Could you elaborate more on the importance of the respiratory pause at end exhalation?

The pause after the exhalation is a way to help you “let go” and “reset” the autonomic nervous system (ANS).  Autonomics is pausing, and pausing is autonomics.  The pause on exhalation helps sensorially by putting heightened feeling or ‘sense’ on the posterior mediastinum, the floor/ground, and extremities.  The amount of time spent on the pause will be different depending on the patient’s fitness level and their autonomic function.  If they are having trouble with pausing after a full exhalation, try maximizing the amount of time that is spent on the exhalation. To control the inhalation of breath, the amount of time spent on exhalation has to be maximized.  To get the most out of our Postural Respiration non-manual techniques (if you do anything with the trunk), there will be a right low trap and right triceps with left IOs and TAs, to help rotate our trunk and maximize more pause with our left side, so we can maximize inhalation through our right lateral chest wall and left posterior mediastinum. To direct the thorax to the right, you have to pause and control the inhalation.  For more information on this topic, Ron Hruska discusses it in much greater detail in a 30 minute video on our PRIVY subscription platform.  

Why in step 5 in the All Four Right AIC Pelvic Floor Respiratory Crawl do you exhale through your nose when you exhale through your mouth in the rest of the steps?

For this technique in step 5 you have your right knee and leg close to each other and are left side bent to the left. The exhalation through the nose in this step is to provide more resistance to activate the L abdominals when they are in that position.

There probably is no greater anti-gravitational muscle we take for granted than the quadriceps. In fact many of us don’t even know when we are using them, because the events associated with the concentric and eccentric force they provide is overshadowed by the mindful result that occurred as they worked.   They are our “ing” muscle.   We use them in walking, squatting, jumping, running, swinging, dancing, lifting, reaching, shifting, and fighting.  Fighting to not fall forward or backward at the same time.  The lower quadriceps tendon pulls us forward so we don’t fall back and our upper quadriceps attachments allow us to extend backwards, with our back extensors, by keeping our pelvis and hips anteriorly rotated.  This concomitant hyperextension of the knee and back decompresses our joint surfaces associated with lateral movement, simply because the quadriceps neurologically and mechanically are associated with autonomic “fight” and “flight” subconscious over sagittal plane stabilization.  

There probably is no greater anti-gravitational muscle that we don’t appreciate for anti-gravitational transverse and lateral control during quadriceps co-contraction than the hamstrings.  The lower hamstrings attachments slightly move the tibia back under the femur as the knee decompresses.   This decompression occurs with hamstring lateral frontal and transverse plane directional, tuning and turning, guidance provided by two hamstrings; one on the outside and one on the inside, of the knee.   The outside hamstring has an external rotational influence on the knee and the one on the inside has an internal rotational influence on the knee.  Thus, both of them acting in unison, provide functional stability as the knee decompresses; while the central tendon of the anterior knee, the quadriceps tendon, destabilizes the joint, because of its lack of lateral joint attachment and its sagittal plane association. The proximal, or upper, attachment of the hamstrings also acts as destabilizer, since it also is central tendon, that attaches to a bone that will decompresses the anterior hip joint when the muscle antagonistically resists the pull of the upper quadriceps, that are acting more as stabilizers, because of their multiple attachment sites. 

There probably is no greater anti-gravitational muscle that stabilizes the femur during quadricep – hamstring co – contraction than the adductor magnus and the biceps femoris muscle.  The first serves as an external rotator of the linea aspera and the second as an internal rotator of the linea aspera.  It compliments the gluteals above the linea aspera and the hamstrings and gastrocnemius below the linea aspera.

Ron Hruska

The TFL and VL are listed as part of the AIC pattern, but the rectus femoris and sartorius are not.  In the Pelvis Restoration course, it is the rectus femoris and sartorius that are mentioned as the ones to inhibit on the left side, and activate on the right to pull the right inlet forward.  I don’t see much mention of the TFL/VL in the exercises, though it is mentioned heavily as one needing inhibited.  Any explanation there? 

