Postural Respiration Home Study

An Integrated Approach to the Treatment of Patterned Thoraco-Abdominal Pathomechanics

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Course Format

$500.00

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

Recognize relationships between static asymmetrical respiration, ideal physiologic respiration, and patterned respiration.
Identify how to restore restrictive polyarticular chains and torsional patterns of the trunk through specific manual and non-manual orientation of ventilatory muscle, and thoracic osseous structure.
Recognize how to maximize thoracic scapular force couples, rib alignment, and abdominal-diaphragm muscle integration for appropriate motor and sensory perceptual skill development of the upper extremities.
Outline how to design a postural isolation and inhibition program that promotes integration of appropriate hemi-thoracic airflow to reduce occupational, leisure, and sleep breathing dysfunction patterns.

Session 1: Static Structural Asymmetry and Dynamic Respiratory Considerations

114 minutes

Session 2: Dynamic Respiratory Considerations (cont.) and Patterned Respiration

108 minutes

Session 3: Anterior Interior Chain (AIC) Overview, Left AIC Testing and Non-Manual Repositioning Techniques (Demonstration)

108 minutes

Session 4: Left AIC Manual Techniques (Demonstration), Left AIC Testing and Non-Manual & Manual Repositioning Techniques (Lab)

130 minutes

Session 5: Brachial Chain (BC) Overview and Posterior Mediastinum Function, Right BC Testing and Reasoning (Demonstration)

113 minutes

Session 6: Right BC Functional Relationships, Right BC Treatment Guidelines, Right BC Non-Manual Repositioning Techniques, Superior T4 Airflow

72 minutes

Session 7: Right Superior T4, Right Subclavius & Infraclavicular Pump Manual Techniques (Demonstration), Right BC Testing and Manual Techniques (Lab), Right BC Treatment Guidelines (Demonstration)

179 minutes

Session 8: Right BC Treatment Guidelines (Demonstration), Posterior Exterior Chain (PEC) Overview, PEC Inhibition Techniques (Demonstration)

124 minutes

Dynamic Function/Posture

Boyle K, Olinick J, Lewis C. The Value of Blowing Up a Balloon. North American Journal of Sports Physical Therapy (NAJSPT). September 2010;5(3):179-188.
Buford J, Yoder S, Givens Heiss D, Chidley J. Actions of the scalene muscles for rotation of the cervical spine in macaque and human. JOSPT Oct 2002; 32(10): 488-496.
DiPanfilo R, Candelaria S, et al. Thoracic mobility and athletic performance. NSCA Coach. Aug 2019;6(2):36-42.
Flynn T. The thoracic spine and rib cage; musculoskeletal eval and treatment.1996. Butterworth-Heinemann, Newton.
Hodges PW. Is there a role for transverses abdominis in lumbo-pelvic stability? Manual Therapy. 1999;4(2): 74-86.
Hudson AL, Butler JE, et al. Role of the diaphragm in trunk rotation in humans. JN Physiol. Oct 2011;106(4):1622-28.
Kolar P, Sulc J, et al. Postural function of the diaphragm in persons with and without chronic low back pain. Journal of Orthopaedic and Sports Physical Therapy. Apr 2012;42(4):352-62.
Jackson LR, Purvis J, Brown T. The effects of postural and anatomical alignment on speed, power and athletic performance in male collegiate athletes: a randomized controlled trial. IJSPT. August 2019;14(4):623-636.
Karimi N, Fathizadeh M, et al. Efficacy of pelvic repositioning exercises on pain, hip and shoulder range of motion and disability of the patients with chronic non-specific low back pain: a single blinded randomized controlled trial. Journal of Rehabilitation Sciences and Research. 2021;8(3):106-114.
Kouwenhoven JW, Vincken KL, Bartels LW, Castelein RM. Analysis of preexistent vertebral rotation in the normal spine. Spine 2006;31:1467-1472.
Mezieres F. “Importance de la Statique Cervicale”, Cahiers de la Methode Naturelle, No. 51, 1972.
Mezieres F. “Le Reflexe Antalgique a Priori,” Cahiers de la Methode Naturelle, No. 44, 1970.
Mezieres F. “Les Pieds Plats,” Cahiers de la Methode Naturelle, No. 49, 1972.
Mezieres F. “Methodes Orthopediques” and “La Fonction du Sympathique,” Cahiers de la Methode Naturelle, Nos. 52-53, 1973.
Morais NV, Pascoal AG. Scapular positioning assessment: Is side-to-side comparison clinically acceptable? Manual Therapy. 2013;18:46-53.
Myers T. Anatomy trains; myofascial meridians for manual and movement therapists. 2002 Churchill Livingstone, Edinburgh.
Nourbakhsh MR, et al. The effects of pelvic alignment versus hip joint mobility on shoulder internal rotation deficit and torque production – A blinded randomized controlled study. Physical Therapy in Sport. 2018; 34:164-173.
O’Sullivan P, Beales D, Beetham J, Cripps J, Graf F, Lin I, Tucker B, Avery A. Altered motor control strategies in subjects with sacroiliac joint pain during the active straight leg raise test. Spine 2002; 27(1):E1-E8.
Oda I, Abumi K, Lu D, Shono Y, Kaneda K. Biomechanical role of the posterior elements, costovertebral joints, and rib cage in stability of the thoracic spine. Spine. 1996;21(12): 1423-1429.
Rothstein JM. Editor’s Note: What we don’t know can hurt us. Physical Therapy. Oct 2002;82(10).
Skaggs JR, et al. The effect of arm and body position on respiratory ventilation in high school athletes: a pilot study. International Journal of Athletic Training. 2016;21(1):30-34.
Szcygiel E, Weglarz K, et al. Biomechanical influences on head posture and the respiratory movements of the chest. Acta of Bioengineering and Biomechanics. 2015;17(2):143-148.
Waldron JL, McKenney MA, et al. The use of postural restoration for treatment of chronic rotator cuff pathology: a case report. Int J Sports Phys Ther. 2020 Oct;15(5):832-839.
Yeamattanaporn O, Mekhora K, Jalayondeja W, Wongsathikun J. Immediate effects of breathing re-education on respiratory function and range of motion in chronic neck pain. J Med Assoc Thai Vol 97 Suppl. 7 2014. S55-S59.

