Science

What a great way to start off teaching my first course of my 2019 schedule at my own clinic here in Southern Pines! Nothing like sleeping in your own bed and walking your dogs at lunch time! I had the help of Sarah Ratti PTA, PRC! Sarah was a member of the 2018 PRC class and I was lucky enough to get to know her in December and have her help during lab!

Sarah Ratti and Jennifer Poulin at the Pelvis Restoration Course

 I was so excited to teach Pelvis Restoration following attending Ron's Non-manual technique workshop last weekend in Lincoln, NE. I learned so much and it certainly help energize my teaching and deeper understanding of the Non-manual techniques! I was able to really help my course attendees with choosing techniques and following a frontal plane progress as it relates to the Pelvis.

Jennifer Poulin Instructing a PRI Non Manual Technique

Every time I teach this course, I learn more and grow not only as a faculty member, but also as a clinician. I am hopeful my course attendees would feel the same. My class was interdisciplinary! We had PT's, PTAs, massage therapist, kinesiologist, strength and conditioning coaches, Yoga Instructors and massage therapists! It was a 50/50 split of newbies and experienced PRI clinicians. Maude and Brenda were my Pure Newbies, meaning they really didn't know what PRI was all about. But they left excited that they had been exposed to the science and couldn't wait to integrate what they learned into their current practice. I was happy to have Malynda Kerksick in my class. Malynda was a former patient of mine and now a PRI enthusiast!

I have had the pleasure of watching her grow as a Yoga instructor and her questions were much appreciated. She also did a great job photographing moments throughout the weekend. She gets photo cred for capturing my pure joy while teaching this weekend. I am so proud to be a part of the growth of Postural Restoration. We get asked all the time which course should I take next? What is the best first course to take? I made sure to emphasize the true nature of feed-forward neurology. You treat a pelvis, you influence the thorax, neck, head and big toe! I hope to see these faces again in a future PRI course! The #PRINation is now stronger than ever before!

Pelvis Restoration Course, Non Manual Technique Demonstration

Pelvis Restoration Lab Demonstration

Posted February 13, 2019 at 5:33PM
Categories: Courses Techniques Science

A few days before this course, I was reviewing the material and made a remark to Jen Platt on how much “good” stuff is in this course, that I forget about from year to year. It is so enjoyable to have an opportunity to discuss the reasoning one might use before selecting a position to place a client or patient in, before selecting a non-manual technique. What went into the thought processing regarding reference centers and concepts and why is it important to select an appropriate primary reference for desirable “referent” behavioral outcomes? 

Ron Hruska demonstrating a Non-manual Technique with Neil Rampe

Results are based on preparation. Preparing the patient on what to be mindful of, sense, possibly expect, experience, etc. are all more important than making sure they are doing the technique “correctly”. Processing information can be difficult if individual centers of tactility are not explored first. Words matter, word placement matters, word meaning matters, word correlates matter, word integration matters and word synchrony matters. 

Ron Hruska Non Manual Techniques Workshop

This course allows me to review this communication process, inhibitory intensity and neurologic effort for those who have unique limitations but very similar outcome needs, relating to pattern development around asymmetrical design. Over twenty different non-manual techniques, many of which were selected by the attendees, were reviewed, torn apart, discussed, re-designed and then re-designed again, to recognize reliability of approach and validity of use. It is personal for me. And therefore, an opportunity for those who share their transparencies to reap “good” stuff.

Ron Hruska Non-Manual Technique

Posted February 12, 2019 at 5:10PM
Categories: Courses Techniques Science

Having the opportunity to discuss the role of the hypothalamus and integrated thalamic function as they relate to autonomic patterned respiration, physiology, posture and central nervous system compensation, was an enduring dream of mine. I could finally, deliver a course that describes how our autonomic and central nervous systems operate with and from  biased cerebral and cerebellum lateralization, hemispheric specialization, and oscillatory compression and decompression.

