An Integrated Approach to Treatment of Patterned Thoraco-Abdominal Pathomechanics
"Posture and breathing have always been important. This gives me a new, better conceptual framework that addresses asymmetry."
See more testimonials below!
This advanced lecture and lab course is structured so that clinicians will gain an appreciation for the patterned respiration influences on: rib torsion, asymmetrical oblique strength, costal and crural function, habitual use of accessory respiratory musculature, and a positionally restricted diaphragm. The focus of this course will be to assess and restore polyarticular muscular chain function of both hemi-lateral thoraxes and their respective pleura. Treatment interventions including manual and non-manual techniques to restore reciprocal and alternating respiratory and rotational function of the thorax will be covered. Participants will be able to immediately apply PRI clinical assessment and intervention strategies when treating diagnoses that are related to undesirable airflow patterns, such as shortness of breath, thoracic outlet syndrome, and shoulder dysfunction.
Education Level: Advanced
Student Faculty Ratio 16:1
Cost: $495 (Early registration rate: At least 4 weeks before the course)
$545 (Late registration rate: Within 4 weeks of the course)
|August 17-18, 2019||Cantrell Center for Physical Therapy Warner Robins , Georgia||Robert "Skip" George||22 Open|
|September 14-15, 2019||Rosencutter Ultra Fitness Greenfield , Wisconsin||Robert "Skip" George||44 Open|
|September 21-22, 2019||Charles George VA Medical Center Asheville , North Carolina||Louise Kelley||32 Open|
|October 26-27, 2019||Motus Integrative Health Crown Point , Indiana||Louise Kelley||34 Open|
|November 2-3, 2019||Los Angeles Dodgers-Spring Training Facility Phoenix , Arizona||James Anderson||43 Open|
|November 9-10, 2019||Robbins Rehabilitation Easton , Pennsylvania||Robert "Skip" George||40 Open|
|7:30am - 8:00am||Registration and Light Breakfast|
|8:00am - 9:00am||Overview of Anterior Interior Chain (AIC), Brachial Chain (BC) and Zone of Apposition (ZOA) Relationships|
|9:00am - 10:00am||Static Structural Asymmetry and Dynamic Respiratory Influences on Hemi-Diaphragm and Hemi-Thorax Function|
|10:00am - 10:15am||Break|
|10:15am - 11:00am||Patterned Respiration and Associate Airflow|
|11:00am - 12:00pm||Anterior Interior Chain: Muscle and Structure|
|12:00pm - 1:00pm||Lunch (on your own)|
|1:00pm - 2:00pm||Left AIC Objective Testing (Demonstration)|
|2:00pm - 3:00pm||Left AIC Non-Manual and Manual Techniques (Demonstration)|
|3:00pm - 3:15pm||Break|
|3:15pm - 4:00pm||Left AIC Manual Techniques (Lab)|
|4:00pm - 4:30pm||Brachial Chain: Muscle and Structure|
|4:30pm - 5:00pm||Overview of Thoracic Mediastinum Function|
|7:45am - 8:00am||Sign-In and Light Breakfast|
|8:00am - 8:30am||Postural Respiration Functional Relationships|
|8:30am - 10:00am||Right BC Objective Testing (Demonstration and Lab)|
|10:00am - 10:15am||Break|
|10:15am - 11:00am||Right BC PRI Treatment Guidelines|
|11:00am - 11:30am||Superior T4 Airflow|
|11:30am - 12:00pm||Right Superior T4 and Right Subclavius Manual Techniques (Demonstration)|
|12:00pm - 1:00pm||Lunch (on your own)|
|1:00pm - 2:00pm||Right Superior T4 and Right Subclavius Manual Techniques (Lab)|
|2:00pm - 3:00pm||Left Low Trap/Left Serratus Anterior Non-Manual Techniques|
|3:00pm - 3:15pm||Break|
|3:15pm - 4:00pm||Right Low Trap/Right Tricep Non-Manual Techniques|
|4:00pm - 4:30pm||Inhibition Considerations for the Right BC Pattern|
|4:30pm - 5:00pm||Case Studies|
Zone of Apposition
Anterior Interior Chain (AIC)
Muscles: Diaphragm, Psoas, Iliacus, TFL, Vastus Lateralis, Biceps Femoris
Opposition Muscles: Hamstrings, Gluteals, Internal Obliques
There are two anterior interior polyarticular muscular chains in the body that have a significant influence on respiration, rotation of the trunk, ribcage, spine and lower extremities. They are composed of muscles that attach to the costal cartilage and bone of rib seven through twelve to the lateral patella, head of the fibula and lateral condyle of the tibia. These two tracts of muscles, one on the left side of the interior thoraco-abdominal-pelvic cavity and one on the right, are composed of the diaphragm and the psoas muscle. With the iliacus, tensor fasciae latae, biceps femoris and vastus lateralis muscles this chain provides the support and anchor for abdominal counter force, trunk rotation and flexion movement.
