Courses

New York City!!! Broadway musicals, Fifth Avenue, Lady Liberty and Finish Line Physical Therapy!!! I was there to teach Impingement & Instability and Michael Conlon PT saw to it that we were well taken care of. I&I is one of those classes from which many clinicians run but that was not the case since we had almost 50 professionals present on that great weekend. It was so nice to see Alicia Ferriere DPT. She is such a wonderful host who, together with the rest of the gang at Finish Line were enthusiastic attendees. I honestly look forward to seeing Alicia at certification in Lincoln, NE this December. I love the emphasis on neurology in I&I and the attendees in the course began to see that resolving various orthopedic issues must take a neurological approach. Consider that nearly all issues of impingement are really occurring by choice! Shocking eh? Want to hear more? Join me or Ron Hruska or James Anderson and buckle up for a deep dive into the rabbit hole! See you soon!!!

Posted August 18, 2017 at 1:59PM
Categories: Courses

We are excited to announce the release of our newest Myokinematic Restoration online home study course! Ron Hruska, MPA, PT is the instructor for the newest version of this course, which has over 15 hours of content. Over the past year, our faculty and staff worked together to update the structure and flow of this course. The core material has not changed, however the layout of the course manual and how the material is presented has been updated based on your feedback. More detailed treatment algorithms for non-pathological Left AIC and pathological Left AIC patterned individuals are now included, along with Myokinematic Restoration Inhibition program considerations. We hope you enjoy the update!

If you completed the Myokinematic Restoration online home study course between January 1, 2017 and August 1, 2017, we would like to offer you 2 weeks complimentary access to this newer version. Please contact us to receive your complimentary access (you will not receive additional CEUs).  

Register

Posted August 7, 2017 at 3:24PM
Categories: Courses Videos

James and I had an awesome weekend in the beautiful college town of Chapel Hill, NC this past weekend teaching PRI Integration for Fitness and Movement. The course was well represented with both attendees that never had attended a PRI course and others that were PRC/PRT certified. We had multiple states in attendance as well as sports medicine professionals from Japan, Australian, and Switzerland! Thank you all who traveled in and a special thank you to Alain Aguilar and Nina Walker and the UNC Sports Medicine Team and Ryan Holleman for Hosting! Amazing host site and our hosts’ attention to detail helped us and all the attendees was spot on to help make it an enjoyable weekend.

The PRI Fitness and Movement course is a jammed packed course committed to give the industry a fresh look at core performance strategies and help professionals understand key biomechanical relationships needed to coordinate core muscles and mechanics in various symmetrical and asymmetrical movement patterns. Our coordinated mobility with the diaphragm and thoracic posture is key to understand how some of the largest and powerful muscles in our human system work. These principles help us ground our systems to sense position to load with empowered core relationships and coordinate extensor strategies to optimize compound ground based training.  We want to encourage people to move often, move well, and maintain key mechanical relationships to breathe, rest, and rotate in their training. 

Four more host courses still available in 2017: Omaha in August, Denver in September, Minneapolis in October, and Frederick, MD in November. 

Posted July 31, 2017 at 2:02PM
Categories: Courses

Impingement and Instability- It was an honor to present Impingement and Instability at the Professional Hockey Athletic Trainers Society Annual Meeting in Phoenix Arizona this year to a fantastic group of professionals. The group was primed and more than prepared for the transition to secondary level courses after having taken Myokinematic Restoration and Postural Respiration at 2 of the previous annual meetings, both taught by Mike Cantrell, MPT, PRC. I spoke to Matt Bain, ATC when I was in Vermont a few weeks ago and he said the PHATS organization was first class and that I would have a great experience presenting at their conference. Mike also told me that I couldn't find a better group of professionals anywhere to spend my time with, and after our interactions during Impingement and Instability I have to say you both were 100% accurate. This group was chalked full of first class professionals that made me feel like a member of the family as we learned together and talked shop. Thank you everyone for living up to your billing and making me feel so welcome.

