We had a grand ol’ time this past weekend here in San Francisco.
One of the top two meatiest PhDs I know came by to tell us how to create pro-exercise habit loops and build sensorimotor competency in high stress humans.
The other meatiest PhD I know was one of my old professors: Dr. Zach Riley.
Pat Davidson, PhD
Zach Riley, PhD
Pat Davidson is a riot. He’s a high energy, hilarious lecturer.
Rethinking the Big Patterns came to life after hearing a lecture from my old boss, mentor, and great friend, Bill Hartman. Bill quoted the statistician George Box…
All models are wrong; some models are useful.
This has become a guiding light in the tiny sub-space of fitness I reside. An antidote to the Imposter Syndrome afflicting many coaches who’ve made it past the 5 year mark. We might find ourselves saying…
How does that joke of a coach get his clients results?
Why can’t I get my clients to workout without me?
I feel like none of my clients are losing weight.
I can get everyone hip mobility except this one. Why won’t this work?
I’m just not sure that what we do matters all that much.
Inspired by Bill, Pat decided to write out his own model.
Lesson #1: Do the work. Nobody else is.
Pat could have just said, “Wow, that Bill Hartman is a smart guy. What a great lecture. I hope to be like him someday.” But he didn’t stop there. He also said, “I will take his advice.”
His “exercise plinko” as he calls it is a nice way to classify basically any movement you could want to use with your clients. It gives insight into physiological adaptations as well as mechanics. It considers kinematics and kinetics.
The best part, though, is that it doesn’t throw away anything you’re already doing that is working. It’s not a system that says, “Our stuff is the best and you need to implement this.” Instead, it says, “You’re already doing this, but this is how I look at training. Does that help?”
Lesson #2: Don’t reinvent the wheel.
One of the most powerful forces we know of in biology is evolution by natural selection. It works so well because each change gets vetted (natural selection) and occurs slowly (genetic polymorphism). It’s the experimental method for genes.
You can, and should, change something sometimes. But you usually shouldn’t change everything.
Asymmetry in the Body
A few people are on the cutting edge of asymmetry in the human body, looking for a more mechanical explanation for why we see such predictable asymmetries.
The most well-known group is the Postural Restoration Institute. They emphasize the neurology of these patterns. In my experience working with it and taking over a dozen of their courses, this is a great way to look at things, but it’s not always the most HELPFUL way to look at things. This comes from my perspective and abilities as a strength coach and personal trainer. The quickest and safest way I can alter your system is through exercise.
The two I’ve talked to the most on the subject are Bill Hartman, PT and Joe Cicinelli, DPT. They’re finding that there are good mechanical explanations for these asymmetries. If you want to dive into that hole, apply to one of Bill’s Intensive weekends or get him to mentor you. He’s shaped me more than any single person in this world.
One of the ways that I use these mechanics these days by examining the pressures in the body. The body is mostly fluid. The thorax is mostly air; the abdomen is mostly liquid. Pressured air can lift a car. If you don’t consider it, you’re not going to get the changes you want.
So I ask myself:
Where is the pressure high?
Where do I want the pressure to build?
If someone has a tight back, they have high pressure in the posterior half of their trunk. I want to increase pressure in the front of the trunk so the pressure in the back can diminish. This is a simple example to get you going, but start looking for it and you’ll see more of the asymmetries.
Lesson #3: Move body pressures to change axial skeleton position.
Gyroscopic motion can even help you understand the angular momentum created by the guts due to gravity. They are fixed to the posterior abdominal wall. Gravity pulls down. The guts anteriorly rotate. What is the direction of the subsequent force in the frontal plane?
This was the best image I could find to explain this right hand rule of physics. The anterior rotation of the guts the four fingers. The direction of the force is the thumb. I’m probably explaining this incorrectly, but I at least tricked myself into thinking I understood it. It’s a pretty cool idea.
Give your clients what they don’t have. If you don’t like doing it, you probably need to do it.
Too many people try to fill the top of the performance pyramid, spin their wheels, and don’t build up. I’ve always found the pyramid example to be helpful, but Pat had another metaphor: fill the holes.
If you’re leveling out ground for a construction project, you don’t put the new dirt where you already have dirt. You put it where you don’t have dirt: in the holes.
Let’s take a powerlifter as an example.
What does a meatball powerlifter have?
What does a meatball powerlifter lack?
You don’t want to steal the things that the meatball is good at. But not having enough of the other stuff can hold you back… at least from feeling better.
