Last week I had the opportunity to take Advanced Integration for the 2nd time followed by 2 days of PRC testing. I found the experience to be extremely beneficial in enhancing my PRI philosophy and skills while also further engraining my connection to our special community. I highly recommend going through this process to those who believe in continuing to expand their PRI methodology and horizon. The journey of taking the required classes, completing the application, preparing for certification, and finally going through testing is a huge learning experience. Completing this endeavor not only demonstrates a certain level of competence of PRI but further develops your relationship with the institute and peers who will always be a significant pillar of support for you. I regard us as a family.
Because I care so much about PRI and its valuable clinical application I thought it would be helpful to my fellow PRI practitioners to share a couple important take home messages that I gleaned from last week’s experience coupled with my 2 years of PRI based clinical practice (not sure if I can count the prior 12 years….) I hope that this knowledge will help others to have more efficient and effective outcomes utilizing PRI’s powerful and unique approach to system integration. Please let my struggles become your success.
Let’s start with the concept of “Biasing Bilateralism.” I can remember back to when I first took Pelvis Restoration and learned about the “PEC.” This is the individual who has both AIC chains locked up coupled with excessively facilitated back extensors (usually R>L). This pattern may also parallel a bilateral BC and/or bilateral TMCC. At the time, I was really excited to learn about this bilateral phenomenon because it seemed like the majority of my patients presented this way. Most of my patients had both legs that would not adduct, arms that would not internally rotate and horizontally abduct, and posterior mediastinums that would not expand. Thus, I readily complied with the PEC algorithm and began doling out a lot of Modified All 4 Belly Lifts, Squat and Reaches, 90/90 Hip Lifts, Short Seated Balloon Blowing, etc. The problem with this was that many of these individuals were still not transitioning into a L AIC/R BC/R TMCC (unilateral) pattern despite my persistence at inhibiting their bilateral posterior mediastinums and posterior outlets while facilitating their left and right zones of apposition in the sagittal plane.
After I took Advanced Integration last year and listened to Ron speak about the necessity of our system to serve as a pump (to push gas, solids, and liquids) I decided to try to apply this concept to my PEC patients. I figured out that if I had my PECs pump their rib cage during bilateral flexion based exercises I got better results. Pumping means I had them do alternating reaching coupled with inhalation and exhalation (R/exhale and L/inhale seemed to work best and is consistent with PRI’s breathing/reaching patterns). I used short seated, all four, 90/90, supine hooklying, and squat positions for the pump activities. I was going rogue in terms of the PRI algorithm and having non-neutral individuals do alternating frontal and transverse plane rib cage movement to reduce extension tone. Even though this alternating motion was not truly authentic (meaning the performing individual did not yet have true full reciprocal motion in all planes) it helped many of my “stuck” PECs to get out of their bilateral sagittal world to either a L AIC/R BC/R TMCC pattern or in some cases actual neutrality. Once they achieved either of these patterns I would then return to the traditional PRI algorithm for further progression.
Even though the pumping was helpful at getting a lot of my bilaterally patterned patients to shift into a unilateral pattern or even neutrality I was still having trouble getting others to change. Thus my first take home message from this past week of PRI extravaganza: Bias your bilaterals! What this means is that when you are doing your bilateral posterior mediastinum/outlet/capsule inhibition and zone of apposition facilitation activities put a twist into the mix. For example, get them to flex and sidebend more on the left compared to the right (thoracic flexion and L abduction), bias them more into L AF IR, have them be more aware of their left periphery, and/or see if they can find their left canines, etc. If you are already choosing a platform activity that puts them into flexion they are less likely to kick in their extension tone when performing the activity. These techniques are still addressing the bilateral extension problem but are also tailored to the underlying asymmetrical extension pattern. Because these individuals are existing in a sagittal reality and are deprived of tri-planar movement variability what they really need is a stimulus to allow them to sense a change to bring them out of their one dimensional existence. They need to experience something different to get their system to shift. They also have to want and see a purpose for making this change but that’s another story… Furthermore, if while performing a unilaterally biased flexion based activity and they do indeed end up undesirably compensating you always have your PRI tests to fall back onto. That way even if you don’t see any extension while they are performing the technique you can always rely on your tests to tell you what really happened.
We now come to the next part of my take home message: Use unilateral sensory integration to bias your bilaterals! As was just explained, we can position our patients when performing their exercises to simultaneously address both the bilateral and underlying unilateral extension pattern. However, when actually executing these techniques to get certain chains of muscles to become more active and others less active you can’t forget about the sensory component to these sensory-motor techniques. In other words, you cannot separate motor from sensory. The brain needs both! What this means is that even though you may be setting them up to perform the exercise perfectly from a biomechanical perspective (which enhances the proprioceptive aspect) you also have to make sure they can actually feel what you are trying to get them to do. For example, do they feel their left basal anterior ribs move down, in, and back? Do they feel their right anterior apical ribs and left posterior apical ribs expand? This concept of sensory “reference centers” is discussed in depth in the Impingement and Instability course but focuses more on the extremity reference centers such as the left heel, right arch, left glut med, etc. This past week, it became even more crucial to me of not only the need for tri-planar rib cage movement but for this motion to be coupled with a parallel sensory awareness of it.
From a clinical perspective, if someone is having difficulty moving and feeling their rib cage with a non-manual activity that is biased towards unilateralism the next step would be to incorporate a manual technique. Similarly to what was explained in the previous paragraph, the purpose of a manual technique is not just to provide increased mobility capacity of connective tissue but also to develop increased sensory awareness of that tissue. Therefore, consider PRI manual techniques to really be motor (breathing component utilizing the diaphragm and abdominals) as well as sensory (manual sensory contact coupled with the kinesthetic perception of rib cage movement and muscle activation). Once again, you cannot separate motor from sensory. Therefore, while performing your manual techniques I suggest cueing your patient to engage with you from a kinesthetic perspective. Can they sense their ribs moving in a particular direction? Are they aware of their internal obliques/transverse abdominus (with a left bias) activating? This brings us to my final concluding point which is to regard manual techniques as both a sensory and motor application to bias your bilaterals as well as integrate your unilaterals. When we consider the core PRI manual techniques they are inherently asymmetrical in nature to reflect this natural human phenomenon. They are already unilaterally biased and thus designed for our asymmetrical design. Thank you Ron Hruska!