Neurology

Bagesteiro L and Sainburg R. Handedness: dominant arm advantages in control of limb dynamics. J Neurophysiol 88: 2408-2421, 2002.
Barnes M, Crutchfield C, Heriza C. The neurophysiological basis of patient treatment. Volume II, Reflexes in motor development. West Virginia, Stokesville Publishing Company, 1978.
Ben-Dov I, et al. Diaphragmatic paralysis: a clinical imitator of cardiorespiratory diseases. Israel Medical Association Journal. 2008; 10(8-9):579-583.
Bertherat T, Bernstein C. The body has its reasons; self-awareness through conscious movement. Healing Arts Press, 1989.

Bordoni B et al. The influence of breathing on the central nervous system. Cureus. 2018;10(6): e2724. DOI 10.7759/cureus.2724
Bordoni B, Marelli F, et al. The five diaphragms in patients following cardiac surgery in sternotomy: An observational study. Int J Complement Alt Med. 2017; 7(6):00245.
Bordoni B, Simonelli M, Morabito B. The fascial breath. Cureus. 2019;11(7):e5208.
Bordoni B, Zanier E. Anatomic connections of the diaphragm: influence of respiration on the body system. Journal of Multidisciplinary HealthCare. 2013:6 281–291.
Bordoni B, Zanier E. The continuity of the body: Hypothesis of treatment of the five diaphragms. The Journal of Alternative and Complementary Medicine. 2015; 21(4):237-242.
Brunnstrom S. Movement therapy in hemiplegia. New York, Harper and Row Publishers, 1970.
Cherniack NS, et al. Responses of upper airway, intercostal and diaphragm muscle activity to stimulation of oesophageal afferents in dogs. The Journal of Physiology. 1984; 349(1):15-25.
Corda M, et al. Proprioceptive innervation of the diaphragm. The Journal of Physiology. 1965; 178(1):161-177.
Day LB, MacNeilage PF. Postural asymmetries and language lateralization in humans (Homo sapiens). J Comp Psychol. 1996 Mar;110(1):88-96.
Elliott S. The new science of breath, 2nd ed. Coherence Publishing. 2005.
Fiorentino MR. Normal and abnormal development. The influences of primitive reflexes on motor development. Springfield, Charles C Thomas, 1972.
Gabbard C, Hart S. Effects of standing and sitting on finger-tapping speed in healthy adults. JOSPT. Oct 2002; 32 (10): 525-529.
Henderson AT, et al. Effects of rib raising on the autonomic nervous system: a pilot study using noninvasive biomarkers. J AM Osteopath Assoc. 2010 Jun; 110(6):324-330.
Hjortskov N, et al. The effect of mental stress on heart rate variability and blood pressure during computer work. Eur J Appl Physiol. 2004 Jun; 92(1-2):84-89.
Hodges PW, Butler JE, McKenzie DK, Gandevia SC. Contraction of the human diaphragm during rapid postural adjustments. Journal of Physiology (1997), 505.2, pp.539-548.
Hodges PW, Heijnen I, Gandevia SC. Postural activity of the diaphragm is reduced in humans when respiratory demand increases. Journal of Physiology (2001), 537.3, pp. 998-1008.
Hodges PW, Richardson CA. Contraction of the abdominal muscles associated with movement of the lower limb. Physical Therapy. 1997; 77(2):132-144.
Hodges PW, Richardson CA. Feedforward contraction of transversus abdominis is not influenced by the direction of arm movement. Exp Brain Res (1997) 114:362-370.
Kenyon CM, Cala SJ, Yan S, Aliverti A, Scano G, Duranti R, Pedotti A, Macklem PT. Rib cage mechanics during quiet breathing and exercise in humans. J Appl Physiol. 1997 Oct;83(4):1242-55.
Khedr EM, Trakhan MN. Localization of diaphragm motor cortical representation and determination of corticodiaphragmatic latencies by using magnetic stimulation in normal adult human subjects. Eur J Appl Physiol. 2001; 85:560-566.
Leonard C. The neuroscience of human movement. 1998. Mosby, St. Louis.
Malik M. Heart rate variability – standards of measurement, physiological interpretation and clinical use. Task Force – European Society of Cardiology and The North American Society of Pacing and Electrophysiology. Eur Heart J. 1996; 17:354-381.
Niedringhaus M, et al. Dorsal motor nucleus of the vagus: a site for evoking simultaneous changes in crural diaphragm activity, lower esophageal sphincter pressure, and fundus tone. AM J Physiol Regul Integr Comp Physiol. 2008 Jan; 294(1):R121-R131.