“I’m Just Here for the Dopamine”
What are the two fitness qualities that are easiest to change?
Strength and aerobic endurance.
Get your newbies on the strength and aerobic endurance program. Measure what matters because what gets measured gets managed. Show them their progress. Create a habit.
How can you make people crave exercise?
Lesson #4: Dopamine first. Training second.
My new goal is to gamify training. How can I incentivize my clients? Show them their progress!
Progression beats variance any day of the week for a reward system.
Pat Davidson (26 AUG 2018)
It’s already been two days since the course ended and my brain is still buzzing. I haven’t gotten this much out of continuing education in a long time.
“There’s nothing worse than a dripping wet penguin walking into your clinic.”
And for those who know Ethan Grossman, you missed a fantastic joke about a jacked penguin named Ethan.
Dude is yoked.
Swimmers are sagittal monsters with extra lordosis in their low back and kyphosis in their upper back.
But it’s not REALLY a kyphosis or a lordosis. It’s a neurological handicap.
Swimmers cannot appreciate the frontal plane, the ground, or space around them. Hence, neurological handicap. They throw their heads forward so that they can feel their back because that’s the only way they know how to deal with gravity, but now they have no helix.
A helix alternates and reciprocates. The joint-by-joint approach to training is a helix, assuming everything is working correctly. The most obvious helix is DNA. Or maybe that’s just obvious to me because I’m a nerd.
But extrapolate this to anything that has rhythm: music, respiration, sleep-wake cycle, or the gastrointestinal system. As I said, this rabbit hole is DEEP.
Remember the talk on the thorax from Day 3? Swimmers use their arms for life instead of using them to create things.
Probably the weirdest line of the weekend, and, hence, my favorite: These guys are eating a Life cereal called LATISSIMUS.
They want to be compressed and they’re going to do it the only way they know how. They don’t have frontal plane, so they’re going to try to find more sagittal plane. How about instead of letting them compress themselves with their lats, you compress them with a hug?
Then, put them in sidelying and WATCH THEM SWEAT. If they truly have frontal plane, then they have sagittal plane. Maybe then they will be able to find the floor. How do you know when they’ve found the floor? They shake. Make them stronger by making them look weaker.
I know I’m bringing the weird in this post. There are a few bullets that I want to include for the two people who will understand their meaning:
New PT students will see a kyphosis and a lordosis, NOT a neurological handicap. Keep that in mind. Skepticism is a good thing.
Breathing is a frontal plane activity.
I may want to examine you in your swimsuit, because that psychologically prepares you. It will change your mindset and perception, which may change your test results.
Non-patho Compensatory Scoliosis
There are two main types of idiopathic scoliosis discussed during AI: non-patho compensatory and patho compensatory.
Non-patho is a C curve with the lumbar spine oriented to the right. There is a thoracic curve that is convex to the right (meaning the middle of the C is on the right side). A right rib hump is present.
Everyone has this curve underlying due to asymmetry in the human body and the way the spinal joints are shaped. When the top and bottom vertebrae of the curve make an angle greater than 35 degrees, you can start to have organ problems.
It is important to realize that this curve is not just frontal plane, but it’s also a twist.
The non-patho scoliosis clients will present like a L AIC and R BC patterned person, have trouble getting into their left hip, and trouble getting their center of gravity over to the left. Normally, we expect to see a lowered right shoulder, but this may not be quite as pronounced in these cases.
Worth noting is that kids with this curve will have restlessness and fatigue easily.
These people need to secure the pelvis with R AIC myokinematics, then maximize right apical chest wall expansion. Remember, this is frontal plane. Following that comes integration of a left zone of apposition (abs opposing left hemidiaphragm) with left thoracic abduction (thorax to the left) with a right low trap and triceps (helps with inhalation on right side).
Patho Compensatory Scoliosis
Patho is an S curve. The lower lumbar spine is oriented to the left and right trunk rotation may be increased, both evidencing compromised right iliolumbar ligaments. There is still a right thoracic curve, but there is also a left lumbar curve. Therefore, there may be a right upper thorax posterior rib hump with a left lower thorax rib hump.
These people will also present like a L AIC, and may or may not have typical R BC test results.
The nature of the S curve offsets itself. This person’s center of gravity may be over to the left, even if they can’t get IR’d into the left hip. They may still be able to balance well on the left leg. These people will be harder to fix because they don’t “need” to change to get themselves to feel balanced.