On day one, we got into the power and significance of the frontal plane in athletic performance and got to analyze the gait cycle in terms of the frontal plane differences and demands seen in early stance vs the frontal plane differences and demands seen in late stance in the left AIC pattern. This included a detailed comparison of what happens on the right side vs what happens on the left side, because, well...thats what PRI does. And then we expanded this view of gait performance to the hockey athlete to help us better understand skating performance during starts, stops and turns when performing on the right leg and on the left leg. A big thanks to Matt Bain, ATC for helping us get the video footage of hockey performance in good old Gutterson Arena that allowed us to compare both right legged and left legged starts, stops and turns. The opportunity to review slow motion video as a group really helped us bring together the concepts as it related to performance tendencies on ice. If a picture is worth a thousand words, there's no telling what these slow motion videos did for the course attendees. Very helpful.

With a gait analysis mindset, a frontal plane mindset and also a hockey performance mindset, the group was able to move through the Impingement and Instability material with a central theme and focus. The calcaneal instability section was highlighted by a demonstration of gait and footwear that helped us appreciate the footwear recommendations and reference center training a hockey athlete may need when they are not in their skates. The mechanics of a compromised kinematic chain disrupted by poor performance of the calcaneus cannot be overlooked or ignored. Its always good to rethink conventional wisdom and outline the best practice for each individual athlete based on the objective findings of each individual athlete. The demonstration was a good experience for everyone in the group. The rest of day one consisted of discussions and demos on femoral instability. We spent a lot of time as a group analyzing the oriented or compensated rotational issues of the femur and the tibia as it related to knee function and pain. We looked closely at several of the attendees and were able to appreciate what was going on as we came to a group consensus of how their femurs and tibias contributed to their knee instabilities.

Day two consisted of detailed analysis of ilial instability and scapular instability issues. The ilial instability section included discussions around ischial tendinitis, hip instability and hip impingement. We analyzed the right legged vs left legged turns of a giant slalom skier and by this point in the course, we could all see the relationship to both gait and hockey skating. In fact, we even went back and reviewed the slow motion hockey videos after talking about the skiers and were able to connect the dots quite well. The scapular instability section included a comprehensive demo of all manual rib techniques merited for a scapular instability athlete. Thank you Tommy Alva, ATC for letting us use your rib cage for group teaching purposes. You were great. And lastly, it was great to take a deep look at scapular performance muscle issues like the difference between the lat and the subscapularis and the power of the low trap and the serratus anterior to offset overactity of the levator and the upper trap. Fun stuff that took on a new relevance for both the right and left handed hockey athlete. Thanks again PHATS for inviting PRI to your annual party. It was truly our pleasure to be there!

Posted June 23, 2017 at 7:34PM
Categories: Courses

The PRI Fitness and Movement Course continues to make progressive leaps and bounds in its development. This course is dedicated to the potential to advance PRI application in various settings related to fitness and movement, as well as help the discussions progress beyond just using PRI as correctives, warm ups, or cool downs.

I believe the strategic partnerships and interdisciplinary teams will most effectively meet today’s fitness, performance and healthcare challenges. Advanced PRI application is a key ingredient needed to conquer these challenges and its groups like we had this past weekend that will continue to progress the discussions involving PRI and keep us all moving forward. PRI really is not just another “tool” in a clinician, coach, or trainer’s toolbox. Its only a tool when you use or know parts and limited pieces of the system. When you understand all the pieces and parts, the PRI science provides us all a framework for which we can optimize various anatomical relationships to enhance human performance.

We devote a lot of time in this course to understanding the thorax and components of pillar core strength. Fitness and movement application has a lot of limitations in core strengthening if respiratory and neurological factors are not respected. We highlight those factors and teach people how to respect them in ways which are functional and easy to implement. For many high level performance athletes as well as any of your fitness clients with chronic pain, its not in strengthening and stretching that they will feel significant improvements in their stability; instead through strategic breath work and inhibiting hyperactive chains of muscles they will be able to synchronize the thoracic-acetabular abduction which is crucial for core stability and it’s that synchronized stability which must proceed the mobility that so many people crave. Let’s rethink mobilizing --- and start synchronizing.

Thanks to all that came out to Performance Gains in Palo Alto! PG Thank you for hosting and it was awesome to see the new beautiful facility! Caleb thank you for lab assisting and helping us out throughout the weekend!