The TFL and VL are part of the polyarticular AIC chain.  The Myokinematics course goes more in depth into FAIR/FAER relationships to inhibit the VL and TFL.  The Pelvis course focuses more the iliacus muscle portion of the polyarticular AIC chain and goes more in depth into AFIR (IPIR/IsPER) and AFER (IPER/IsPIR) position to facilitate and inhibit the proximal fibers of the iliacus muscle.  The Sartorius/Rectus Femoris muscles on the left and right side proximally influence the AFIR/AFER position, but are not part of the AIC polyarticular chain of muscle.  As you know, many PRI exercises are integrating  all of the concepts and science from the primary courses (Myokin/Pelvis/and Postural Resp.) and this is discussed more thoroughly in the Advanced Integration Course.  For example, if your patient is doing the Right Sidelying Supported Hemi 90-90  taught in the pelvis course the left iliacus muscle is being facilitated on the left side for AFIR positon thru the pelvis  and the femur for FAIR.   So I am facilitating the left iliacus proximally  while inhibiting both the VL and TFL thru FAIR facilitation of the anterior glute medius.  Again, the concepts have to be broken down into the primary courses due to time constraints and introducing PRI, but are discussed further in the Advanced Integration course.

It seems, when one has a patient that needs the Pelvis Restoration sequence, because the adduction drop is negative now, but they still have a + PADT or PART, one could take them to a very good place using the pelvic sequence detailed by Lori Thomsen, without ever having to go back and do the Myokinematic Restoration algorithm.  They have many points in common of course, but it seems that I may never use the myokin sequence put out, since so many patients seem to have a pelvic issue as well.  Any thoughts on that? 

The Myokin sequence is important if your patient is having difficulty facilitating or inhibiting FAIR/FAER and the Pelvis Course sequence is important if your patient is having difficulty achieving AFIR/AFER.  Truly, integrating concepts taught in both courses with PRI objective tests will enable you to pick the best PRI activities for your patient.  I feel patients advance quicker thru integration of all of the Primary Courses.

-Lori Thomsen

It seems so many  of my patients have a BC component, and need Postural Respiration  matieral as well.  The first exercise taught for repositioning in the Myokinematic Restoration course, the 90-90 Supported Hip Lift with Hemibridge, doesn’t really address that to a significant degree, like the 90-90 Supported Hip Shift with Hemibridge and Balloon from the Postural Respiration course does.  I find that I never use 90-90 Supported Hip Lift with Hemibridge, but maybe I am missing the boat on it?  It sure is easier to teach, but is it as effective to clear up the BC pattern?  What kind of patient WOULD you use it on?  One with mainly only AIC pattern?  I never seem to get those kinds of patients.

I would use the basic 90-90 Hemibridge with someone who has no brachial chain findings. They do exist, but just not as often. However, you can *usually* never go wrong doing the more integrative technique (with the balloon), and it is probably a common go to for others in the group. I say usually because you may find that with some patients they cannot process all of that together in one technique, so you may have them isolate hamstring and pelvic repositioning with the first technique and if they need emphasis on breathing you could give them a separate technique of just learning to breathe (exhale) and blow up balloon – in seated position for example (Stair Short Seated Balloon), or supine in 90-90 position.

-Jen Platt

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!   

Recent course question: Is the Asymmetrical Tonic Neck Reflex (ATNR) ever fully integrated, or is it constant presence throughout our lives?

I am reviewing the Cervical revolution text and have a question. Page 46 in the grey box first point: Lateral Pterygoid pulls ipsilateral base of sphenoid down and forward while the ipsilateral (what the text states) OR contralateral (what seems correct) greater wing simultaneously raises? 

In OA osteo kinematics section the O rotates contralaterally to lateral flexion, Atlas goes opposite and Axis follows O (p31.) But in Arthrokinematics section Lateral flexion of O on A with conjunct contralateral O rotation, alar ligaments causes ipsilateral axial rotation and contralateral atlas rotation (atlas follows O.) Can you explain this? I cant seem to make it right in my head. 

Page 46 is correctly written and holding a model of a sphenoid or looking at a 3-D image of one would possibly help understand the relationship of the lower base of the sphenoid to the greater wing.   I can appreciate the difficulty you may have in their relationship.

The first sentence on page 31 relates only to Occipital (O) movement on the Atlas (A) in lateral flexion if the axis of the spine in general is in a neutral position. Often this is not the case. In a neutral position the last sentence on page 31 is also correct.  However, keep  in mind the mechanics of C1, or the atlas, on C2, or the axis, or C2 movement on C1 could  be challenged in lateral flexion if the lateral flexion of O on A or A on O occurred on a cervical spine that is positionally  laterally flexed to the right or to the left.

