Posts by Louise Kelley

DPT, PRC

I really enjoyed presenting Postural Respiration at the very place that PRI began – Lincoln, NE – to a hybrid group of enthusiastic and inquisitive in-person and virtual attendees.
We spent the weekend learning about the influences of the left AIC, right BC, and bilateral PEC patterned overactivity on hemi-chest compression, air flow, and movement. Our most primal movement pattern, respiration, is directly reflected in how we move our bodies in space. The quality, efficiency, fluidity of our walking is directly impacted by where air is directed in the chambers of our thorax.  The numerous videos and photos, presented throughout the weekend, provided stark examples of the deleterious effects of patterned respiratory mechanics on upright posture and movement.

Through lab breakouts, the in-person attendees helped me talk through and demonstrate how to determine if, and how much, a person is being driven by polyarticular muscle overactivity that prevents proper compression and decompression of our systems for healthy movement and physiology.

 This being Lincoln, NE, and not Providence, RI, balloons were back in business, allowing attendees on both sides of the screen to experience eccentric and concentric abdominal contraction and air flow into previously compressed regions of the thorax.
We discussed how the ability of the right 1st rib to move reciprocally is key to enabling the remaining ribs to reciprocally move. Its ability to raise and lower for compression/decompression of the apical chest wall is compromised with overactive scalenes that encourages the subclavius to join the party.  With this disruption in hemi-rib uniform movement at rest, we become stuck in a respiratory state of twist that an individual doesn’t know how to get out of. Hemi-rib uniform movement at rest is a prerequisite for calming the nervous system, so that we can truly rest at night.

Thank you for the many questions to clarify concepts for all attendees. I think I speak for everyone when I say the additional insights that many of you provided, especially in response to the non-manual techniques, were helpful and appreciated. Finally, a big thank you to RJ Hruska for deftly handling the A-V while answering questions and keeping this instructor hydrated and on schedule!

Posted May 31, 2022 at 4:55PM
Categories: Science Courses

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.

Posted May 5, 2022 at 9:06PM
Categories: Clinicians Courses Science

Malta, New York’s colorful foliage and Capital Area Physical Therapy and Wellness welcomed Postural Respiration into its PT-owned clinic. Course attendees had expertise across multiple disciplines -- physical therapy, strength and conditioning, internal medicine -- and patient populations, from pediatrics, geriatrics, basal ganglia and other movement disorders, and high school through professional athletics. Most expressed gratitude and satisfaction with getting back to a live course following the covid sequester. With so much of the weekend devoted to hands-on lab time, Postural Respiration is better experienced live.

Postural Respiration, Postural Restoration, Primary Course, Diaphragmatic Breathing, Zone of Apposition

Postural Respiration

Abundant research exists that describes the role of the diaphragm in facilitating physiologic processes and homeostasis. Less understood and studied is its role in regulating pressure within the chambers of the body to produce integrated and coordinated movement. When the diaphragm’s shape is altered from patterned postural positions, movements, and behavior, the result is asymmetrical air flow patterns that become ever more patterned. Practitioners encounter this phenomenon every day in our patients/clients and witness its influence on autonomic variability, a concept fundamental to the Postural Restoration Institute.  

Throughout the weekend, we considered questions such as:  
-    How do the left and right diaphragm position and function influence rest, recovery, and performance?  
-     Why are the right triceps, left internal obliques and transverse abdominus, and bilateral low traps and serratus anterior so crucial in establishing and maintaining effective length-tension properties of the thoracic diaphragm? And how do they influence new, unfamiliar, yet optimal, patterns of movement in our patients’/clients’ day-to-day lives?
-      When and why do the scalenes, notably on the right, conspire with the subclavius and pec minor, to produce unrelenting activity and the pathological respiratory syndrome known as superior T4?
-     How does the PRI paradigm fit within a clinician’s current approach to evaluation and treatment?  
-      If you have only thirty minutes with a patient, how do you prioritize?  
-     Why/how do patients/clients benefit from reaching activities? Balloon blowing?

It was a treat to be reunited with Kathy Metzger, PT, PRC, a fellow member of the PRC squad of 2011. Kathy applied her experienced hands on many rib cages to teach the nuances of objective tests and treatment techniques.  Thank you for all your help!  

We greatly appreciate our models:  Christopher Denio, DPT, Mike DeMille, DPT, PRC, Andrew Gaetano, DPT, Ken Jin, DPT, and Trisha Livermore, DPT.  Your willingness to participate allowed all of us to gain a deeper understanding of the tests, interpretations, and techniques.

    

A special thank you to Evan Marsh, DPT, and Andrew Gaetano, of Capital Area Physical Therapy and Wellness, for opening your doors and welcoming this wonderful group of clinicians! 

Posted October 20, 2021 at 1:30PM
Categories: Clinicians Courses Science

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!