Posted June 16, 2017 at 3:31PM
Categories: Courses

Postural Respiration - I had a really nice weekend in St Paul Minnesota with some of the old and new staff from Impact Physical Medicine and Aquatic Center, a long time advocate of PRI education and training. I have had a lot of great experiences at this facility over the years, but I have not been back in at least 2 or 3 years. It was nice to meet the new members of their staff and to see all the positive changes they have experienced with the new design and expansion of their clinic. I was grateful for the support of my lab assistant and long time friend, Curt Johnson, PT, PRC. His assistance explaining the objective tests and guiding the group in the performance of manual techniques was very helpful and appreciated.

We had a diverse group in attendance who individually brought a lot to the table that collectively strengthened the experience of the entire group. I appreciate each one of you taking the time to attend the course and for contributing to the learning experience for the rest of us. Thank you Esther Hill, for traveling all the way from Tulsa Oklahoma to take your first PRI course. It was refreshing and fun to see your enthusiasm as your paradigm shifted the way it did throughout the course. Thank you Erik Krueger for taking 2 days during your busy schedule as a PT Student to expand your knowledge of respiratory and thoracic mechanics. You helped me appreciate the strong desire to learn all you can that is present in so many young up and coming professionals. Thank you Kari Kantack Miller for your expertise as both a chiropractor and an athletic trainer and for the administrative skills you bring from your work at Bemidji State University. It was fun to help you connect the dots professionally and personally as we worked through the respiration material. Thank you Mayumi Ogino for your continued support and your insights as an athletic trainer who works with Division I collegiate women's volleyball athletes. Yes, they tend to overuse their necks to coordinate their breathing, which in turn contributes to their tendency to develop Superior T4 Syndrome. And thank you Steve Babcock for following up your recent experience taking PRI Integration for the Home with this Postural Respiration course. It was fun to talk functional integration of the material in the real world and to see you gain further confidence with the science.

The Postural Respiration course is the heart and soul of this institute and one of my favorite courses to teach. It's always great to breakdown the right sided vs left sided performance of muscles like the respiratory diaphragm, the serratus anterior, the lower trapezius and the oblique abdominal wall. I enjoy discussing and explaining system asymmetry, diaphragm function, airflow, thoracic gait, thoracic neurology and respiratory lateralization. Every time I have the privilege of explaining these fundamental PRI concepts and the powerful influence they collectively have on human movement, I am grateful to Ron Hruska for his lifetime commitment to learning and sharing.

 As I taught this course I thought to myself, there is no way I would be able to have this type of advanced discussion on any of these topics with a group of Postural Respiration course attendees in 2017 without Ron's clinical experiences back in the 1980's and his commitment to put his observations together and form this institute back in the 1990's. I recognize that I personally would not know what I know about any of these concepts or understand what I do about human performance without the benefit of Ron's lifetime of experiences. It helps me to think back and remember where we have come from and how we got here as I work to help others begin their journey with PRI and expand what they know about breathing and thoracoabdominal performance. I'm grateful to be a protégé under such a great mentor like Ron and to in turn have the privilege to be a mentor to others.

Posted May 30, 2017 at 3:57PM
Categories: Courses

"Two short days" in Denver, CO at Ethos Colorado Training Facility went by swiftly! Thank you Jonathan Pope and the Ethos team for graciously hosting our Lumbo-pelvic-femoral discussion and application lab. I thoroughly enjoyed my time introducing and helping to refine the implementation of PRI science to a sharp, articulate, interactive group of strength trainers like Stephanie Zoccatelli, massage therapists like Libby Tegeler, ATC's like Daniel Waterman, physical therapy assistants like Richard Johnson and physical therapists like Amanda Quanstrom.

Thank you Matt "Big Fish" Malloy, Brittany Marlow, Craig Weller, "Sir" Rachel Voyles, and Gentle Jason Bushie for assisting with lab demonstration. Thank you Amanda Quanstrom, Maria Kyong and Daniel Waterman for timely and apt questions to stimulate thought and flesh out details of AF and FA mobility, position and triplanar dynamics and functional implementation of acquired positions to oppose compensatory "tall truck" strategies.

Thoroughly enjoyed my time with this group of enthusiastic learners! Be well, and here's to "four...long...years" and then some, implementing your strategies with clients!

Posted May 25, 2017 at 3:53PM
Categories: Courses Website

This year’s Interdisciplinary Integration was a symposium that brought together researchers and clinicians in a great two days of learning. Below are some photo highlights of the two days.  

