We received a question about treating Superior T4 syndrome using the gluteus medius.  James Anderson, MPT, PRC did a great job explaining the rationale behind this:

When I took the Myokinematic Restoration class you said to email you about some information on Superior T4 syndrome.  You mentioned working your glute med’s for Superior T4’s.

Please read a handout I put together on Superior T4 syndrome.  Click HERE!

The reason I said the glute medius was such a big deal with the T4 patients is because of all the things that must be in place in order for the glute medius to be properly felt during single leg stance.  In other words, the Adductor Pull Back must have been well coordinated with proper breathing to clear out the right BC while it approximated the left femur up into the acetabulum.  In fact, your Adductor Pull Back should have restored full right HG IR to ensure that the left ZOA has been restored and the right BC has been inhibited.  The deliberate left hip approximation is a precursor for left posterior hip capsule stretching, which is often needed prior to the glute medius being able to properly work when doing single leg left AF and FA IR training.  Also of note, if the right thigh does not stay positioned ahead of the left thigh during single leg left AF IR training (like the Retro Stairs), then you are probably not maintaining the needed left AF IR state to keep the left glute medius active during single leg stance training.

I hope this helps clarify what I said about the glute medius.  And I hope the T4 document is helpful as well.  But remember, if the left hip does not do all of the above described items, your left hip comes out of place and the base of your spine will orient towards the right (something you’ll struggle to overcome with just upper half exercises).

-James Anderson, MPT, PRC

Posted July 12, 2010 at 2:19PM
Categories: Techniques Articles

**To review the exercise technique mentioned below, click here!

I was reviewing the blog section and I saw that the Standing Serratus Stomatognathic Squat can be used to determine bite position.  When I took The Cervical-Cranio-Mandibular Restoration course, we did not discuss this technique.  Could you give me some information?

The first picture is taken with her weight through her heels and her scapulas supported by the wall.  Her levator scapulaes, upper traps and SCM’s are relaxed.  Her thoracic lumbar and cervical lordosis will be placed in the end range of her normal lordotic range of these 2 areas of her spine.  Her teeth should be able to make uniform contact on both sides of her mouth and through the posterior teeth. 

The last picture shows the end range of normal thoracic and cranial flexion.  She should be able to touch her teeth evenly on both sides and through her posterior teeth.  If she cannot feel uniform closure in both of these positions she may need a splint to re-orient or support her occlusion and cervical-cranial imbalances. 

An open bite on one side is indicative of possible frontal plane asymmetry at the cranium or cervical spine.

If she can’t touch front teeth together (incisor to incisor and then close with good posterior molar contact and then back to incisor to incisor, etc) in the first or last position as reflected by the above 1st and last pictures, cranial mandibular, cranial cervical and cranial thoracic muscle cannot rest during resting bite, regardless of cranial or cervical position or the degree of cranial or cervical flexion or extension. 

This is why I did not talk about this bite issue in great detail.  It will be reviewed and discussed in greater detail at the Orthognathic Dentistry and PRI integration course this fall.

Posted June 25, 2010 at 3:57PM
Categories: Techniques

The Standing Serratus Stomatognathic Squat is a brand new activity that is being introduced in the Cervical-Cranio-Mandibular Restoration course!  This activity is not only used for a home program, it is also used to help the clinician determine bite position!  Learn all about this activity in our next Cervical-Cranio-Mandibular Restoration course being offered in Lebanon, NH!

Posted October 20, 2009 at 4:37PM
Categories: Techniques

Have any of you ever noticed this wear pattern on the left shoe?  If you have, this is a good indicator of right adductor hyperactivity.  When the right adductor is overly hyperactive, the left heel will come out of the shoe when beginning to initiate the swing phase.  Another good indicator of right adductor hyperactivity will be no right arm swing.  These patients will need a right adductor magnus inhibition program along with verbal cues to maintain heel contact with gait!

Posted September 8, 2009 at 4:25PM
Categories: Techniques

Michael Mullin, ATC, LAT, PTA from Portland, Maine recently sent us this helpful hint to use with our patients that enjoy running!

