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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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Impingement and Instability – A Recap

I spent this past weekend in lovely Phoenix, Arizona to reunite with old friends, meet the legend that is James Anderson, and learn all the things. Check out the Twitter action.


Phoenix is seriously 40 degrees warmer than Indianapolis and seven thousand less percentage humidity, so I was immediately caught off guard. Though I didn’t have my physical therapist friends test me right away, I’m pretty sure the unpredictable environment would have stolen my neutrality, had any remained after four and a half hours on a plane.

It didn’t.

I don’t get to put things in practice as much as most of the other attendees, so this overview is both for you to become aware of what the Postural Restoration Institute is doing, and for myself to cement the information.

I’ll give you some of the highlights of my notes in bullet form. Quotations will not be attributed to any one person to protect anonymity. You can assume I said the inappropriate things and that James said the intelligent things.

“PRI is neurology, but the mechanicoventilatory system is used to regulate neurology.”

This is a big deal. A lot of people think PRI’s system is just to strengthen some well-illustrated muscles. This couldn’t be further from the truth. The concept of neutrality is the centerpiece. This neutrality isn’t just a pelvis that is in the right position, but a brain that doesn’t perceive harmless stimuli as threatening. We can use these muscles, your shoes, your eyesight, and a million other things to get you neutral. My good friend and hotel-mate, Zac Cupples, gave me neutrality (albeit only for a short while) by softly saying, “Lance, just go neutral, bro.”

“Ron Hruska puts his hands on a joint – and he’s not thinking about that joint.”

That joint is the farthest thing from his mind. This ties into the previous quote. Neutrality is neurology, not biomechanics.

“Girl, that ganglia’s so hot.”

The new pickup line for women who are stuck in extension. James quickly illustrated this point to us by having my table neighbor, Maegan, stick her arms into some bands running vertically down a stretching cage. The bands represent the sympathetic trunk. Maegan’s arms represent closing of the posterior mediastinum from extension. An extended spine forces the vertebrae anteriorly, which compresses the contents of the posterior mediastinum.

Mediastinum transsection

A side note that I want to mention: this is why PRI is my crack addiction. James prioritized. He opened with the neurology talk and vividly has Maegan demonstrate to us the detriment of an extended posture. As someone who helps others learn anatomy, I admire the teaching ability of the presenters.

“Don’t fight the brain.”

This was something Mike Cantrell opened my eyes to last month at Postural Respiration. A big breath is worth nothing if it’s perceived as a threat, even if you’re doing a manual technique at the time. The purpose isn’t to get as much air in as possible. So if you see someone fighting through inhalation with their neck muscles, you need to stop that. Slow inhales. Let it come in – don’t make it come in. The same can be applied to putting weight on your right leg. You don’t need to only have your left leg down for PRI techniques to work.

“When I wear these shoes, my arm freeze up.”

Frontal plane support at the heel helps you maintain neutrality. Your soft Nike Frees could be throwing you into a state of extension. Check out the 2013 Hruska Clinic recommended shoe list.

“When I squat the way the strength coaches tell me to, I can’t get off my right quad?”

We discussed the bro mentality that more weight is always better. James suggested looking at the objective outcomes like 40-yard-dash time and vertical jump and seeing what actually improves those measures.

“How come I’m squatting heavy, but my vertical is going down?”

See above.

“Make a neurological wedding between the left heel and the floor.”

This alludes to the six reference centers they discuss. If your client can feel those, you’re doing things well. These reference centers are going to be useful when coaching exercises.

“I got Apollo Ohno right butt syndrome.”

Apollo Ohno has to turn left to be good. His right glute max is working well in the transverse plane instead of the general PEC patterned individual’s “sagittal plane only” right glute max.

“‘Trunk’ means above T8.”

This was something I had struggled with for a long time. Now the semantics make sense.

“The key to triplanar performance rests in a triplanar ZOA.”

The Zone of Apposition (ZOA) is not found unless it is found in all three planes. Thoracic abduction (a frontal plane translation), lateral flexion, rotary orientation, and extension all need to be taken care of. Abs are not a good thing if you have them without a triplanar ZOA. Use exhalation to get good abs.

“That’s my favorite weight belt called bilateral low trap.”

Picture the spine as a flagpole. Each low trap can prevent the flagpole from tipping over (in the frontal plane). A right arm reach can orient the spine back to the left. It can also get you a triplanar zone if you couple it with exhalation. Hold the reach. Inhale. Then you get right trunk rotation with filling of the right mediastinum. Right low trap is important to consider because it’s being lengthened from both ends (scapula protracts, IRs, anteriorly tilts while spinous process moves away).

Appreciate the lower trapezius!

“Serratus without low trap day at the gym? Stay home.”

The upper body musculature works together to intricately. Right upper trap opposes subclavius. Low trap is useless without serratus and vice versa.

Look at that serratus sling!

Right serratus anterior acts as a sling on the side of the chest. When this contracts, it pushes the thorax to the left side. A movement called left thoracic abduction. The left low trap pulls the spine into left thoracic abduction at the same time to reinforce this movement. And this is only the frontal plane.

“Breathing is gait and gait is breathing.”

If you don’t use the mechanicoventilatory system as a tool, you’re making things hard on yourself.

“Left pec is a stupid muscle.”

Why is he trying so hard to get air in? Just get a left ZOA instead.

 

I love PRI. It is my addiction. See you at the next course! They’re coming to Indianapolis next year…

This may have further confused my search. What should I do with the rest of my life? Well, I don’t know, but I want to be able to get people neutral. What’s the best avenue for that?

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