People with a patho curve need to get secured into their left hip (left AF IR) while integrating the left IOs/TAs and inhibiting the right adductor. As you can tell, these people also have a huge emphasis on the frontal plane. Following this, they should learn how to abduct their right hip while laying on their left side with their left hip IR’d.
PAUSE: that’s basically the same thing as the first step, just in sidelying.
After left sidelying comes right sidelying left hip abduction. Then you go upright and learn to secure in the left hip while rotating the trunk to the right on one leg.
Learning anecdote: PRI includes treatment sequences like this for all types of diagnoses. I’ve always glossed over them in lieu of learning the basics. It has always just seemed, superficially, that the course of treatment is the same: fix what they need. As I reviewed the treatment for these two scoliosis patterns, I actually found it very helpful. Laying it down on a notecard was worthwhile. I will do more of this in the future.
Dr. Heidi Wise came up to talk to us about vision. Though this was my first real PRI exposure to visual integration, I took away some things I can use in the gym with my people.
“Do you feel like you use one eye or both?” Don’t put their left side next to a wall if they already feel like they aren’t using their left eye because that removes peripheral space to be noticed.
SIDE NOTE: While writing that, I realized my sweatshirt hood was on and was blocking my ability to perceive space. Took it off and it’s like a weight had been lifted off of my face.
If they stare at the ground a lot, maybe I need them to face out through a window while pushing into it. In initial development, the gross motor and vestibular systems drive vision. Later on, it switches. There needs to be integration of the gross motor mechanical and visual systems.
We need to integrate sight, sound, space, and ground.
Heidi gave us some things we could ask our eye doctors to make sure we aren’t overprescribed:
“Can you please make sure my eyes aren’t overworking and my vision isn’t overcorrected?”
“Can you balance my eyes so that they can work the best that they can together?”
Go to COVD.org to find an eye doc who is interested in vision for function.
Go to NORA.cc to find an eye doc for someone with brain injury.
Day 4 Conclusion
The scoliosis section has two pages of references. I wanted to review them all, but I don’t have time for that at this moment. Maybe in the future that will become a write up, but for now, you will lie in wait.
One more thing to note which we talked about briefly in Day 1: between the ages of 7-19, you have more power in terms of advanced integration. The way you inhibit younger individuals is through alternating activity. At 21 years old, however, you need to think more about inhibiting.
Day 3 was the first appearance of James Anderson, and this dude knocked it out of the park.
Ron is, well, the king. Lori is the empathizer. Cantrell has patience. J-Poo (THE Jen Poulin) helps you apply. And James makes things visual.
And none of them will baby you.
They’re some of the best teachers in the world, and James made sure we knew that.
Thoracic Scapula Gait Kinematics
PRI is an iceberg.
When Bill first exposed us to it at IFAST several years ago, we saw the tip of the iceberg.
“Oh, so you should foam roll your right adductor, do right clamshells, and left adductor pullbacks.”
The Myokinematic Restoration manual lists a treatment algorithm based on position and pathology. Seeing and feeling the changes from repositioning had me hooked immediately. So, naturally, we had an exercise for each of the first four sections and everyone did them. But can you break stuff down that easily?
Turns out you can’t.
Our initial vision only saw the tip of the iceberg. Now that I’m underwater, I can appreciate just how broad and complex this PRI thing is. My goal with these blogs is to convey this complexity to all of the people who invest their time reading my words.
I try not to post much directly from the manual because I think you should get it and go through it for yourself, but the following list opened the Day 3 section of our manual and I think it is a good representation of the depth of the PRI rabbit hole:
Right Brachial Chain (R BC) or Posterior Exterior Chain (PEC) gait patterns reflect:
body structure (endomorph, ectomorph, mesomorph)
bilateral or hemi – paravertebral extensor tone
breathing pattern (ZOA opposition)
frontal plane dysfunction
cranial neurological orientation (conscious and subconscious)
girdle impingements (temporal, scapula, or pelvic innominate)
(PRI AI 2014 Manual, p. 162)
Are you considering all of the possibilities?
Bet you didn’t consider the possibility of this picture
Here are the main concepts of this section
The upper body gait affects the lower body gait
The trunk consists of about half of our body weight
If the upper extremity is not stable and mobile, you’ll create a new set of feet on your hands.
Okay, so on to gait. When during gait is my head directly over my feet?
