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Blog Posts in April 2017

This past week, at our Annual Interdisciplinary Integration Symposium, we presented the PRI Director’s Dedication Award to two very deserving women who have had a tremendous impact on our Institute; Lori Thomsen and Jennifer Poulin. The PRI Director’s Dedication Award was established by the Board of Directors (Ron Hruska, Janie Ebmeier, Jennifer Platt and Bobbie Rappl) in 2012 to recognize individuals’ ongoing dedication to their advancement in PRI.

Past PRI Director’s Dedication Award recipients include: Susan Henning and Joe Belding (December 2012); Kyndall Boyle and James Anderson (April 2014); Michael Cantrell (December 2014); Jason Masek (April 2015); and Michal Niedzielski (December 2015). An award recognition plaque is currently being designed and constructed, and will be displayed at the Postural Restoration Institute®, recognizing each of the PRI Directors Dedication Award recipients.

Lori Thomsen graduated in 1995 from the University of Nebraska Medical Center with her Masters in Physical Therapy. She was first introduced to PRI while working at RiverView Health in Crookston, MN in 2003. Lori was a member of the 2005 Postural Restoration Certified™ (PRC) class. Lori spent countless hours with Ron Hruska helping to organize and structure the Pelvis Restoration course, and joined the PRI faculty to begin teaching this course in 2010. Lori is a teacher at heart, both with her patients as well as colleagues in her PRI courses. You will see this demonstrated in the many videos, articles and blogs she has created over the years.

Jen Poulin graduated in 1991 from the University of Vermont with her Bachelors of Science in Physical Therapy. She attended her first PRI course (Protonics) in Burlington, VT in 2001. Jen and her husband Chris opened Poulin Performance and Rehabilitation in Burlington, VT in 2002. Jen was also a member of the 2005 Postural Restoration Certified™ (PRC) class. In 2012, Jen and her family moved to Southern Pines, NC and opened Sandhills Sports Performance, where their staff continues to grow, as they mentor them with PRI. After expressing her interest in teaching PRI to Ron, Jen joined the PRI faculty in 2009, teaching Myokinematic Restoration, and Pelvis Restoration beginning in 2013.

Thank you Lori and Jen for your ongoing dedication to the Postural Restoration Institute®, and congratulations on receiving the PRI Director’s Dedication Award!

Posted April 28, 2017 at 10:18AM
Categories: Clinicians

This year’s Interdisciplinary Integration was a symposium that brought together researchers and clinicians in a great two days of learning. Below are some photo highlights of the two days.  

Posted April 27, 2017 at 3:38PM
Categories: Courses

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 2:16PM
Categories: Website Courses Science

No fools this April weekend! Just returned from a trip to the Metroplex of Texas and enjoyed a weekend with some friends from northern Texas to speak to a predominantly first time PRI crowd about the big science of acetabulofemoral and femoralacetabular movement as a part of lumbo-pelvic-femoral movement.

This group of scientists was as hospitable as they get, with representatives from stateside physiotherapists like Dana Martin, ATC students like Patrick Ebke, school coaches like Mario Saldivar, strength coaches like Justin Roach, PT/ATC's like Stephen Laplante, PTA's like Lindsey Wheeler and ATC's like Yoshimi Toguchi to name a few. We broke down the notion of strength as a function of triplanar neuromechanical position first and discussed the need to be aware of AF pathology, and how to do so. More importantly, we had good lab and detailed case study sample discussions about the application of our coursework to clients from all fields. Thank you Miles McGriff for the excellent discussion about integrating the science of PRI in a respectful, professional fashion among the multiple disciplines this science spans. Thank you Kelli Cutshall and Stephanie Hill, the giggle sisters, for keeping attentive and lively throughout the course.

Thank you Adrian "Commander" Pettaway, James "TSA" Edwards and Tim Garland for being willing participants during discussions and commentary. Tandra Langford, your founded PRI science clinical questions added depth to the discussion, Laura Paley and Steven Coppolecchia you were invaluable in assisting our course by serving as examples during lab time.

Finally, thank you Charles in charge Ferruzza, Jared Whitmire and the EXOS team for your time and effort in hosting the course in the "everything's big in Texas" facility. Beautiful!

Thanks again for a great weekend!

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


Hello everyone!


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。


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.


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.


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.!


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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