PRI Postural respiration - Cliff notes

PRI stands for Postural Restoration Insitute - a group of very clever folks led by Ron Hruska, working out of the Hruska Clinic in Lincoln Nebraska.  Anyone scanning the internet for training / rehab information will have undoubtably come across writing either by them, quoting them, or at least heavily influenced by them.

I was introduced to the PRI school of thought whilst spending some time at Cressey Performance in December 2013.  I was, quite frankly, pretty taken aback at the dramatic impact some simple breathing drills could have on my hip and shoulder range of motion, and that some niggly SI joint pain I'd had for years had 'magically' vanished. Needless to say - after getting back to the UK I was very keen to get into a bit more detail as to the hows and whys of PRI methodology and signed up for their certification program.

 

Now PRI courses are very anatomy heavy - and very technical in their descriptions of internal kinematics.  Bit my attempt at a cliff note summary is below:

 

Human beings are hard wired to not die.  When we talk about primal patterning - nothing is more 'functional' than staying alive.  This is a key concept of how PRI methodologies work.

[caption id="attachment_90" align="aligncenter" width="300"] Staying alive is important.
And JT opening up his right chest wall helps him do this.[/caption]

The PRI thought process is that we as humans will adopt some postural changes as a result of both internal and external influences.  Internal being the internal anatomical asymmetry we are all born with - larger chest cavity on the right side, thicker diaphragm leaflet on the right, heart and vena cava on the left - making it easier for us to collapse the right chest cavity than the left.  Throw on top of that the right sided world we have created around us - where even the southpaws will generally have to reach for most things with their right hand and you can see why what PRI term the Left AIC Right BC pattern is so frequently adopted

 

[caption id="attachment_91" align="aligncenter" width="194"] Left AIC Pattern.
Credit: Postural Restoration Institute.[/caption]

So if we have settled into a posture like the one above - we have closed down the right mediastinum and created a less than optimal mechanism for respiration.  However - respiration is a pre requisite for life - and we are hard wired to ensure that we can continue to exchange gas no matter what.

Now there lies the rub - a less than optimal respiratory mechanism will require greater assistance from the accessory respiratory muscles (lats, upper traps, legator ecap, scaliness, SCM) and start to create all kinds of associated problems relating to over activity or hyper tonicity in these areas - this list is seemingly endless and ranges from upper trap trigger points through to thoracic outlet syndrome, migraines and anxiety.  But... as we need to breathe...we will use whatever means necessary to do so - and if that means recruiting all these other muscles to do it then so be it - it may screw us up - but at least we're not dead....  However, thats not the while story - now that we have figured out a new way to breathe, our in built survival mechanism will not actually permit movements that it sees as a threat to this new pattern.  So if you are using your neck to breathe - your neck is 'on'  - and don't expect it to be 'off' until you have fixed the pattern - all the stretching in the world won't solve that problem as the neural tension created is (as far as your nervous system is concerned) what is keeping you alive.

Now we know what the problem is then how do we fix it?

PRI non manual techniques are essentially taking the subject to the opposite posture of the one s/he is in (so typically externally rotating the right shoulder and ribcage and internally rotating the left hip) and carrying out controlled, forceful, diaphragmatic breathing in that new posture.  The purpose of this is to 'trick' your nervous system into allowing inhibition of the overactive accessory muscles.  In simple terms convincing yourself that coming out of the adopted posture is no longer a threat....

The list of PRI positional breathing drills is immense and way too long to go into here - but they are all built on that underlying principle of reversing the acquired posture - and learning to breathe there.  Only when you can breathe there can you 'own' the new pattern you are trying to create.

So there it is  - 20+ hours of lectures down to a few paragraphs and a John Travolta picture.  Hope this summary is useful - and I highly recommend checking out the full PRI resources.

 

 

PRI Postural Respiration - Cliff Notes

How Functional is the Overhead Squat?

I am well aware that this post may upset a few people – and whilst upsetting people is not its main aim – I do like to encourage people to challenge ideas, ask questions, and formulate their own opinions rather than blindly follow

 



 

Over the past decade there has been a shift away from the single joint machine based training popularized by Joe Weider in the 80s, and towards ‘functional’ exercise.  I am all for this – preparing people for life outside of the gym  - whether its on the sports field or simply being able to climb the stairs at home without any pain – that is what I’m all about.  However, there is a case to be made for the pendulum having swung too far…

 

[caption id="attachment_81" align="aligncenter" width="224"] Awesome bosu leap brah, let me high five myself in the face[/caption]

A functional exercise by definition must have a function.  As simplistically stupid as that may sound.