Midstance, correct. Now when is my potential energy highest?
Mistance, correct, because center of gravity (COG) is highest there. What makes it higher?
Thoracic extension, correct. Man you’re good at this. So if I drive more thoracic extension, my COG will go up. If I start up higher like this, but I still need to control my gait, what is needed?
More kinetic energy, correct. Because energy is conserved and, during gait, it is shifted between potential and kinetic energy based on where you are in the gait cycle. This is a simple view, but still effective for learning. Now can I access the kinetic energy I need if I am unable to flex my thorax?
No I can’t, you are correct. So I can’t transfer energy well. Picture efficiency of gait as being like water. Dissention and fighting the forces of nature does not help you, you need to learn to go with the flow.
Normal sagittal plane motion of the shoulder during gait is 6 degrees of flexion and 24 degrees of extension (PRI 2014 AI Manual, p. 166). If I don’t have that arm swing, do you think I’m walking effciently? No way. I don’t have the arm swing to help decelerate trunk rotation and my back has to start working overtime. I’m walking with two feet on my feet and two feet on my hands. I’m no longer a biped.
Same goes for all of those other bullets we talked about. Can’t flex your thorax? You suck at making kinetic energy during gait. Can’t IR your left hip? Can’t IR your right shoulder? Can’t rotate your thorax? Maybe I only notice my right visual field and these limitations are driven from that.
What about those people who can’t stop looking at the ground? As I was giving some exercises to one of our more tenured clients the other day, her positions looked great, except that her head was down. Way down. When I asked her to bring it up and look at the garage 75 feet away, she broke down. Her shakes made it look like a deadlift PR. She needs help learning how to manage space.
Because, you see, if she’s looking down (cervical flexion), then her thorax is extended. In order to flex the thorax, she needs to appreciate appropriate cervical extension. Instead of referencing the ground with her feet, she uses her eyes.
“You need to learn how to push on the floor or the floor will push on you.”
If we don’t help her learn how to manage space, she’ll use her neck. Do any of your clients have neck stiffness? I know mine do.
Day 3 Conclusion
I hope the physics talk about gait and energy helped you (I know it helped me to go through it).
The majority of James’s talk was on the Superior T4 Syndrome patient, where the right neck becomes overactive. There are complex implications in the position of the rib cage, rotation of the thorax, and various thoracic musculature. You’ll have to get him to tell you about those things. I went over some of it in last month’s Elite Training Mentorship video.
Other bullets from Day 3:
On rectus abdominis: “I can’t tell if it’s my back or my abs, but the truth is… it’s BOTH.” -James Anderson
You need a pec to develop power, but not to move a thorax.
When you see a varus (like in the tibia or the calcaneus), you know they need to overpronate if they’re going to find the floor.
Day two was all about frontal and transverse integration and consisted of great presentations from Mike Cantrell and Lori Thomsen. I can’t say enough good things about these two.
I’ve met Mike before and there is not a single person in this world that cares more about teaching you than he does. I like to think that I am similar, but this dude blows me out of the water.
I had the pleasure of finally meeting Mrs. Lori Thomsen during Advanced Integration. She may not think she’s funny, but some of the most hilarious antics I have ever been a part of went down that weekend. And they were all her doing. Very excited to welcome her to her new home away from home in Indianapolis when she comes to teach the Pelvis course in March (you better be there).
I’m going to break this day down by each of the speakers and some of the highlights they had to say.
DISCLAIMER: this post will reference PRI tests. If you are unfamiliar with them, you will be lost.
The biggest take home point is that pathology occurs when you can’t maintain flexion while moving in the frontal and transverse planes.
For those who are unfamiliar with PRI, they have three foundational courses: the leg course (Myokinematic Restoration), the arm course (Postural Respiration), and the pelvis course (Pelvis Restoration).
Lori put together the pelvis course, so she went through the pelvis tests with us.
The Adduction Drop Test: can the left innominate of the pelvis get to neutral?
The Pelvic Ascension Drop Test: can the left innominate extend? Can I get into stance phase of gait?
The Passive Abduction Raise Test: can my innominate get into swing phase?
Important clarification: these tests tell me a lot of things in addition to the bullets listed above. I will not go into all possible presentations and what they mean. It is helpful for me, however, to think of these tests in terms of the gait cycle as Lori presented them.
Moving on, we talked about PECs. This acronym signifies a person who uses their back a lot.