Pickering M, Jones James FX. The diaphragm: two physiological muscles in one. J. Anat. 2002; 201: 305-312.
Porac C and Coren S. Lateral preferences and human behavior. Springer-Verlag New York, 1981.
Previc FH. A general theory concerning the prenatal origins of cerebral lateralization in humans. Psychol Rev. 1991 Jul;98(3):299-334. Review.
Redding G, Song K, et al. Lung function asymmetry in children with congenital and infantile scoliosis. The Spine Journal, 2008; 8(4):639-644.
Shumway-Cook A & Woollacott M. Motor control; theory and practical applications. 1995. Williams & Wilkins, Baltimore.
Terada M, Kosik KB, McCann RS, Gribble PA. Diaphragm Contractility in Individuals with Chronic Ankle Instability.
Tokizane T el al. Electromyographic studies on tonic neck, lumbar and labyrinthine reflexes in normal persons. Jpn J Physiol 2:130-145, 1951.
Volkmann J, Schnitzler A, Witte OW, Freund H. Handedness and asymmetry of hand representation in human motor cortex. J Neurophysiol. 1998 Apr;79(4):2149-54.
Vrijkotte TG, et al. Effects of work stress on ambulatory blood pressure, heart rate, and heart rate variability. Hypertension. 2000 Apr; 35(4):880-886.
Young RL, et al. Sensory and motor innervation of the crural diaphragm by the vagus nerves. Gastroenterology. 2010 March; 138(3):1091-1101.

Respiration

Barral JP. The thorax. 1991 Eastland Press, Seattle.
Basu S, Kakade PP, et al. Influence of abdominal and hamstring muscle activation exercises over iliotibial band stretching on a positive Ober’s test in subjects with low back pain. Global Journal for Research Analysis. May 2017; 6(5):704-705.
Beeckmans N, Vermeersch A, et al. The presence of respiratory disorders in individuals with low back pain: A systematic review. Manual Therapy. 2016;6:77-86.
Bertherat T & Bernstein C. The body has its reasons; self-awareness through conscious movement. 1989 Healing Arts Press, Rochester.
Bordoni B, Morabito B. Symptomatology correlations between the diaphragm and irritable bowel syndrome. Cureus. 2018;10(7):e3036.
Boyle K, Olinick J, Lewis C. The value of blowing up a balloon. North American Journal of Sports Physical Therapy (NAJSPT). September 2010;5(3):179-188.
Bradley H, Esformes J. Breathing pattern disorders and functional movement. The International Journal of Sports Physical Therapy, Feb 2014, 28-38.
Buchholz I. Breathing, voice, and movement therapy: applications to breathing disorders. Biofeedback and Self Regulation.1994;19 (2): 141-153.
Calais-Germain B. Anatomy of breathing. Eastland Press, Inc. Seattle. 2006.
Carreiro JE. An osteopathic approach to children, 2^nd ed. Churchill Livingstone. 2009.
Chaitow L, Bradley D, Gilbert C. Multidisciplinary Approaches to Breathing Pattern Disorders. Churchill Livingstone. 2002.
Chaitow L. Breathing pattern disorders, motor control, and low back pain. Journal of Osteopathic Medicine 2004; 7(1): 34-41.
Courtney R. The functions of breathing and its dysfunctions and their relationship to breathing therapy. International Journal of Osteopathic Medicine. Elsevier 12 (2009) 78-85.

