We had a great time last night on our first "PRI Breathing Mechanics in COVID Times" free webinar! We had around 250 people join us, and we look forward to hopefully growing this number in the coming weeks. If you missed the live webinar last night, you can access the recording on the Webinars page on our website. A PDF handout of the PowerPoint slides is also available on the Webinars page.

Below is the 3rd (of Ron's Top 10 Chest Wall COVID Breathing Techniques that we will be discussing further on these webinars) non-manual technique clinical reasoning break down. We invite you to review and try this technique a few times over the next week, as we will be discussing this and more on next Tuesday's webinar.

Standing Supported Left Glute Push

Let’s start with the title of this PRI Non-Manual technique.

This “standing” technique requires wearing shoes that provide good heel counter support, arch support and a toe box that will allow the toes and forefoot to easily spread out in the shoe. You will also need to push a table next to a wall to prevent it from moving forward as you push it forward with your hands (or you could use a kitchen or bathroom counter in your home). This PRI technique is designed to place one in a 'Valsalva-like' maneuver position between the exhalation and the inhalation phases, without blowing up a balloon and holding the expelled air or while pinching off the nose. 
 
In this technique, the force applied by the table and floor allow the tongue and mouth to close off the airway and properly use the abdominal muscles and the diaphragm to exhale and inhale without engaging the neck or back under moderate pressure created by closing off the pharynx with the pharyngeal muscle and the larynx/trachea with the tongue muscle. This voluntary control of the abdomen is maintained during the entire technique, without having to think about how to “hold” the contraction of the abdominals during both phases of the respiration cycle. It is a wonderful way to teach someone how to inhale with good opposition to the diaphragm so that its effectiveness on opening up the mid and lower chest wall is maximized, as the subconscious effort of maintaining abdominal stabilization is minimized.

The “support” of the upper extremities, offered by the stable table or counter, also allows one to lift the right leg up and the right foot off the floor as the left glutes "push” the body forward to further stabilize the lower trunk and pelvis as the right hip is raised up. This activity co-activates more integrative assistance from the right hip flexors, the right lower trapezius and long head of the triceps and left abdominal wall. When all said and done the tension and internal pressure created by the lengthened anterior shoulder and hip flexors enables one to breathe with the diaphragm under high compliance and forgiveness of lateral and posterior chest wall tension.
 
This technique is, therefore, a good technique because the lateral, posterior, apical and base surfaces of both lungs can expand easily upon diaphragmatic contraction, secondary to chest wall compliance and the gravitational force displaced on the abdominal contents. The internal organs fall anteriorly and off the front of the thoracic and lumbar spine. It is also, an excellent postural drainage technique for the posterior lobes of the mid to lower lungs, preceding the standing positional induced coughing that more than likely will follow with those who are experiencing difficulty breathing because of fluid-filled alveolar sacs.

Here are some additional comments about the steps that follow the title and pictorial examples, along with the reasoning for the procedural step.

Stand with your feet parallel to each other and directly under both hips. While keeping both heels on the floor lean forward to place your outstretched hands on the table in front of you. Now move your feet back so that your back is close to being parallel with the surface your hands are supported by, and the floor or ground you are standing on. You should feel a gentle stretch through the back of your heels and lower legs. Maintain heel contact with the floor or ground surface, especially on the left side.

These first two steps are important because you are now in a position where anything you do from this point on will foster more uniform opening of the entire circumference of your chest walls. This position, as reflected by the person in the second photo, also indicates that the attachment sites of the latissimus muscle on the side of your chest wall is in its lengthened state, as both of its attachment sites are distracted from each other. In other words, the arms are moving away from the mid to low spine, as the spine is more rounded than “U” shaped in this position.

This is an optimal position for the diaphragm to be in for coastal or mid to lower rib cage expansion upon contraction. It also is a great position for one to sense the abdomen lift the abdomen up against gravity and feel how one’s own body weight can serve as an element for abdominal strengthening with optimal diaphragmatic influence on the chest wall mechanics for ideal ventilation and perfusion at the anterior base of each lung’s lower lobes.
   
