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Tag: Adduction Drop Test

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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Defining Neutrality

One of my goals for my non-athlete athletes (the teachers, moms, doctors) is neutrality.

But what does that even mean? What’s not neutral about me?

It’s reminds me of the intro in Van Halen’s “Hot For Teacher”. I don’t feel asymmetrical.

I don't FEEL asymmetrical

 

Asymmetry is Natural

Forgive the morbid visual, but if you cut yourself right down the middle and looked at your right and left insides, no part of your rational brain would think, “I’m a perfectly symmetrical human being.”

And what does that make you? That makes you and I part of the same Homo sapiens family. That’s it. Asymmetry isn’t weird, it’s normal. It’s necessary.

The biggest internal asymmetries that I like to point out to clients are the size of the thoracic diaphragm, the side of the liver, and side of the heart. These make us really good at standing on our right legs and breathing into our left chest wall.

Where's the left liver?

 

And going back to Van Halen, most people I’m cuing won’t feel asymmetrical until I get them neutral. If you live a life on your right leg (hint: you do), you’d feel weird on your left leg, too! Remember the story I wrote about from that course a few weeks back?

 

 

The Origins Project

It’s impossible to say where or why or how this asymmetry has come about to be so prevalent, but I can make a guess (because that’s what the interwebz is so good for: speculation).

It makes sense to me that this asymmetry has come about from natural selection, just like, you know, everything else. The infamous Pat Davidson recently shared a quote with me that sheds some light on the topic from the point of view of a physicist.

“…right-handed DNA for all is the rule. Evolution plays an essential role in this. As only like spirals can link to make a double helix, there is no advantage if some of us had right and others left, or if we had a mix of both. It appears essential for effective procreation, that the half provided by the male matches that from the female, and the most efficient way is if they have only one and the same handedness. While this does not explain how and when the asymmetry in the amino acids of our DNA originated, evolutionary advantage aided by the vastness of time could be the cause.”
-Frank Close, “Lucifer’s Legacy”, p. 76

If you think about the beginning of life on Earth, making two sets of DNA would, at best, halve the chances of life forming. So these all-right-sided DNAs had a huge advantage in making copies of themselves.

 

Defining Neutrality

If I go any further on origins, I’ll be stepping out of my bounds of education, so let’s shift gears. What am I examining to see whether or not you’re neutral?

Well, as someone who works with bodies and weights, the best way I know how to attack the situation is through movement. Even though not every change is orthopedic, these changes are the most tangible to you and I.

So I do some tests. I look at the position of your lower body with an Adduction Drop Test. This will tell me a lot, but most specifically, it tells me the position of your pelvis. Can you adduct?

There are some other accessory lower body tests that I’ll do to confirm my findings because I mess up sometimes. Hip motion tells me a lot of things.

Then I do some tests to look at the position of your upper body. An Apical Expansion test is the first time I ask you to breathe for me. Can you exhale on the left side? Can you inhale on the right side?

Then I’ll confirm my findings, which I find is especially important for the Apical Expansion test because it’s hard to judge the results without tester bias. Shoulder motion tells me a lot of things.

I always look at the way your neck moves, too. This Cervical Axial Rotation test is important because your neck motion tells me a lot of things.

If I can get all of these tests cleared, you’re neutral. If you’re neutral, you can effectively move side to side. You can walk with two legs instead of a right leg and a left kickstand. You can aspire. You can create.

Based on the natural asymmetry I was talking about earlier, I’m able to make some test predictions. If all of these predictions prove correct, I would call you “classic”. A classic left AIC, right BC, right TMCC. A classic human.

Then I can give you an exercise or push on your ribs to help you get neutral.

 

The Epilogue

After you get neutral (note the wording; I’m not doing it, you are), I give you some homework to make it stick. Neutrality isn’t a forever-defined state.

This reminds me of a tenured client I’ve worked with many times at IFAST. She got neutral months ago and was so proud of the progress she’s made. I imagine me watching this is what it feels like when parents see their child walk for the first time.

Then she got busy at work, started sleeping less, eating worse, not coming into the gym consistently, and getting neck problems. I was able to look at her one-on-one and found out that she’s not neutral anymore. What gives?

The state of your system is dependent on so many factors: what you see, what you hear, the exercises you’ve been doing, what has happened to you in the past, who’s around you… Any perception of threat steals your neutrality and puts you into survival mode. What happens for someone like our client in this case is she forgets what it feels like to be neutral. My job is now to remind her. But how?

For some people who aren’t too far locked into the normal, asymmetrical pattern, the task I give you might be to find your left heel a few times a day while you’re at work. This could be enough to remind your body that you have a left side that likes attention, too.

For most people, I’m going to give you some exercises to do at home and in the gym. You may have years of adaptations and compensations that we need to combat, and those tests I listed above tell me which of these we should focus on. And if you’re trying to get stronger and healthier, these exercises can help mitigate the negative effects of weight training.

Most commonly, I see a locked up pelvis on both sides because I see people who like to lift heavy things. If this is you, part of your program is going to be opening up the outlet of your pelvis. As I tell my anatomy students, this makes it so you can poop. Though this is hilarious to tell people in public, it’s not the only side-effect. Remember Bob Ross?

Then we’ll follow up with a lot of reaching activity. If the butt is closed off, so is the back. Active reaching helps make things stick better.

Then I might give you an exercise that reminds your body how to work as one whole system; an integration exercise. Moreover, I’d like this exercise to be done while standing, because you’ll be standing when you’re going about your daily life without me. I want to teach my baby birds to fly.

This pathway isn’t set in stone, it’s just a blueprint. Some people get different homework. Some people get the same homework for different reasons. Some people get the same homework for the same reasons.

That’s just a quick primer on neutrality. If you know someone at the White House, can you suggest to them that we make the first 24 hours of winter Neutrality Day? Neutral people welcome the winter because they have bodies that can deal with change.

Do you welcome winter?

Before you leave, do me a favor:

  1. Send this article to the last person with whom you talked about neutrality.
  2. If you haven’t yet, subscribe to my newsletter to get the information I don’t put on the blog.

And as always, comments and emails are always welcome.

All the best,
Lance

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