Fried R. Breathe well, be well. John Wiley & Sons, Inc. 1999.
Gilbert C. Hyperventilation and the body. Journal of bodywork and movement therapies. July 1998.
Hellyer N, Andreas N, et al. Comparison of diaphragm thickness measurements among postures via ultrasound imaging. PMR. 2017;9:2-25.
Hodges PW, Gandevia SC. Changes is intra-abdominal pressure during postural and respiratory activation of the human diaphragm. J Appl Physiol. 2000:89:967-976.
Hodges PW, Kaigle Holm A, Holm S, et al. Intervertebral stiffness of the spine is increased by evoked contraction of transversus abdominis and the diaphragm: in vivo porcine studies. Spine. 2003:28:2594-2601.
Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis. Spine. 1996;21:2640-2650.
Hodges PW, Richardson, CA. Transversus abdominis and the superficial abdominal muscles are controlled independently in a postural task. Neurosci Lett. 1999;265:91-94.
Homma I, Hagbarth K. Thixotropy of the ribcage respiratory muscles in normal subjects. Journal of Applied Physiology 89:1753-1758, 2000.
Horris H, Anderson BE, et al. Clinical breathing mechanics differ based on test and position. Journal of Sport Rehabilitation. 2019;28:635-639.
Hruska RJ. Influences of dysfunctional respiratory mechanics on orofacial pain. Dental Clinics of North America. April 1997; 41(2): 211-227.
Izumizaki M, Shibata M, Homma I. Factors contributing to thixotropy of inspiratory muscles. Respiratory Physiology and Neurobiology 140:257-264, 2004.
Kiesel K, Rhodes T, et al. Development of a screening protocol to identify individuals with dysfunctional breathing. IJSPT. 2017 Oct;12(5):774-781.
Kocjan J, Adamek M, et al. Network of breathing. Multifunctional role of the diraphragm: a review. Advances in Respiratory Medicine. 2017;85(4):224-232.
Kolar P, et al. Analysis of diaphragm movement during tidal breathing and during its activation while breath holding using MRI synchronized with spirometry. Physiol. Res. 2009;58:383-392.
Layachi L, Georges M, et al. Diaphragm pacing failure secondary to deteriorated chest wall mechanics: When a good diaphragm does not suffice to take a good breath in. Respiratory Medicine Case Reports 15 2015:20-23.
Lomax M, McConnell A. Ispiratory muscle fatigue in swimmers after a single 200 m swim. Journal of Sports Sciences, 2003; 21:659-664.
Newton A. Breathing in the gravity field. Rolf Lines Fall 1997; 27-33. Available online.
Obayashi et al. Effects of respiratory-muscle exercise on spinal curvature. Journal of Sport Rehabilitation, 2012; 21:63-68.
Priyanka P Ostwal, Wani SK. Breathing patterns in patients with low back pain. Int J Physiother Res. 2014; 2(1):347-53.
Puliti B. Resistive Breathing Influence on Performance. Advance Aug 2007; 13-15.
Russell MEB, Scott AB, et al. Inclusion of a rest period in diaphragmatic breathing increases high frequency heart rate variability: Implications for behavioral therapy. Psychophysiology. 2017; 54:358-365.
Seo KC, Cho MS. The effects of a balloon-blowing exercise in a 90/90 bridge position using a ball on the pulmonary function of females in their twenties. J Phys Ther Sci, 2018;30:1267-1270.
Shimozawa Y, Kurihara T, et al. Point prevalence of the biomechanical dimension of dysfunctional breathing patterns among competitive athletes. J Strength Cond Res. 2022 May 24.
doi: 10.1519/JSC.0000000000004253.
Snosek M, Tubbs RS, et al. Sternalis muscle, what every anatomist and clinician should know. Clinical Anatomy. 2014;27:866-884.
Hirasawa T, Kuratani S. A new scenario of the evolutionary derivation of the mammalian diaphragm from shoulder muscles. J Anat. 2013 May;222(5):504-517.
Wallden M. The diaphragm – more than an inspired design. Journal of Bodywork and Movement Therapies. 2017 Apr; 21(2):342-349.
Wilson R, Legrand A, Gevenois PA, De Troyer A. Respiratory effects of the external and internal intercostal muscles in humans. Journal of Physiology. 530.2:319-330, 2001.

