Enveloped by palm trees and the salt-water aroma of the Atlantic Ocean is a gem of a clinic: Arise Center for Athletic Development, our host for Postural Respiration.
Arise was filled to capacity, evidence of the thirst for PRI in the Sunshine State. With her wedding just days away, Tia Moir was determined to put aside her pre-wedding jitters and focus instead on growing her understanding of PRI concepts. Tia, I hope your wedding day was glorious!

Postural Respiration lays the groundwork for concepts that are reinforced in every one of the Institute’s courses: the neurology of movement and the role of the thoracic diaphragm on patterned, habitual activity and our nervous system’s state of tension and twist present in all our patients-clients. Through lecture and lab, attendees gained a thorough understanding of, and experienced within themselves, the power of the hemi-diaphragm’s most important characteristic: its zone of apposition. Loss of the left hemi-diaphragm’s ZOA initiates deleterious air flow patterns and is the underpinning of movement dysfunction. Attendees learned how to coach their patients-clients through numerous non-manual techniques that place an individual in novel, biased positions and challenge the nervous system to disengage old movement patterns and replace them with healthy, efficient ones.
Post-lab comments included: “My left side feels heavier.”  “My back tension is gone.”  “I can breathe deeply again.”

It was our good fortune to have in class Amy Brown, PT, PRC. Amy assisted in lab and shared her clinical perspectives throughout the weekend. Amy is well-versed in the PRI approach and is a great resource for the Floridian contingents, especially those starting their PRI journey.

Many thanks to the team at Arise:  David Donatucci, Austin Hetzer, Jen Lewis, Mickey Massucci, and Ahmed Rashwan.  You were instrumental in providing an atmosphere of comfort with good energy and flow.  
Thank you to our models, who greatly enhanced the learning for all:  Joi Dupre, Rogelio Govea, Amy Haddad, Hugh Pun, Ahmed Rashwan, Rosaline Riuz-Go, and Brandon Van Kempen.   
Arise will host Myokinematics next year.  Faculty member Kasey Ratliff will bring her PRI prowess and clinical versatility to strengthen your PRI knowledge and understanding of how the neuromusculoskeletal system really works.

As always, I enjoyed my weekend at the home of PRI in Lincoln, NE to present Postural Respiration to an in-person and virtual group with my friend and colleague Jen Platt, PT, PRC. Although virtual learning can be a challenging format to gauge the interest and energy of attendees, such was not the case with this group, who offered many questions, insightful comments, and thumbs-up to relay to this instructor “Yes, we got this concept.” Our in-person squad was instrumental in helping illustrate concepts, serving as models for the PRI tests and non-manual and manual techniques. A huge thank you to our models Hailey Beasley, PTA, Jason Bushie, ATC, Ellen Kindelsperger, DC, and Tasuku Kurane, ATC, for your willingness to express what you sensed during and following each technique.

As anyone who has taken Postural Respiration knows, there is a great deal of research and conceptual material to sift through, contemplate, and consider. What is quickly understood, by practitioners both new to the science and with numerous courses under their belt, is that the PRI approach can be applied to any and all patients/clients. Its techniques offer a game-changing approach to care. The many lab sessions provide experiential learning and an opportunity to practice how to present and explain the how and why of assessment and treatment with the “patient” in front of you.

It is not enough to simply move air in and out of the thorax. All humans accomplish this, one way or another, to stay alive. It is the ability to direct that bolus of air into different regions of the thorax that determines how variable and efficient our movements may be, how we experience the environment around us, and how well we rest at night. This ability becomes compromised the longer we are constrained by the human’s natural asymmetries that become reinforced by static postures and repetitive activities of daily life. Ensuring the balanced roles of the left and right hemi-diaphragm, that of both posture and respiration, requires an understanding of how to maintain each diaphragm’s zone of apposition, inhibit deleterious muscle over-activity, and re-establish a sense of expansion of the posterior mediastinum from which new, healthier patterns of movement can emerge. These foundational concepts are what Postural Respiration is all about.

Thank you to all attendees for taking time out of your summer to challenge your thinking and grow professionally. It was nice to see many newcomers to the science as well as veterans such as Brittany LaFountaine, DPT, PRC, and Joe Siracusano, DPT. I encourage all of you to keep asking questions and seeking answers, through the PRI website resources, dialogue with fellow clinicians, PRIVY, and the many courses that PRI has to offer

The clinicians of Lancaster General Hospital are pros at hosting PRI courses. Last weekend’s Postural Respiration course was their seventh. This instructor had moments of déjà vu, since LGH was the location of the first PRI course I attended, back in 2007. Two participants, Deborah Schrodi, PT, and Cathy Ingram, PT, were also in attendance at that very course 15 years ago! The surrounding Amish community, who eschew automation, provided an interesting contrast to our modern way of life and its epidemics of myopia, asthma, and loss of movement variability. These modern ills can be traced, by-and-large, to technological “advancements”.   

