Advanced Integration Day 3: Thoracic-Scapula Integration

Day 3 was all thorax and scapula. Here we go!

For day 1, click here

For day 2, click here

A Philosophical Ron Intro

Since the day began talking thoracic-scapula, Ron started us off by showing all the T-S connections in the body.




Tri-os coxae—-Sacrum

You will notice that the thorax is very connected to many of these areas. Therefore,  it is very important to control this area early on; especially if one’s problem is in the cervical spine.

The “pattern” dictates the thorax governing the cervical spine because the neck follows suit with the rotated left thoracic spine. Thus, if we restore position to the thorax, oftentimes neck position will clear up.

From here, my man James Anderson was introduced, and we started off the
discussion with a bang.

Brain, Brain, and a Little More Brain

The first hour was spent talking about a subject much needing discussion: PRI’s cortical foundation. James really hammered the fact that our brains are what drive us to the right.

None of the previous mentioned material matters. Zones don’t matter, left AFIR, right shoulder internal rotation, nothing, if you can’t get the brain to change out of a left hemispheric dominance.

How do we do this? Per James, let’s get a zone of apposition (ZOA) in a right
lateralized pattern.


Say what? All the talk you have been hearing involves getting out of this right-sided dominance. But think of PRI activity in this fashion. We are most comfortable with performing right-sided activities. So why not use graded exposure to slowly get us onto our left side? Since ZOA establishment is the foundational piece, let’s just get that and slowly work towards using our left side.

The activity above was something James showed us at Impingement and
Instability. As you can see, my pelvis orients to the right and thorax to the left with this activity i.e. the pattern. However, James got one of my classmates neutral with this exercise. Because we achieved ZOA in the pattern, the brain can safely begin to lateralize to the left without a threat response sending us back into our comfortable right dominant pattern.

Explaining Superior T4

Superior T4 syndrome is another PRI concept that for me was very difficult to understand. But after AI, this syndrome was cleared up for me.

In a normal patterned individual, the left ribs are externally rotated and in an inhaled state, and the right ribs are internally rotated in an exhaled state.

In a superior T4 syndrome, the first rib becomes elevated anteriorly on the right. This change occurs when the scalenes begin to act as accessory respiratory muscle.

Overactive scalenes will alter rib orientation down to T4 level because that is the level the first rib is located at.

Pretty close as you can see.
Pretty close as you can see.

When this elevation occurs, ribs 1-4 internally rotate on the left and externally
rotate on the right. This pulling creates torsion in this area, thus altering rib
orientation and the movement synchrony of the ribcage.

The internally rotated left upper ribs decrease apical airflow simply because there is no rib expansion. This airflow type leads to corresponding decreased shoulder internal rotation bilaterally and impaired
subclavius mobility secondary to rib and shoulder girdle compensatory positioning.

Postural Respiration on Steroids

James gave a very clear explanation as to why certain muscles are targeted in a right BC pattern. Let’s discuss them below.

Right low trap – Based on the thorax’s orientation in a patterned individual, the right low trap is long at both ends.

  • Kinda Too Good at: The lengthened right trap helps stabilize the right abducted thorax poorly by partnering with the right ab wall.
  • Goal: We want the low trap to retract and posteriorly tilt the protracted scapula, as well flex the thorax.

Left low trap – Based on the thorax’s orientation in a patterned individual, the left low trap is short on both ends.

  • Too good at: The left trap does very well concentrically stabilizing spinal rotation in the transverse plane secondary to shortness.
  • Goal: We want the left low trap to help stabilize a left abducted thorax.

Left Serratus Anterior – Shortened due to thoracic and scapular position.

  • Too good at: Left serratus drives the thorax into right abduction to further facilitate favorable right hemidiaphragm position.
  • Goal: Improve thoracic kyphosis sagitally and promote rib IR via upper fibers to drive thorax out of left rotation transversely. Will help anchor ZOA because ribs retract and increase left posterior mediastinum activity.

Right Serratus Anterior – Lost leverage by scalenes and abdominal wall shortening the surrounding areas, thus making serratus long.

  • Too good at: Sagittal activity.
  • Goal: Drives the thorax into left abduction to quiet the right ab wall and scalenes. Also externally rotate ribs to increase apical expansion.

Right Subscapularis – Mechanically disadvantaged against the lat and pecs due to scapular position.

  • Too good at: Not much. Trouble overpowering the lat
  • Goal: Will keep the lat quiet once thorax and scapula are properly positioned. If your patient/client has positive RBC tests except full shoulder internal rotation, then some issues once all these tests are clear, go after this muscle.

(In)famous Ron Quotes

• “Give the least amount necessary to be successful. Need to get you there and
then take it [the activity] away.”
• “God love ya, but I just don’t want to focus on provoking pain.”
• “If you gotta travel with pillows, you got issues.

Great James Quotes

• “The brain is right lateralized. Your 12 o’clock is not 12 o’clock.”
• “The brain is the heart of integration through the thorax.”
• “When your soul burns, you’re integrated.”
• “If you think you’re feeling your ab wall, I think you are not integrated.”
• “Don’t fight the brain.”
• “If you leave the brain on the table, you are not playing.”
• “I’m like Dr. Seuss. I’ll get a ZOA in a box, I’ll get a ZOA with a fox.”
• “Breathing and autonomics are the same word.”
• “If you think it’s AFIR you missed the show. You are at my daughter’s third
grade magic show and I’m at Vegas with David Copperfield.”
• “Your ab program is likely a neck program.”
• “John Wayne knows how to work serratus.”
• “When subscap becomes subscap, it will give you internal rotation

  1. Hi Zac, thanks for all the great info you post. I am a physio in New Zealand, and have started getting really interested in the PRI approach, (mainly trying to sort out my own chronic neck and back issues). I feel I fit into the superior T4 syndrome category, with right neck pain and overactive scalenes. I have read a few different pieces about the importance of activating both the right and left seratus anterior/LFT. Is it important to activate one before the other, or just work on both? Also, your video on another post which shows the left seratus anterior/LFT exercises doesnt work, can you describe what this exercise is? Thanks again, Marcel