Posts by Louise Kelley

DPT, PRC

Robert Newhelfen, DC, founder of Motus Integrative Health, describes his clinic as “a full integrative health clinic bringing new and unique treatment options to the people of Northwest Indiana.” In keeping with this vision, his clinic hosted Postural Respiration, a unique and integrative approach to addressing postural influences of rib torsion, inconsistent breathing patterns, habitual use of accessory respiratory musculature, and a positionally-restricted diaphragm. As in most PRI courses, we had an interdisciplinary group of course attendees, comprised of PTs, chiropractors, ATCs, and strength and conditioning experts in professional baseball and soccer. Also in attendance was Ruth Hennessey, MM, a vocal specialist well-known in the world of singing. Thank you, Ruth, for your insights into how singers develop faulty breathing strategies and retain undesirable tension that can affect their voice.

   

From the get-go, we discussed human asymmetry, most notably of the right and left hemi-diaphragms, leading to predictable patterns of muscle activity and movement. Our inherent asymmetry gives us a starting point from which we  shift our bodies and rotate. It is what an infant relies on to make its way from the womb to the external world. This applies to every developmental milestone, from crawling to running. However, when patterned muscle activity "goes rogue", from too much sitting or engaging in the same, repetitive activities, day in and day out, the results are patterned restrictions, injury, and fatigue.  

Course attendees served as one another’s case studies as they compiled PRI objective data to assess for both lower and upper body neuromuscular dys-synchrony and to guide treatment. Thank you to Rebecca Custer, DPT, and Wynne Conklin, CPT, our templates for the entire class for right BC over-activity and its pathological sibling, superior T4 syndrome. We discussed how this syndrome limits first rib mobility. The first rib is the driver behind the mechanics of the entire thorax and, therefore, must remain mobile! This course was updated a year ago. It includes a new test for the brachial chain as well as where, when, and what inhibition techniques fit into the treatment scheme. If you haven’t taken Postural Respiration in a while, it’s time for a refresher!


 
Thank you everyone for your thoughtful questions. Nate Kloosterman, DPT, OCS, gets the prize for most questions asked, keeping this instructor on her toes. A special thank you goes to Adrian Gutierrez, DC, for handling the set-up, food, sign-in, etc.   You were a gracious host and helped make this weekend an enjoyable experience.

Posted November 5, 2019 at 4:16PM
Categories: Clinicians Courses Science

“I have several cases I can apply this to already.”

“The course met the objectives to the full extent. Loved the course!”

“I am so glad I finally got to do a PRI course!”

“I learned a tremendous amount of information that my client base can benefit from.”

The physical therapy team of Charles George VA Medical Center hosted the most recent Postural Respiration course. This facility is considered among the top VA hospitals in the country, noted for its clinicians’ care and expertise. Surrounded by the splendor of the Blue Ridge Mountains, the 40 attendees, comprising PTs, OTs, PTAs, ATCs, DCs, and one student contemplated the asymmetrical diaphragm and its influence on pelvic-femoral and rib cage position and function. Movement starts with diaphragm, driving our lower half to one side while our upper half counter-rotates to the other. It’s a neurological concept, and it's what allows humans to be adept at things like throwing a ball, dancing, and doing flips and twists mid-air. Rib cages come in all shapes and sizes, formed not just by genetics but also by the activities a person engages in, positions they hold themselves in, and his or her unique responses to physical and emotional stress. However, regardless of rib morphology, every cage is under the influence of a powerful diaphragm that pulls it to the right, driving predictable patterns of air flow and movement. When not countered, and if skewed too far for too long, the result is pain, rib deformity, poor physiology, shortness of breath, anxiety, etc.

