Author: Zac Cupples

Chapter 1: What are Breathing Pattern Disorders?

This is a chapter 1 summary of “Recognizing and Treating Breathing Disorders” by Leon Chaitow. It’s Been A While I know it has been a while for some Therapy Notes (©™®#zacistheshizzy), but I decided to revisit some Chaitow as I read his new edition. The chapters have changed quite a bit so far, and many new things have been added. Here is the updated chapter one. A Lotta History Hyperventilation disorders have been through the ringer, and to this day are hardly diagnosed. Some of the biggest classifications in my eyes arrived in 1908-09 from phsyiologists Haldane, Poulton, and Vernon. These fellows classified symptoms of overbreathing to include: Numbness Tingling Dizziness Muscular hypertonicity. This symptom cluster occurred with respiratory alkalosis. In 1977, Lum, Innocenti, and Cluff developed assessment and treatment programs for breathing disorders in the UK, which spearheaded breathing disorder literature. Despite these scientific advancements, many physicians do not diagnose hyperventilation as a legitimate problem. Some of these patients even go so far as to being accused as malingering. Hearing this problem is quite unsettling, as I am seeing more and more people who overbreathe; and possibility correlating, more and more people with chronic pain. A future post is in order to show how I think the two are connected. Breathing Pattern Disorders (BPD) and Symptoms So many symptoms could occur with BPDs. The most extreme of these symptoms is hyperventilation syndrome, defined by the following: Breathing in excess of metabolic requirements. Reducing CO2 concentrations in the blood below

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Course Notes: PRI Pelvis Restoration

Just recently attended another excellent PRI course taught by Lori Thomsen and new instructor Jesse Ham called Pelvis Restoration. The weekend was filled with great discussion about inlets, outlets, shoes, and many other pearls that helped solidify my PRI understanding. So without further ado, let’s summarize. If this is your first reading on a PRI course, it may be beneficial to review my post on Myokinematic Restoration. PRI 101 Jesse started off the class discussing some PRI basic philosophical tenets. In PRI, we talk a great deal about position, which will be defined as a stance or posture at one point in time. Or as Jesse defined it, a position one can maintain for an extended period of time without pain. With this operational definition, our goal as a PRI clinician or trainer is to organize activities in the following order: Reposition – inhibit muscle chains. Retrain – Facilitate muscle chains Restore – Create reciprocal alternating activity (using all muscle chains when it is desired). Reciprocal activity is defined as going from one end-range to another (extension to flexion) and alternating activity is switching from one side of the body to another (right to left stance). When we alternate, the joint on one side of the body ought to do the exact opposite at the other side. With the above treatment hierarchy, we are working on allowing positional freedom within the person being treated. We call this movement in multiple planes. Now the Pelvis This part is where things can

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The Year of the Nervous System: 2014 Preview

It’s All Part of the Plan And if you see my course schedule this year, the plan is indeed horrifying.   I wanted to write a post today to somewhat compose my thoughts and plans for this year, as well as what I am hoping to achieve from the below listed courses. Because of the course load and some of my goals for the year, I am not sure what my blogging frequency will look like. I have begun to pick up some extra work so I am able to attend as much con ed as I do. The Amazon affiliate links that I don’t get money for because I live in Illinois simply cannot pay for classes :). I am just putting these links up here because I want to encourage you to read these books on your own. Use my site as a guide through them. Big Goals My biggest goal for this year is to successfully become Postural Restoration Certified (PRC), and my course schedule below supports this goal. The amount that I use this material and the successes that have come along with it simply compel me to become a PRI Jedi. I see the PRC as a means to achieving this goal. The application thus far has been quite time-consuming. There are a total of 3 case studies, 5 journal article reviews, and tons of other writing that has to be done. Couple that with studying the material, and I have had a very busy

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Course Notes: Advanced Integration Day 4 – Curvature of the Spine