The overhead squat is often billed as the ‘king of functional exercise’ and the be all and end all of programming. In many functional gyms.   I would strongly beg to differ on this point.  How many times in your every day life, or even in your sports are you required to hold a load directly overhead and squat to the ground repeatedly, whilst keeping said weight directly over your head?

The overhead squat is a derivative of the snatch – one of the most dynamic and explosive movements in competitive sport.  As well as requiring speed and power, the snatch also requires technical expertise .  The ‘catch’ position of a snatch is, essentially, the bottom of an overhead squat.  For the competitive Olympic lifter – training this movement under load makes a lot of sense – they may have all the speed in the world to get under the bar, but without adequate core stiffness and lower extremity strength they wont be able to get ‘out of the hole’.  If your goal is to perform a loaded snatch, then yes, the OHS will be an important programming concern for you.  Now whether you should be programming the snatch for either yourself or your clients is a while other conversation!

 

[caption id="attachment_82" align="aligncenter" width="236"] Olympic lifter at the bottom of a snatch. note the heels, hips, shoulders, head and the centre of the bar are all directly above one another.[/caption]

The overhead  squat, in my mind, is an excellent assessment tool – it gives an indication of ankle mobility,  hip mobility and stability, core stiffness, thoracic mobility and scapular stability – all important parts of successful and pain free movement.

However – how many people that we assess ace it on every one of those?  Not many…   So how many of those could or indeed should be loaded through this movement pattern?  Even fewer….

 

[caption id="attachment_83" align="aligncenter" width="300"] Well aligned olympic lifter on the left. The guy on the right has neither the ankle, nor hip mobility to be in this position. The bar has to be above his feet or he will fall over - he is going into an excessive lumbar extension, forward head posture and hyper extension of his neck to try to maintain some kind of balance. Note the knees collapsing in due to the excessively wide stance he has had to adopt to get down there, this is also causing inversion at his ankles. We won't even go into whats going on with his shoulders.[/caption]

Heck 90% of the clients I work with (everything from Olympians through weekend warriors, to orthopedic referrals) don’t do any form of overhead lifting. Ever!

Now lets take those small number of  the population who can safely be loaded in an OHS position.  If we remove those who are competitive O – lifters, then what training effects are we going to give to the rest?

Can the person stably support enough weight in the overhead position to get any kind of training effect in their legs and hips?  I doubt it  - not unless the you were looking at higher repetition sets, however, in a high rep set what is going to fatigue first - the upper back or the legs?  When the upper back and the posterior cuff start to give out, and you're plugging away trying to get something out of it for your legs, what takes over?  Your lumbar extensors and the passive retrains in your shoulders - so essentially you promote hyper lordosis and hang out on the ligamentous structures of your shoulders - nice.

At best you may build in some upper back hypertrophy – given the time under tension required through the thoracic extensors. But if thats really your goal there are far safer ways to achieve it.

If I want to train an average Joe or Jane to get stronger, so they can better function in the outside world – surely deadlift variations, anterior loaded squat patterns, and loaded carries have far more relevance…

I’m fairly sure that when I changed my dishwasher the other day I pulled and lifted the old one over the step with it in front of me – I did not hold it above my head and repeatedly squat up and down with it.

If we think through the activities and movement patterns in most peoples daily lives, or indeed within competitive sports, the deadlift, and its derivations are infinitely more ‘fucntional’ than the overhead squat.

This is not to say the overhead squat is an entirely redundant movement.  Far from it.  as mentioned above I find it an excellent assessment tool, a very quick and easy way to get a snapshot of an individuals gross movement patterns.  I also think it has a place as a mobility drill, and I often use it as part of my clients dynamic warm ups.  It has a nice 'feel' for the client getting in and out of the position with stability, and is a great prep for doing some loaded front squats.    However,  just because something is a useful mobility tool does not mean we stick 60% of their bodyweight on a bar and ask them to do it to failure!

As Gray Cook  - creator of the FMS system so simply put it "Train the deadlift, maintain the squat"

Stretch What's Tight.....?