Lab time was generous to allow proficiency in PRI techniques, both manual and non-manual, and objective tests that indicate an individual’s neurological patterning and presence of pathology. Attendees experienced the power and swiftness of PRI’s neurological techniques -- inhibition and facilitation – to create changes to pathology-producing patterns. There isn’t a patient population out there that wouldn’t benefit from the PRI approach. Thank you to lab assistants Josh Owen, ATC, PRT, and Tracy-Lynn “I am SO ready to get my PRC” Schuster, DPT, whose guidance and clinical expertise provided clarity throughout the weekend. Great to see PRC clinics well-represented: Josh Olinick’s Steps for Recovery, Jen and Chris Poulin’s Sandhills Sports Performance, Advance PT, and Tracy Lynn’s Schuster Physical Therapy. Thank you to our avatars Debra Albrecht, PT; Nathan Crosby, DPT; Charles Fairbanks, PTA; Anthony Figuera, DPT; Linda Gutowski, DPT; Carl Heldman, DPT; Megan Humpal, PT; Caroline Lounsbury, ATC; Christiana Marron, DPT; and Pete West, DPT. Also thank you to our reader, Onyeamaechi Arinze, PT (my apologies again for botching your name all weekend. If we meet again, I’ll need to shorten it to “O”!). Finally, thank you so much to our hosts, who made the weekend go smoothly: Nathan, Anthony, Carol Harty, Deanna Mihok, Monica Sety, Keith Silcox, Pete, and Sharon Wisner. It was a pleasure to meet you all! Charles George VA will be hosting Pelvis Restoration in 2020. I highly recommend a visit to Asheville for this course. Be sure to treat yourself to a few days before or after the course to enjoy the gorgeous hikes and all that Asheville has to offer.

Posted September 27, 2019 at 4:59PM

Boston is a city known for its innovation – ranked fifth in the world – likely due in part to the 54 colleges located within the metro area. As so it was that 50 course attendees descended upon the campus of Northeastern University to learn how to apply the innovative concepts of patterned thoraco-abdominal mechanics into their existing treatment paradigms.

Many attendees had Myokinematic Restoration and/or Pelvis Restoration in their wheelhouse, so they were excited to expand upon their understanding of how it is that the diaphragm and rib cage, via directing air flow patterns, enables us to shift our COM to from the left to the right, and back again, for efficient gait.

Discussion of the differences in the neuromuscular behaviors of the right and left hemi-diaphragms, and their profound influence on the nervous system, movement quality, and behavior, are fundamental in PRI courses. This includes the differences in the right and left diaphragm’s Zone of Apposition and its role in rib cage expansion to allow our axial skeleton shift and rotate. Arm swing, when done properly, supports this process, promoting good rib movement and hemi-diaphragm position to reduce fatigue and promote healthy air flow patterns. These concepts were brought to life by the many photos of real patients. Their backgrounds gave insight into why it is they sit, stand, and breathe the way they do.

Of course, we had our own class of individuals who provided insight. Anita Furbush, PT, PRC, and Tyler Tanaka, DPT, PRC, were instrumental in providing clinical pearls and guiding participants during lab. Johnathan Blake, CPT, Amanda Donahue, ATC, Rachel Ferrucci, DPT, Brianna Papotto, ATC, Mansi Shah, DPT, and Sean Sheridan, DPT, kept the questions coming, prompting me to clarify concepts, which benefited the whole class. Thank you to our live “case studies”: Katie Brooks, MA, CPT; Lindsey Rockett, ERYT; and Joshua Robinson, CPT, who allowed us to identify and address the different patterns of polyarticular muscle chain over-activity that a patient/client may present with. Finally, a huge thank you goes out to the folks at Northeastern for hosting: Katie Brooks, Jai Chopra, ATC, Mark Mastone, ATC, CSCS, and Dan Sanzo, ATC, CSCS. Great facility and wonderful group of attendees!

Boston Postural Respiration Course at Northeastern University Postural Restoration Institute

Boston Postural Respiration Course at Northeastern University Postural Restoration Institute

Boston Postural Respiration Course at Northeastern University Postural Restoration Institute

Posted June 17, 2019 at 3:18PM
Categories: Courses

It’s not often that I look out the window at the end of April and see snow falling, but here in beautiful Saranac Lake, NY, this is pretty typical! Matt Powers, DPT, and his team at Adirondack Regional Hospital hosted the updated version of Postural Respiration. This was the second PRI course for many, and they were eager to both expand upon and consolidate PRI concepts they learned in Myokinematics last year.

Postural Respiration Course, Saranac Lake, NY Postural Restoration Institute (PRI)

PRI is a broad science, and this course focuses on polyarticular muscular chain function of the thorax and how it contributes to patterned respiration and patterned movements, as evidenced by neck and belly breathing, rib torsions, asymmetrical abdominal oblique activity, and asymmetrical air flow patterns. Patterned activity can be a good thing. After all, it allows us to avoid an on-coming car as we cross the street, creates the beautiful music of a skilled musician, and gives the appearance of effortless movement in a professional athlete. However, the inability for the nervous system to shut off overly-patterned activity becomes a mechanism for chronic back and neck pain, shoulder and hip pathology, shortness of breath, anxiety, etc.