Today we get wild and crazy and talk about scoliosis and the like; the last day of AI. For day 1, click here For day 2, click here For day 3, click here Scoliosis Variations The entire day focused predominately on treating scoliosis, which oftentimes amounts to exaggerations of the common patterns PRI discusses. Because scoliosis is an exaggerated PRI pattern, one must beget the question if the pattern or scoliosis came first? This question obviously cannot be answered, but for our intents and purposes we ought to assume pattern precedes curve. That way we may be able to alter the impairment. The scoliosis we can alter is often functional aka rotational. These types are ones that everyone has; the question is to what degree. Nonpathological Curve The nonpatho curve is an exaggerated version of the LAIC/RBC pattern, oftentimes with superior T4 syndrome involved. In this pattern the left ribs are externally rotated and right internally rotated. This reason is why 98% of scoliosis has right sided rib humps. A rib hump is akin to excessive rib internal rotation.  In this case, the spine looks like so… Here we can see how the spine excessively right orients up to T8-T9, then rotates left superior to that. These patients will present with typical Left AIC and Right BC test results along with typical right lateralization. One difference may be the right shoulder is not as low as typical with most patterned individuals. This change is due to compensating for the excessive curve. When

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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. Temporal——-sphenoid Thoracic———sternum Thoracic———scapula 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

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The Post Wonderful Time of the Year: Top Posts of 2013

The Best…Around Time is fun when you are having flies. It seems like just yesterday that I started up this blog, and I am excited and humbled by the response I have gotten. Hearing praise from my audience keeps me hungry to learn and educate more. I am always curious to see which pages you enjoyed, and which were not so enjoyable; as it helps me tailor my writing a little bit more. And I’d have to say, I have a bunch of readers who like the nervous system 🙂 I am not sure what the next year will bring in terms of content, as I think the first year anyone starts a blog it is more about the writing process and finding your voice. Regardless of what is written, I hope to spread information that I think will benefit those of you who read my stuff. The more I can help you, the better off all our patients and clients will be. So without further ado, let’s review which posts were the top dogs for this year (and some of my favorite pics of course). 10.  Lessons from a Student: The Interaction This was probably one of my favorite posts to write this year, as I think this area is sooooooo under-discussed. Expect to be hearing more on patient interaction from me in the future. 9) Clinical Neurodynamics Chapter 1: General Neurodynamics Shacklock was an excellent technical read. In this post we lay out some nervous system basics, and

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Advanced Integration: Day 2 (Triplanar Activity)

For day 2 we discuss more and more the areas that help support ZOA establishment. Read on comrades. For day 1, click here Neutral Neutral can be described as a position in which certain muscles are disengaged; those that make up chains in the human system (i.e. left AIC, Right BC, right TMCC). It is neutrality that allows us to function out of an unbiased non-lateralized position. We will never be fully symmetrical because we are neither built as such nor function cortically as such. But being able to be as symmetrical as possible may allow our bodies to function favorably. Achieving neutrality is only step one in the process. It allows for someone to accept triplanar movement. Once one can reach neutral, then you may teach them how to move with the left and right sides of the body. Is it possible to be too neutral? The answer is it depends. Mike Cantrell, one of PRI’s instructors, discussed a sprinter he was treating. Mike was able to get him neutral, but once this occurred his times worsened. This result goes back to part 1’s discussion regarding variability. In this case, being neutral, being too parasympathetic, made him slower. We could akin this to almost parasympathetic overtraining. The crazy thing? This sprinter’s sister had died earlier in a week he was scheduled to see Mike. The guy came in as neutral as could be. His nervous system shifted him towards this state as a way to disengage, thus leading him

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Course Notes: Advanced Integration Day 1 (Synchronous Breathing)

Mind Blown My mind is still racing from PRI’s annual Advanced Integration course. It is over these four days that we linked all the chains learned in the basic courses into one interdependent system. As I have not taken all the PRI courses yet, I was very fortunate to have Bill Hartman, Doug Kechijian, and Young Matt to help me through the rough patches. Courses are so much more enriching when taken with friends. There was way too much material covered over the four days to write in one post. So here is the first of a four part series on this excellent class. Read on.  Autonomics and the ZOA The first day’s primary objective was establishing a zone of apposition (ZOA), the diaphragm’s cylindrical aspect that lies along the chest wall. Establishing this zone is of utmost importance, as it allows for favorable respiration. Respiration influences movement by allowing better change of direction and variability. If I establish and maintain a ZOA, then I can effortlessly maximize movement in all three planes.  When I cannot perform in this way, then I have less triplanar activity when I move. When one does not establish a ZOA, one must greater rely on the autonomic nervous system (ANS). Depending on what your goal is, this shift can be well and good. Take an example I got from Bill and my friend Eric Oetter. A sprinter or powerlifter who moves in one direction would not like much variability in how they move, thus

