Postural Restoration Institute Review
Terms in this set (387)
What is apposition?
The condition of being side-to-side or close to one another.
What is the relative number of proprioceptors in the diaphragm?
There are relatively few proprioceptors in the diaphragm.
Because there are relatively few proprioceptors in the diaphragm, the ZOA is largely influenced by what?
Rib cage orientation largely influences ZOA.
Which hemidiaphragm is larger?
The right hemidiaphragm.
Is the right or left vagus nerve longer?
The right vagus nerve is longer.
Which side of the body has better ZOA?
The right side.
The thorax is rotated in which direction?
To the left.
Which hemidiaphragm has relatively limited respiratory function?
The left hemidiaphragm.
Which chest wall tends to lack mobility?
The right chest wall,
Is there better lumbopelvic stability on the right or left?
On the right.
According to Zac Cupples' review, the left AIC consists of what three things?
1. The left innominate being anteriorly tipped and forwardly rotated.
2. The left lumbar spine being lordotic.
3. The spine being right oriented.
The brachial chain consists of what eight muscles?
Anterior intercostals, deltoid, pecs (major or minor?), sibson's fascia, triangularis sterni, sternocleidomastoid, scalene and diaphragm.
The Left AIC pulls a person in "blank" stance.
The left AIC pulls a person into right stance.
How do the ribs appear in a normal Right BC?
The left ribs are externally rotated and the right ribs are internally rotated.
In a normal Right BC, the thorax abducts to which direction and rotates to which direction?
The thorax abducts to the right and rotates to the left, though the thorax is still right-oriented.
Note: Thoracic abduction is synonymous with ipsilateral side-bending.
In a normal Right BC, how is the left scapula oriented?
The left scapula is oriented in elevation, adduction, external rotation and downward rotation. It appears retracted.
In a normal Right BC, how is the right scapula oriented? (Five details.)
The right scapula is oriented in abduction, depression, internal rotation and upward rotation. It appears protracted.
In Superior T4 Syndrome, why might the right scapula appear retracted?
Because of the compensatory action of the right subclavius.
In a Right BC, shoulder internal rotation is decreased on which side?
The right side.
If shoulder internal is full on the right side in a Right BC, then what is possible?
A SLAP lesion is possible.
In a Right BC, horizontal abduction should be decreased on which side?
On the left side. (<35 degrees)
If a Right BC has full left horizontal abduction, then what pathology might they have?
They might have costoclavicular hypermobility or left anterior shoulder instability.
In a Right BC, shoulder flexion should be decreased on which side?
They should have decreased left shoulder flexion.
If a Right BC has full left shoulder flexion, then what pathology might they have?
They might have multidirectional instability.
A Right BC should have limited cervical axial rotation in which direction?
They should have limited left cervical axial rotation.
A Right BC should have limited apical expansion on which side?
They should have limited right apical expansion.
What are the five main BC opposition muscles?
The triceps, lower trapezius, serratus anterior, internal obliques and tranversus abdominis.
With the BC opposition muscles, the goal is to create what three things?
The goal is to create left thoracic abduction, left posterior mediastinal expansion and right apical expansion.
How does an overactive right scalene, as occurs in Superior T4 Syndrome, affect the right ribs, the left ribs and the vertebrae?
When the right scalenes increase their tone, they externally rotate the upper two ribs on the right. The external rotation of the upper two ribs on the right causes upper two left ribs to internally rotate. T1-T4 rotate to the right.
The lower right ribs are internally rotated. The upper right ribs are externally rotated. The lower left ribs are externally rotated and the upper left ribs are internally rotated.
Why is apical expansion limited on the left in Superior T4 Syndrome?
Because the right scalene externally rotates the upper two ribs on the right, which internally rotates the upper two ribs on the left, which "closes off" airflow into the left chest wall.
What is the main indicator that someone is a Superior T4?
If they have limited left apical expansion after the Superior T4 manual technique.
What manual technique do you use on someone with Superior T4 Syndrome?
The subclavius manual technique.
After you use the subclavius manual technique on someone with Superior T4 Syndrome, what two muscles do you want to facilitate?
You want to facilitate the left lower trapezius and the left serratus anterior.
The left lower trapezius and left serratus exercises do what to the mid-thoracic spine and left ribs?