In the Arthrokinematic section of the Cervical Revolution manual, page 37 compliments page 31.  The top of page 38 is also correctly written with respect to the alar ligament and soft tissue in general.  Our control and stability of the O on A and the A on O depends on this counter balance provided by this tissue to offset osteokinematic momentum and obligatory osseous directive force.  Therefore, without this contralateral arthrokinematic tension the osteokinematic directional guidance from the bone surfaces of the O and A would promote over lateral flexion, rotation, sagittal movement at some place or point in the transverse or frontal planes and possible joint subluxation.

I hope this helps in understanding the role eccentric ligament and muscle tension plays during opposite obligatory osseous directed movement.  Thanks again for inquiry.   

Ron

For the Supine Active Sacro-Spheno Flexion, I have a few questions:
1. What is the benefit of the forward jaw?

2. Why not allow OA flexion? I thought the TMCC pattern involves SB flexion with OA extension and lower cervical flexion, wouldn’t the OA flexion promote the SB extension that is needed?

3. If we are using the Styloid to help ER the R temporal bone, where is the tongue (as it relates to the hyoid bone) during this exercise?

The benefit of moving the jaw forward is that the lateral pterygoids help move the cranium back and around the rolled up towel under the mid neck.  Cranial retraction allows more freedom at the articulating paired bones of the cranium and promotes OA extension, which is a precursor for cranial flexion (and is the expansion and “repositioning” segment of the technique).  The right TMCC pattern includes left SB flexion and OA extension when compared to the position of the right cranium that is in a probable state of right cranial extension and OA flexion. So, we are setting up for cranial flexion through the OA by acquiring “normal” OA extension or neutral position by bringing the mandible forward so that both sides of the cranium and cranial base are capable of being repositioned.  OA flexion would promote SB extension and if you would only perform this on the left, you would also promote more OA extension on the right when considering the influence the left OA would have on the right OA, during this accompanying cranial rotation to the right.  So, we want to promote more right OA extension in most humans to reverse or establish head or sphenoid rotation to the right and accompanying thorax rotation (T4) to the right .  I am using the styloid muscle to assist with ER and anterior rotation of the right temporal bone as OA extension is preserved across both occiputs and as cranial flexion is enhanced through right temporal ER.  The OA extension on the left should not interfere with cranial function since both sides of the cranium are now in flexion.  One would need more OA flexion on the left for left sphenoid or cranial extension, if more active cranial and head rotation to the right is desired.  But, in this technique we are establishing neutrality at the base of the head and then promoting biased cranial flexion on the right through temporal movement.  The tongue should be relaxed and inactive as it rests in the freeway space of the anterior oral cavity.  I am depending on the styloid hyoid and the strylopharyngeal muscle to pull the temporal styloid process and reposition the temporal bone on the right, not necessarily the styloglossus muscle, because the aforementioned muscle is now adhered to secured pharynx and hyoid because of the neutral rest position that the head and neck are in.  Too many of us use the styloglossus muscle to “move” or stabilize the temporals and this technique more than likely reduces the demands on the tongue and placing more demands on temporal pharynx and temporal hyoid movement versus pharynx temporal, hyoid temporal and glossus temporal  movement. 

–Ron Hruska

Is it correct that the Left diaphragm is more responsible to pull the air to Right chest and Right diaphragm is more responsible to pull the air to Left chest? I was looking for the mechanism of this from PRI textbook and other resources, but could not find the one that makes this clear for me. I would really appreciate if you could explain the mechanism and/or give me some resource to explain that.

