An Integrated Approach to Treatment of Patterned Thoraco-Abdominal Pathomechanics
An Integrated Approach to Treatment of Patterned Thoraco-Abdominal Pathomechanics
West Jordan, UT
"I was tired of practicing and applying correctives that didn't always fix problems. PRI, has an amazing integration of neurological recruitment and immediate physiological change that other techniques can't touch. Disease has always played a huge factor in breathing pathologies and this course shows you how to teach people to breathe and be functional. I'm so thankful for Ron Hruska, and his team. My clinical life has changed and will never be the same."
See more testimonials below!
We have taken video from the live 15-hour lecture and lab course including Power Point slides, demonstration, lab, and audience question and answer sessions. This home study course is available online/digital which allows for viewing in the comfort of your home or office. You will have 21 days to complete the home study from the time you receive online access.
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
$475 (Online/Digital – you will have online access to all materials and will print your own manual)**
* Home Study Advantage: $237.50 (If you have taken the live course in the past 6 months you are eligible for 50% off the regular price) Learn More
Session 1: Static Structural Asymmetry and Dynamic Respiratory Considerations
Session 2: Dynamic Respiratory Considerations (continued)
Session 3: Patterned Respiration and Anterior Interior Chain (AIC) Overview
Session 4: Left AIC Testing and Non-Manual & Manual Repositioning Techniques (Demonstration & Lab)
Session 5: Brachial Chain (BC) Overview and Posterior Mediastinum Function
Session 6: Right BC Testing and Reasoning (Demonstration & Lab)
Session 7: Right BC Treatment, Superior T4 Manual Technique & Superior T4 Syndrome, and Right Subclavius Manual Technique (Demonstration & Lab)
Session 8: Right BC Treatment, Posterior Exterior Chain (PEC) Overview, and Inhibition Considerations
Session 9: 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.
Licensed Physical Therapists and PT Assistants
Licensed Occupational Therapists and OT Assistants (Classification Codes)
Certified Athletic Trainers
Certified Strength & Conditioning Coaches
Certified Personal Trainers
Licensed Massage Therapists
Other Healthcare and Fitness Professionals
PRI welcomes any licensed healthcare or certified fitness professional to attend our courses. You may be asked to submit your license to practice as a healthcare professional or qualified fitness or strength coach certification (though an organization that is recognized in the United States) to attend PRI courses. Students studying to become a healthcare or fitness professional at an accredited universtity are encouraged to enroll, and may be asked to provide enrollment status and program/degree information. If you have questions about whether you are eligible to complete PRI courses, please contact us. Attendees are responsible for following their state statutes regulating their professional practice. A certificate will be awarded to attendees upon completion of this course or any of the other PRI courses.
Due to known copyright infringement and illegal pirating and distribution of PRI course material in locations across Asia, we are no longer allowing course attendance for PRI home study and live stream courses from several countries in Asia.
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 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.
Approved by the California Board of Chiropractic Examiners for May 1, 2020 - April 30, 2021. 17 Hours of Category B -Physiotherapy, CA-A-20-05-10060.
Approved by the Minnesota Board of Chiropractic Examiners for 15 regular units of instruction for 2020. Course Approval #70408.
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 1.7 AOTA CEUs/17 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 17 EBP Category hours/CEUs. ATs should claim only those hours actually spent in the educational program.
Approved by the Canadian Athletic Therapists Association (CATA) for 5.6 CEU's. Approval valid January 1, 2020 – December 31, 2020.
Strength and Conditioning Coaches
This course is approved by the Collegiate Strength and Conditioning Coaches Association (CSCCa) for 6.25 CEU's.
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.
Register online or by phone
You will receive an email within 24 hours after purchasing the home study with instructions to login and begin your home study online. (*Please note that you must order before 3pm CST on Friday to receive your online access information before the weekend. If you order the home study after 3pm on Friday, you will receive your online access information on Monday). You will receive all materials online including the videos and course manual (which you will be able to download and print). You will also complete the post-test and course evaluation form online. You will need high speed internet in order to watch the videos (the videos are NOT downloadable). Once you have been emailed your online access information, you will have 21 days to complete the course online before your access to the course materials will expire.
You will receive a Certificate of Completion by email if post-examination test is passed (miss 8 or fewer) and course evaluation summary is completed.
Online/Digital Format – Each registrant will receive online access to the approximately 15 hours of course video content, as well as access to download and print the entire course manual (printing the manual is recommended). The post-test and course evaluation form will also be completed online. You will have 21 days to complete the course material, before your online access expires.
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.
Cancellation and Refund Policy
To cancel your registration, please call as soon as possible for a full refund. Cancellations and refunds will not be accepted once the course registrant has set up their online username/password.