The exercises rotate the mid-thoracic spine to the right, which internally rotates the left ribs. They also create a desired kyphosis.
The ribs need to be "blank" and "blank" in order for the diaphragm to be optimally domed, which occurs during exhalation.
"Down" and "in."
How does the liver affect the shape of the right hemi-diaphragm?
The liver allows the right hemi-diaphragm to better maintain its dome shape.
What does it mean that the left hemi-diaphragm is concentrically effective for left thoracic rotation and extension?
The left hemi-diaphragm is flat, which causes it to pull on the spine. It takes your thorax and pulls it into left rotation and extension (i.e., left trunk rotation). The left hemi-diaphragm isn't effectively positioned for respiration.
The "blank blank" rib hump matches the left anterior rib flare.
The right posterior rib hump matches the left anterior rib flare.
The left psoas major orients the lumbar spine to which direction?
The left psoas major orients the lumbar spine to the right.
The dome of the diaphragm sits at what vertebrae?
The orientation of the diaphragm is the same as the orientation of which part of the spine?
The orientation of the diaphragm is the same as the orientation of the lumbar spine. Where the diaphragm goes, the lumbar goes, and vice versa.
The usual pattern: standing on the "blank" leg, thorax oriented to the "blank" and reaching with the "blank" arm.
Standing on the right leg, thorax oriented to the left and reaching with the right arm.
What is a pseudo-ZOA?
When the sternum is depressed without exhaling.
Anytime you see a flat thoracic spine, what is true of the ribs?
The ribs are anteriorly flared.
What are the three/four characteristics of "flatback" syndrome?
The spinous processes of the lumbar vertebrae are prominent (i.e., they have a hyperextended lumbar spine), they have a flat thoracic spine and flared ribs.
The term "trunk" refers to the thoracic spine above what vertebrae?
The thoracic spine above T8.
The "blank" posterior ribs are a reference center.
The left posterior ribs are a reference center.
The left posterior ribs, which are a reference center, is the location of what?
The left posterior ribs is the location of the posterior left diaphragm.
The sympathetic ganglia are in what part of the thoracic vertebral bodies?
The sympathetic ganglia are in the ventrolateral aspects of the thoracic vertebral bodies.
What posture "locks" a person in extreme sympathetic tone?
Why does flatback posture "lock" a person in extreme sympathetic tone?
Because the person has a flat thoracic spine, the sympathetic ganglia within the vertebrae are extended, which increases their activity. Getting flexion in the thoracic spine inhibits the sympathetic nervous system.
"Thoracic extension tazes sympathetic ganglia."
Inhibition occurs with inhalation if it is preceded by what?
Inhibition occurs with inhalation if it is preceded by good exhalation.
The trunk rotation test is a measure of the orientation of what?
The trunk rotation test is a measure of the orientation of the lumbar spine and trunk.
What should occur in a trunk rotation test for someone who is a Left AIC, Right BC?
The knees should go farther to the right than to the left, since their lumbar spine is oriented to the right and the trunk is rotated to the left.
What is a polyarticular chain?
A polyarticular chain is a "muscle" (group of muscles) that cross many joints. The activity of one muscle in this chains affects the activity and functioning of the other muscles in the chain.
Why does the right scapula appear to be depressed even though it is elevated?
Because the right rib cage is depressed.
What is the action of the triangularis sternum?
The triangularis sternum pulls the ribs down.
Which triangularis sternum do you want to inhibit and which do you want to facilitate?
You want to inhibit the right and facilitate the left. Facilitating the left would help deflate the hyperinflated left lung.
Explain why the pressure gradient favors air flow into the left side.
It's harder to drive air into the right chest wall because the volume of the right side is less than that of the left side. Because pressure and volume are inversely related and air flows down a pressure gradient, then air won't flow as readily into the right chest wall. The pressure gradient favors the left side.
The lats drive "blank."
The lats drive extension.
The lats are agonists of what muscles and antagonists to what muscles?
The lats are agonists of the paraspinals and antagonists to the abs.
The lats prevent the ribs from doing what?
The lats prevent the ribs from depressing.
The right serratus quiets what two muscles?
The scalenes and internal obliques. It internally rotates the upper ribs and externally rotates the lower ribs.