DEFINITION. PEC: posterior exterior chain of muscles; person with these muscles facilitated.
This PEC pattern drives extension. Very active people often fall into this category because strong backs lead to strong people. The purest example of a PEC is a 100m sprinter.
You may not want to take that away from a competing athlete because it may make them slower. If they need greater movement variability (i.e. their sport/activity has more frontal and transverse plane demands), they probably need to learn how to shut down that PEC.
Some PECs are just locked up, and Lori suggested using alternating activities to help free these people up. The caveat, however, is that they need to have at least a 1/5 on the Hruska Adduction Lift Test, or else they don’t have abs for alternating.
After the PEC is inhibited, the person regresses to a left AIC or to neutral.
DEFINITION. Left AIC: left anterior interior chain of muscles; L diaphragm, L psoas, L iliacus, L vastus lateralis, and L biceps femoris; drives contralateral stance phase.
DEFINITION. Neutral: “the human body posture is in a position in which a set of muscles [left AIC, right BC, and right TMCC] is disengaged.” (AI 2014 manual, p. 78)
Lori also went through the Respiratory Adductor Pullback non-manual technique and explained how it was a frontal plane exercise. This was an AH-HA! moment for me because it has always looked like a transverse plane exercise to my feeble mind. The following picture diagrams the exercise for those of you who are familiar with it. Basically, we “inhale and pull back” to put the exhaled left posterior outlet in a state of greater inhalation, and we “exhale and push the knee down” to put the inhaled left anterior inlet in a state of greater exhalation. This allows the pelvic diaphragm (septum) to rise on the left and helps us achieve stance phase on the left side.
Lastly, there was another brilliant takeaway in coaching wall squats: If they can’t feel their quads, they’re using their backs.
The “hips back” cue is becoming more and more scarce in my coaching.
Seriously, Lori is fantastic. Can’t wait to see more of her at IFAST in March.
Before we get too far into what he talked about during Day 2 of the course, I want to mention that Mike received an award for being such a great teacher. Nobody is more deserving than this man.
Mike started by asking us if we though SI fusion was usually a good strategy for treatment. The class consensus was no, at least before trying less invasive treatment.
“Why are ya’ll fusing SI joints then?”
He then talked about the “posterior gluteus medius” for a long time. I put it in quotes because it was really a talk about the frontal plane.
“The dirty little secret of PRI is that we’re not good at right stance either.”
We are not good at getting to the left, which makes us bad at left stance, but we’re also OVERlateralized to the right, making us bad at right stance.
Summary of this talk: if your right glute max doesn’t put you in your left hip, you’re just fusing an SI joint.
He also broke down the Hruska Adduction Lift Test, going through all of the frontal plane for which you could ever ask. Sometimes you just need to put them in sidelying and WATCH THEM SWEAT.
Here’s a sweet picture of that talk.
After day two, an unnamed accomplice helped us break into Ron’s office that night, where a few of us abused his desk.
After days of heavy information, travel, and other matters, this break for laughter was much needed. I am eternally grateful to have been a part of this.
Though I think the gold is supposed to be a secret, this picture shows how funny it was:
One of the things that sets PRI apart from other courses is their ability to teach. There’s a whole section in the Advanced Integration manual where you color a bunch of anatomy by what “family” they are in.
Frontal – Adduction
Frontal – Abduction
This instructor-guided color coding helps you understand the integration of anatomy so well.
I was just talking about this yesterday with my coworker Jae Chung, but anatomy is one of the more difficult pieces of this model to understand. With this difficulty, however, comes a huge payoff which cannot be overvalued.
Day 2 Conclusion
Think in the frontal plane. And learn your anatomy.
Foreword: This is part 1 of a four part series of posts. All parts have all been published, so here is part I, part II, part III, and part IV.
Over a month has gone by, and I’m still going through the material from PRI’s 2014 Advanced Integration course.
You know, it’s funny: during the course, I thought I was grossly underprepared to take much away. It was as if Ron Hruska, the primary presenter and founder of the Institute, was continously devouring my brain. By the end, he was just picking at a carcass.
Look at that carnivore. And my neurotic note taking habits.
But after reviewing some things, I don’t feel as bad. There’s still a ton I missed, but there’s also a ton I gained.
Disclaimer: This post is for people who want to learn and explore about the human body. I don’t know this stuff well enough to make it simple. I also ask that you think of this post as more of a conversation, as I’m not tied down to most of the information in here.