I just had a patient come back to see me and she stated:

“I just returned from Everest and it was the hardest thing I have ever done in my life.  There were times when I was having a really hard time breathing above 17,000 feet, and without oxygen, you are trying to find air.  There were others that needed to be evacuated, but I practiced the diaphragmatic things you taught me about full exhalation and re-oxygenation and I swear it saved me—literally saved my life when I did not think I was going to make it”.

I have been having my runners work on a breathing cycle with quite good results:  inhaling on 2 strides and exhaling on 3 strides.  This reinforces not only good respiratory control and reducing hyperinflation, but it also allows them to push off on exhalation on alternating legs to maintain symmetry.

Posted July 23, 2009 at 9:05PM
Categories: Techniques

If any of you use the Two Point Stance activity found on the 2nd Edition Non-Manual Techniques CD-Rom you may want to make this correction on your handout!  Roberta Delfun, PT, PRC found a mistake on the original exercise!  When performing this technique in left sidelying, the right arm should move back on INHALATION and come forward on EXHALATION.  The first row of pictures has the 2nd and 3rd picture reversed.  To print a new copy, click here!

Posted July 13, 2009 at 9:20PM
Categories: Techniques

We recently received this question:
Why are so many of the PRI exercises isometric, rather than using the more typical type of PT exercise that uses movement against resistance?

Here is our response:
PRI non-manual techniques are organized by muscle, position and suggested sequence of progressive application.  Therefore, each technique precedes a technique that requires increased neuromotor integration, increased inhibitory activity from compensatory patterned muscle, and an increase in multilevel tri-planar positional organization.  In order to carry this type of function out, the patient needs to “find” and “feel” isometrically a specific muscle in a specific position to learn a behavioral pattern or strategy with this isolated muscle engaging into an integrated “family” of muscle, without dropping off because of position or sequence of movement events.  Many of the more integrated techniques do incorporate “movement against resistance” while the early techniques in each position on initiation, are isolated to inhibit undesirable compensatory activity and identified by the patient for later integration neuromuscular non-compensatory function.  Without awareness of this identified and isometric trained muscle, higher levels of neuromotor demands could reduce the needed concomitant activity of this muscle. 

Posted June 23, 2009 at 7:56PM
Categories: Techniques

Can you achieve a Level 5 Functional Squat grade while also keeping your low traps engaged?  Learn more about this new activity in our Impingement and Instability course!  Our next course will be in August right here at PRI!  To register, click here!

Posted June 16, 2009 at 8:03PM
Categories: Techniques

If you have been to a PRI course before and are using PRI Non-Manual Techniques, you have probably noticed a common theme through each technique.  Almost every technique instructs the patient to “hold for 4-5 deep breaths in through the nose and out through the mouth and relax and repeat 4 more times”.  So…why 4-5 breaths in and out, why 5 times?  To read the rationale behind this, click here!

Posted April 16, 2009 at 6:31PM
Categories: Techniques

If you attended day four of our Interdisciplinary Integration course, you learned about Pelvic Floor Dysfunction and the positive effects squatting can have on treatment of this condition.  Following the course, one of the attendees sent us this email that confirmed PRI’s position on the power of squatting…

I wanted to share something else with you all, especially Lori and Ron.  Lori highlighted the importance of squatting and it’s impact on constipation.  My 3 year old, has struggled with constipation since birth.  She literally will go poop once to maybe twice a week if she is lucky and it is always with tears and an all day event.  We have tried everything, from suppositories, Miralax, Benefiber supplements, high fiber diet, Flax oil, Mineral oil, infant tummy massage, etc.  Anyway when I got home Sunday night she was still awake.  After the excitement of seeing each other again, I put her on the toilet in the squat position and she immediately started pooping!  I was ecstatic!  We did the same thing yesterday and today with the same results!  This makes arecord three days in a row of her pooping without tears or pain!  I truly feel that God brought me down to Lincoln for many reasons and this is definitely one of them.  Thanks to you all for all of the work you do to help people.  This simple thing will be life changing for everyone in my daughter’s life, as it was always so hard to watch her be so uncomfortable and not be able to help her.  Thanks again!

Posted April 6, 2009 at 6:42PM
Categories: Techniques
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