In a Right BC, why is the right lower trapezius lengthened from both ends?
The right lower trapezius is lengthened from both ends because the spinous processes of the vertebrae are rotated to the left and the spine of the scapula is internally rotated.
How does flattening the thoracic spine affect the area of the posterior mediastinum?
Flattening the thoracic spine decreases the area of the posterior mediastinum.
Why is it better to inhale through the nose?
Inhaling through your nose prevents your back and neck musculature from assisting with inhalation.
Why is it good to exhale through your mouth?
When you exhale through your mouth, it helps you engage your abdominal wall.
"Anytime necks are working, it's because the 'blanks' aren't working."
Anytime necks are working, it's because the abdominals aren't working.
Why might it be better to do the Thomas Test before the Adduction Drop Test?
Doing so allows you to determine if they can even extend. If they have a positive Thomas Test, then they automatically have a positive Adduction Drop Test.
Of course, a person can have a negative Thomas Test and a positive Adduction Drop Test, which indicates pathology of the anterior hip (e.g., compromised iliofemoral ligament).
Explain why "subclavian lockdown" occurs.
The scalenes pull on the upper two ribs to get air into the right chest wall, which jams the upper two ribs into the clavicle.
Is the right or left scalene more active?
The right scalene is more active.
Why do the shoulders appear level in Superior T4 Syndrome?
The shoulders appear level because the right scalenes elevate the two upper ribs on the right.
What are the two actions of the subclavius?
The subclavius depresses the clavicle. According to PRI, the subclavius also retracts the scapula.
What causes the right subclavius to be locked down?
The scalenes-mediated elevation of the upper two ribs.
What are the consequences of the right subclavius being locked down?
If the right subclavius is locked down, then the right shoulder girdle will be stuck in retraction. In this position, the right lower trapezius and right serratus are disengaged.
Why is the right pec minor short?
The right pec minor gets short because the coracoid process is pulled forward into internal rotation and protraction. (It's also short because it tries to elevate the right ribs in order to increase airflow into the right chest wall??)
How does a flat or twisted thoracic spine affect the sympathetic ganglia?
A flat and twisted thoracic spine may overstimulate the sympathetic ganglia, which puts a person into sympathetic overdrive.
How will a left AIC patterned person press on the sympathetic ganglia?
A left AIC patterned person will press on the sympathetic ganglia due to the rotational component.
Why will a PEC's spine press on the sympathetic ganglia?
The PEC's spine will compress the sympathetic ganglia due to the gross extensor pattern.
Explain how a hyperkyphotic posture is still an extended, hyperinflated posture.
The person hyperinflates the lungs, while simultaneously flexing the spine to try to dome the diaphragm.
What are six reference centers?
1. Right medial longitudinal arch when the left leg is in acetabulofemoral (AF) internal rotation.
2. The left posterior calcaneal tuberosity.
3. The left ischial tuberosity.
4. The left anterior hip capsule/right posterior hip.
5. Left internal obliques/Transversus abdominis and left posterior lower ribcage (THE MOST IMPORTANT)
6. Right lateral posterior upper ribs when in left AF IR.
"Blank" allows for movement variability.
Flexion allows for movement variability.
Variable movement reduces what?
Variable movement reduces threat perception.
System flexion leads to increased "blank" and the risk of what?
System flexion leads to increased instability and the risk of falling forward.
Increased stability via extension is desirable in what condition?
Increased stability via extension is desirable when under threat, but not for the long term.
According to I&I, what is the goal?
The goal is to build control within flexed instability so the system can stay variable; to remain upright without extension.
How can we remain upright without impinging into extension?
We can remain upright without impinging into extension by developing interoceptive and exteroceptive awareness of stability points in system flexion. More specifically, stability points created in left stance.
Reference centers keep a "blank" system "blank" in the environment.
Reference centers keep a flexed system upright in the environment.
What are the consequences of losing a frame of reference in flexion?
If we lose a frame of reference in flexion, then we lose stability. If we lose stability, then we extend to become stable. If we extend to become stable, then we impinge to create reference.
What reference center in what position gives you right glute max?
The right medial longitudinal arch gives you right glute max when in left AF IR.
What reference center gives you left IC adductor?
