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.
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.
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.
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!
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.”
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.
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.
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.!
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!
Message from Ron:
I have been following Benoît Bardy and reading his work and materials for a number of years and am personally looking forward to hearing him discuss how our patients use “self-produced” and “environmental” information to stabilize or destabilize postural synergies. There have been so many instances in my life where the need to destabilize a dynamic movement pattern preceded the need for stabilizing a pattern that appears to exist because of weakness. Benoît has a gift to interface the unique individual characteristics of postural control (motor signature) to the same individual’s characteristics of social interaction and response to the “existence” of others. His work will have an impact on how we look at social interactions that may be restraining ideal movement and motor “synchronization”. Just this verbiage gets me excited!
Information-Induced Destabilization of Posture and Movement
In this presentation, the role of information in the (de-)stabilization of postural dynamics will be addressed. I will present the postural system as a complex dynamical system composed of many interacting degrees of freedom, giving rise at the behavioral level to functional, adaptive, and efficient postural synergies. I will show how endogenous (i.e., self-produced) and exogenous (i.e., from the environment) information can be used to modulate the postural system for functional purposes, for instance during learning and rehabilitation. Illustrations will include (i) vision-based rehabilitation of posture after stroke, (ii) coupling of sound and posture during standing, (iii) music-induced stabilization of walking and running in both healthy participants and patients suffering from Parkinson's Disease.
Interpersonal Synchronization of Posture and Movement
The coordination between body segments during standing and walking, or between the body and the environment, has classically been studied individually. However, social interactions are essential parts of our daily life, and they constraint the way we stand or move in a group. In this presentation, I will review the recent literature on interpersonal coordination of posture and movement — the study of motor synchronization between people, and will illustrate the circular relation between postural control and social rapports: the way we stand and move in a group influences, and is in return influenced by, our social interactions. Recent results will be presented showing in various postural synchronization tasks the existence of individual motor signatures (IMS), how these IMS are influenced by the presence of others, and the way technology can be used to facilitate postural synchronization. The consequences for the rehabilitation of patients suffering from social disorders (schizophrenia, autism, social phobia) will be addressed.
Benoît G. Bardy earned his B.S., M.S., and PhD (1991) in Movement Sciences at the University of Marseille in France. He was awarded a Georges Lurcy fellowship and a NATO postdoctoral fellowship to continue his research on perception and action in virtual reality at Brown University in Rhode Island, USA. Upon completion of the fellowship he returned to Marseille and worked as a lecturer in Movement Sciences, developing research on perception-action and postural control. Selected as a new professor at the University of Paris (Paris-Sud) in 1999, he created there a Research Center in Sport Sciences, and entered the Institut Universitaire de France as a junior member (2001-2006). In 2005, Benoît returned to the south of France and founded a few years later EuroMov, the new European center for research, technology and innovation in movement sciences (www.euromov.eu). EuroMov is a new concept in the country, at the crossover between fundamental and clinical sciences, technological development, and health-oriented entrepreneurship. Today the center welcomes in a brand new (2500 m2) building located in Montpellier around 100 researchers, engineers, and entrepreneurs from 12 countries collaborating on various scientific and R&D projects related to Movement for Health, in general. The center hosts iMose – Interactive MOtion Simulator at EuroMov – the largest motion-based simulator in France (http://euromov.eu/project/i-mose-lab/). In 2012, Benoît was re-inducted into the Institut Universitaire de France (IUF, 22th promotion) as a senior member.
Benoît’s research is concerned with dynamical approaches to problems of coordination and control of movement, in real and virtual situations, with a particular interest for personalized technology-oriented rehabilitation. Benoît is the author of 200+ scientific articles and 380+ lectures, communications, and conferences worldwide. He is the current coordinator (2013-2016) of two large-scaled European research projects. ALTEREGO (www.euromov.eu/alterego) develops innovative rehabilitation methods to improve relational deficits of patients suffering from social disorders using virtual reality and humanoid robotics. BEAT-HEALTH (www.euromov.eu/beathealth) exploits the tight link between music and movement and delivers embodied, flexible, and personalized rhythmical auditory stimulation (RAS) in order to enhance health (walking in PD patients) and wellness (Running across the lifespan).