Posted September 21, 2021 at 9:58PM
Categories: Courses Science

After a nearly 18-month hiatus, it was a thrill to present Postural Respiration to my fellow clinicians in the very place the science originated. The combination of live and zoom attendees -- PTs, PTAs, ATCs, Massage Therapists, Chiropractors, Students, Strength and Conditioning Specialists, a Pilates Instructor, and a Kinesiologist -- hailed from the US, Canada, Germany, and Ireland.

The weekend was devoted to the asymmetrical, patterned thoracic diaphragm and its influence on the autonomic nervous system, patterned movement, and the brain’s sense of itself in space. We learned that our asymmetrical body is a necessary design for survival and is kept “in check” when we engage in varied activities throughout our lives. However, most of our patients-clients fail to do so, which kick starts pain, pathology, and injury.

As the Olympics come to their conclusion, it seems apt to compare PRI’s treatment approach to a track relay:
Leading off and exploding out of the blocks are the abdominals (internal obliques and transverse abdominus), which enable full lung expulsion of air and establish the (left hemi-) diaphragm ZOA.
The second leg, the diaphragm itself, now pulls air in with an adequate ZOA and hands off the baton to the third leg…
…the rib cage, whose external rotation and internal rotation properties are restored, particularly in the left posterior mediastinum and right apical and lateral chest wall regions.
Finally, our anchor leg, the lungs, bring the baton home. They now have the space to expand into and out of regions that were previously closed off, for the health of the many vital vessels that travel in, around, and through the thorax.  Moreover, the restoration of alternating, reciprocal lung compression-expansion produces alternating, reciprocal movement, both simple and complex.

More HERE

Ample lab time was devoted to assessment of the patterned body so that each attendee had confidence come Monday morning with replicating the tests on their patient-client. Instruction in manual rib cage techniques was also heavily emphasized, so that attendees had both observational and tactile sense of patterned air flow. Finally, many non-manual techniques were discussed and performed, including when and why you choose them and how to coach your patient-client through them.

Thank you to all of those who asked questions. You enhanced the course experience for all. Thank you to our avatars Brett Dougherty, PT, Matt Mandich, SCCC, CSCCA,  Joshua Werk, ATC, CSCS, and Tammi Zimmerman, LMT for allowing us to bring the tests and techniques to life.     

Thank you to Justin Pastoor, MS, CSCS, for your clear verbal instruction while tests and techniques were demonstrated.  

I now fully understand what Ron means when he says he couldn’t have presented the material with the same easy flow and energy without the assistance of Jen Platt. Thank you for ensuring there were no technology glitches, deftly navigating the camera angles, monitoring questions, and keeping this instructor and live attendees well-hydrated and fed.

Looking forward to seeing many of you again as you continue your PRI journey!

Posted August 18, 2021 at 3:40PM

“Lots of evidence-based practice.”
“I plan to integrate the information immediately into my practice.”

Thank you to Heather Golly, ATC, PhD, Beth Marschner, DPT, and Dawn Mattern, MD, faculty at Minot State University, in Minot, North Dakota, for hosting Postural Respiration this past weekend. We were able to sneak this course in before the travel and conference bans were enacted and had plenty of hand-sanitizer at our disposal!  

MSU was the host site for Myokinematics last year, so most attendees had that course under their belt.  It served as a springboard to understanding how the top half of the body, the thorax, influences and is influenced by the lower half.

Our ability to fully and properly compress and decompress our bodies – the thorax, abdominal, pelvic, and cranial chambers -- in the space around us is dictated by air flow patterns provided by hemi-diaphragms that are in position to do so.  This is compromised if abdominals, which wrap around the lower ribs and shape the hemi-diaphragms within to preserve their length-tension properties, aren’t sensed and facilitated.  Therefore, training the abdominals first and foremost for respiration, not core stability, is imperative.  All our movements and physiology, from HRV, digestion, and the ability to concentrate, depend on this.

One attendee grappled with when to consider prone “I’s”, “Y’s”, and “T’s” in their program.  This led to a helpful discussion, and paradigm shift, on the need to first address thoraco-scapular mechanics, as achieved by diaphragm position, rib cage expansion, and alterations of air flow patterns, before introducing scapula on thorax activity.  Without proper respiratory mechanics in place, muscles of the scapula acting on the thorax are simply out of position and lack meaningful leverage to provide safe, effective cervical and upper extremity joint performance.

Everyone appreciated and learned from those who stepped up to demonstrate non-manual techniques and to act as patient models for lab:  Stephanie Boespflug, PTA, PRC (my fellow PRC 2011 alum), Beth Marschner, Kirk Mason, DC, Terry Quijano, ATC student, Rebekah Rye, ATC, and Shane Williams, ATC student.  They enhanced and clarified how we define R BC/L AIC patterned activity and how we differentiate this presentation and its treatment considerations from that of superior T4 and B PEC compensations. Thank you also to Kari Harris, DPT, and Heidi Folk, PT, for adding to the discussion with insightful questions and personal clinical examples. I appreciated everyone’s warmth and hospitality, North Dakota-style. Thank you all for a wonderful weekend. The Institute looks forward to bringing more courses to your neck of the woods!