Zone of Apposition

Bacci I, Richman M. Fibromyalgia: a new paradigm for its origins and treatment. ADVANCE for Physical Therapists and PT Assistants. Dec 3, 2001:31-32.
Bartels L. Rib cage influences on the volleyball players shoulder. Performance Volleyball Conditioning. 2007;13(7).
Boyle K, Olinick J, Lewis C. The Value of Blowing Up a Balloon. North American Journal of Sports Physical Therapy (NAJSPT). September 2010;5(3):179-188.
Boynton B, Barnas G, Dadmun J, Fredberg J: Mechanical coupling of the rib cage, abdomen, and diaphragm through their area of apposition. J Appl Physiol 70:3, 1991.
Buchholz I: Breathing, voice, and movement therapy, applications to breathing disorders. Biofeedback Self-Regul 19:2, 1994.
Cassart M, Pettiaux N, Gevenois PA, Paiva M, Estenne M. Effect of chronic hyperinflation on diaphragm length and surface area. Am J Respir Crit Care Med. 1997 Aug;156(2 Pt 1):504-8.
Clanton TL, Diaz PT: Clinical assessment of the respiratory muscles. Phys Ther 75:11, 1995.
CliftonSmith T, Rowley J. Breathing pattern disorders and physiotherapy: inspiration for our profession. Physical Therapy Reviews. 2011;16(1):75-86.
De Troyer A, Wilson TA. Action of the diaphragm on the rib cage. Journal of Applied Physiology. 2016; 121(2):391-400
De Troyer A, Estenne M: Functional anatomy of the respiratory muscles. Clin Chest Med 9:2, 1988.
Estenne M, Derom E, De Troyer A. Neck and abdominal muscle activity in patients with severe thoracic scoliosis. Am J Respir Crit Care Med. 1998 Aug;158(2):452-7.
Flynn T: The thoracic spine and rib cage. Musculoskeletal evaluation and treatment. Butterworth-Heinemann, Newton, MA. 1996.
Goldman M, Mead J: Mechanical interaction between the diaphragm and the rib cage. J Appl Physiol 35:2, 1973.
Hodges P, Gandevia S, Richardson C: Contractions of specific abdominal muscles in postural tasks are affected by respiratory maneuvers. J Appl Physiol 83:3, 1997.
Hruska RJ: Influences of dysfunctional respiratory mechanics on orofacial pain. Dent Clin North Am 41:2, 1997.
Hruska RJ: Management of pelvic-thoracic influences on temporomandibular dysfunction. Ortho Phys Ther Clin North Am 11:2, 2002.
Hutt D, Parisi R, Edelman N, Santiago T. Responses of diaphragm and external oblique muscles to flow-resistive loads during sleep. Am Rev Respir Dis. 1991;144(5): 1107-1111
Ishida H, Watanabe S. Changes in lateral abdominal muscles’ thickness immediately after the abdominal drawing-in maneuver and maximum expiration. Journal of Bodywork & Movment Therapies. 2013;17:254-258.
Kolar P, Neuwirth J, et al. Stabilizing function of the diaphragm: dynamic MRI and synchronized spirometric assessment. J Appl Physiol. Oct 2010; 109(4):1064-71.
Koo P, Gartman EJ et al. Physiology in medicine: Physiological basis of diaphragmatic dysfunction with abdominal hernias-implications for therapy. J Appl Physiol, 2015. 118:142-147.
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.

Maskill D, Murphy K, Mier A, et al: Motor cortical representation of the diaphragm. J Phys Great Britian 443:119, 1991.
McKenzie DK, Gandevia SC, Gorman RB, Southon, FCG. Dynamic changes in the zone of apposition and diaphragm length during maximal respiratory efforts. Thorax. 1994;49: 634-638
Mead J: Functional significance of the area of apposition of diaphragm to rib cage. Am Rev Respir Dis 11:31, 1979.
Michaelson JV, et al. Effects of two different recovery postures durign high-intensity interval training. Translational Journal of the ACSM. Feb 2019;4(4):23-27.
Nason L, Walker C, et al. Imaging of the diaphragm: Anatomy and function. Radiographics. 2012;32:E51-70.
Petroll WM, Knight H, Rochester DF: Effect of lower rib cage expansion and diaphragm shortening on the zone of apposition. J Appl Physiol 68:2, 1990.
Reddy V, Sharma S, Cobanoglu A: What dictates the position of the diaphragm – the heart of the liver? J Thorac Cardiovasc Surg 108:4, 1994.
Reid WD, Dechman G: Considerations when testing and training the respiratory muscles. Phys Ther 75:11, 1995.
Valenza MC, et al. The immediate effects of doming of the diaphragm technique in subjects with short hamstring syndrome: a randomized controlled trial. Journal of Sport Rehabilitation. June 2015.
Vostatek P, Novak D, et al. Diaphragm postural function analysis using magnetic resonance imaging. PLOS ONE. 2013;8(3):e56724.
Vleeming A, Mooney V, Dorman T, Snijders C, Stoeckart R. Movement stability and low back pain. The essential role of the pelvis. Churchill Livingstone, 1997.
Walpin L. Sitting: there is more to it than meets the eye…or seat. Physical Therapy Products. Sept 1996: 64-67

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

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.

International Attendees

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.

- The following states accept other state approval and thus would honor this course as an approved course:
  Alabama, Arizona, Colorado, Connecticut, Washington DC, Delaware, Georgia, Hawaii, Idaho, Indiana, Iowa, Kentucky, Maine, Massachusetts, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Oregon, Pennsylvania, Rhode Island, South Dakota, Utah, Vermont, Virginia, Washington, Wyoming.
- Approved by the Illinois Physical Therapy Association for 15 CE Hours. Approval #205-9500. Approval valid January 1, 2025 – January 1, 2026.
- Approved by the Wisconsin Physical Therapy Association for 15.75 contact hours. WPTA Approval #19630. Approval valid July 20, 2024 – July 20, 2025. CEUL138558.
- Approved by the Louisiana Physical Therapy Board for 15.75 clinical hours. Approved for the 2024 calendar year.
- Approved by the Louisiana Physical Therapy Board for 15.75 clinical hours. Approved for the 2025 calendar year.
- Approved by the New York State Education Department, Office of the Professions. Approval valid February 18, 2022 – February 17, 2025; renewal approved and valid February 18, 2025-February 17-2028.
- Approved by the Texas Board of Physical Therapy Examiners as meeting continuing education requirements for PTs and PTAs for 15.75 continuing competency units (CCUs). Course approval #79057TX. Course approval valid July 20, 2024 – July 20, 2026.
- Approved by the Minnesota Board of Physical Therapy for Category 1 continuing education credit for 15.8 hours. Approval #11827. Approval valid January 1, 2025 – December 31, 2025.
- Approved by the Maryland Board of Physical Therapy Examiners for 1.5 CEU’s. Approval valid January 12, 2022 – January 12, 2026.
- Approved by the Ohio Physical Therapy Association for 15.75 contact hours. Approval valid September 13, 2024 – September 13, 2025. Approval #24S2365.