Postural Respiration - Postural Restoration Institute

Posterior Mediastinum Expansion reach test, Postural Restoration institute

This course has plenty of lab time devoted to assessment and treatment of compromised diaphragm position and polyarticular muscle chain overactivity. Lab time provided many “aha” moments as attendees saw in their partners, and felt in themselves, improvements in air flow patterns and tri-planar motion immediately following non-manual and manual rib cage techniques.

Hruska Adduction Drop test - Postural Restoration Institute

Ann Marenick, Sara Goldfine, and Brendon Olsen were our class demonstrators of several repositioning exercises and a few challenging lower trap, tricep, and serratus non-manual techniques. Ann was able to move her left shoulder and Sara was able to turn her neck, with greater ease and without the tension and resistance they had felt just minutes before. Brad Collins was the recipient of a 2-person manual technique. Christine Hill and I worked together to help Brad bring his rib cage on both sides into a state of more internal rotation to establish ZOAs and chest wall mobility. Upon getting up off the table, Brad smiled and said, “I feel looser all over.”

Postural Respiration Course - Postural Restoration Institute

Special thanks to Matt and Brendan, who came to the rescue following my rental car fiasco. I enjoyed the one-on-one time hearing about your families and your love of life in the Adirondacks. I’ll be teaching next at Northeastern University in Boston on June 8-9. There are a few seats available, so sign up now!

Posted May 6, 2019 at 9:06PM
Categories: Courses Techniques

Paula Webster, PT, invited us into her Canton, CT, clinic for the weekend to host Postural Respiration. This was one of the most unique clinics I’ve seen: a renovated 1812 home, with its original bee hive fireplace, whose previous owner was involved in the abolitionist movement.

Postural Respiration - Canton, CT

 This was the first PRI exposure for close to half of the participants. It was also a first for me to have a gastroenterologist in attendance, Dr. Kiran Sachdev, who provided insights into the connection between GI issues and patterned respiratory mechanics.

 Discussion opened with the asymmetrical diaphragm and its role in patterned lumbo-sacral-pelvic mechanics below and rib and humeral-glenoid mechanics above, driving us into L AIC and R BC patterns that direct air flow patterns and influence every physiologic system in the body.

As always, the concept of the Zone of Apposition, as needed on the left, was thoroughly defined. This left ZOA indicates left lower ribs that are held down, in, and back to lateralize the body to the left and enable healthy air flow directed into the left posterior mediastinum and right apical areas. With a sufficient ZOA, the left hemi-diaphragm is able to regulate and balance thoracic pressure and abdominal pressure so that its dual roles of respiration and stabilization are preserved.

 We emphasized the three-dimensional function of the abdominal-pelvic and thoracic cavities, and discussed numerous examples of “deflated, converged” cages and thoracic flat back posture, presentations that require over-activity of necks, bellies, and backs to breathe.

Then it was off to the gym for lab time, to practice PRI’s objective tests, including the new "posterior mediastinum respiratory reach test", along non-manual and manual techniques. Attendees put their hands and minds to work to facilitate and experience the powerful sense of rib cage expansion and freedom. How apropos to sense this freedom within a former abolitionist’s home!

PRI - Postural Respiration Subclavius Technique

Thank you to Paula’s Canton PT colleagues, Jeanne Daubert, DPT, Heather Mogielnicki, OT, and Shanya Stearns, DPT, for welcoming us into your clinic and tending to the nitty-gritty to help the course run smoothly. Thank you to Robert Barksdale, DScPT, FAAOMT, for your crucial A-V assistance. I also appreciate the willingness of everyone to act as models for various demonstrations. You were a fun group to hang out with all weekend!

Posted March 25, 2019 at 4:34PM

Thank you to Karen Taylor Soiles, PT, PRC, of Collaborative Physical Therapy, who, together with The Teal Center for Therapeutic Bodywork, welcomed 34 clinicians curious about the science and application of Postural Respiration. Karen’s attention to detail, including the wide array of healthy snacks, kept our bodies nourished and brains alert and focused throughout the weekend.

