LanceGoyke.com

Learn the secrets to long term health

Lifting Talk on YouTube

Fix your lifts one day at a time

Tag: sphenoid

Postural Respiration Recap

This was my third time through the Postural Restoration Institute’s (PRI) Postural Respiration course (1 home study + 2 live courses). I’ve been super busy since this course, and frankly a little overwhelmed at how incredible it was. This marked the first PRI course hosted by our gym (IFAST), but you know I have to talk about the whole weekend and not just the course.

 

Friday

With Ty, our night trainer, on location in Florida, I was filling in Friday night coaching sessions when past interns and their friends started arriving. The one and only Grant Gardis, weightlifting coach extraordinaire, was present to get worked on for an ailing knee and coaching like an assembly line.

Friday night IFAST family dinner

The wrapping up of IFAST coaching led into a generous family dinner orchestrated by Bill Hartman and the woman behind the scenes, Kirsten Shaw. It was so great to catch up before a two-day intensive mind penetration. Even driving to and from the airport is fun when you have Connor Ryan and Eric Oetter.

If you didn’t notice above, I would like to point out Kyle O’Flaherty’s photo bomb.

Can this kid ever be serious?

Saturday

After an early breakfast on Saturday with Eric, it was time for Ron Hruska, who was joined by his “third wife” Jennifer Gloystein. He began by asserting his dominance – no slides necessary – just riffing on what the big picture is, how this course is only a piece of the puzzle, and general PRI-isms. This serves well to get everyone on the same page. For me, this is a helpful brain warm up.

This course is about getting things to pump.

Pumping allows for exchange. The most basic example is respiration.

If you can’t oscillate, you’re dead.

Consider frequency, which is something you may remember from courses like physics. We all have “hertz” in our body. Respiration, mastication, circadian rhythm… it’s everywhere, and respiration is the slowest oscillation in the body.

Then, I start to wonder, “Why do we like music?” So I got the book Ron recommended (yes, it’s sitting on my desk already, thanks to Amazon Prime).

I’ve talked about a zone of apposition (ZOA) before, but it’s equally accurate to call it a zone of aspiration. You need the aspiration to breathe better so that you can use your appendages. You need a diaphragm that works for respiration instead of posture to have the aspiration to do things.

 

Asymmetry is Natural

There aren’t two sides that are even close to symmetrical.

This becomes more and more apparent as you read and explore. I was all up in the thorax of a cadaver a few months ago and the asymmetry is obvious. If you get the opportunity to do this, I encourage you to go explore.

They can’t walk into your clinic with symmetry because they wouldn’t walk into your clinic.

If you think in symmetry, you underestimate the system as a whole. Walking is impossible if you can’t get asymmetrical. Remember you have two lumbar spines – a left one and a right one. A left diaphragm works posturally to center you over a right side. Both the left and the right diaphragms are good at getting air into the left lung when you’re on your right leg. And you’re living with a brain that says, “Survive on the right side.”

You cannot be left dominant. I’ll show you the literature.

I need to read more. He also added that people who are left-handed will be ambidextrous.

Under every symmetrical movement is an asymmetrical challenge.

Understand that even when you’re squatting or deadlifting, you need to consider the underlying asymmetry. The brain wants the right leg because it’s more stable over there.

 

You Orthopedic-Minded Therapists!

Early on, Ron did the coolest thing to demonstrate how these concepts are not orthopedic, but neurologic. He stood on everyone’s left the whole time, but told us to freeze as he walked to the right side of the room.

With a rigid body, my eyes followed him to the right.

1 o’clock: doing okay
1:30: bad things are happening
2 o’clock: very dizzy
2:30: full-blown anxiety

He hung out at my 2:30 for a few seconds and asked us if we wanted him to move back.

God yes.

2 o’clock: so much pressure in my head
1:30: WILL THIS EVER END?
1 o’clock: sigh of relief
12 o’clock: melted into my seat

Ron always stands on the audience’s left when he speaks because he wants them to be able to learn. A brain cannot learn if it’s preoccupied (multi-tasking is a myth).

 Does the cortex you own understand inhalation?

A pectus, where the sternum area looks concave, is the first sign the cortex doesn’t understand inhalation. “You’ll get real smart if you start looking at pectuses.”

Pectus excavatum

“I can touch your breastbone and tell whether your neck is flat.” When you use a balloon, you aren’t working the mechanicoventilatory system, you’re working the cortex.

Today we’re going to  take a hand (or four) to guide neurology [not respiration].

The manual techniques are guiding the patient’s mind, not simply guiding sternums down. As he said after a sternal repositioning technique, “Those three bones all knew what was happening.” The sacrum, sternum, and sphenoid are linked by neurology.

Before you can take care of hyperinflation, you need to get air out.

You can’t fill a lung that’s already filled. Learn to exhale. Whitney Houston joke.