The left posterior (center) calcaneal tuberosity gives you left IC adductor.
What reference center gives us left hamstring?
The left ischial tuberosity gives us left hamstring.
The left molars are equivalent to what other reference center?
The left molars are equivalent to the left calcaneus.
What are three general qualities of good PRI shoes?
Stiff heel counter both laterally and posteriorly, no bend in the midfoot and bend in the toe box.
If there is limited hip abduction in one hip, then what is the person likely doing with the ipsilateral foot?
If the person has limited abduction in one hip, then they are likely overpronating with the ipsilateral foot.
Can a left AIC alternate? Can they reciprocate?
The Left AIC can't alternate, but they can reciprocate. They can reciprocate because they're stuck in right stance and left swing, but they can't alternate because they're stuck in this position. The left innominate is stuck in IP ER and the right is stuck in IP IR.
Can a PEC alternate? Can they reciprocate?
They can do neither, since both innominates are stuck in IP ER (i.e., forwardly rotated, abducted and externally rotated).
What are the Three R's? What is their order (i.e., the order you in which you organize your activities)?
1. Reposition: inhibit muscle chains.
2. Retrain: facilitate muscle chains.
3. Restore: create reciprocal alternating activity.
Feeling the left anterior gluteus medius working means that what deeper muscle is also working?
If you feel the left anterior gluteus medius working, then the left iliacus is also working.
Feeling the right glute max means that what two deeper muscles are also working?
If you feel the right glute max working, then the right coccygeus and right piriformis are also working.
If you feel the left IC adductor working, then what four deeper muscles are also working?
If you feel the left IC adductor working, then the left puborectalis, pubococcygeus, obturator internus and iliococcygeus are also working.
What does a positive Pelvic Ascension Drop Test indicate?
A positive Pelvic Ascension Drop Test (PADT) indicates that the outlet is adducted. The PADT is an active Adduction Drop Test. If the ADT is also positive, then we know that the ilium is flexed and abducted.
How do you facilitate the right anterior inlet, as you do with a Left AIC?
To facilitate the right anterior inlet, you facilitate the right rectus femoris and right sartorius.
How do you facilitate the left anterior pelvic outlet?
To facilitate the left anterior pelvic outlet, you facilitate the left adductors (e.g., right sidelying left adductor pullback). You get left IsP ER with IP IR.
How do you turn on the left posterior pelvic inlet?
To turn on the left posterior pelvic inlet, you facilitate the left glute medius and left iliacus.
How do you turn on the right posterior pelvic outlet?
You turn on the right posterior pelvic outlet via the right glute max (and coccygeus and piriformis).
How do you inhibit the left anterior inlet (i.e., promote inlet extension)?
You inhibit the left anterior inlet by turning on the left internal obliques and transverse abdominis.
How do you shut off the right anterior outlet (i.e., inhibit the right adductor)?
You shut off the right anterior outlet (i.e., inhibit the right adductor) by facilitating the left adductor and left glute medius.
What is needed to maintain uprightness when the body doesn't recognize the forces of the ground and gravity?
When the body doesn't recognize the forces of the ground and gravity, extension is needed to maintain uprightness.
According to PRI, why do some people look at the ground when they walk?
They look at the ground when they walk, which is normally something only done by peripheral vision, because the body doesn't feel the connection with the feet. Thus, the eyes have to observe what is happening.
Which one is a state of inhalation and which one is a state of exhalation:
Visual focus and Visual relaxation
Peripheral vision awareness and Central vision awareness
Eyes moving with the head and Eyes moving independent of the head
1. Visual focus (inhale)/Visual relaxation (exhale)
2. Central vision awareness (inhale)/peripheral vision awareness (exhale)
3. Eyes moving with the head (inhale)/ eyes moving independent of the head (exhale)
What is a technique to relax visual focus and promote visual recovery?
1. Focus on an object that is five feet away or closer.
2. Find an object that is at least fifteen feet away.
3. Alternate between looking at the two objects.
The Bilateral BC is like the PEC of the "blank."
The Bilateral BC is like the PEC of the thorax.
When the Left AIC pulls a person into right stance, in what five ways does the Right BC compensate to view the environment?