Occupational Therapists and OT Assistants

PRI is no longer recognized as an Approved Provider through the American Occupational Therapy Association (AOTA). Many states do not require any sort of pre-approval process. And of the ones that do, most state licensure boards allow self-submission of CE programs. Please check with your state licensure board to determine if you will be able to submit PRI courses for CE hours.

Chiropractors

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 Minnesota Board of Chiropractic Examiners for 15.5 regular units of instruction for 2025. MBCE ID Number: 87391
Approved by the New York State Education Department, Office of the Professions. Approval valid February 18, 2022 – February 17, 2025; renewal approved and valid February 18, 2025-February 17-2028.

Athletic Trainers & Athletic Therapists

The 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 15.75 Category A hours/CEUs. ATs should claim only those hours actually spent in the educational program.

The Postural Restoration Institute is approved as a CATA Accredited Provider, which enables the provider to offer courses to CATA members as pre-approved for members to earn continuing education units (CEUs). CATA CEUs are assigned to a course based on the following equation: Course contact hours x 0.4 = CATA CEUs. This home study course awards 6.3 CATA CEUs.

Strength and Conditioning Coaches

This course is approved by the Collegiate Strength and Conditioning Coaches Association (CSCCa) for 6.25 CEU’s.

Pilates Teachers/Instructors

This course has been approved by the National Pilates Certification Program (NPCP). Course ID #43663-7750. This home study course awards 12.00 NPCP CECs. Approval valid March 29, 2025-March 29, 2026. *Pilates teachers are only granted 12 CECs for successful completion of the course, since manual techniques cannot be accepted for CECs.

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.

PRI reserves the right to cancel and refund a course attendee’s registration if any concerns arise regarding the course attendee’s qualifications as a healthcare or fitness professional, copyright infringement, or any other illegal activity involving PRI copyrighted materials. International attendees may be required to review and sign a Copyright and Intellectual Property Recognition and Disclosure Contract prior to receiving access to course materials.