Benoît is consulting expert and an evaluator for the H2020 research program of the European Commission.
Register: To register log in and go here.
I had a great time teaching Myokinematics of the Hip and Pelvis last weekend in Salem Oregon! The staff of Hope Orthopedics have been waiting for a PRI class for a year and I hopefully did not disappoint them! Suzie and her co-workers made me feel very welcomed and Norm kept me from running into various obstacles as I discussed the finer points of human patterned asymmetry as it relates to an A on an F and a F on an A! Minh Nyugen, OT PRC is a dear friend of mine who hadn't seen me teach since my last training course with James in the fall of 2010. I love to see my PRI family and meet new friends. I was also able to spend a few extra days with my own personal family that made traveling out of my EST zone that much better! The new and improved Myokin course was a pleasure to teach and although we NEVER have enough time to go over all of the finer points in an Intro course, I feel confident that the course manual will guide their clinical practice. Thank-you to all of the course attendees who came to my last course of 2016! I will work on refining my sometimes unorganized delivery and my jokes in my off-season. Thank-you to all I humbly had the pleasure to teach to this past year. I am honored to be a part of this amazing team. Have a great Holiday season PRINation! See you all in 2017!
This past weekend I had the pleasure of returning to EXOS (formerly Athletes Performance) in Phoenix, AZ. It was 5 years ago that I taught Myokin as a New Faulty member. What was even greater was seeing 40 new faces in the audience! Only my good friend Connor Ryan, PRC was known to me and he graciously came to help Dan and I lab assist. I flew in early enough to get a chance to hike up Camelback Mountain on Friday afternoon. It is always great to get outside and appreciate the beauty of this country. What a different terrain and air quality from where I awoke in NC that same morning! As much as I complain about leaving my time zone (sorry PRINation), I am always happy to come back to AZ. The desert is healing and the air is dry, but the enthusiasm and brain power in that room was anything but dry! Almost 90 % were taking their first PRI class with a few others on their way with learning of PRI science. The new format flowed well and the amount of content we put in this new manual was awesome. I kind of felt like a newbie myself as I navigated day 2 in presenting the integration of what we all learned in theory and testing on Day 1. Dan did a great job co-teaching the course with me and I was proud of him. The course had a diverse group of clinicians. The questions went from basic concepts to in depth gait analysis. I love to be challenged as a speaker. I reminded the class the only way to grow and truly learn is to be taken out of your comfort zone. I think we all were taken there in one way or another. I was reminded of something Ron talked about at our Faculty retreat this past summer. "Why do we teach? We teach to learn." A special shout out to the staff of EXOS for being such gracious hosts: Graeme Lauriston, Jas Randhawa, Jean Trolano, and Jason Hettler all attended from the EXOS organization. I also want to recognize the students in our class: Byron Miller, Kelsey Kankelfitz, and CJ Frizzell. Remember PRINation: "All your brain knows is patterns.." Ron Hruska
PRI Integration for the Home. Seattle Washington. Jill Moynahan and the team at Providence Homecare in Renton Washington were fantastic hosts for a great weekend with a super group of people in a very beautiful place. Thank you for your kind hospitality and the opportunity to enjoy such a fun weekend together. The class enjoyed going over the new and improved PRI Integration for the Home material, including the new ADL exercises and the standing resisted squat progressions. A couple of attendees who had taken the course prior to the new updates said it was totally worth attending again, simply because they were able to learn about and practice these new techniques. And if you haven't had the opportunity, Seattle Washington is a beautiful and super fun place to visit. My wife Karen was able to make the trip with me and we enjoyed going to great places like the Seattle Art Museum, the Pike Street Market, the Space Needle, Lake Washington and the Columbia Tower. The view of Puget Sound and the City of Seattle from the rotating restaurant at the top of the Space Needle really gave us an appreciation of the majestic beauty the great Northwest has to offer. Thank you Seattle for your ongoing interest in PRI and our opportunity to visit your beautiful city.