Underscoring the Institute’s interdisciplinary mindset, the class was comprised of a mix of clinicians, including physical therapists, physical therapy assistants, athletic trainers, massage therapists, and personal trainers. Many were new to the science, while others had multiple PRI courses under their belt.

The Institute continually works to update course material, adding research articles and patient photos and videos to illustrate and support course concepts. Our left and right hemi-diaphragms are different in size and have differences in abdominal support.  This “static asymmetry” creates a teeter-totter effect within our body, keeping us reflexively alive and providing a starting point from which to move. When this teeter-totter situation reaches a tipping point, we have only a “totter”. The right side remains pinned-down, grounded, and compressed. The left side is held aloft, remaining ungrounded and decompressed. We cannot thrive in this state.

Our patterned, maladaptive hemi-diaphragm position and activity has consequences on movement, physiology, and behavior. Humans require oscillating compression and decompression of our lungs and rib cage to provide movement and ensure the health of our tissues, most notably the nervous system. An outward sign of this lack of oscillation is breathing pattern dysfunction, such as belly breathing, chest wall elevation, and superior T4 syndrome, the underpinnings of many of the syndromes that we treat.

Postural Respiration is a lab-heavy, hands-on course, better taken live, if possible. Participants came away proficient in performing and interpreting PRI’s objective tests to identify overactive left IAC, right BC, and B PEC chains of muscles and the pesky superior T4 syndrome. These patterns need to be inhibited so that we can efficiently and effectively inhabit the environment around us, without deleterious effects on our neuromusculoskeletal system.

A huge shout out to Frank Mallon, DPT, PRC, owner of Renaissance Physical Therapy in near-by Philly. Your expertise and instruction on the nuances of the Institute’s non-manual and manual techniques was invaluable!

Thank you to all who asked questions and provided clinical comments, keeping the energy level high. Thank you to our models, who enhanced the learning experience: Kirsten Ditzler, DPT; Kelly Faller, PTA; Eileen Herman, PT; Isha Mody, PT; Joesph Newton-Pretko, DPT; Kyle Price, PT; Lori Shearer, PTA and Michael Polejav, PT who all helped facilitate our learning.

Thank you to the LGH clinicians for your efforts in set-up and clean-up. I appreciated the opportunity to present this material at the place where my PRI journey started.

Nestled among the hemlocks and Douglas firs, with Olympic National Park beckoning in the distance, IRG Physical and Hand Therapy in picturesque Mill Creek, WA, opened their doors to host Postural Respiration.

The clinicians in attendance were energetic, collaborative, and engaging, hailing from the worlds of physical therapy, massage, athletic training, and chiropractic. One attendee, Samarpan Buchalter, DC, plans to return to, of all places, the Amazon Rainforest in Brazil and the indigenous Yanomami Tribe to introduce the Postural Respiration concepts and techniques. PRI keeps expanding its reach!

The theme of the weekend was that of the twisted diaphragm, created by its left and right-sided differences in girth and abdominal support. Coupled with a preference for right stance, this twist creates on-going and un-relenting asymmetrical air flow patterns and a tendency toward hyperinflation. Individuals don’t recognize they’re in this state and don’t know how to resolve it. Through non-manual and manual techniques, we learned to help our patient-client by first guiding them to sense and maintain left abdominal functional concentric and eccentric activity, or a left zone of apposition (ZOA). Lung and rib cage regions that, in the pattern, are restricted, can now expand with a left diaphragm that is more respiratory, and less postural, in its role. We learned the importance of “reach”, a huge PRI concept, since it promotes diaphragm ZOA, normal thoracic kyphosis, rib cage internal and external rotation, and spinal rotation. Furthermore, reaching inhibits overactivity of the over-worked and over-trained pecs, lats, and paraspinals. The net result is alternating, reciprocal airflow for efficient breathing and effortless forward locomotion.

Thank you to models Samarpan, Christa Byler, LMT, Jonette Ford, PT, Christopher Gant, PT, and Joshua Schwartz, PT, who graciously allowed me to demonstrate objective tests and techniques. With their help, we were able to identify various patterns of overactivity and learn of their injury histories that supported the findings. Erin Rajca, PT, PRC, was instrumental in providing clinical pearls from her many years of experience, offering one-on-one expertise in lab, and acting as my human GPS Sunday morning when my Waze app was stymied by the clouds! Finally, a huge thank you to Jennifer Wright, PTA, ATC, our host site coordinator, for all the work you put into making the weekend run smoothly. Your generosity and effort were much-appreciated!