Posted April 27, 2017 at 8:38PM
Categories: Courses

A Recent Email question (from 2008) on understanding psoas relationships with the diaphragm in general: 

“In Myokinematic Restoration, James Anderson talks about how tightly woven anatomically the psoas major is into the right diaphragm leaflet.  Can we then assume that activation of the right psoas can be used and is advantageous to use as a method of activating the right diaphragm/pulling it down to enhance right intercostal expansion?”

Ron’s response: “The interesting thing about the psoas major and the diaphragm is that they have similar influence on the spine in the sagittal plane, but they have an opposite influence on the spine in the transverse plane.  In other words, in the transverse plane, the right psoas major compliments (is agonistic to) the left leaflet of the diaphragm; and the left psoas is agonistic to the right leaflet of the diaphragm.  They work with one another through their “tightly woven” attachments ipsilaterally in the sagittal plane to enhance the extension activity of an extended patient, but work with each other contralaterally across the anterior vertebral bodies in the transverse plane.  So, if you activate the right psoas, you are enhancing the sagittal influence of the right diaphragm leaflet and the transverse influence of the left leaflet (something that is desirable in both planes at both of these sites).  As far as using the right diaphragm to enhance right apical expansion is concerned, it’s incorrect to view it that way.  In fact, it is the torsional respiratory influence of the left diaphragm (not the right) that is primarily responsible for expansion of air into the right chest wall and mediastinum.”

Here are my initial thoughts on the email question: The R hemi-diaphragm doesn’t need help in its respiratory role.  It already has plenty of help in the form of a liver below, larger, thicker crura and central tendon, and better abdominal opposition to maintain its domed positon.  Its dominant respiratory activity contributes to chronic tension, not only of the abdominals, intercostals, and lats on the R side, but also of the muscles associated with the R brachial chain.  This is the crux of the reduced R intercostal and apical expansion.  So can activation of a R psoas change this, and can it improve R apical expansion?  Yes, indirectly, with a host of other muscles, but not by “activating a right diaphragm”.

Ron’s response was to acknowledge that a relationship does exist between the psoas and both the ipsilateral and contralateral hemi-diaphragm.  He states: “So, if you activate the right psoas, you are enhancing the sagittal influence of the right diaphragm leaflet and the transverse influence of the left leaflet (something that is desirable in both planes at both of these sites).”

However, it’s not as simple as flexing your R hip.  To clarify:

In our conversation about this email, Ron reminded me that occasionally a R psoas, not just a L psoas, can get hypertonic in a L AIC pattern. How?

Our brain simply wants fulfillment of L spinal rotation, and these 2 muscles may work together in an attempt in to satisfy the brain’s “request”. 

How is it that the R psoas and L diaphragm (and L psoas and R diaphragm) work harmoniously, if not through “tightly woven attachments”, as is the case ipsilaterally?

A vector force, through fascial connections overlying the anterior vertebral bodies, creates this contralateral influence.

Is this right psoas-left leaflet connection in the transverse plane significant?

No, they are ineffectual in achieving L lower spinal rotation. Why?  Because of the L side’s hyperinflated state and externally rotated ribs.  There is air in the way!

(another consideration:  Because of the orientation of the facets, minimal transverse rotation occurs through the lumbar spine.  That area moves more in the sagittal and frontal planes.  Therefore, it is the psoas’ frontal plane influence that is more significant when it comes to breathing and walking.)

Could a right psoas assist a L diaphragm with drawing air into the R apical chamber? 

Indirectly, yes, along with a host of other muscles.  However, certain conditions must first be met.

James Anderson states: “Limited influence of L crura in the transverse plane, lack of well-established L ZOA, and lack of L abdominal opposition, all complement R lumbar spine orientation.”

The R diaphragm partners with its abdominal wall to maintain its position as a powerful muscle of respiration and rib orientation.

