There’s no bigger insight into someone’s behavior than the head and neck. But what drives the head and neck?
If you want to be a great movement coach, you need high empathy and knowledge of anatomy. What is someone feeling and how does that feeling affect the structures of the body?
I’m not even talking about empathy in the obvious sense of human interaction. Will it help you seem like less of a robot? Sure. Will more people like you? Probably. But the hidden power of empathy for coaches is in decision making.
Imagine the basketball coach who keeps telling a kid to stay low out of a cut. The coach repeats the same words — over and over — throughout the season, but the kid does not respond.
Most coaches would say this kid is unathletic, unteachable, or disobedient.
But what if that kid cannot physically move his body that way? Maybe he just eats too much food before practice and pops straight up out of a cut because his hip is impinging in the bottom. I say this with 100% certainty of possibility.
If this coach wants to improve, he should know basic nutrition, biomechanics of the hip joint, and the anatomy of the thorax and abdomen. And, perhaps most importantly, he cannot assume anything.
This example and the hip joint is a starting point, but what about the head and neck? It’s the same, just in a different part of the body. I make better coaching decisions now that I’m paying attention to my clients’ head positions.
If someone has a rib cage that’s riding up, I’ll look to see what’s happening at the pelvis.
If someone has a slight head tilt when moving their arms, I’ll look to see what I can change at their thorax.
If someone is constantly looking down, I’ll challenge them to look straight ahead.
If someone is popping up out of a cut, I’ll look to see if their head and neck can bend.
The complexity of the joints in the head an neck make this undertaking difficult, but the sternocleidomastoid is the best place to start. This is the single muscle with the greatest ability to affect the head and neck because it’s relatively thick and has huge moment arms. It is, therefore, a strong mover in all three anatomical planes of motion.
As if the physics wasn’t enough, remember that the brain is always preoccupied with what the head is doing. Don’t believe me? Here’s a short list of what’s on the agenda for today:
Movements produced by the SCM
Movements kind of produced by the SCM
The thorax during respiration
Forward head posture
Snapchat after workouts
My flourishing artistic abilities
Relative motion of joints
Basic angular physics
How the head can move the feet
…and a bunch of examples
I’m here to help you dissect this topic piece by piece. I’ve included references for those who want to dive deeper. Each section of this post is meant to lead into the next one, but I’ve supplemented the writing with many pictures in hopes to make this article clearer and more engaging. If you want, you could get away with skipping around.
“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.