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
Read MoreChapter 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
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 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 MoreExplain Pain Section 4: Altered Central Nervous System Alarms
This is a summary of section 4 of “Explain Pain” by David Butler and Lorimer Moseley. CNS Alarms While much of talk in rehab deals with tissue injury and tissue pain, realize that the brain always makes the final decision as to whether or not you should feel pain. No brain, no pain. This sentiment does not mean that pain is not real. All pain is real. However, pain is a construct that the brain creates in order to ensure your survival. Spinal Cord Alarms When an injury occurs and the DRG receives impulses from peripheral structures or the brain, the spinal cord neurons must adapt to better uptake all these signals. In essence, the DRG becomes better at sending danger messages up to the brain. This change leads to short term increases in sensitivity to excitatory chemicals. Those stimuli that didn’t hurt before now do (allodynia) and those that used to hurt now hurt more (hyperalgesia). In persistent pain, this change continues occurring to the point where neurons that do not carry danger messages start growing into space where danger messages are taking place. Now innocuous stimuli such as grazing the skin begin hurting. The pain may be normal, but the underlying processes become abnormal. When these spinal cord alarm systems become unhealthy, the brain no longer receives an accurate message of what is going on. The alarms become magnified and distorted. The brain is told there is more damage in the tissues than is actually present. What is good is
Read MoreThe Sensitive Nervous System Chapter V: Neurodynamics
This is a summary of Chapter V of “The Sensitive Nervous System” by David Butler. Intro Neurodynamics is the study and relationship of nervous system mechanics and physiology. The testing protocols for neurodynamics assess the nervous system’s ability to lengthen, glide, and change amongst interfacing structures. When discussing neurodynamics, it is important to think of the nervous system as a continuum. Mechanical, electrical, and chemical changes in one part of the nervous system affect other related parts. Gross Movements and Dynamics When having a nervous system, the following qualities, movements, and buffering capabilities are necessary: Slide, glide, strain. Elongate (think gymnasts) and return from elongated position. Compress (ulnar nerve during elbow flexion). Stength (kicking a field goal). Jolting (whiplash). Repetitive forces Bending Fluid/chemical selectivity. Neural Connective Tissue These include the meninges, nerve root complex, and peripheral nerve structures. Broken down as follows: Meninges Dura mater (outer, tougher) Arachnoid mater Pia mater (inner, thinner) Nerve root complex Root Sleeve Dorsal and ventral roots DRG Spinal nerve. Peripheral nerves Epineurium Perineurium Endoneurium Mesoneurium – Sheath that surrounds a nerve. Contracts like an accordion to glide along adjacent tissues. Can become fibrotic with injury. Important Attachments Meningovertebral ligaments – anchor down to spinal canal, which could become symptomatic. Rectus capitus posterior is connected to the dura mater between the occiput and atlas; helping the dura fold. Makes you wonder what you are truly doing when you release this structure. The sympathetic trunk’s proximity to the spinal column makes it susceptible to increased loads
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