Posted March 13, 2020 at 8:49PM
Categories: Courses Clinicians Science

“This course was mind blowing!”
“This was my third of the basic PRI courses. This really helped to bring all the information together.”
 “Before working on shoulders, I now know I need to retrain the diaphragm and restore rib position.”

Attendees came from far and wide to the most recent Postural Respiration course, held at Body Dynamics in Falls Church, VA.  Nicholas Clark, PhD, PT, hails from London, where he recently stumbled across the science of PRI on YouTube.  “After trying a couple of the PRI exercises, my arm numbness, that I had been dealing with for many months, resolved.” That experience convinced him he needed to learn more.   

Half of the attendees were brand new to PRI, their eyes opened to a new and different perspective on human movement and behavior.  The clinicians at Body Dynamics (Lisa Clarkson, PT; Jennifer Gamboa, PT; Deborah Gilpin, PT, ATC; Gwynn Hegyi, LMT; Kathryn Sparks, LMT; Ashley Templer, PT; and Jorge Villalobos, PT) hosted Myokinematics a year ago, and they were ready to deepen their PRI knowledge.  Many Myokinematics concepts were presented and reviewed, most importantly the left anterior interior chain of muscles’ influence on pelvic-femoral dynamics and a person’s ability to shift their center of mass fully and effectively to the left.  Once the body’s foundation was established, we moved up to the thorax and assessed its ability to function in three dimensions.  

Discussion began with our body’s normal, typical asymmetries which create lateralization to the right.  Countering this lateralized state begins with establishing a zone of apposition of the left hemi-diaphragm, which allows us to deflate a left chest wall, giving us a sense of weight on the left, and inflate a right chest wall to enable rotation of the thorax.  When people engage in occupations and sports that require repetitive movements (think lawyers, dentists, musicians, runners, and baseball players -- the list goes on), the ZOA becomes compromised, leading to the postural maladies that we clinicians witness every day:  hyperinflation, forward head posture, concave chests, scoliosis, winging scapulas, and thoracic flat backs.

Ample time was spent in lab to experience PRI’s non-manual and manual techniques.  Attendees learned concepts such as sensing rib expansion, biasing air flow patterns, sensing reference centers to re-direct the nervous system to new strategies of movement and perception of stability, and guiding a patient through a logical progression, from supine 90-90 positions to upright, rotational performance called gait.

Our labs were enhanced by our attendee-models:  Grace Ball, Pilates trainer; Scott Birch, PT; Nicholas; Bethany Middleton, PTA; and Keith Zrinyi, DC.  Thank you to all of you!

It was awesome to have Sarah Ratti, PT, PRC, in attendance, who brought her colleagues from Bon Secours in Richmond.  Tom Van Ornum, PT, also introduced his colleagues from M.O.S.T. to the science of PRI.  A huge thank you goes out to Karen Soiles, PT, PRC.  Karen is highly experienced and knowledgeable in the science of PRI, and she provided helpful guidance, clarity, and context throughout the weekend.  

Posted January 31, 2020 at 10:31PM
Categories: Clinicians Courses Science

Kelsie Giles, PTA, and her team at Elite Physical Therapy (Michael Brown, PT, Kara Patterson, PTA, Luke Rowan, PT, and Matthew Thomas, PT), hosted Postural Respiration, the first-ever PRI course held in Mississippi!
Attendees grasped key concepts, including what is the ZOA, how do we establish it on the left, how does it change pathological patterned air flow, and what areas of the thorax need to expand to achieve alternating, reciprocal movement when we move?  How does hyperinflation restrict our movement from side to side?  How does blowing up a balloon change pelvic orientation, rib mechanics, and scapular position?  How does the right lower trap and tricep help us feel the ground under our left foot?  Why would Jimmy Kimmel benefit from a PRI program?


The course cites multiple research articles and includes numerous photos of typical humans with typical jobs and hobbies to illustrate how patterned breathing, from patterned position, stemming from the natural, normal asymmetries within us all, feed patterns of muscle over-activity. These patterns become entrained in our nervous system and underlie and explain the onset of neuro-musculoskeletal pathologies. Thank you to our models, Kelsie and Michael for helping the class better understand the superior T4 syndrome – what it looks like and how to address it.  Our other models, Kaitlyn Keyser, TP, Kara, Herb Reinhard, ATC, Luke, and Nathan Yost, ATC, were game to take on some challenging non-manual techniques.  There were lots of good questions to clarify concepts, most notably from Micheal Brown and Donna Rush, PT.  Jason Reeves, PT – your oratory skills were much appreciated as we guided our models through non-manual techniques.


Thank you to the entire group for a wonderful weekend.  Your southern hospitality was a treat for this Marylander!

Posted January 24, 2020 at 5:28PM

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
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