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.