Shift your left hip back in Step 3 to engage your right hand as a pusher and to sense, activate, and lengthen your left outside hip muscles in preparation of using these same muscles to lift your right foot a few inches off the floor. While keeping your back parallel to the floor, in other words do not let your mid back sag toward the ground, lift your right knee up and your right foot off the floor/ground. The weight of your body should now be felt through both wrists and hands, your left hip, your abdominals especially on the left, (if you feel your right abdominals more than the left, you need to push more with your right hand into the table you are supported by) and the entire bottom of your left foot. This ‘highly integrated contracted’ position replaces the need to do this activity by blowing up a balloon correctly using PRI methodology.

Now hold this position as you take a deep breath in through your nose as you “push” with the above musculature and reference sites, outlined in Step 3. Then blow out through pursed lips or your mouth slowly by pushing slightly more with above muscles and sites. The most important consideration in Step 4 is to transition slowly from exhalation to inhalation with a “pause” (Valsalva pause) in between the exhalation and inhalation phase, without losing the “push” from your body while breathing in this reciprocal state of glossal sealing and pharyngeal closing during respective inhalation and pre-exhalation reciprocal breathing.

Stay tuned for more discussion on Ron's Top 10 Chest Wall COVID Breathing Techniques on our upcoming webinars and blog!

As an introduction to our free "PRI Breathing Mechanics in COVID Times" webinar series that is debuting tomorrow, we invite you to view a free trial privy episode titled "Integrated Pulomonary Compliance". During this privy episode, Ron and I discuss lung compliance and two techniques that are incredibly valuable for maximizing pulmonary compliance during this COVID-19 pandemic. As promised, Ron has broken down this technique and provided further reasoning behind the title and each step of the technique below. Stay tuned for the second technique, which will be posted to our website tomorrow. And, don't forget to REGISTER for week one of our free webinar series, which debuts tomorrow at 6pm CT.

Standing Supported Right Step Around with Right Quadratus Lumborum Stretch and Right Apical Expansion

Let’s start with the title of this PRI Non-Manual technique.  

You need to be in a “standing” upright state, preferably with good arch and heel cup supporting shoes on, as you hold on to a “supporting” dowel, pool stick or some type of rod in your right hand. The right hand needs to be in a position where the palm is down and the thumb is up, as your hand is wrapped around the stick. [This will position and assist your “right apical” or upper chest wall into an “expansion” state, or more open state, which is one of the desired area that this activity will focus on.] The right foot will “step around” the left foot to assist in lengthening, or “stretch”, a muscle that is connected to the top of your iliac crest or hip bone, the last rib of your rib cage and the first four vertebrate of your lower back. This muscle, the “right Quadratus Lumborum”, often becomes very short, tight and restrictive when your upper chest doesn’t turn or rotate to the right as your lower chest turns or rotates to the left. This muscle also can limit lower trunk and hip turning or rotation and forward movement to the left at the low back; as a result of the backside of the last right rib being held down by this muscle. [This right low back area will be the other desired area you will be focusing on.]

Here are some additional comments about the steps that follow the title and pictorial examples, along with the reasoning for the procedural step.

Stand with your feet parallel to each other and with your hips directly over your feet. Place your right hand on the dowel or stick at right shoulder level.  Place the dowel’s or stick’s other end on the floor at approximately arm reach in front of the right foot. This step is important because it begins to put your right shoulder and chest in a position where your air flow can begin to move more easily into your right upper lobe of your right lung under your right anterior and lateral chest walls.  

As you try to cross your right foot in front of your left foot, you may notice that you can not make a perfect “T” with your right foot perpendicular to your left. If you can not make a “perfect T”, do the best you can. Both feet need to be, however, flat on the floor. This means you should feel your inside arches of your feet hit the bottom of the shoe as you put weight through each foot. Step 2 provides the anchor needed for your right lateral and back side of the chest to open up as you stand in the final position as outlined in Step 5, and as you breathe in when in step 6.  