Awesome course! Definitely changing the way I think through things in a great (sometimes challenging on the brain) way! | October 2024
It was great and incredibly useful and applicable! | July 2024
I thoroughly enjoyed the presentations of all three of the presenters – clear, articulate, approachable! | April 2024
It was amazing! | January 2024
BEST course I have taken that really understands neuroscience and is comprehensive | July 2023
Absolutely amazing. Truly a great contribution to mankind’s understanding of ourselves | May 2023
Wonderful course! Thoughtful, comprehensive, and relevant content for any PT | March 2023
Simply great content, unable to express in words | February 2023
Wonderfully done, can’t wait for my next course! | May 2022
This was just fantastic, and I’m so thankful to Ron and Jenn for making it possible | February 2022
I believe it is one of the most important discoveries for human health and feel very privileged to be part of it. | January 2022
PRI is way ahead of the rest of medicine in how it incorporates a practical algorithm to treat our complex nervous system. Bravo to unlocking our asymmetries into a functional and repeatable treatment protocol. | December 2021
Loved every minute of it, great information and really well presented. Being presented by people so passionate about it made it very easy to absorb and understand. | November 2021
Fantastic course, extremely detailed and well explained. A ton of light bulb moments for me and gems sprinkled throughout the course (After following PRI for over a year now, the small details really hit the nail on the head). | August 2021
Excellent food for thought that translates beautifully into the clinic. | November 2020
Very cool information that I haven’t heard of in my 30+ courses I’ve taken. | September 2020
Such great demonstartions for an online course! | June 2020
It was awesome. I plan to continue taking courses with you. I love looking at the body as the integrated whole that it is instead of in parts. It makes sense to look at a living human being as an integrated whole instead of like the artificially separated cadavers we had in lab. The coolest things I’ve ever learned! Instructors seem like really wonderful people. I look forward to taking an in person class with you at some point and getting to know the community. | March 2020
I should have taken this course 14 years ago!!!!!! | February 2020
I was first exposed to this material through Ron at the beginning of PRI. The presentation of this material has evolved in a most excellent and more easily digestible way. It is a wonderful thing to see. I look forward to retaking the other material and seeing some of the new advanced information. | February 2020
I thought James was excellent at making a potentially confusing topic very digestible. Ron was excellent at providing additional information throughout James Lecture to fill in thoughts. I thought the way they interacted with the attendees was empowering and it showed their appreciation for people in general and their passion for the material. I really enjoyed learning from both of them. | January 2020
I never thought about rib internal and external rotation as something treatable or necessary to treat until this course. And to have it turn out to be the most important thing to restore neutrality blows my mind. That the rib cage can go backward, and not the scapula to sit on it was also an incredible realization. The ZOA achievement is another thing I was not thinking about, and again the incredible importance of it just is boggling that it never came up before throughout PT school or any other continuing education! I feel lucky to have taken this course and the world it has opened up to me within my practice and for my patients. | January 2020
I have seen these postural patterns in my patients for years and wondered why treating individual ortho components did not help patients maintain gains, and this explains it. | January 2020
I work in an outpatient facility that uses the PRI approach to treat most of its patients. I took this course with some of my co-workers and we practiced the lab segments together, which was very helpful. This course has helped to not only improve my understanding of the concepts but also helped me to feel more confident in my assessment skills and manual techniques as well as more confident in treatment rationale/non-manual technique selection. | December 2019
James did a phenomenal job simplifying and explaining Ron’s brilliant concepts. Greatly appreciate Ron’s dedication to improving this course and for his genuine care and concern for his students and patients. | November 2019
This home study was very intensive. It has opened my eyes to new concepts and I have been a therapist for 30 years. I have a lot of new ideas to work with in the clinic now and can’t wait to see the results. The manual will definitely be used weekly. | November 2019
I’ve done all the courses and for me it’s the only time in 10 years that I’ve been wowed. I’ve done loads of courses in the past but nothing has connected the dots like these courses have. Many courses are good in theory but PRI courses truly reflect with what I’m seeing in real life and that’s a game changer for me. | November 2019
I am extremely grateful for the quality, pace, and detail that went into producing this course. It was such an upgrade from my initial respiration live course experience. It was like a whole new course. I am very glad that I was encouraged to take it. | November 2019
I think my overall framework of thinking and evaluation of a patient has to change after taking this course. I can’t go backward. Careful consideration of the patterns present and the importance of diaphragm driven movement will be quick changes I implement in my everyday practice. | November 2019
I’ve been a strength and conditioning coach/CrossFit coach for 10 years and I can’t believe how much these PRI courses align with what I am seeing. I’ve already implemented some exercises at the end of classes and my own private sessions, and I’ve actually changed technique on certain movements to cater for this asymmetry. | November 2019
This information should be an integral part of every PT student’s program! If only I didn’t have to learn this so late in my career. Hopefully you are making some inroads to that effect. Thank you, Ron and crew for recognizing your gifts of the knowledge of Postural Restoration and sharing the information. | October 2019
This information should be an integral part of every PT student’s program! If only I didn’t have to learn this so late in my career. Hopefully you are making some inroads to that effect. Thank you, Ron and crew for recognizing your gifts of the knowledge of Postural Restoration and sharing the information. | October 2019
I learned so much that I started using what I learned with patients even before completing the entire course. | October 2019
Cannot wait to put this all together. Best post-graduate courses I have taken in my 33 year experience as a PT. | September 2019
I found this information very enlightening and useful. Even though I work in a neurological versus orthopedic setting, I feel this will be very useful to treat postural impairments and improve functional mobility even in a limited state. | September 2019
The lab/demonstration section can be very challenging to present effectively in a home study format, but I was so impressed with how well this was put together! I may have even gained more insights with this lab than I did the last time I took the live course. Since taking this course, I have already seen an improvement in how much objective change I see with my patients following manual techniques. Thanks, James and Ron! | September 2019
I took the live Postural Respiration course several years ago and really enjoyed it. I am glad that I took the course again because I feel that the interventions/case study material has improved a lot since I last took the course. Thank you for including the additional video with case studies. This has been very useful clinically! | September 2019
I am a pelvic floor physical therapist, these implications of the diaphragm are huge in my everyday world! I cannot wait to use them. | August 2019