Brachial Chain (BC)
Muscles: Anterior-Lateral Intercostals, Deltoid-Pectoral, Sibson’s Fascia, Triangularis Sterni, Sternocleidomastoid, Scaleni, Diaphragm
Opposition Muscles: Triceps, Lower Trapezius, Abdominal Obliques
There are two brachial polyarticular muscular chains lying over the anterior pleural and cervical area. These chains influence cervical rotation, shoulder dynamics and apical inspirational expansion. They are composed of muscle that attaches to the costal cartilages and bone of ribs four through seven and xiphoid to the posterior, inferior occipital bone, anterior, inferior mandible and coracoid process of scapula. These two tracks of muscles, one on the left side of the sternum and one on the right, are anterior to the medial and upper mediastinum and upper thoracic cavity and are composed of the triangular sterni, sternocleidomastoid, scalene, pectoralis minor, intercostals and muscles of the pharynx and anterior neck. They provide the support and anchor for cervical-cranial orientation and rotation and rib position. The right brachial chain muscle is opposed by the right posterior back muscles (PEC), lower trap, serratus anterior, and external rib rotators, in addition to the left internal abdominal obliques. The brachial chain muscle on the left is opposed by the left posterior back muscles (PEC), lower trap, serratus anterior, external rib rotators, and right internal abdominal obliques.
Posterior Exterior Chain (PEC)
Muscles: Latissimus Dorsum, Quadratus Lumborum, Posterior Intercostals, Serratus Posterior, Iliocostalis Lumborum
Opposition Muscles: Abdominal Obliques
Patient lies in supine with knees flexed to flatten the lumbar spine. Passively take the patient’s arm into horizontal abduction while securing the shoulder joint with one hand and maintaining forearm supination with the other hand.
A positive test is indicated by limited horizontal abduction of one extremity when compared to the other. Less than 30° is considered limited.
Patient lies in supine with knees flexed to flatten the lumbar spine. Position the patient’s bent arm at shoulder level. Stabilize the shoulder by placing firm pressure on the anterior shoulder joint. Passively rotate the patient’s arm toward the mat as far as it will go. Repeat the test on the opposite extremity. A positive test is indicated when the patient’s arm will not fully rotate towards the mat or table.
Patient lies in supine with knees flexed to flatten the lumbar spine. Patient inhales through nose, upon exhalation guide left rib cage down. Hold ribs down as patient attempts to fill opposite chest wall. Repeat on opposite side.
A Positive test is indicated when the patient is unable to draw air into the right thoracic chest wall as easily as on the left, through patient report or tester observation. Limitation in expansion of the right thoracic-apical chest wall reflects right rib internal rotation orientation with accompanying left rib external rotation orientation secondary to possible compensation of thoracic rib cage to the left as a result of thoracic “spinal” orientation to the right.
Lando Y, Boiselle PM, Shade D, Furukawa S, Kuzma AM, Travaline JM, Criner GJ. Effect of lung volume reduction surgery on diaphragm length in severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999 Mar;159(3):796-805.
Mead J. Functional significance of the area of apposition of diaphragm to rib cage. Am Rev Respir Dis. 1979;11:31.