 

Why is Neutrality Important?

There are many ways to define neutrality, but for the respiration-minded, it means the diaphragm can contract without the expense of extension. This is specifically important in the spine, but the whole system extends.

I would pay you for your right lung because at least I can use it.

If you can’t use your right lung, you aren’t neutral. Until you figure out how to use it, you’re lifting weight even when you aren’t weightlifting.

We talk about these more abstract concepts a lot (Heidi Wise had a good piece on the PRI Vision blog). You can’t “feel” the floor. Your body feels heavy. You feel slow.

Picture someone who can’t find a reference. They grind their teeth at night. They like when their shoulder clicks. They can’t get off their right leg. These people use their extensors to pull their feet away from the floor and their heads down onto their thorax. These people can’t feel the floor. They feel heavy. They can’t laugh. They can’t enjoy music. Ron had a case study of a roofer who was having these problems.

There are a lot of roofers out there sitting behind keyboards. They’re called repetition.

Why would I help this person get their strength back if they can’t use it?

If you’re going to change a pattern with a pattern, you will fail.

It is the position that shuts off the the system; a position that isn’t threatening. You can’t restore neutrality without position, and that must come first.

 

A Cootie Bug Thorax

She is not a patellofemoral, shoulder, etc. patient. You treat that and you’ve failed.

Cootie Bug

Ron loves the cootie bug toy because in order to play with a cootie bug, you need a thorax first.

Pedestrian walking requires a cootie bug thorax.

Gait that isn’t alternating (i.e. you’re using a right leg and a left kickstand instead of two legs) leads to an overactive neck.

Create left cootie bugs.

You need left abs to oppose a left diaphragm and overcome the right diaphragm.

 

Treatment

You need three things when treating a thorax:

  1. Maximize inhalation on the right.
  2. Maximize exhalation on the left.
  3. Alternate.

This is the biggest takeaway from the course. This is applicable immediately.

What’s the difference between a hand on a thorax and a wall? NADA.

The Postural Respiration course has a lot of manual techniques where the therapist helps the patient find neutrality. These aren’t always necessary to use. Always go to non-manual techniques first when treating someone because they are stronger teachers. This is just like how you remember more when you perform an activity as opposed to listening to a lecture.

In a non-manual technique, we can use something like a wall to give the patient a reference. With manual techniques, my hands become the reference. Now I’m asking myself, “How will I give you a reference?

One thing that I’ve been using with a lot more success lately is the cue “knees forward” instead of telling them to tilt their pelvis. This helps reduce abdominal tone for the repositioning techniques. I’ve also tried using more verbal cues so that they can make their own representations of the activity they are doing. It doesn’t work all the time, but it sticks better.

These runners. These SICKOS. Right and left doesn’t exist in their vocabulary, only extension.

This is hilarious, but it’s not limited to runners. I just taught at a USA Weightlifting course full of Crossfitters. They feel great when they work out, but they can’t come down. They can’t shut off. They can’t relax. So they just train more often. Again, why would I help you get your strength back if you can’t use it? In regards to alternating activity (#3 above), ask if you can rotate that vertebra to the right without coming off the left leg. Ask if you can rotate a central tendon to the right from the left side. Ask if your sacrum, sternum, and sphenoid are alternating – because that’s gait.

When I hear “dys-” and “shoulder”, I think lat.

The lat is a road bomb to your body. The Achille’s tendon may be the largest tendon in the body, but the lat tendon is the strongest. “You can never annihilate a lat enough.

I’m gonna get every single millimeter of my God-given mediastinum.

Left serratus anterior pulls the ribs back to open up that left posterior mediastinum. How am I going to give you a reference for your posterior mediastinum? Maybe I make sure you have the correct chair at work and ask you to feel your back in it every once and a while.

 

Saturday Night Dinner

I had the amazing opportunity to go to dinner with Ron, Jenn, Bill, Robert Lardner, and Richard Ulm. The knowledge at the table was overwhelming, and it wasn’t from me. If we mapped the concentration of knowledge like you would to should charge distribution of a molecular compound, the table would look very similar to the electrostatic potential map of lithium iodide.

Lithium iodide electrostatic map

Our server didn’t know what to do when Rich, Robert, and Ron all ordered the right rack of ribs.

The right rack of ribs. [From left]: Robert, Ron, Richard

And it’s not a PRI party if someone doesn’t start talking about right trunk rotation (ribs moving up on the right and down on the left).

Right trunk rotation. [From left: Robert, Ron, Richard]

Suffice to say this may have been the best dinner ever.

 

Sunday = Biobehavior

After an interesting discussion at dinner, Ron opened up Sunday a little closer to his home. He wrote a bunch of inputs into the system on the board: visual, vestibular, proprioceptive, etc. They were big words that I don’t remember.