By slightly bending your knees, in Step 3 your low back will relax and your mid to upper back of your chest, on both sides of your back, will expand and gently begin to open up during normal breathing. By “shifting” or moving your left hip back, your body weight will be directed and moved over to the left foot, more than the right. Try very hard to keep your right arch and foot on the floor as you do this. Your entire lower body and lower chest will be turning to the left as your upper chest is essentially turning to the right, simultaneously. As your left lower posterior chest wall is lengthening, decompressing and beginning to open, your right lateral chest wall is simultaneously opening.

Begin to “round our your trunk” in Step 4 by slowly lowering your left arm, as your right arm is held up the dowel, that is secured by your right hand.  Slowly breathe in through your nose and out of your mouth, as you lower your left shoulder. Simultaneously place emphasis on rounding your back to open the back of your chest walls on both sides of your back. Take a few seconds and pause after each ‘breathe out’ through your mouth, before you take a new one in through your nose. This pause allow your mid back to expand, open, and loosen any “mucous” in the posterior regions of your lower and mid lobes of your right lung and your lower lobe of your left.

As you continue to breathe in and out, begin to “reach for your right toes with your left hand” during the exhale phase of this slow, methodical breathing cycle you are in. You may not be able to touch your left toes. This is OK. Over time as your chest wall becomes more flexible, you may get close to your toes, or you may actually touch them. Let the back side of your right leg or hamstring area dictate on how far to reach with your left hand as you exhale. This is not a right hamstring stretch activity, although you will feel that area being pulled. More importantly, let your right hamstring region hold, stretch and anchor you as you breathe in slowly to fill and expand the back side of your left lower chest. This will allow your left posterior lower lung lobe and right anterior upper lung lobe to open, drain and exchange air more efficiently.

After you have arrived at a comfortable state of reaching with your left hand toward your right toes, concentrate on filling your right upper lung and stretching open your right upper anterior chest wall, as you slowly take deep breaths in, after each long breath out. Try very hard to “maintain” your hand and foot positions as indicated in Step 6. This ensures good respiratory mechanics for ventilation of lung surfaces in the upper lobe under your right, upper, anterior and lateral chest wall; a region of our body that is often compressed and restricted because of handedness and our human asymmetrical bias toward managing posture through our right body activity.

Step 7 reminds you to accept the “stretch” you should feel through your “hips, back and right chest wall”. This stretch sense is especially desirable upon exhalation. So exhale, and pause, to experience this wonderful “lung” related stretch sense. Your diaphragm will work so much more effectively, after this final step. Your chest walls, in general, will expand so much more efficiently and your ventilatory gas exchange will enhance your mood, behavior and decision making.
   
By continuing the sequence recommended, in Step 8, your chest wall reciprocal movement associated with inhalation and exhalation mechanics, will allow better alternation of chest wall movement when you walk and swing your arms and legs and when you sit and turn to one side and then the other, or when you lie down and turn one direction followed by another. This PRI technique fosters more desirable, unrestricted chest wall mechanics, lung drainage and diaphragmatic productivity both at rest and with upright bilateral extremity movement.

On April 18th and 19th our Institute hosted its first live stream course on the importance of maintaining and facilitating the tone and tension needed for 30 degrees of cervical symbiotic movement. Two cortical hemispheres, two communities of inter-neuronal highways, two lateralized sets of appendages and two autonomic systems of drive, that are all associated with one “neck” of their being.  Regardless of the side of the relationship that is more dominant, or more sensed, or more patterned around a vertical axis, or more associated with emotion, fear, decision making, or physiology, both sides have to communicate with biased biologic messages going up and down through their one and only neck.

A few minutes ago I finished a face time conversation with Maureen Henderson PT, PRC regarding our 20th year anniversary as an Institute. She also told me she would be sending me a book written by Robin Wall Kimmer, entitled ‘Braiding Sweet Grass’.  She said the book reminded her of our relationship and the role the Postural Restoration Institute serves for masting. Mast seeding, also called "masting", is the production of many seeds by a plant every two or more years in regional synchrony with other plants of the same species. Mast seeding is an effective defense because the seed predators become satiated before all the seeds have been consumed.