If the R psoas becomes busy trying to rotate the lower spine to the L with a L hemi-diaphragm that has a smaller, shallower crura and with L ribs that are in ER, it will need L IOs/TAs to provide the needed pull on the L lower ribs for thoracic flexion and doming of the diaphragm.  Additionally, L abdominal wall opposition creates intra-abdominal pressure and, therefore, a counter-force to the descending diaphragm.   As long as those L ribs remain in ER, the L hemi-diaphragm will remain in a tonic state, influencing the tonicity so often seen in the L psoas.  In summary, when the L hemi-diaphragm contracts unopposed by the L abdominals, our upper body mass tends to shift to the L and, therefore, force us to compensate by spending more time and placing more weight on the R lower extremity in stance or L swing phases of gait, creating and perpetuating dysynchrony!

So while the R psoas can exert some degree of sagittal plane and L transverse plane motion, it serves us better in the frontal  plane, creating convexity at the lumbar spine to provide fulcrum from which L thoracic abduction can occur.   L thoracic abduction is a necessary movement pattern for maintenance of L ZOA and to provide the L hemi-diaphragm with a fulcrum (L hip) that is now situated directly below.  With an established L ZOA through L IO/TA activation, the L hemi-diaphragm can do its job of breathing – creating pressure differentials that allow us to manage gravity and walk, efficiently – with the least amount of force and torque.  This is how a R psoas indirectly enhances R apical expansion, along with many other muscles not mentioned in this orchestrated movement pattern.

 L IOs/TAs and a domed L hemi-diaphragm are the principle lower spinal/sacral/pelvic rotators to the L. 

Finally, why is it that the L hemi-diaphragm, not the R, expands the R intercostal and apical regions?

Rib position determines a hemi-diaphragm’s respiratory direction of flow.  When ribs are IRd on one side, they are ERd on the other.  IRd ribs assist the hemi-diaphragm with achieving and maintaining its ZOA to effectively draw air in.  Therefore, sufficient activity of the IOs/TAs, via their attachments to the ribs and their influence on intra-abdominal pressure, is a requirement for that hemi-diaphragm’s ZOA. 

IRd ribs don’t allow for much expansion. ERd ribs do. Therefore, once sufficient L IO/TA activity exists, creating L IRd ribs and a ZOA that is now effective for ventilation, the L hemi-diaphragm can draw air into the R apical chest wall, assisting with, and maintaining, its ERd ribs. Remember, when ribs are IRd on one side and ERd on the other, the thorax is positioned in ipsi-lateral abduction and contra-lateral rotation. Hence, it is “the torsional respiratory influence of the left diaphragm (not the right) that is primarily responsible for expansion of air into the right chest wall and mediastinum.”

We have 117 techniques in the standing integration section to teach us to get the R side to let go and to get the L side of rib cage to IR, highlighting the importance of L IO/TA activation to establish L hemi-diaphragm ZOA and restore its respiratory role.

Posted April 18, 2017 at 7:16PM
Categories: Website Courses Science

Our right triceps become very challenged if we can not sufficiently engage our left internal obliques and transverse abdominals during active late left lower extremity ‘push-off’ and concomitant active late right upper extremity ‘push-back’ (shoulder extension). Our bodies lose their ability to become centered over the left when our left abdominals, left hamstrings and right triceps disengage as a functional group. A few weeks ago Sy Abe-Hiraishi, a PRI faculty member, asked me about a non-manual technique called the ‘Supine Weighted Tricep Curl’ and the reasoning behind the two methods of instruction. I absolutely loved the question, the dialogue and the timing, since I will be presenting information on group function afferentation at this year’s Spring Symposium. Please read her summary and the response that is presented from a question that was initially asked by a course attendee that attended one of her courses in Japan. So awesome!   

Gratefully, Ron

アメリカの皆さんこんにちは!

Hello everyone!

日本講習担当、PRI講師の阿部さゆりです。昨年の12月に日本で初めてポスチュラル講習の開催をすることができたのですが、その際に参加者さんから出た質問とその答えを今日はここで共有したいと思っています。ロンが日本語と英語の両方でアップして!というので、両方でお届けしますですよ。

This is me, Sy writing this blog post – those of you who do not know me, I am one of the two PRI faculty members that are designated to teach courses in Japan. We hosted our very first Postural Respiration courses in Japan in December, and this interesting question came up from a participant. Today I am hoping to share the question and answer with y’all…(in case you cannot tell, I currently live in Texas). Ron specifically requested that I post this both in Japanese and English, so here it is – hope y’all enjoy!