Thank you for this unbelievably effective and special movement system! This information is outstanding. | August 2019
I appreciate what you all are doing and the content you’re producing. These courses are providing answers to questions and solutions to problems I’ve been attempting to address for some time. I’ve tried many methods of treatment and systems of “corrective exercises” with minimal long term effect. PRI is the first “system” that has provided a seemingly sustainable solution for many of the issues I’ve experienced in my own body as a weightlifter and athlete and those I’ve seen in clients throughout the 15+ years I’ve been personal training. | August 2019
I’ve always suspected ribcage involvement have been slowly seeing some of these patterns orthopedically. I knew that I was missing something with the ortho patterns I’ve been seeing and knew that it was in PRI. So, I can’t wait to apply it to everyone. | August 2019
I am a ATC/CSCS gym owner. I already use PRI concepts as a large part of the individualized training I provide. This course made that training even better. | August 2019
Wow! Ron know this material inside and out. So thankful for getting to learn from them, even in a video format. | August 2019
Really excellent part of the course is the amount, breadth and depth of the manual. | July 2019
Taking this online, I was a bit nervous regarding the hands-on learning component of the course. However, the home study was set up excellent and included lots of opportunities to watch and learn. The instructor’s explanations also made it easy to apply the feedback given to others in the course at home. | June 2019
I have been applying PRI concepts since the first course I attended. This course refined my skills and cleared up some things I had been questioning. | June 2019
I believe this content aligns well with a holistic approach to healthcare and treating the whole patient. Too often, we focus on the area of pain, instead of searching for the bigger culprit. | June 2019
This is the 2nd PRI course I have done and am completely hooked on the Kool-Aid! I hope to attend a live course in Nov. Thank you for this life changing information! | May 2019
I am incorporating all of the assessments and techniques along with soft tissue mobilization which have yielded amazing results! | May 2019
I was really looking forward to this new home study and I get a lot out of watching all of them. I have attended close to 20 PRI courses and I must say that the home studies are still very relevant and helpful in my application of the primary course material. | May 2019
This course was extremely helpful for me. I have been actively practicing, utilizing these techniques for 9 years, since I first took this course! Was a great experience to go through it all again. | January 2019
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. | November 2018
One of the best courses I’ve taken! Completely changed the way I look at posture and breathing. | November 2018
Good overall content. Course instructor was very knowledgeable and engaging. | August 2018
Great course, even though it was a online course, I feel comfortable and confident with the techniques. | July 2018
I absolutely love this material. I am so excited to see an approach that appreciates the cross-sections of medical and orthopedic consequences. I have been observing so much of this in my career and personal life, so THANK YOU for painting such a clear picture and providing a way to finally understand breathing dysfunction, overextension, impact on balance, vision, POTS, and so on! | June 2017
Postural Respiration is the difference between attempting to drive a sports car with the e-brake half on and removing the restriction to allow for optimal performance. We as strength coaches can only build as high as the athlete’s foundation will support. PRI provides a mature understanding of these foundational intricacies for an objective approach to training that yields game changing results. | May 2017
So glad I found you all! The available offerings on the subject of breathing with regards to clinical work has been on the periphery and insufficient to address the obvious prevalence of breathing issues with all patients I have ever dealt with. I am grateful for finding your course. I hope to do more in the future. Thanks so much! | May 2017
I can say without being overdramatic that the Postural Respiration course, my first PRI course, has revolutionized my practice. It’s answered some deep questions I’ve had for years about the continuity between manual therapy and conditioning exercises, and the real causes behind the patterns we see in patient after patient. A huge thank you! | March 2017
It was an amazing course, truly life-changing. I been a personal trainer for 20 years, this was hands down the best learning experience I have had. The changes I see in my clients, more importantly the changes they feel, are amazing. If you want to help people flourish, this is the place to start. I look forward to my journey with PRI. | January 2017
This is one of the best courses I have taken. Great applicability across multiple settings and case loads. Felt like I could start incorporating ideas immediately. | Springfield, IL, May 2015
This course has changed the way that I practice. Thank you! | Illinois, December 2014
Best course I have taken in both content and organization! Thank you! | Ellicott City, MD, March 2014
Excellent overall, eye-opening eval. and treatment techniques as I have been a PT for 24 years and continue to enjoy learning to enhance patient treatment. | Monroe, Louisian, August 2013
This is an extremely powerful treatment technique that has not yet reached its apex in current clinical practice! It’s applications for treating patients are unbelievably broad! | Providence, Rhode Island, March 2013
This course was OUTSTANDING. I can’t wait for Myokinematic Restoration to come to Atlanta this fall. PRI is the only continuing education I want to take. I love how integrative it is! | Decatur, Georgia, January 2013
Overall, great course. Exciting information. Very helpful. Can’t wait to use. | Hudson, Wisconsin, January 2013
It was amazing and works incredibly well. | Toronto, Ontario, Canada, Alabama, October 2012
It was very informative and enlightening. I am returning to PT career after several years off and starting in a different area of PT. I will use this information with all my patients. I am excited to take the next course. | Sammamish, Washington, October 2012
Really great stuff – paradigm shifting – look forward to taking more – excellent! Thanks a lot! | Spokane, Washington, October 2012
Can’t wait for the next one!! Thanks for offering home courses. | Winston-Salem, North Carolina, June 2012
I find this body of knowledge very interesting, valid and worthwhile. It makes kinesthetic sense to me. I feel it in my own “normal human body,” and I see it in others. | Victoria, BC, Canada, Alabama, June 2012
Fabulous-this course and the Myokin course changed my entire practice! | Salt Lake City, Utah, November 2011
I plan to use techniques in my daily assessment and treatment of patients as well as promote awareness about ‘patterns’ that lead to dysfunction. The video taping was very good – tape angles were easy for viewer to see techniques! | Huntsville, Alabama, February 2011
I liked having the DVD so I could back it up to repeat concepts I didn’t get. Ron is very knowledgeable and gives a lot of tips not included in the manual so I was able to rewind and write them down. | Goldfield, Iowa, February 2010

Attendees

Course

Registration Details

Registration Process

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.

Course Materials

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 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.

Discounts

Those who have earned the designation of Postural Restoration Certified (PRC) or Postural Restoration Trained (PRT) are eligible for a 50% discount. Students are eligible for a 25% discount.

If you have taken the live course in the past 12 months you are eligible for 50% off the regular price.