There is really no ‘one’ excellent resource to go to that will talk about hemi-diaphragm activity influence on the chest wall uniformly or non-uniformly.  There is no discussion how tidal volume or residual  volume of the lung is influenced by thoracic rotation or hyperinflation more so on one side of the chest wall than the other, even when you review the Scoliosis literature.  However, there is a great deal of information on how ribs are influenced by spinal coupling and directional rotation.  The costal aspect of the diaphragm is responsible for rib external rotation upon diaphragm contraction, while the crural fiber is primarily responsible for dome descension and thoracic lumbar spinal extension.  We have two sets of these muscles and when one rotates to the left with the rib cage or thorax, the ribs on the left are externally rotated with respect to the ribs on the right and the extension of the back at the thoracic lumbar vertebral wall is more extended on the left when compared to the right (Left AIC pattern).  Therefore, the costal and crural fiber on the left is at concentric end range and any respiration that occurs in this pattern will primarily occur with the hemi-diaphragm on the left because of the lengthened state of the crural and costal fiber on the right compared to the left.  Reciprocal breathing in this pattern will more than likely compliment reciprocal thoracic wall expansion on the right, because the costal fiber can pull the ribs up on this side, and the recoil upon exhalation is preserved because of the position the thoracic mediastinums.   Most researchers in pulmonary medicine or in functional performance do not measure tidal volume with individuals in this extreme state of torsion or rotation, either because they do not understand how posture can actually be challenged by these concepts or because it is a very untraditional method that would have a very difficult time being accepted by research reviewers and readers, since they probably would not appreciate the significance of thoracic mechanical expansion or lack of, when considering pulmonary function.  PRI is the only resource you will probably find that postulates these concepts that are scientifically sound because of what already exists in evidenced based research to date on rib mechanics, thoracic function and pulmonary studies.  Patterns of respiration such as the Left AIC or Right BC have not been ever considered to my knowledge.   

Asymmetrical ventilation and perfusion between the right and left lungs occurs in more than half of the children with severe congenital and infantile thoracic scoliosis.  However, the severity of lung function asymmetry does not relate to Cobb angle measurements.  Asymmetry in lung function is influenced by deformity of the chest wall in multiple dimensions, and cannot be ascertained by chest radiographs alone (Redding G. Song K. et al Lung function asymmetry in children with congenital and infantile scoliosis. The Spine Journal, 2008, vol 8,(4) 639-644.).  The last sentence describes it all.  It is very difficult to measure lung or perfusion function unilaterally with an x-ray, or any other pulmonary study method only because of the inability to separate flow from one side of the thorax upon normal non-compensatory postural positions versus compensatory postural positions that become neurologically habitual patterns of the “way” we breathe. 

–Ron Hruska

How does the left low trap and serratus “secure the spine” (as mentioned for management of superior T4 following treatment of it)?

The left lower trapezius muscle rotates the mid thoracic spine to the right as it assists with internal rotation of the left ribs that are attached to the thoracic spine, and movement of the same ribs posteriorly. An individual with a superior T4 syndrome is experiencing difficulty in moving the right first and second ribs into internal rotation and the first and second ribs on the left, concomitantly, into external rotation upon left trunk rotation. During right trunk rotation, all the ribs on the left rib cage need to simultaneously rotate into internal rotation and likewise all the ribs on the right rib cage need to rotate into external rotation. After performing a right subclavius manual technique to increase the length of the right subclavius muscle, spinal rotation to the left is needed to take advantage of implementing internal rotation of all the ribs on the right, since now, ribs one and two on the right can internally rotate and ribs one and two on the left can externally rotate.

By reaching forward with the right arm to activate the right low trap and right serratus anterior for left spinal rotation and scapular movement on the thorax, you re-align all the ribs by moving the right ribs into internal rotation. Reaching forward with the right arm a little more upon exhalation would help this process even more. Then, reverse and move the left arm forward, upon exhalation, to rotate the spine and rib cage to the right. Every time you inhale, with the left arm reaching forward, expand or move back the left posterior ribs a little more. By moving the left ribs back on inhalation with the left serratus anterior, as the spine is being held or stabilized in right trunk rotation, the diaphragm can assist with air flow into the left posterior chamber of the left lung promoting universal posterior thoracic expansion during right trunk rotation without losing internal rotation provided by the left serratus anterior of the left lower ribs.

From this point on, your right lower trap will now experience more stabilization from the left lower and mid ribs and the left lower trapezius during alternating arm reaching or trunk rotation. In essence, the left lower trap is now serving as an eccentric stabilizing force for left posterior thoracic expansion during left heel strike and left arm reach. Without the left lower trapezius and left serratus anterior functioning upon left arm reach, the spine would not need to rotate to the right with the left lower trapezius because it may already be oriented to the right because of lost left posterior thoracic expansion and inability to open the apical or posterior left lung and chest wall. The left first and second ribs staying in an internal rotated state, limits the ability to expand the upper posterior mediastinum or lung tissue. Therefore, following the right subclavius manual technique used for treatment of a superior T4 syndrome, alternating right lower trapezius and right tricep with left lower trapezius and left serratus anterior is highly recommended for spinal stabilization during alternating trunk rotation or gait.

-Ron Hruska