Ron Hruska demonstration during Cranial Resolution in Seattle

Over two decades of literature review, clinical application, multi-disciplinary experience and evidence based outcome methodology, built with the help of an Institute I started for these course objectives, fulfilled me in ways that are very difficult to express. I trusted an idiosyncratic educational process that challenged me as a pre-dentistry student. A clairvoyant process that required collegiate patience, faith in humanity and belief in our holistic, biological and neurological system. I appreciated the 41 course ambassadors who also trusted this process. I hope they came away with a sense of how we patterned humans resolve to make sense of what we don’t sense through pattern compensation of air flow, fluid movement, and cavity fluctuation as it relates to ischial and occipital (sacral and cranial) rhythm and thus autonomic processing. 

Christopher Murphy at Cranial Resolution, Alpine Physical Tehrapy

Cranial Resolution Course Attendees, Seattle, WA

This course was strengthened by the input and participation from too many people to list here, but I especially appreciated the support from Erin Coomer DPT,OCS, Laurie Gribschaw PT,DPT,ATC,AT/L,PRC,  Janine Peacock DPT,OCS, Paige Raffo MPT,OCS and Kelly Martin PT.  I could not have asked for a better audience and support group.   There were many reasons I wanted to give this first course in Seattle but three of those reasons are Christopher Murphy DPT,OCS,PRC,  Jeremiah Ferguson DPT,OCS,PRC, and Eli Zygmuntowicz DPT,OCS,PRC. These three men are absolutely the embodiment of family. I will always be grateful for their warmth, charismatic charm and pedagogical approach. I had so much fun and look forward to the next opportunity to talk about pendular parasympathetic process. 

Alpine Physical Therapy

Jen and I had the pleasure of returning to the APTA Combined Sections Meeting this year in Washington, D.C. Years past have provided us great discussions with both Physical Therapists and Physical Therapy Assistants as well as Students who are seeking these professions. This year once again proved the value of our attendance and allowed us to inform many individuals interested in the science of Postural Restoration. It is so re-assuring and invigorating to be able to discuss our science with those who may not have been exposed prior to attending.

The Combination of both PT students and seasoned Physical Therapist's provided a myriad of conversations and allowed us to connect with both sides of the spectrum. Many faculty members from various institutions and organizations asked passionately about our science and wanted to be better at introducing it to their students. Many students asked passionately about finding a PRI Clinician in their area for mentorship and clinical experience as they complete schooling. Interests in specialization areas continues to grow and we were excited to discuss our Affiliate programs in Pediatrics, Geriatrics and all others with those who find interest in these populations.

Shortly after a discussion regarding our PRI Integration for Fitness and Movement course we were surprised to see a familiar face come across our booth! Little did we know Julie Blandin was in attendance and literally ran into us amongst the crowd. What a great surprise!

Although running into a PRI faculty member was unplanned, we were lucky to have several PRC’s and PRT’s reach out to us as they learned of our stay in the area. On day 2 of the conference we received another surprise as our dear friend and PRT Navin Hettiarachchi sent us a text. “I don’t know how but I have found 3 tickets for you to tonight’s game!”, we had discussed possibly meeting up with Navin but due to the Golden State Warriors coming to town we all thought it would be difficult to find tickets. Although we loved our first NBA experience it was perhaps more fun to see Navin in action with the team. He is a true gift to any organization, as his smile is infectious and his care for his players is unmatched. They are lucky to have him and we are lucky to call him our friend and have him in our PRI Family.

We were also able to meet up with PRC Heather Carr, who has been part of the PRI Family for many years. It was great to see her and to meet her husband Jan, as they provided us with local recommendations and things to see. Heather continues to introduce PRI to many others and we are so grateful for her support. Our last evening included a dinner reservation with PRI Faculty Louise Kelly and her husband Bruce and it was such a great way to finish our weekend. Bruce and Louise met in graduate school and it was a true pleasure to take a walk down memory lane with both of them. Although the food was great the conversations shared and laughs that were had truly made our last night in DC special.

Thank you to all everyone who made this conference a success. The science of PRI continues to grow and each conference we attend makes it apparent that word of mouth is still one of the best ways to connect and share our passions with others. Thank you in particular to Navin, Heather, Julie and Louise for going out of your way to spend time with us. PRI has a way of connecting people and it was great re-connecting with each of you!