On November 3rd, 2001 Maureen attended her first PRI course, Postural Restoration (the name of this course was changed to Postural Respiration in 2004) on the campus of the University of Minnesota. She reminded me that she was tired and had jet lag but wanted to go to this course because of the inter-connectedness associated with the material in a course she received from a recent course she attended on ‘Protonics’ that was taught by Karen Swanson PT, through the Postural Restoration Institute. “The core of my being is that everything is connected and meeting you and hearing you for the first time satisfied my core”, was a statement that resonated with me, because we truly have similar DNA, similar thoughts about purpose, similar respect for nature and trees… Both Maureen, and my son, RJ, know that we are all truly connected, just as all trees are.

Trees and plants talk to each other using an internet of fungus. Hidden under our feet is an information superhighway that allows plants to communicate and help each other out. Mycelial networks of fungus allows individuals (trees) who may be widely separated, to communicate and help each other learn new ways to survive, commit new mistakes, and to boost their host plants’ immune systems.  Fungi have been called ‘Earths’ natural internet (Paul Stamets 2008 TED talk on “Earth’s Natural Internet”). Both the tree trunks and our human necks need biologic tone, social tension and regional connected support that is enhanced through “masting”, so that a few of us who breathe and respect the science of PRI can further nurture the evidence behind the need for 30 degrees of cervical rest. Our “masting” effort, our inter-neuronal highways, and our interconnected hemispheres just got a huge boost from live streaming on April 18th and 19th , through the use of the internet; just like the trees we walk under that are getting a huge boost from the Mycelia fungi that never stop networking.

Full Cervical Revolution Live Stream Photo Album

Kind Regards,
Ron

“Lots of evidence-based practice.”
“I plan to integrate the information immediately into my practice.”

Thank you to Heather Golly, ATC, PhD, Beth Marschner, DPT, and Dawn Mattern, MD, faculty at Minot State University, in Minot, North Dakota, for hosting Postural Respiration this past weekend. We were able to sneak this course in before the travel and conference bans were enacted and had plenty of hand-sanitizer at our disposal!  

MSU was the host site for Myokinematics last year, so most attendees had that course under their belt.  It served as a springboard to understanding how the top half of the body, the thorax, influences and is influenced by the lower half.

Our ability to fully and properly compress and decompress our bodies – the thorax, abdominal, pelvic, and cranial chambers -- in the space around us is dictated by air flow patterns provided by hemi-diaphragms that are in position to do so.  This is compromised if abdominals, which wrap around the lower ribs and shape the hemi-diaphragms within to preserve their length-tension properties, aren’t sensed and facilitated.  Therefore, training the abdominals first and foremost for respiration, not core stability, is imperative.  All our movements and physiology, from HRV, digestion, and the ability to concentrate, depend on this.

One attendee grappled with when to consider prone “I’s”, “Y’s”, and “T’s” in their program.  This led to a helpful discussion, and paradigm shift, on the need to first address thoraco-scapular mechanics, as achieved by diaphragm position, rib cage expansion, and alterations of air flow patterns, before introducing scapula on thorax activity.  Without proper respiratory mechanics in place, muscles of the scapula acting on the thorax are simply out of position and lack meaningful leverage to provide safe, effective cervical and upper extremity joint performance.

Everyone appreciated and learned from those who stepped up to demonstrate non-manual techniques and to act as patient models for lab:  Stephanie Boespflug, PTA, PRC (my fellow PRC 2011 alum), Beth Marschner, Kirk Mason, DC, Terry Quijano, ATC student, Rebekah Rye, ATC, and Shane Williams, ATC student.  They enhanced and clarified how we define R BC/L AIC patterned activity and how we differentiate this presentation and its treatment considerations from that of superior T4 and B PEC compensations. Thank you also to Kari Harris, DPT, and Heidi Folk, PT, for adding to the discussion with insightful questions and personal clinical examples. I appreciated everyone’s warmth and hospitality, North Dakota-style. Thank you all for a wonderful weekend. The Institute looks forward to bringing more courses to your neck of the woods!