Physical Therapists and PT Assistants
Occupational Therapists and OT Assistants (Classification Codes)
Strength & Conditioning Coaches
Other Healthcare Professionals
PRI welcomes any interested healthcare professional to attend our courses. Attendees are responsible for following their state statutes regulating their professional practice. A certificate will be awarded to registrants upon completion of this course or any of the other PRI courses.
Accessible Learning Environments
All participants in Postural Restoration Institute™ (PRI) continuing education courses are entitled to an accessible, accommodating, and supportive teaching and learning environment. Participants have the right to request accommodations and the responsibility to provide disability documentation that supports those requests. PRI has the right to establish eligibility guidelines in accordance with both law and policy regarding disability and provide those accommodations that appropriately provide equal access to the programs and activities it sponsors.
A Certificate of Completion for 15 contact hours is awarded to attendees upon the successful completion of this course. Before attending a course, please verify CEU acceptance with your profession’s regulating body.
Physical Therapists and PT Assistants
In the states where PRI is sponsoring courses and where approval through state American Physical Therapy Association (APTA) or licensing agencies is required, PRI will apply for approval for CEUs for Physical Therapists and Physical Therapist Assistants.
In the states where PRI is sponsoring courses and where approval through state licensing agencies is required, PRI will look into applying for CEUs for Chiropractors (upon request). Requests must be made at least 90 days prior to the course date.
Occupational Therapists and OT Assistants
The American Occupational Therapy Association (AOTA) recognizes PRI as an Approved Provider of continuing education. AOTA Provider #6596. Please note that the assignment of AOTA CEUs does not imply endorsement of specific course content, products, or clinical procedures by AOTA. This course awards 1.5 AOTA CEUs/15 Contact Hours.
Athletic Trainers & Athletic Therapists
Postural Restoration Institute (BOC AP# P2376) is approved by the Board of Certification, Inc. to provide continuing education to Certified Athletic Trainers. This program is eligible for a maximum of 15 EBP Category hours/CEUs. ATs should claim only those hours actually spent in the educational program.
This course is approved by the Canadian Athletic Therapists Association (CATA) for 6 CEU's. Approval valid November 10, 2016 - November 10, 2018.
Strength and Conditioning Coaches
This course is approved by the Collegiate Strength & Conditioning Coaches Association (CSCCa) for 7.5 CEU's.
Since continuing education courses are not required to have pre-approval through the National Strength and Conditioning Association (NSCA), this course is not currently approved through the NSCA. NSCA certificants interested in completing this course may contact the NSCA to inquire about CEU eligibility.
PRI is approved by the National Certification Board for Therapeutic Massage & Bodywork (NCBTMB) as a continuing education Approved Provider. Provider number 451877-12. *Approval not valid for New York licensed massage therapists.
Other Healthcare and Fitness Professionals
PRI Welcomes any interested healthcare or fitness professional to attend our courses. Attendees are responsible for following their state statues regulating their professional practice as they integrate interdisciplinary PRI concepts.
Participation is limited to ensure a low faculty to student ratio. Please register early. Courses will be canceled or rescheduled if fewer than 15 participants have registered by the early registration deadline of four weeks prior to the scheduled course date.
Special Needs Requests
If you have a disability and require accommodation in order to fully participate in this course, please contact us at least two weeks prior to the course date or prior to purchasing any online home study course so that arrangements can be made.
The course must be attended in full, and a course evaluation summary completed in order to receive a certificate of completion for 15 CE hours. If you arrive late, or leave early, your certificate of completion will be adjusted for the number of CE hours you were in attendance.
Cancellation and Refund Policy
Tuition is refundable less $50 if cancelled 14 days before the course date. Tuition is not refundable for registrations or cancellations within 14 days of the course. However, you may have someone attend in your place or attend on another date. If you choose to attend on another date, a $50 fee applies to transfer your registration. If you are a no show and we have no communication with you before the course you will forfeit your course tuition. PRI reserves the right to cancel a course and will refund the tuition fee only.