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Treatment of Shredded Cheese of the Hip: A Case Report and Rant

A Long Day I officially eclipsed my longest work day ever. Started seeing patients at 7:30 am and finished training my last client at 10 pm. So exhausting, but the bright side is my new schedule prevents me from waking up that early ever again! Hooray for sleeping in…sort of. I figured while I had some time in the airport before my next course, I would write a little something about a patient I evaluated right before my lunch break on this long day. Needless to say, I didn’t get much of a break. Her Story This lovely lady is a nurse with a history of chronic left hip pain. She has predominately been treated surgically via labral repairs and muscle reattachment. Her most recent symptom exacerbation involved putting on her socks about a month prior. She heard a pop as she bent over and could not walk. She initially saw two ortho docs. One specializes in total hips, the other in scopes.  Since she was not appropriate for a total hip, this doc referred this lady to his associate. After some imaging was done, she found out that she could not have surgery because she had several muscle tears. Or in the language that the doctor used: “I have nothing to work with. Your hip is shredded up like cheese.” This lady knew no other treatment but surgery, and hearing this news was devastating for her. Thoughts of a brutish life and an end to her fulfilling job flooded

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Chapter 5: Interaction of Psychological and Emotional Effects with Breathing Dysfunction

This is a chapter 5 summary of “Multidisciplinary Approaches to Breathing Pattern Disorders” by Leon Chaitow. The second edition will be coming out this December, and you can preorder it by clicking on the link or the photo below. Intro This chapter is dedicated to showing the connection between the body and consciousness; how our psyche is influenced by breathing and vice versa. This chapter was easily my favorite out of the entire book. Breathing Strategies Optimal breathing involves moderate abdominal expansion, some intercostal involvement, and minimal involvement of accessory muscles. Conversely, chest breathing is dominated by accessory muscle use. These two breathing styles are merely end points on a continuum rather than discrete categories. In terms of which strategy is used, chest breathing is often the preferred route for consciously mediated intentional breathing; whereas abdominal breathing is the main route for relaxed, automatic breathing. One reason you would want to override automatic breathing is to prepare for sudden action. At the onset of exercise, ventilation immediately jumps.  This change occurs via three phases, with the first phase occurring independent of exercise load. This phase is a conscious exercise preparatory action. The other increases occur as exercise demands increase. When we are in an emergency situation, these breathing phases change. Prior to the initial pre-action deep breath comes a breath holding phase, which helps increase sensory organ stability. These preparatory breathing changes are great for imminent danger or action, but problematic when threats are non-physical and in the future.  While

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Course Notes: PRI Impingement and Instability

Soooooooooo Dense It has been a long, busy, and great few weeks for me. After attending a cluster of courses, playing around with some new jobs, moving, and working, I got some time to settle down and review PRI’s I&I material. I traveled to Phoenix to take this course. My man James Anderson taught and several good friends attended. James did not disappoint. I&I was easily one of, if not the best course I have ever taken. You did it again PRI! The only real disappointment was leaving Arizona. The temperature was in the 80’s and the sun was shining. Now here I am in the Midwest with the temp in the mid-20’s. Why did I stay here again? 🙂 This course combined and fleshed out the concepts of respiration and myokin, and added so many more layers onto what we previously learned. I&I was what DNS C should have been. I left the course with many answers, but double the questions. You truly cannot appreciate how complex the nervous system is, and how the total body responds to perceived threat until you delve into this material. I am so excited to learn more. This course had so much information regarding the entire body that there is no way I could post all the relevant info and do it justice. It really was a 4 day course done in 2. So here are a few of the gems I got from this weekend. The PRI Basis The course started off

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