Visiting the Country of Japan, left all of us longing to speak their language and be able to communicate with them in their culture more directly. Japanese is not considered an easy language to learn as it “borrows” 3 sets of characters from other languages in the region such as the Chinese “Kanji”. For many western travelers looking to visit this island, this may perhaps be the biggest hurdle. We were very fortunate to have the help, guidance and translation from our PRI Japan faculty and staff, who graciously helped us navigate the transit system which is the largest and busiest in the world.

Summarizing these 10 days into one page, feels like trying to interpret Japanese all over again. There is no way to accurately relay our deep respect and appreciation for the people we met along the way. Although there was at sometimes an inability to communicate these feelings to one another. They were greatly felt, through the smiles, bows, shared meals, and sightseeing that we accomplished while visiting.

We started the trip with the presentation of Cervical Revolution by Ron Hruska, in Tama Center, Tokyo at Teikyo University. Mr. Takahashi, was generous to pick us up and drive us to the course each morning and made the transportation such an ease. The Teikyo University facilities and staff there are some of the most hospitable and friendly group of professionals we have been around, and they love to have FUN! These 3 days provided a deeper discussion on the Secondary PRI concepts relating to the Cervical Spine, and the course attendees were eager to learn.

Following the Cervical Revolution Course we had scheduled two question and answer sessions in Tokyo, and Kyoto. The goal of these Q&A sessions was to answer any questions related to PRI that the community in Japan may have had throughout their attendance to Postural Restoration and Myokinematic Restoration. It was a tremendous success and although Sy had prepared several slides of possible topics to discuss, we never relied on their use. The audience was active and the questions (which were translated to Ron) ranged from the foundation of the science of Postural Restoration, to specific course questions and everything in between.

The rest of our trip revolved around seeing, experiencing and doing as much as we could in the remaining few days we had. We visited countless Shrines, and Temples and after our stay in Takashi’s home of Kyoto, we headed to Kobe. Kobe captivated us for many reasons but speaking as a Nebraskan from the Great Plains, I think we were all excited to see more of the countryside and less of the underground subway stations. As soon as we arrived in Kobe we started exploring. With only one day there, we knew it was going to be full. The morning started by taking a gondola to the top of the Kobe Herbal Gardens and the view at the top was breath taking. Soon after we were met by Mr. Akira Yoshimoto (who visited Lincoln a few months back, and has become a great friend) and his colleague, who guided the second half of our day. They took us out on a ferry ride through Kobe Bay, followed by dinner and a mountain top view of the skyline. This dinner deserves a blog alone, as the Kobe Beef experience was one I will never forget.

(Port of Kobe)

(Golden Palace)

No amount of time or words can do justice to the amount of love we received during this trip. Many people deserve recognition for making it a success. Specifically Kenny, Sayuri (Sy), and Takashi as they were our lifeline every day. They are all three living in Japan for the first time in years, as Kenny and Sy, until recently remained in the US. Not only did these three individuals create a once in a lifetime experience for us, but they work tirelessly to further the growth of PRI Japan. They have now translated all three primary courses and continue to host these primary courses throughout the year. We already miss them, and although there is now a few more hours added to their flight time, we are hopeful that we will still see them throughout the year.

One of the only words I made sure to learn the first day we arrived was “Thank you”. Arigato Gozaimasu! I knew it would probably be the only word(s) that would matter, and 2 weeks later I wish I had said it ten times more.

Thank you to everyone involved with PRI Japan! Thank you to the course attendees who traveled and took off work and asked questions. Thank you to all of the host sites. Thank you to the PRT’s and PRC’s located throughout Japan, and thank you again to our PRI Japan faculty. We look forward to continuously growing with you all.

View more photos HERE!

