The Pilgramage One of the many reasons I was drawn to make the trek to Lincoln was to experience my man James Anderson’s original affiliate course. I always enjoy hearing James’ perspective on PRI, and he did not disappoint here. The course felt like an Impingement and Instability with a bias towards the geriatric/chronic pain populations. Some might argue that James is the king at implementing PRI here. I really admired James saying throughout the course that the Geriatric population houses his favorite athletes, and they really are. High performance at any task, be it sprinting 100 meters or walking to pick up the mail, require similar alternating and reciprocal components. We still go after the same pieces to achieve different goals along a continuum. So let’s dive into this high performance course for some high performing individuals. PRI 101…or at Least the Pieces You Didn’t Get from My Other Reads The affiliate courses have a huge introduction that gives an overview of PRI principles, namely the Left AIC and Right BC patterns. I’m not going to go through all the nitty gritty as this course did, but instead I’ll review concepts that James cleaned up for me. Think of this post as an in-depth FAQ. If you want to learn more about the left AIC, you might want to read the course notes on Myokinematic Restoration and Pelvis Restoration. If you want to learn more about the Right BC, then read my Postural Respiration notes. The Overviewing Overview The big keys
Read MoreTag: movement
PRI and Pain Science: Yes You Can Do It
Questions You may have noticed that my blogging frequency has been a little slower than the usual, and I would like to apologize for that. I am in the midst of creating my first course that I am presenting to my coworkers. It has been a very exciting yet time-consuming process. It makes me excited and more motivated to someday start teaching more on the reg. Ever since I started blogging people started asking me questions. These range from many topics regarding physical therapy, career advice, and the like. Some of the more frequent ones include: What courses should I look at? Any advice for a new grad? Seriously, Bane. What’s the deal? But the one I get asked more often then not is as follows: “Zac, how do you integrate PRI into a pain science model?” A great question indeed, especially to those who are relatively unfamiliar with PRI. With all the HG, GH, AF, FA, and FU’s, it’s easy to get lost in the anatomical explanations. Hell, the company even has the word (gasp) “posture” in the title. Surely they cannot think that posture and pain are correlated. I think there is a lot of misinformation regarding PRI’s methodology and framework. What needs to be understood is that PRI is a systematic, biopsychosocial approach that predominately (though not exclusively) deals with the autonomic nervous system. The ANS is very much linked into pain states, though not a causative factor. But of course, that may not be enough. Perhaps
Read MoreThe 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
Read MoreCourse 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
Read MoreThe 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
Read MoreAdvanced 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
Read MoreCourse 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
Read MoreCourse 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
Read MoreCourse Notes: FMS Level 2
Mobility, Stability, and the Like I recently attended the FMS Level 2 course after rocking the home study. In my quest to take every con ed course known to man, I got into the functional movement people because the idea of improving movement over isolation exercise interests me. I find the way they build up to the patterns very logical, namely because they liberally use PNF and developmental principles; and they do so quite eloquently. But really, I wanted to go to this class so I could meet and learn from Gray Cook. And his segments did not disappoint. While I may not agree with everything he says, he is a very brilliant man and knows movement. The only disappointment I have to say about this course was that I did not get enough Gray and Lee. I would say I probably saw them teach 30% of the time, with another FMS instructor just running us through their algorithms. I am sorry, but if you are going to advertise Gray Cook and Lee Burton as the instructors, then I want Gray and Lee instructing me! A lot of these exercises were review for me, but there were definitely some tweaks that I liked a great deal. I think if you are new to more motor control-based exercises, this course is great for you. Just make sure you are taking it from Gray and/or Lee. Why Screen? The FMS is predominately used to manage risk and prioritize exercise selection. They look
Read MoreChapter 4: Biomechanical Influences on Breathing
This is a chapter 4 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. Loose-Tight Chaitow likes to use the loose-tight concept as a way of visualizing the body’s three-dimensionality while assessing. He likes to look at comparing structures as tight or loose relative to one another. Those areas which are loose are often prone to injury and more likely to be nociceptive. If we try to see which muscles have a tendency towards tightness or looseness, stabilizers tend towards laxity and mobilizers to increased tone. Obviously, all muscles function in both capacities, and some even stay more towards the middle (scalenes). But the tendency depends on which function is more dominant. Posture and Respiration (Not PRI, Peepz) Taking the previous concepts, Janda’s crossed syndromes can have a role in ones breathing function. With an upper crossed posture, the slumped upper body position negatively influences breathing function. Lower crossed syndrome will put the diaphragm in an anterior facing position, thus affecting diaphragm length-tension and breathing function. Facilitation Facilitation is an osteopathic term for a process involved in neural sensitivity. There are at least two forms of facilitation: spinal (segmental) and local (trigger points). Once facilitation occurs, any additional stress the individual undergoes can increase neural activity in the segment. There are several ways to observe facilitated segments. You can observe these via palpation: Goose flesh
Read MoreChapter 1: General Neurodynamics
This is a Chapter 1 summary of “Clinical Neurodynamics” by Michael Shacklock. Concepts When we first started working with the nervous system, oftentimes we called pathological processes adverse neural tension. The problem with this name was that it left out nervous system physiology; it was mere mechanical concepts. Hence, we call the movement and physiology of the nervous system neurodynamics. General neurodynamics account for whole body fundamental mechanisms, regardless of region. Specific neurodynamics, on the other hand, applies to particular body regions to account for local anatomical and biomechanical idiosyncrasies. The System There are three parts to the neurodynamic structure: 1) The mechanical interface 2) The neural structures 3) The innervated tissues The mechanical interface is that which is near the nervous system. It consists of materials such as tendon, muscle, bone, intervertebral discs, ligaments, fascia, and blood vessels. The neural structures are those which make up the nervous system. These structures include the connective tissues that forms the meninges (pia, arachnoid, and dura mater) and peripheral nervous system (mesoneurium, epineurium, epineurium, and endoneurium). The nervous system has mechanical functions of tension, movement, and compression. It also has physiological functions to include intraneural blood flow, impulse conduction, axonal transport, inflammation, and mechanosensitivity. The innervated tissues are simply any tissues that are innervated by the nervous system. They provide causal mechanisms for patient complaints, and are able to create nerve motion. When we have neural problems, sometimes the best treatment is to these structures. You must treat everything affected. Mechanical Functions
Read MoreChapter 15: In Conclusion
This is a chapter 15 summary of the book “Movement” by Gray Cook. The Goal The goal of movement retraining is to create authentic unconscious movement at acceptable levels. We can develop many methods to achieve our goals, but working under sound principles is paramount. Some of the principles Gray advocates include: Focusing on how we move. Look to movement to validate or refute your intervention. Movement is always honest. When designing a movement program, we must operate under the following guidelines: Separate pain from dysfunctional movement patterns. Starting point for movement learning is a reproducible movement baseline. Biomechanical and physiological evaluation do not provide a complete risk screening or diagnostic tool for comprehensive movement pattern understanding. Our biomechanical and physiological knowledge surpass what we know about fundamental movement patterns. Movement learning and relearning follows a hierarchy fundamental to the development of perception and behavior. Corrective exercise should not be rehearsed outputs. Instead, it should be challenging opportunities to manage mistakes on a functional level near the edge of ability. Perception drives movement behavior and movement behavior modulates perception. We should not put fitness on movement dysfunction. We must develop performance and skill considering each tier in the natural progression of movement development and specialization. Corrective exercise dosage works close to baseline at the edge of ability with a clear goal. The routine practice of self-limiting exercises can maintain the quality of our movement perceptions and behaviors and preserve our unique adaptability that modern conveniences erode. Some things cannot
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