I spent a great weekend at the Fortius Sport and Health complex in beautiful Vancouver British Columbia. What an awesome host site. And what a super group of professionals attending, most of whom were attending their first ever live PRI course. Ryan, you were a great host and all the attendees were great, especially considering that we were holding the course on the weekend of Thanksgiving in Canada (and the Toronto Blue Jays were back in the playoffs!). Thanks for spending time with us and missing or rescheduling your Thanksgiving turkey dinners. As for the majestic beauty of Vancouver, this is God's Country. Wow! Reminded me of my youth growing up near beautiful Glacier National Park in NW Montana. And when I went on a walk around the lake across from the complex and saw a "Caution, Bears in the Area" sign, I felt right at home. Fortunately, I didn't run into any bears or other wild animals.
But it was beautiful. As for the Myokinematic Restoration course, this weekend was a nostalgic experience for me. One, because my PRI journey started with this course and it has been my pleasure to have taught it so many times over the years to so many new and energetic attendees, both live and through the home study. Two, because I realized I will not be teaching this course as much in the future because of my expanding affiliate course responsibilities and because we have a growing number of new faculty members who will have the responsibility of teaching our primary courses. I'm excited for our institute's growth and development, but I must say, a reflective weekend like this in such a beautiful place really made me miss those early years of PRI and all those great experiences. A big "thank you" to anyone who has ever shared a Myokin moment with me over the years. You are what makes it all worth it!
It was a joy to once again travel to St Lukes. This time however it was different. The class was Cervical Revolution and the attendees were on hand to learn about the amazing "super computer" called the cervical spine and cranium. We went over, in detail how the mandible and the neck are related, how the neck is the controlling factor for cranial strains. This led us to the reasons why individuals have neck pain and headaches. Finally we got into integration with the dental profession, splint discussions and detailed management with dentists. Now we have a better idea WHEN to call the dentist! If you have had any thoughts about attending this amazing class I would encourage you to do it as soon as you can! Especially if you are a dentist!
Mike Roberts and the good folks at Central Mass Physical Therapy did an excellent job hosting Impingement and Instability this past weekend in beautiful Worchester, MA. I was able to spend some time visiting family and friends and I took the opportunity to visit Minuteman National Park in Concord MA. Here the British Red Coats faced down the early colonists across the Old North Bridge prior to the firing of "The shot heard round the world". I went to the nearby Acton Memorial Library and saw the actual sword, a blood stained hat band and a lock of hair from 3 of the colonists that died on that day. Cool stuff. I'm a history buff and I had an awesome time taking in some of the great American history that region has to offer. Anyhow, as far as the course was concerned, we had a great experience exploring secondary level PRI integration with a fantastic group of people. We had a fun combination of rehab, strength, performance and training professionals in attendance who were willing to do their part to make it a great learning experience for the group. They came together to take a more advanced look at the science of PRI, after having done some of the due diligence required with our primary course material. Its always great to take things to the next level in a secondary course like this, especially with an interactive group who came prepared with so many great questions. We talked about the human sense organs and how all things come together to help us sense the space around us and the ground beneath us. The concept of reference centers was well received and it seemed to help all in attendance become better at what they already knew about PRI movement science. The questions were awesome and it was fun to demonstrate so many of the principles taught on course attendees with specific instabilities or a lack of perception and awareness across specific reference centers. Nothing teaches a confusing principle better than seeing it demonstrated on a person with a similar deficit or problem to someone you have seen yourself and didn't know what to do with. We talked about he many ways and reasons the human system becomes lateralized to the right and how the neurology of perceiving space, both the space around us and the space within us, helps us negotiate these lateral tendencies. There were a lot of "ah ha" moments as the class considered the affect of asymmetrical hyperinflation, overactive unilateral muscle chains and asymmetrical ways of stabilizing our body when we stop to rest or attempt to move. These principles were put into play to decrease the negative effects of calcaneal instability, patella femoral instability, ilium instability and scapular instability. The thoughtful questions from the group and their requests to see techniques demonstrated throughout the course added to our overall learning experience. So, thanks again for all the great contributions everyone and for making our time together so practical and fun.