The stuff in the manual is evidence-based.

If you’re worried about the evidence supporting PRI, buy a manual.

I do manual work to open up something behaviorally [not manually].

He told us to write down the above heading on our note paper. Ron is all about the vestibular system. This ties back to the cervical-cranio-mandibular course I took a few weeks back.

I’m not teaching you how to open up a chest wall, I’m teaching you how to teach them to open up a chest wall.

As I alluded to above, you’re guiding neurology, not adding sarcomeres in series. And “the sternum is the best thing we have for regulating.”

I like working with a patient with CVA because now when I do this stuff, suddenly it’s okay. “They have neglect!”

Those who don’t understand will criticize.

I’m never worried about physical trauma, I’m worried about psychological trauma.

More biobehavior. Repect psychology. See if your patient can articulate their thoughts into words. Talk to them. What worries them?

The number one things that scares me these days is Lasik surgery.

After Lasik, you’ll be taking in a lot more information than you normally do. How do you shut down such a huge input?

If I don’t pretest, I can’t understand pathology. If I get you neutral and don’t treat the pathology, I won’t be able to keep you there.

I’ve been picking up more assessments at IFAST lately, so I shadowed Bill one day to hone in my skills. This point was made to me then. Being neutral is only the tip of the iceberg. Make it stick.

Before I get that dental impression made, I’m going to free up the first rib.

Subclavius and scalenes on the right side can get really active to try to open up the closed right upper ribs. This is called Superior T4 Syndrome in PRI. I need to regulate everything I can before I get some sort of dental intervention that will hold me there because I don’t want it to hold me in the wrong position.

Similarly, if you have a left pec major that won’t shut off, you need to give it a reason to shut off. Stretching is not that reason. You need to restore position of an S bone called a sternum to regulate neurology, otherwise the brain will keep telling it to turn on so it can open up the right chest wall.

If I have someone who can’t feel what I’m trying to do, I probably need more hands.

These systems are locked up and will take some work to unlock. The manual techniques you use for these people will need more than just one set of hands. Find a mom or a co-worker.

Our room was full of jacked lifting bros, also known as extended bros. There were only a handful of women. Ron mentioned that this type of “clientele” is not normal, but it’s pretty common for the people I get to see in the gym. If non-manual techniques don’t work, these people are going to need more than two hands on them.

All in all, Ron was great again. The course wouldn’t have gone nearly as well if he hadn’t brought Jenn along with him, so hats off to her as well.

 

Post-Course Dinner

Not one to pass up a dinner, Bill invited everyone over to his place, catered by the lovely Mayor Lisa. The place was packed. So packed that I had to skip my hockey game to attend.

This was the largest family dinner I’ve ever been to. And the loudest.

 

Closing

Robert Lardner had a great point to make during the second day.

This stuff has been done for [hundreds of] years, but we’re just coming back to it because we’re just starting to affirm it.

Robert is a very smart man who is paying attention to what goes on around him. I don’t know the history of yoga, but apparently that’s been going on for quite some time.

 

Hope to see you at the next course!

IFAST group photo

 

 

Miscellaneous Quotes

Don’t get wet, drown with this stuff.

Learn more. And don’t stop.

…a major neuromuscular disease called a spouse.

Lost my mind when he said this.

We treat our cars better than our patients.

Get a tune up and pay attention to the system.

 

You need to attend this course.

If you liked this post, please share it with someone who would like it, subscribe so you don’t miss the next one, and leave a comment below telling me what course you’re going to next.

More Research Linking the Feet and Head

In a previous post, I discussed some of the research done by Dr. Brian Rothbart, a Doctor of Podiatric Medicine (DPM), which shows a definite relationship between the feet and the head.

In response to what I wrote, Dr. Rothbart added a comment citing some of his more recent research. The full text is available on his site.

After reading the paper, I wanted to go through it with you guys.

The Case Study

Rothbart examined four subjects with cranial radiographs. These pictures were taken (1) without intervention, (2) with a prescribed dental appliance, (3) with some sort of foot orthotic, and (4) with both interventions.

Two of the subjects saw the most improvement when using both interventions. Check out the example below.

Baseline

After intervention

Very cool stuff. But what about the other two subjects?

The Meat and Potatoes

Subject AD saw worsening when using both the dental appliance and the foot orthotic. The confound here, and why this study offers so much, is that AD was not using Rothbart-prescribed insoles, only generic ones.

The author used this piece of evidence as a very important talking point: keep a global view helping someone. He suggests that generic insoles, like the ones AD used, may alleviate feet symptoms while increasingly destabilizing the cranial bones and potentially lead to headaches. This outcome was noticed in AD and is a classic demonstration of treating the symptoms, but not the problem.

Check out two of AD’s radiographs below. Take special note of the second from the bottom (level of the mastoids) before and after intervention.