ポスチュラル講習では左のハムストリングを使って骨盤を起こすように、右のトライセップスを使って右肩甲骨を起こすことがいかに重要か、という話をしますよね。その流れで講習中スーパイン・ウェイテッド・トライセップス・カールズの解説と実技ラボをおこなったのですが、このエクササイズにはやり方が二通り(ポジションA vs B)あり、「このエクササイズのポジションの違いは何?どういう状況の場合、どちらを選ぶのが正解なの?」という質問が日本人参加者さんから出たのです。

In Postural, we learn to use the Right Triceps to “get the scapular up” just like we learn use our Left Hamstring to “get the pelvis up” in the Myokin course.  One of the exercises we demonstrated and practiced in our Postural courses in Japan was “Supine Weighted Triceps Curls,” and that’s when this question was brought up – “I see, in the manual, that this exercise can be performed in two different positions – the original (Position A) and the alternate (Position B). What is the difference and what are some of the reasons we should pick one over the other?”

                           Position A                                                               Position B

What a great question! This got Ron super-excited because no one in the U.S. ever asked this question to him, and Ron and I had a great conversation about it over lunch the other day. So let me first share the short version of the answer – “You should always try Position A first. If it does not work, try Position B as this should be the “mechanically advantaged” version of the same exercise.”

最初に答えを書いてしまうと、どんな患者相手にもまず試すはポジションAです。このポジションでは、歩行時に左足で身体を前に押し出して、右手を前・上方に振り切った状態(=右立脚中期)からエクササイズが始まるんだ、とイメージするとわかりやすいかも知れません。ここからPropel (前進)するために次にすべきは右腕を振り下ろし、後方に振り切ることですよね。同時に左腕も前に振り上げれば、体幹の右回旋・骨盤の左回旋と一緒に右足のpush-offが起こり、左前方への体重移行が可能になります。

平たく言えば、トライセップス・カールズはこの右腕の「振り下ろし始め」を練習するエクササイズなのです。エクササイズ開始時のポジションでは右肘と右肩は共に屈曲位にあり、上腕三頭筋をisolate(隔離)するのに最適と言えます。肘と肩、両関節で伸長位に置かれたこの筋肉を、肘伸展を通じて収縮させることで「腕の振り始め」に真っ先に上腕三頭筋にスイッチを入れる感覚を体得できた人は、そのあとの「右腕の後方振り切り」はモーメンタムと広背筋らの協力を得て比較的楽に、自然とおこなえるんだということに気が付くかもしれません。

And here’s the longer-version of the answer. Everything we do can be applied into various phases of the gait – so please picture yourself being in the right mid-stance. Your L AIC pushed you over to the right, you are feeling the right heel and the right mid-foot, and you just finished swinging your right arm all the way forward. Now look at Position A – both right shoulder and elbow are flexed – doesn’t it look awfully similar? If you are thinking this position is mimicking the I-just-finished-swinging-my-right-arm-forward phase, you are absolutely right!

Now think what needs to happen next. You will need to begin swinging your right arm towards the back as you start to prepare yourself for the push-off phase, and eventually to shift your body weight to the left. The initiation of the right arm swing is essential because, without this, your right arm won’t be pulled all the way back, your right trunk won’t be pulled back, and the right trunk rotation won’t occur. Combined with L AF IR, the back-swing of the right arm is the key for the upper and lower body integration as shown in the picture below.

 (89) Left Stance Interrupted Swing

**改めて言及しますが、右の腕を後ろに引く、ということはロンがどの講習でも何度も繰り返し強調する、超超超超超重要事項です。右の腕を後方に振り切るということは右の体幹を後ろに引く、つまりは体幹が右に回旋するということでもあります(例: 下の写真参照)。体幹の右回旋は骨盤の左回旋(L AF IR)と対になるべきPRI介入には欠かせない要素です。ロン曰く、「左スタンス時(下写真)に荷重されていなければならない肢がふたつある。なんだかわかるかい?左足と、右腕だよ!」。歩行時に腕を荷重だなんて、その表現の仕方がまたロンらしいですけれど、つまるところ彼は空間把握や自我確立を導く神経的道具として、この状況では左足右腕が真価を発揮しているべきだと言いたいのです。

And hence the beauty of this exercise. Triceps curls in this position (Position A) is a great way for us to practice the initiation of the right arm swing. In this position, the triceps are elongated through the combination of shoulder flexion and elbow flexion and can be effectively isolated isolate.

