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.
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:
(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
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.
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:
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.
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 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.
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.
Think in the frontal plane. And learn your anatomy.
…And have fun sometimes.
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.Continue reading