In the fall of 2017, Jen was contacted by Jessica Tidswell, PT, ATC, SCS, PRT, assistant professor for the Physical Therapy and Athletic Training programs at the University of Utah. We have requests for information, providers, course questions and many other inquires on a daily basis, but the request Jess had was different. She has the pleasure of working closely with the graduate athletic training students, and instructs several graduate courses while remaining clinically active through the University. She typically offers an Independent study as part of this course work and had a strong desire to somehow include PRI concepts as part of her 2017 fall semester. Jess has taken several PRI courses including all three primary courses as home studies, and after her conversation with Jen it was determined that our home study would be the perfect fit. Jess decided to focus the entire semester’s independent study on Pelvis Restoration. We were thrilled to have our course be the focus of a graduate level review and after a few more conversations with Jess, we had them up and running. Not only was this the first time the Home Study was used in this way, but she later decided to follow-up the fall semester this spring with the Myokinematic Restoration course for another semester long independent study. Jess is a pioneer in more ways than one. Receiving a Doctor of Physical Therapy in 2002, Jess was clinically active for several years before deciding something was missing. Her background and passion in Exercise Science and Athletic Training led her to return to school, as a student, seeking her second Bachelor’s degree in Athletic training. Jess recently completed her PRT credentialing and is the first DPT, ATC to be credentialed in our  Postural Restoration Trained™ (PRT) credentialing program. Highlights from several of the students who were a part of this Independent study can be read below, and an interview of PRT Jessica Tidswell can be read HERE.

Thank you to Jess, and the students from the University of Utah, who continue to seek a better understanding of our science, and make these semester reviews a success. If any educators are interested in setting up similar Independent Study courses, please feel free to contact me!

Student Reviews:

Upon signing up for this semester-long independent study Pelvis Restoration home study course, how much knowledge of Postural Restoration® did you have if any? If this was your first exposure to the science, what stood out the most to you about this novel way of looking at human asymmetry?

“This was my first exposure to Postural Restoration, and being able to look at postural muscles in a different way and how they affect the innominate bones changed the way I treat my athletes and improved my outcomes.” - Bryan Erspamer, ATC

“Prior to signing up for the independent study, I had previously taken the in-person postural respiration course. I was first exposed to PRI from an athletic trainer and mentor during my first job after graduating from undergrad. It immediately peaked my interests due to its holistic view of the human body. The concepts described by the institute on how our inherent asymmetries relate to dysfunction were initially hard to grasp as a young clinician. However, the more I asked questions and critically applied the science, the more that I knew this was going to be an essential part of my career. Initially, much of my treatment focus was on the location of the injury itself. The Postural Restoration Institute provided the big picture and not only altered how I care for my patients, but also totally revamped the way I view human anatomy.” - Chris Michaels, LAT, ATC

“The semester-long independent study of Pelvis Restoration was the first time I had been introduced to PRI. I appreciated how the PRI approach has a strong focus on the kinetic chain bilaterally. PRI showed a unique perspective to optimize total body function by addressing the inhibition and facilitation needs on each side of the body individually.” - Julia Villani, ATC

As you got closer to the end of the semester did the course material challenge your thinking, or way of looking at certain injuries or dysfunction, that you encounter as an Athletic Trainer? What are some of the ways that you plan on implementing this material, or how do you see this material being utilized in your setting in the future.

“PRI changed the way I treated my athletes, I went from using a lot of muscle energy techniques for short term relief, to putting athletes on PRI programs to actually resolve the underlying issues. Working with hockey players, I see a lot of chronic hip and low back pain. Due to the mechanics of skating hockey players are prone to being in a PEC pattern, so I see myself using PRI on a broader scale in the future, implementing these techniques team wide.” - Bryan Erspamer, ATC

“The course material throughout the semester was both challenging and eye opening. Learning about the intricacies of pelvic motion, how pelvic position relates to asymmetry and dysfunction, and how I can use the Postural Restoration® science to make a long term impact on my patients was career altering. I work with college softball players and often times they complain of shoulder pain, but after taking a more extensive history, I learn that they also suffer from chronic low back and/or knee pain. While doing exercises on the lower extremity as part of an upper extremity rehabilitation program can often seem strange to my athletes, after taking the pelvis course, I know that this approach is essential for long term, total body health. In the future, I hope to implement PRI as a part of my pre-participation physical examinations to screen my athletes and get them started on a Postural Restoration® program prior to competition.” - Chris Michaels, LAT, ATC