That’s what we’re all taught in PT school right?  Strengthen what is weak and stretch what is tight…  Or in todays parlance – mobilize and stabilize.

 

Is it that simple though?  How many clients do you work with who had a tight hamstring, you stretched it and fixed the problem…  Not just got some transient improvement for a couple of hours, but genuinely addressed the tightness?



We should be a bit smarter than that by now.  The question what is tight is not enough – we need to be asking why its tight.

 

There are a number of reasons a muscle can ‘feel tight’ – ranging from genuine tissue length restrictions through to protective tension and alignment issues.

 

So how do we know what it is? We do assessments!

As ‘The Injury Whisperer’  Dean Somerset says: “If you aren’t assessing you’re just guessing.”

Try this simple assessment and correction for the any of your male general fitness clients who are suffering from the ‘tight hamstring’ epidemic:

 

Take a look at the line of their shorts from the side.  If you note a significant downslope on the waistband from back to front they are likely to be sitting in an anterior pelvic tilt (a very common posture for a desk-bound male).

 

[caption id="attachment_75" align="alignnone" width="300"] Anterior pelvic tilt - or 'lower body cross syndrome'[/caption]

Have them perform an active straight leg raise – take a note of where they get to.

 

[caption id="attachment_76" align="alignnone" width="300"] Active straight leg raise to assess hip flexion[/caption]

Then have them perform a maximal effort front plank with a neutral pelvis keep in mind if they are starting from a position of anterior tilt they will need to aggressively fire their glutes to back to neutral – in fact it would do no harm for these folks to be cued slightly into a posterior tilt (flat back).  Have them take 6-8 deep diaphragmatic breaths with a forceful exhalation – if it’s a genuine max effort plank this will be enough to have most people shaking like the proverbial dog on a comfort break.

Next  - re test the active straight leg raise and see if they perform any better…

 

Now if they perform better on the re-test you have given the person increased range through hip flexion.

 

But hang on -  you haven’t stretched their tight hamstring!

 

If we get a positive result with this correction – then the restriction was as a result of protective tension – and we have simply given the client a platform allowing the hamstring to ‘switch off’ and permit a movement that was previously considered as threatening.

 

Womens Health

Those of you who know me, and my training philosophy, will know that the whole '10 week challenge' body transformation thing is about as far removed from what I practise as it is possible to be.

I don't claim to be a 'diet guy' or to be the one to turn to when prepping for photo shoots. I train my clients and athletes to get stronger, perform better, move more efficiently, avoid and recover from injury.

However, this time last year I took on a project for Womens Health Magazine that was exactly that.  Take a 20 something journalist still slightly living the student lifestyle, and see what we can do with her in a 10 week training cycle.   We didn't do anything mind blowing - we worked on her alignment and mobility, then once her movements were cleaned up she trained to get stronger in some basic lifts whilst cutting out the junk from her diet.   She trained hard,  lifting 4 days per week with an active recovery low intensity 'fuel burning' session thrown in.  The diet was sensible, 90% 'clean' leaving room for a few treats and cheats.

 



The reason I am re visiting this subject now is that I have been updating a training program this morning for a colleague of this 20 something journalist.  Some 12 months on from the original project.  The program is again focussing on movement quality over quantity, and improving athleticism and performance.   It is not about quick fixes, fad diets and 'transformations'.

Training for improved performance gives specific, measurable results and sustainable benefits to quality of life.  There is a reason why 12 months on we're still going.....

Read the full article here

 

Goal Setting Part 2 - Supercharge your Goals

Further to my post on SMART goal setting,  I wanted to follow up on how to really make your goals ‘stick’….

 

What makes a goal far more likely to be achieved is attaching an emotional quantity to it.  A SMART goal may be ‘I want to lose 2 inches off my waist by my summer holiday’.  Yes it is specific, measurable, attainable, relevant and time bound… but what is to stop this trainee falling off the wagon?

 

[caption id="attachment_61" align="alignnone" width="300"] Supercharge your new year resolution[/caption]

We can write the target down, put it on the top of their training program, even cover their work station with those annoying yellow stickies.  But…  once the New Year, new you, spring into summer or whatever other horrifically unimaginative gym promotion starts to wear off  how do we keep the eyes on the prize?

