternating Rhythms of the Human Body” has been broken up into 5 parts describing this phenomenon in addition to the story of how and why our asymmetry came to be. It can also be accessed at on my website where I have written on other various topics that relate to PRI. 

CLICK HERE to read Part 4: "How Does One Reconcile an Asymmetrical Neuromuscular System?"

CLICK HERE to read Part 3: "How Did Humans Become Asymmetric?"

CLICK HERE to read Part 2: "What Does Asymmetry Provide for a Human Being?” 

CLICK HERE to read Part 1: "The Prevalence of Human Asymmetry and Lateralization"

Posted April 2, 2015 at 4:07PM
Categories: Clinicians Articles

In PRI, we are typically focusing on creating a reciprocal and alternating neuromuscular system. However, our neuromuscular system is connected with all the other systems in our body. There appears to be a coupling between autonomic, central, endocrine, and gastrointestinal systems which, in parallel with our neuromuscular system, are also asymmetrical and rhythmically shifting. “Asymmetry, Lateralization, and Alternating Rhythms of the Human Body” has been broken up into 5 parts describing this phenomenon in addition to the story of how and why our asymmetry came to be. It can also be accessed at on my website where I have written on other various topics that relate to PRI. 

CLICK HERE to read Part 3: "How Did Humans Become Asymmetric?"

CLICK HERE to read Part 2: "What Does Asymmetry Provide for a Human Being?” 

CLICK HERE to read Part 1: "The Prevalence of Human Asymmetry and Lateralization"

Posted March 15, 2015 at 9:42PM
Categories: Clinicians

In PRI, we are typically focusing on creating a reciprocal and alternating neuromuscular system. However, our neuromuscular system is connected with all the other systems in our body. There appears to be a coupling between autonomic, central, endocrine, and gastrointestinal systems which, in parallel with our neuromuscular system, are also asymmetrical and rhythmically shifting. “Asymmetry, Lateralization, and Alternating Rhythms of the Human Body” has been broken up into 5 parts describing this phenomenon in addition to the story of how and why our asymmetry came to be. It can also be accessed at on my website where I have written on other various topics that relate to PRI. 

CLICK HERE to read Part 2: "What Does Asymmetry Provide for a Human Being?” 

CLICK HERE to read Part 1: "The Prevalence of Human Asymmetry and Lateralization"

Posted March 3, 2015 at 1:59AM
Categories: Clinicians Science
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