Subject AD baseline

Subject AD cranial destabilization after intervention

Subject HB was described to have blocked sacrum. This concept makes sense when you see that the data showed improvements with the dental appliance, but not the prescribed proprioceptive insoles; there was a break in the chain.

The treatment of HB is another demonstration of the importance of maintaining a global view. It also illustrates, however, the need to clear up restrictions. As the author mentions, ankle problems may be fixed, but the subject had increased low back pain.

As Rothbart summarizes: “In both of these cases, from a strictly podiatric point of view, the proprioceptive therapy might be considered successful. But from a holistic point of view, the proprioceptive therapy would be considered inappropriate.”

Summary

Keep in mind that this is all my interpretation of the research, but I’d say it definitively shows a link between the head and feet. Care to offer anything? Add it in the discussion below!

You Want to Give Me a Mouthpiece for My Foot Pain?

UPDATE (11 Dec 2013): Click here to see more recent research.

 

The problem with having specialists in so many different areas these days is that the whole problem gets neglected.

Steve has foot pain. He’s referred to a podiatrist who says, “We need to open up your foot.” Foot pain comes back after surgery because his flat feet are being driven from the top down: an anteriorly rotated inominate, internally rotated hip, knee valgus, and excessive pronation at the feet.

But how far can we extend connections like these?

It’s not too difficult to get from the hip to the foot. Brian Rothbart doesn’t stop there. (2008; Rothbart 2008)

Poor “teeth coming together-ness” associated with foot position. If that isn’t cool, I don’t know what is.

Rothbart looked at the foot, the hip, and the cranium and drew relationships between them all. The summary is that when you look at a person (more specifically, a young Mexican subject), their more pronated foot is associated with shorter vertical facial dimensions on the same side.

Looking at it in more detail, a pronated foot is linked with an anteriorly rotated innominate via the mechanism I mentioned above. It is also associated with an anteriorly rotated ipsilateral temporal bone (think bringing the mastoid process up and making it less palpable, a.k.a. counterclockwise rotation in the photo below). The sphenoid is pulled downward, and the maxilla is pushed upward. There we have it: short face! There’s a helpful radiograph in the article linked above.

 

The skull

A right innominate

Pelvic bones and temporal bones look pretty similar, don’t they?

He briefly mentions a fix for malocclusions. Check out the video below for an introduction to Advanced Lightwire Functionals.

The DO lady in that video mentioned using the ALF to treat people with autonomic problems. The central goal of the Postural Restoration Institute – as I understand it – is to get at the nervous system. We want the body to have sufficient variability to do what it wants to do. We don’t want to be stuck on our right leg. We don’t want to be stuck in extension. We don’t want to be sympathetically toned up. Realigning your temporal bones, innominates, and feet are just neutrality acting on the nervous system.

Consider another article from Rothbart (2011) where he describes a foot condition.

On a side note, does anyone have a problem with him naming this condition after himself?

In people with Rothbarts foot, the first ray (that is, metatarsal up through big toe) hovers over the ground even when the talus is neutral. The big toe can’t feel anything underneath it, so when walking, the foot pronates hard to “find the floor”. These videos on rearfoot varus and forefoot varus can help you picture it.

The neurophysiological model which Rothbart proposes helps explain why proprioceptive insoles can make people better. Contrary to traditional orthotics that offer support, these insoles simply give the foot something to feel. Rapid pronation every time your heel strikes the ground holds the body in a state of extension. Good input on the bottom of the foot sent up to the cerebellum helps keep the person’s system neutral.

And as we already talked about, this can help a lot of things. From feet, to hips, to teeth!

Make sure you step back and look at the whole person when you’re helping them; getting too focal traps you into the specialist mindset. Better to be the person who sees everything than the person who misses the big picture.

 

References

Rothbart, B. a. (2008). Vertical facial dimensions linked to abnormal foot motion. Journal of the American Podiatric Medical Association, 98(3), 189–96. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18487592

Rothbart, B. A. (2008). Malocclusions Linked to Abnormal Foot Motion. Positive Health Online. Retrieved from http://www.positivehealth.com/article/bodywork/malocclusions-linked-to-abnormal-foot-motion

Rothbart, B. A. (2011). Primus Metatarsus Supinatus (Rothbarts Foot): A common cause of musculoskeletal pain – Biomechanical vs Neurophysiological Model. Podiatry Review, 68(4), 16–18.

© 2019 LanceGoyke.com

Theme by Anders NorenUp ↑

[wpforms id="1948"]
What is the single most important goal of the site? Do you want this to supplement a physical location? Or is this more of an online-only project? Do you have a compelling offer for new customers? Do you have testimonials to show people? Do you have pictures you can use without violating copyright? Do you have someone to write compelling sales text? I can help you work through these questions if we do end up working together.