“Absolutely, my view of overuse injuries and dysfunctional movement has changed. Now, I not only address the chief compliant but I take a much more detailed look at the pelvis and how it may be influencing the issue. I plan on incorporating PRI techniques in most of, if not all of my overuse injuries and dysfunctional movements. I have yet to find an athlete that would not benefit from some level of PRI exercise.” - Julia Villani, ATC

Overall would you recommend an independent study PRI home study course to other graduate students? How did your view of the science of Postural Restoration® change from the beginning of the semester, once you had completed the course? (Any additional feedback or comments are welcomed below)

“I would absolutely recommend a directed independent study focused on PRI to any graduate level AT. I feel that this was the best way to be introduced to PRI as we had Jess directing us and always willing to answer any questions we might have had. The environment also allowed us to work together as graduate students and better understand the language, the science, and the implementation of PRI. As the semester progressed and I got more of a grasp on the concepts and science behind PRI, I was able to start implementing PRI programs in the clinic. In the independent study set up, I was always able to address any questions or problems I might have had with Dr. Tidswell.” - Bryan Erspamer, ATC

I would strongly recommend the independent study PRI home study course to other graduate students. Taking this course alongside my classmates has created a collaborative learning experience that extends beyond the classroom. Throughout the semester, my classmates and I would meet in the clinic to either talk through questions we had from the course, or practice the special tests and exercises we learned during class time. I think the best part of taking this course as an independent study was that even once the class ended, a sort of PRI culture was created amongst the students who took the class. We all still make a point to check in with one another to discuss how we are applying the material and how we might be able to improve the way we utilize the concepts with our patients. We also have an online group where we share research, videos, and other useful material related to PRI. The independent study PRI home study course has fostered an environment of continuous learning and has changed the way we treat our patients.” - Chris Michaels, LAT, ATC

“I have no hesitation recommending a home study course to other graduate students. In my experience, newly certified athletic trainers have a limited number of tools in their toolbox to address overuse injuries and dysfunctional movement. This course not only helped me deepen my knowledge of pelvic anatomy, but also how imbalances in the core and pelvis reflect through the kinetic chain.” - Julia Villani, ATC

We recently were made aware of four journal articles that use PRI techniques to study the effects that they have on lumbopelvic pain, knee osteoarthritis pain, illiotibial band tightness and chronic low back pain. We are excited to see the growth in research for techniques that PRI Therapists have been using clinically for years. All of the articles below are available free of charge.

To view all of the articles click here.

    Posted March 2, 2018 at 5:34PM

    We recently received a copy of PRT Jessica Kisiel’s newly released book Winning The Injury Game – Alignment Strategies for Healing and Performance, and wanted to share the news with PRI Nation. Below are a few words from Jessica about her story and inspiration for writing the book.

    “I was diagnosed with severe hip osteoarthritis (OA) at the peak of my professional mountain biking career. The devastating pain in my hip and back made it impossible for me to cycle comfortably. Upon receiving an orthopedic surgeon’s advice to prolong a hip replacement as long as possible, I set out to find an alternative path to healing. Winning the Injury Game tells the story of my journey from pain and desperation back to hope and competitive athletics. This book shares the lessons I learned as a patient and coach, providing a mix of personal and client experiences with professional knowledge. I am happy to say that I have not had that hip replacement, and I still enjoy playing a variety of sports. The aim of Winning the Injury Game is to help you to do the same. You can overcome your injury—and you can confidently return to pain-free activity for the long-term!”

    Do you have patients or clients who want to learn more about their pain and the process of recovery from someone who has experienced what they are going through, and has an understanding of the importance of alignment, balance, wellness, and performance? If so, you should check out this personal and inspiring book, which includes many references to Postural Restoration®.

    Jessica is offering a 10% discount to PRI providers, which can be purchased on her website The Pain Free Athlete, using the code PRI10 . PRI does not sell or benefit from the sale of this book.

    Posted January 23, 2018 at 10:52PM

    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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