The need to position the left hemi diaphragm was introduced right off the bat to ensure that the right diaphragm autocracy stops ruling our autonomics! Other key concepts included the need to facilitate hamstrings and IOs/TAs to establish a left ZOA followed by reach activities to hold the ZOA and direct air into previously-restricted areas of the rib cage. A series of gait videos enabled us to view firsthand various pelvic and thorax movement strategies. Lack of arm swing on one or both sides were reflected in our PRI tests. They served as a reminder that arm swing is 50% of the gait cycle!

Thank you to Kathryn Bragg, PT, and Laurie Johnson, PT, seasoned clinicians tuned into nuances of performance of PRI non-manual techniques. The take-home from that discussion: So long as the reference centers are sensed by the patient, stated in the instructions as “You should feel…”, the exercise can be quite effective. Ultimately fine-tuning areas that are holding tension and tweaking alignment can help the process.

With Jill Tender, DPT, as our superior T4 model, we succeeded in unearthing a compensatory respiration strategy that responds to additional non-manual and manual techniques beyond what is needed to manage those who have not yet resorted to this compensation. Others who enriched our learning-through-demonstration were: Amelia Franklin, DPT, OCS; Benjamin Fuentes, PT; Tara Pickett, DPT, GCS; Jacqueline Richards, DPT; and Karthik Yadagiri, PT. I really enjoyed my weekend with this wonderful group of clinicians. They gained an appreciation for just how influential alternating, reciprocal rib cage movement is to efficient movement and to the overall health of human physiological systems….and collectively rejoiced in the resolution of wallet-gate.

Posted October 12, 2018 at 7:36PM
Categories: Courses

Providence, RI, one of the oldest cities in the U.S., is home to University Orthopedics. This PT clinic is GOAT, with large windows and water views on three sides, providing a parasympathetic balance to the focused attention on the impact of human asymmetry. It was wonderful to have professionals from different backgrounds (PT, PTA, ATC, CSCS, LMT) and skill sets come together to consider the profound impact of the diaphragm and rib cage on our movement. Following the discussion on the differences between optimal and sub-optimal breathing patterns, one attendee revealed that this was the first time in her life that she was able to inflate a balloon😊. The smaller-than-typical group size allowed for more one-on-one time in lab, ensuring attendees’ proficiency at carrying out objective tests and non-manual and manual techniques. Thank you to our models (Daniel Anthony, ATC; Kerri-Lynn Francis, LMT; Landa Pappas, PTA; Damion Perry, BS, CSCS; Joseph Robinson, ATC; and Maurice Sicard, ATC) and our reader, Stacey Brennan, MT, PTA – you greatly enhanced our understanding of course concepts. A huge thank you to our hosts at University Orthopedics (Dan Bien, PT, OCS, CSCS; Stacy Faiola, PT, CSCS; Kevin Mahoney, DPT, ATC; Dave Pezzullo, MS, PT, SCS, ATC; and Ed Wojciechowski, PT) for all of the work you put forth to provide a fantastic learning environment!

Posted September 4, 2018 at 7:05PM
Categories: Courses

The Sunshine State, and its urban gem, Miami, was the destination for the latest Postural Respiration course. Where else does one listen to Cuban salsa performed live outside the local grocery store? Thank you Cyndi Becker, MS, LAT,ATC, Lauren Reynolds, ATC, and Rodrigo Martinez, DAT, LAT, ATC for hosting at Florida International University, and giving this speaker a respite from the heat and humidity of DC (yes – Miami is more pleasant than DC in mid-July!).

For the majority of the class, this course was their first exposure to the paradigm-shifting tenets of PRI, supported by knowledge of human anatomy and by scientific literature that spans many decades and disciplines. We evaluated models from both the power point and in the flesh for evidence of sub-optimal breathing patterns and postural influences: thoracic flat backs, loss of apical expansion, belly and neck breathing, paradoxical breathing, and hyperventilation. We correlated these findings to our objective tests and patient-client complaints.

Participants learned the value of establishing and maintaining a left diaphragm ZOA, without which movement quality suffers and the ability to recover sufficiently is unlikely. Our discussion on non-manual techniques included their value in positively changing movement behavior through manipulating the nervous system and shifting the locus of control onto the individual. This group developed solid competency in performing and interpreting PRI objective tests, manual rib techniques, and effective cueing of non-manual techniques. You are ready to go forth and practice in a way that will be forever different than you used to!