How about if we ask the question ‘what does achieving this goal mean to you?’

Asking this question brings us to start making statements like:

‘If I add 10kg to my deadlift in 4 months I will be strong enough to compete’

or

‘Losing 2 inches off my waist by my summer holiday will give me more confidence on the beach’

All of a sudden we are attaching significance to what was previously a fairly dry statement.  This goal is now charged with emotional value.  For those of us who deal with clients or athletes on a daily basis this is key.

The numbers alone may well be enough to motivate athletes through yet another grueling winter but our general fitness clients may need a little more.  They may see the value of getting stronger, leaner, or improving athleticism – however – is this enough to get them out of bed at 5.30 on a February morning?  In my experience the real, and tangible effect of hitting the target provides far more of a drive than the target alone.

 

Goal Setting Part 1 - SMART Planning

Its almost that time of year when gyms and training centres around the world are going to be full to the brim with New Years Resolutionees.  Both people new to the world of fitness and those who’s motivation has ‘lapsed’ with the winter festivities….

If you fall into one of those categories  - or even if you’re aready taking care of your health and fitness it can never hurt to sit back, take stock and figure out just what you want to achieve out of 2014.

[caption id="attachment_52" align="alignnone" width="300"] I think the word is 'cosy'[/caption]

It has been said that a dream is a dream until you write it down – then it becomes a goal.   By far the most effective way to get the most out of your training – or indeed any aspect of your life is to take the time to set clear goals for yourself and really think about what you want to achieve both long and short term.

The process of goal setting has been done to death by the corporate world – and over caffeinated, khaki chino wearing, acronym wielding, table thumping motivational speakers may seem to have no place in the world of sport, health and fitness – but  - there is a part of corporate speak that we can borrow…

[caption id="attachment_56" align="alignnone" width="300"] Say no more. Really.[/caption]

 

In his book ‘Attitude is Everything’ Paul Meyer described the application of SMART goals for every corporation, department, and individual.  Yes it is an acronym – but please bear with me.  Smart stands for:

Specific

Measurable

Attainable

Relevant

Time bound

Specific.  By far the most common thing I hear in the gym is ‘I want to get in shape’.   This is a goal that is set up to fail – how do you know when you’re ‘in shape’  what does ‘in shape’ mean to you?

I work with clients ranging from Olympic athletes to rehab cases and everything in between.   In shape for one group is going to be spectacularly different to the next.  I am working with an international bobsledder who needs an additional 3cm on his standing vertical jump., whilst a second client wants to improve her shoulder range of motion enough to be able to brush her own hair.

Think about what it is you specifically want to achieve and we’re in a much better place to start.

Measurable.  Intrinsically linked to the first point – a goal must be measurable.  If you want to ‘get in shape’ or ‘put on some muscle’ how do you know when you have done it?   In my experience people do well with numbers – you want to lose weight – how much?  You want to increase your bench press stick a number on it.  By quantifying our goals we make ourselves accountable.  You either achieved it or you didn’t.

Which brings me on nicely to…..

Attainable.  I would like to do a Jonny W and hit a last minute 3 pointer to clinch a world cup final.  I would also like to win worlds strongest man, a not been filmed yet series of Gladiators and become a Jedi master.I think you know where Im going with this one…  Make it challenging, but we have to be at least vaguely sensible about it.

[caption id="attachment_53" align="alignnone" width="300"] Everyone loves a trier[/caption]

Relevant.  I work in a gym, albeit a very well equipped one.  I can help you with human performance, injury prevention and management, body composition (as long as you do your bit in the kitchen!).   I can’t help you get that promotion at work or make you get around to painting your skirting boards.

Time bound.  Procrastination is the thief of time.  As well as attaching a number to what you want to achieve, you must attach a number to when you want to achieve it.

This works both ways – saying you want to add 20kilos to your bench press in 4 weeks would be ridiculous.  Targeting it over 12 months would be aggressive – but (depending on your training age)  - it could be done.

 

Hopefully you can see that  as well as being applicable in the boardroom – this also has a place in the weight room.

Sensible or SMART goal setting can be the difference between being one of the masses who will get into health and fitness this January yet lose their way by March.  And being one of those who makes long lasting, meaningful and positive changes to their health, lifestyle, and longevity.

Next post – Goal Setting Part 2:  Supercharge your goals.