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Course Recap: PRI Advanced Integration Day 4

This is part IV of a four part series. All parts have all been published, so here is part I, part II, part III, and part IV.

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Day 4: Curvature of the Spine

“We’re learning how to get up into space because we can’t handle space down here.”
-Ron Hruska

We started Day 4 talking about swimmers and penguins and people and helices.

 

Swimmers

“There’s not a swimmer in the world that appreciates the ground.”
-Ron Hruska

Swimmers are not land animals.

To clarify, I’m talking about human swimmers. Not fish, dolphins, or sperm.

swimmers

Photo credit: trackplc

Swimmers have PENGUIN-ITIS.

“There’s nothing worse than a dripping wet penguin walking into your clinic.”
-Ron Hruska

And for those who know Ethan Grossman, you missed a fantastic joke about a jacked penguin named Ethan.

Ethan Grossman = jacked penguin

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.

What in the world do you mean they have no helix?

Children with a helix on a helix

Photo credit: James Gentry

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.

 

Vision

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.

You also missed Emily Soiney teaching Ron and I some yoga.

ron yoga

me yoga gif

 

Advanced Integration 2014 Conclusion

Advanced Integration: the monster of the PRI courses.

I leave the fundamental, two-day courses absolutely exhausted. This one is twice as long. As you can imagine, my brain was on vacation after this.

Though this course was heavily theoretical, there were plenty of takeaways. I left with a shift in mindset, a less myopic view of PRI, and plenty of great cues to use on my clients.

As this course was four days long, there is a ton of information I have left out. I highly recommend taking this course, as it helps you understand the more overarching concepts of PRI.

Here’s to a fun weekend with a great group of people! Thank you so much for reading this.

good peeps

group

 

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Course Recap: PRI Advanced Integration Day 3

This is part III of a four part series. All parts have all been published, so here is part I, part II, part III, and part IV.

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Day 3: Thoracic-Scapula Integration

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:

  • occupational mechanics
  • body structure (endomorph, ectomorph, mesomorph)
  • health status
  • personality
  • bilateral or hemi – paravertebral extensor tone
  • breathing pattern (ZOA opposition)
  • handedness
  • 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?

with joe in whole foods

 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.”
-James Anderson

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.

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Course Recap: PRI Advanced Integration Day 2

This is part II in a four part series. All parts have all been published, so here is part I, part II, part III, and part IV.

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Day 2: Triplanar Activity

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.

 

Lori Thomsen

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.

Made on www.biodigitalhuman.com. Note that the left anterior interior chain is only the left half of the diaphragm.

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.

respiratory adductor pullback

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.

 

Mike Cantrell

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.

Cantrell award

cantrell award speech

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.”
-Mike Cantrell

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.

Frontal plane

 

Debauchery

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:

shirt is too funny

 

Coloring

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.

  • Sagittal
  • Frontal – Adduction
  • Frontal – Abduction
  • Transverse
  • IR

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.

…And have fun sometimes.

 

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Course Recap: PRI Advanced Integration Day 1

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.

selfie with ron

 

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.

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Course Recap: She’s Just Jenny from the Block

Boy, you missed a good weekend.

IFAST hosted Jennifer Poulin and her rendition of Myokinematic Restoration this past weekend.

We had a great group of people. And we had dinner.

brandon-and-james

zac-and-jen-dinner-night

And we welcomed our Nebraskan special guest, Matt Hornung!

matt-hornung

Whether you’re a therapist or a strength coach, you need to take this course. And you need to start coming to IFAST for your PRI needs because we have too much fun.

I’m going to summarize some main points from the course, but keep in mind that the content of this blog post is everywhere. You should not proclaim you understand PRI solely from this blog post.

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