Posts by Louise Kelley

DPT, PRC

The ENT Institute of Atlanta played host to the most recent Postural Respiration. This course encouraged attendees to look below the head and neck for “bottom-up” influences on the conditions you treat. What do hip pathology, low back pain, headaches, and TMD have in common? A thoracic diaphragm that is patterned in its position and activity.

We discussed how the static asymmetries of our torso lead to overactive chains of muscle below the diaphragm (anterior interior chain and posterior exterior chain) and above the diaphragm (brachial chain). These chains create dynamic patterns of breathing that become entrained in our nervous system and that can restrict healthy alternating, reciprocal movement when upright. Numerous videos were presented that reflect how patterned breathing influences walking: poor posterior right arm swing, reduced thorax rotation and center of mass shift onto the left leg, and waddling, to name a few. Our stronger, better leveraged right diaphragm creates twist and torsion of the airway which, in turn, promotes inefficient strategies to pull air in, including belly and neck breathing, with their associated forward head posture, hyperinflation, and overly extended thoracic spine and rib cage. Neurologically-driven patterns of airflow define how we sense ourselves in the space around us, how we move through it, and our vulnerability to pain and injury.  

Many thanks to Kaitlin Blankenship, ATC; Jose Crespo, PT; Mischelle Hardwick, PT; Allison Robbins, PT; Tre Tate, CPT; and Adria Wofford, PT for volunteering to model the tests and techniques.    

Kristen Spencer, PT, PRC, was invaluable in assisting with lab and adding clarity to questions and concepts.  

The practitioners at ENT Institute did an awesome job of accommodating us guests: Jose; Ann Gerber, PT; Jennifer Hansen, PTA; Mischell; Jennifer Harrell, PT; Deisy Nunez Aguirre, PT; Allison; Olivia Terrell, PT; and Cristen Walker, PTA.   

I hope you get the chance to host again. If so, Cervical Revolution would be a natural fit for your caseload.  You will learn about the influences of an additional chain of muscles, the temporal mandibular cervical chain. You will gain an understanding of how the concepts of Postural Respiration and patterned air flow apply to the cervical spine and cranial patterns and their potential to create malocclusion, TMJ dysfunction, headaches, and visual-vestibular disturbances, all of which you routinely address in the clinic.

Posted March 23, 2023 at 3:32PM
Categories: Courses Science

I felt right at home with the clinicians at Finish Line Physical Therapy, all seasoned runners. Photos of their and their patients’ running accomplishments, all smiles at the completion of a race, adorn the space – and make for the perfect back-drop to discuss the impact of undesirable airflow patterns, habitual use of accessory muscles of breathing, and a restricted diaphragm on movement.


Asymmetry is the rule of the body and brain. As such, humans, by design, exhibit a right-sided preference, which is reinforced by a culture that favors sitting and a lifestyle made easier by technology. The result is a form of “hemi-neglect” of left sided muscles of grounding – hamstrings, gluts, and abdominals – needed for weight-shifting. Rib cages remain under the influence of muscles that don’t promote alternating internal and external rotation and the associated sense of expansion and recoil. The result is a form of left or bilateral COPD, with its distinctive hyperinflation.

   
Stiff, patterned rib cages and abdominal oblique disuse cause the diaphragm to undergo twist and torsion that, in many cases, cannot get out of. This twist of our respiratory system is a significant mechanism underlying the many syndromes and injuries that we confront in the clinic.


Many thanks to our weekend avatars, whose willingness to demonstrate and receive techniques enabled us all to better understand PRI concepts: Patrick Cronin, PT; Laura Gibbons, PT; Laura Loftus; Iris Platt, PT; RikkiLynn Shields. Thank you Yohei Takada, PT, PRC and Andrew Xenophontos, CSCS, PRT for your tremendous help in lab, coaching the attendees in the nuances of the manual and non-manual techniques, allowing them to experience the power and influence of these techniques on the neuro-muscular system. Finally, thank you to the physical therapists at Finish Line PT for being gracious hosts: Mandy “I WILL blow up a balloon” Fox, Connor Hesselbirg, Jaclyn Massi, Ryan Matisko, Timothy Waanders, and Jimmy Williams.

 
Finish Line PT is a clinic for runners and triathletes, people who strive to be their best selves. To all of the course attendees, I hope the material you learned this weekend will help take you to new heights in your careers and shift your stride to a new way of looking at, and improving, movement.  

Posted March 9, 2023 at 3:37PM
Categories: Courses Science

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.

Posted November 16, 2022 at 7:46PM
Categories: Courses Science

What was I doing in a bank vault all weekend, admiring larger-than-life action shots of Steph Curry, Lindsey Vonn, Misty Copeland, and Michael Phelps? Presenting Postural Respiration to a fantastic group of clinicians, of course!   Baltimore’s iconic Bank of America building has been refurbished and now houses FX Studios and the Under Armour Performance Center.

Half the class were newcomers to the science of PRI. The science asks these newcomers to, for a moment, put down your beveled scrapers and dry needling filaments. Pause a moment before you mobilize a joint or release fascia. Put aside any preoccupation with extremity joints and focus your attention, instead, on where movement begins: the thorax.

 

Throughout the weekend, we cited research from luminaries, such as Kapandji, Hodges, Wallden, Chaitow, and DeTroyer, to support the concepts covered in this course:  
-    Diaphragm zone of apposition (thank you Nate Taylor for reminding us of its importance).
-    Respiratory state of twist that is the precursor to habitual, reflexive patterns of movement and the musculoskeletal pain syndromes that we treat.
-    Paradoxical, inefficient breathing that impacts and reflects chest wall and pleura restrictions.
-    How to restore pelvic and rib cage position, through techniques that reinforce abdominal oblique activity and chest wall expansion.
-    How to retrain previously inhibited, inaccessible muscles to promote new, healthy patterns of movement to better sense the environment they’re in and efficiently move through it.

Lab sessions provided application of the above concepts and allowed participants to discover how the “patient-client” in front of them displayed biased sense of air flow and biased orientation of their chest wall. They learned how to coach their partner to novel positions that retrain the nervous system and promote a new, desirable sense of compression and decompression. All participants sensed freedom from habitual movement patterns.

 

I can’t help but think that the athletes adorning the walls, all of whom reached the pinnacle of their respective careers and displayed remarkable longevity, mastered the art of air flow, pressure regulation, and chest wall movement variability during both performance and during rest and recovery. This is what we should strive for in all of our patients-clients.

A huge “thank you” to the professionals of FX Physical Therapy for hosting: Matt Bordeau, Sean Jones, Christine Spurlock, Morgan Taylor, Jennifer Tola, and Mary Williams.  

Thank you also to Miranda Stauffer, Danelle Warner, Amy Morris, Kenya Lewis, Dylan Irving, Jackie De Conti, and Kenneth Scott for your willingness to be the models for tests and techniques.  

I hope all attendees left the course feeling empowered to immediately apply the tests and techniques and begin to weave this new, powerful paradigm, one patient-client at a time, into your approach to care. And to the Newbies:  Welcome to PRI Nation!

Posted October 4, 2022 at 6:38PM
Categories: Courses Techniques Science

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

Posted August 24, 2022 at 8:51PM
Categories: Courses Techniques Science

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
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