The ENT Institute of Atlanta played host to the most recent Postural Respiration. This course encouraged attendees to look below the head and neck for “bottom-up” influences on the conditions you treat. What do hip pathology, low back pain, headaches, and TMD have in common? A thoracic diaphragm that is patterned in its position and activity.

We discussed how the static asymmetries of our torso lead to overactive chains of muscle below the diaphragm (anterior interior chain and posterior exterior chain) and above the diaphragm (brachial chain). These chains create dynamic patterns of breathing that become entrained in our nervous system and that can restrict healthy alternating, reciprocal movement when upright. Numerous videos were presented that reflect how patterned breathing influences walking: poor posterior right arm swing, reduced thorax rotation and center of mass shift onto the left leg, and waddling, to name a few. Our stronger, better leveraged right diaphragm creates twist and torsion of the airway which, in turn, promotes inefficient strategies to pull air in, including belly and neck breathing, with their associated forward head posture, hyperinflation, and overly extended thoracic spine and rib cage. Neurologically-driven patterns of airflow define how we sense ourselves in the space around us, how we move through it, and our vulnerability to pain and injury.  

Many thanks to Kaitlin Blankenship, ATC; Jose Crespo, PT; Mischelle Hardwick, PT; Allison Robbins, PT; Tre Tate, CPT; and Adria Wofford, PT for volunteering to model the tests and techniques.    

Kristen Spencer, PT, PRC, was invaluable in assisting with lab and adding clarity to questions and concepts.  

The practitioners at ENT Institute did an awesome job of accommodating us guests: Jose; Ann Gerber, PT; Jennifer Hansen, PTA; Mischell; Jennifer Harrell, PT; Deisy Nunez Aguirre, PT; Allison; Olivia Terrell, PT; and Cristen Walker, PTA.   

I hope you get the chance to host again. If so, Cervical Revolution would be a natural fit for your caseload.  You will learn about the influences of an additional chain of muscles, the temporal mandibular cervical chain. You will gain an understanding of how the concepts of Postural Respiration and patterned air flow apply to the cervical spine and cranial patterns and their potential to create malocclusion, TMJ dysfunction, headaches, and visual-vestibular disturbances, all of which you routinely address in the clinic.

I felt right at home with the clinicians at Finish Line Physical Therapy, all seasoned runners. Photos of their and their patients’ running accomplishments, all smiles at the completion of a race, adorn the space – and make for the perfect back-drop to discuss the impact of undesirable airflow patterns, habitual use of accessory muscles of breathing, and a restricted diaphragm on movement.

Asymmetry is the rule of the body and brain. As such, humans, by design, exhibit a right-sided preference, which is reinforced by a culture that favors sitting and a lifestyle made easier by technology. The result is a form of “hemi-neglect” of left sided muscles of grounding – hamstrings, gluts, and abdominals – needed for weight-shifting. Rib cages remain under the influence of muscles that don’t promote alternating internal and external rotation and the associated sense of expansion and recoil. The result is a form of left or bilateral COPD, with its distinctive hyperinflation.

   
Stiff, patterned rib cages and abdominal oblique disuse cause the diaphragm to undergo twist and torsion that, in many cases, cannot get out of. This twist of our respiratory system is a significant mechanism underlying the many syndromes and injuries that we confront in the clinic.

Many thanks to our weekend avatars, whose willingness to demonstrate and receive techniques enabled us all to better understand PRI concepts: Patrick Cronin, PT; Laura Gibbons, PT; Laura Loftus; Iris Platt, PT; RikkiLynn Shields. Thank you Yohei Takada, PT, PRC and Andrew Xenophontos, CSCS, PRT for your tremendous help in lab, coaching the attendees in the nuances of the manual and non-manual techniques, allowing them to experience the power and influence of these techniques on the neuro-muscular system. Finally, thank you to the physical therapists at Finish Line PT for being gracious hosts: Mandy “I WILL blow up a balloon” Fox, Connor Hesselbirg, Jaclyn Massi, Ryan Matisko, Timothy Waanders, and Jimmy Williams.

 
Finish Line PT is a clinic for runners and triathletes, people who strive to be their best selves. To all of the course attendees, I hope the material you learned this weekend will help take you to new heights in your careers and shift your stride to a new way of looking at, and improving, movement.  

I enjoyed teaching from the Postural Restoration Institute and in my hometown, Lincoln, NE this past weekend.  I want to thank Alex, Carlos, Allison, Paul, Becky, Lee, and Jordan for attending in person and allowing me to demonstrate on you and to let your fellow colleagues learn from you during our lab time.  Also, a huge shout out to those in Zoom (too many names to list) for spending two days with me as well.  I thoroughly enjoyed teaching you all and appreciated the questions and participation.  

The Pelvis Restoration course goes into the weeds of AFIR (IPIR/IsPER) and AFER (IPER/IsPIR) positioning of the pelvic inlet and outlet.  It is a lot of information, but clinically it can be a game changer to assist your patients. The pelvis is like the foundation of your house—it’s positioning can affect the rest of the body.  The pelvis integrates the thorax and hip and foot/ankle, which allows our patients to be grounded and regulate airflow/pressure needed for forward movement.  The IO/TA’s, Glute Max, and Glute Med play in an important role with pelvic inlet positioning as the Hamstrings, I.C. Adductor, and Obturators for the pelvic outlet.  One course participant stated “this course connected so many dots for me.”  It was a wonderful weekend, thank you for allowing me to be a part of your PRI journey.

Welcome to 2023! It's hard to believe that we have moved into an entire new year. With the turn of the calendar to a new year, we kicked off 2023 with the first PRI course of the year. Impingement and Instability has had a relatively new re-write a few years ago, and it is now a great introduction to other PRI Secondary and Tertiary courses, as well as being a clinician's course. It provides the clinician with integration strategies and lays a neurophysiological framework for why PRI is so effective as a science.  

We were fortunate enough to have 53 people join us for Impingement & Instability, which is an astounding number for the first course of 2023. Our first several hours are spent delving into the neurological aspects of how and why PRI does what it does, and why it works. Since this is no longer a specific orthopedic-driven course, we started making integrated connections between the foot and scapula within the first 30 minutes of the course.  

This course has evolved, not only in the last few years, but in the last several times I've taught this course. We've added more demonstrations and explanations of how to use the reference centers to change the emphasis of a non-manual technique, depending on what the client of patient requires to reduce their functional cortical dominance.  And there are four unique non-manual activities that are discussed in this course and are not found in any other PRI course.

We had a great group of movement specialists from several countries. It was great to have Dana Hirsch, DC, Logan Thomas PT, Minh Nguyen OTD, PRC, Kurt Van Kuiken, ATC, Ryne Gioviano, CSCS, and Nora Harris, yoga instructor in attendance. We had so many great questions and participation from our live stream crowd.  My thanks to Collin Kidwell, CSCS, Nick Rosencutter, CSCS, and Jack Wong, DPT for their attendance in-person and their willingness to help with our demonstrations. And thanks again to RJ Hruska for his exceptional assistance with the production of course. And on his birthday weekend, no less!