Everyone facilitated the learning through their questions and comments. A special thank you to our models and readers: Amy Brown, DPT; Erik Kilstrup, CSCS; Rene LeBlanc, MPT, OCS; Rodrigo Martinez DAT, LAT, ATC; Julian Rivera, DPT, ATC, CSCS; Edwin Santiago, CPT, CES, PES, CS; Joseph Vuksanovic, LMT; and David Young, CSCS. A heartfelt “thank you” goes out to Megan Bollinger, DPT, PRC, for her thoughtful comments and great energy in lab. All of you Floridians have a superb mentor in your midst who would love to help you on your PRI journey.

Posted July 19, 2018 at 2:16PM
Categories: Courses

The spacious auditorium of St. Luke’s Hospital was the weekend home for 44 course attendees. The science of PRI continues to expand its reach to professionals from a variety of disciplines (PT, OT, PA, DC, PTA, ATC, and CSCS), with the lively Marquette University training staff well-represented.

This course dives right into discussion of our asymmetric diaphragm, creating lateralized patterns of air flow and obligatory patterns of movement, defined as the L AIC, and R BC. Attendees learned: the correlation between PRI tests and a person’s ventilatory – thus walking – strategy; how to identify joint pathology that can develop when the typical human patterns of the L AIC and R BC go awry; and how to identify pathological breathing strategies that develop from patterned position and activity – namely superior T4 and PEC syndromes.

Lab provided a kinesthetic and aural dimension to assessing activity of the left and right AIC, BC, and PEC, the quality of ventilation, and the degree of rib cage pliability/restriction. Our rib cages benefited from manual guidance to fully exhale and expand. Further lab was devoted to experiencing non-manual techniques that reinforce sensing of opposition muscles that shape the left diaphragm’s ZOA and shift our center of mass to the left while rotating the upper torso back to the right.

Special thanks to:

- The models who donated their bodies for the benefit of all: Cathy Curran, DPT, Audra Hawkins, PTA, Elizabeth Majszak, DPT, Steve Schmidt, DPT, and Brandon Yoder, ATC. ,

- Mary Jo Herrick and Selene Wang, DPT, of Aurora Healthcare, for the set-up, break-down, and keeping us hydrated and fed.

- Gabe Champeau, DPT, and Anita Panagiotis, MSPT, PRC for assisting during labs and sharing your clinical pearls.

Posted June 8, 2018 at 4:16PM
Categories: Courses

Philadelphia – “City of Champions” – provided good karma for the latest Postural Respiration course, hosted by Jon Herting, DPT, CSCS and Rob Rabena, MS, CSCS at Maplezone Sports Institute/The Training Room Physical Therapy. This was the first PRI course for half of the attendees. The class comprised a mix of PTs, PTAs, strength and conditioning specialists, coaches, massage therapists, and student PTs, with a range of experience and patient populations. Artem Imnadze, Nick Perugini, and Chris Stires, our students, confirmed that, still, there is virtually no discussion in the PT curriculum of the diaphragm’s functions. We addressed that short-coming through in-depth analysis of our lateralized diaphragm and its impact on human movement, physiology, and behavior. Ample time was devoted to testing and re-testing, following non-manual and manual techniques, to ascertain the each person’s degree of patterning and how challenged, or effective, they were in achieving tri-planar diaphragm position and activity. Participants learned that orthopedic dysfunction stems from our neurology and the patterned diaphragm. Therefore, breathing patterns and associated rib movement (or lack thereof) must be assessed and addressed to ensure recovery! Many mentioned they had “aha” moments throughout the course. Others had patients in mind that they planned to apply the material immediately. Thank you to Jon and Rob for hosting and to Jon and Frank Mallon, DPT, PRC, for your outstanding assistance with lab and clarifying concepts. Special thank you to Alfredo Aviles, NSCA-CPT, Ray Carr, DPT, Christopher Carroll, DPT, NCS, Justin DePermentier, DPT, ATC, Leor Giladi, DPT, CSCS, Tracey Emrey, MSPT, Michele Kersman, PTA, Nicole Ledbetter, LMT, Sheree McMullen, PTA, LMT, Jennifer Nieberlein, PT, ATC, Akil Piggott, DPT, Karen Vozzella, DPT, Michael Wehrhahn, DPT, CSCS, and Ryan Wolff, DPT for your insights, reading aloud to the group, modelling for lab, and setting up and taking down.

Posted April 12, 2018 at 8:31PM
Categories: Courses
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