しかし、このポジションで陥りやすいワナは「非常に矢状面に特化したエクササイズであり、上腕の屈曲には腰椎の伸展も伴いやすい」という点です。PRIの基本は適切なポジションで適切な筋肉を使う練習をするところですよね、ですから、患者さんがもしこのエクササイズで呼気(state of exhalation)のポジション、つまり胸郭の屈曲を保てなければ次はAlternate Position(代わりとなるポジション)であるポジションBを試すべきです。

However, here’s a pitfall of “Position A.” Because performing triceps curls in this position promotes sagittal movements, some patients just cannot help but extend their back. Those individuals weren’t quite ready to truly isolate the triceps and may need to take a step back – and try the alternate position, Position B.

ポジションBでは同じ歩行は歩行でも腕を縦ではなく横に振りながら、水平面で胴体を回旋させながら歩行してるイメージです。右の腕をぶん、と横にスイングし前に持ってきたようなこのポジションでは腰椎の伸展は格段に起こりにくいばかりでなく、体幹の左回旋が促進され、左腹壁の活性化と左後方縦郭の拡張、そして右肩甲骨の安定が起こりやすいのが特徴です。つまり、こちら(ポジションB)のほうが上腕三頭筋を単独で活性化させる(ポジションA)前に、腹壁・胸郭・肩甲骨と腕との統合をまずマスターしなければいけない患者に適したエクササイズなのです。

So now look at Position B. You also see the same gait phase in Position B, but the arm is swung to the side (on the transverse plane) instead of up to the front (on the sagittal plane). This arm position promotes the trunk rotation to the left, the better left abdominal engagement and the right scapular stabilization on the thorax, which further secures the right triceps. In this position, the patient will be given the mechanical advantage to remain in the state of exhalation (and thus not to extend the back) while activating the right triceps.

要約すると、「右上腕三頭筋の活性化にトライセップスカールを用いる場合、最初はポジションAで、もし腰椎の伸展がどうしても起こってしまう場合はポジションBでこのエクササイズをおこなう」ということです。こんな話をロンとしていたら、「こんな質問、アメリカでは受けたことないよ!」と非常にうれしがっていました。日本の方の思考力の助けを得ながら、これからも日本での講習でPRIコンセプトをこれでもかというほど切り刻んでいきたいと思います。アメリカの皆さんもこの回答を楽しんでいただければ幸いです。

Let me summarize it – “When using triceps curls to facilitate the activation of the right triceps, anyone should try Position A first. If the patient extends the back in this position, try the alternate position, Position B for the better abdominal integration.” I hope that this answer helps y’all, PRI families in both Japan and the U.S.!

追記ですが、ロンに日本のPRI講習で使っているスライドを見せたら「なにこれ!すごいねすごいね、これも一緒にアップしてよね!」と興奮して大騒ぎされてしまったので、私たちが日本ポスチュラル講習で使ったスライドの写真もおまけに付けておきます。アメリカの皆さんにも、PRIを日本語に訳すのがどれだけ大変だったか、これを見れば少しだけわかっていただけますでしょうか?

P.S. – I showed this (power point slides that we used in Japan) to Ron and he told me I HAVE to post this photo in this blog. I created some visuals and added them to the slide explaining the importance of the right low trap and right triceps…well, I am sure y’all can read the rest ;)  We will continue to strive to teach high-quality, full-of-fun PRI courses in Japan!

Circle Explanation: That's the cross-sectional view of the R BC-patterned chest....L lungs are more inflated than R, and the sternum tipped to the R. Orange semi-circles in this diagram represent SAs, and the light-blue lines are the lower traps. I use this diagram to explain how "L SA is rounded yet elongated (= challenged)" and "R SA is shortened yet flattened (= also challenged)" - sort of like obturator internus. Also, this diagram may help visualize how low traps are positioned in the transverse plane. For example, R low trap is shortened in the frontal plane (as shown in the image on the left...the back view), yet it is actually elongated in the transverse plane if you are to take a look at the image on the right (light-blue line)...the opposite is true for the L low trap... and therefore, again, both lower traps are challenged in its own way.

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