1. The left ribs externally rotate; the right ribs internally rotate to the center the body.
2. The thorax abducts to the right and begins rotating to the left (though it's still right-oriented).
3. The left scapula is oriented in elevation, adduction, downward rotation and external rotation. The left scapula appears retracted.
4. The right scapula is oriented in abduction, depression, upward rotation and internal rotation. It appears protracted.
5. In the case of Superior T4 syndrome, the right scapula may appear retracted by the subclavius muscle compensation.
Thoracic abduction is synonymous with what?
Thoracic abduction is synonymous with side-bending. It involves the contraction of the lateral abdominal obliques (internal obliques and transverse abdominis). According to PRI, humans tend to be stuck in right thoracic abduction.
According to Zac Cupple's summary from Advanced Integration, as a rule of thumb, which of the three ZOA's (pelvis, thorax and cranium) should you target first?
You should start by establishing neutrality with the pelvis, then with the thorax, then with the cranium. However, you may need to first go after the most limited of the three.
Is the trangularis sterni/transverse thoracis a muscle of exhalation or inhalation?
The trangularis sterni/transverse thoracis helps with exhalation. It's larger on the left thorax than on the right, which helps with exhaling the hyperinflated left lung.
Excessive tone in what muscle limits left horizontal abduction?
Excessive tone in the left pectoralis major limits left horizontal abduction.
In the Hruska Adduction Lift Test, the bottom leg is looking at "blank" phase and the top leg looks at "blank" phase of gait.
In the Hruska Adduction Lift Test, the bottom leg is looking at stance phase and the top leg looks at swing phase of gait.
What are the six muscles of the Left Anterior Interior Chain (L AIC) polyarticular chain?
The Left AIC consists of the diaphragm, psoas, iliacus, TFL, vastus lateralis and biceps femoris.
What is the septum of the pelvis?
The sacrum is the septum of the pelvis.
The position of joints reflects what?
The position of joints reflects the position, length, and tone of muscles.
The position of what reflects the position of the muscles?
The position of joints reflects the position of muscles.
Should you treat the pattern or treat the symptoms? (Perhaps somewhat of a false dichotomy.)
Treat the pattern (e.g., Left AIC, PEC, Patho-PEC), not necessarily the symptoms.
When sitting, many patients don't know how to find what reference center?
When sitting, many patients don't know how to find their left ischial tuberosity.
When walking, many patients don't know how to find what reference center?
When walking, many patients don't know how to find their left calcaneus.
According to Lori Thomsen, what percent of patients will have problems with their pelvis?
According to Lori, 80 percent of patients will have problems with their pelvis.
In a Left AIC, the person's pelvic inlet might be facing in which direction even though they're standing on their left leg?
In a Left AIC, the person's pelvic inlet might be facing to the right even though they're standing on their left leg. The person can't get out of right stance, left swing. They don't know how to pull their left inlet back and their right inlet forward.
Left ilio-pubo external rotation (L IP ER) means the left ilium is in what position?
L IP ER means that the left ilium is flexed, abducted and externally rotated.
L IP ER is synonymous with what Myokinematics term?
L IP ER is synonymous with L AF ER (left acetabular femoral external rotation) from Myokinematics course.
In a Left AIC and PEC, how does the left posterior ilium rotate on the sacrum?
In a Left AIC and PEC, the left posterior ilium internally rotates on the sacrum.
L IS IR = Left ilio-sacral internal rotation
In a Left AIC, how does the left posterior ilium rotate on the sacrum? How does the right posterior ilium rotate on the sacrum?
In a Left AIC, the left posterior ilium internally rotates on the sacrum, while the right posterior ilium externally rotates on the sacrum. There is reciprocal position.
If there is L IP ER, then what must be happening at the L IS and L IsP?
If there is L IP ER, then there must be L IS IR and L IsP IR.
The opposite of what is happening at the left anterior inlet (i.e., ilium) is happening at the left anterior outlet (i.e, ischium) because it's all the innominate bone.
L IsP IR means the left ischium is in what position?
L IsP IR means that the left ischium is extended, adducted and internally rotated.
The position of the pelvic inlet is the same as the position of the ipsilateral femur or the pelvic outlet? The position of the pelvic inlet is the opposite of the position of the ipsilateral femur or pelvic outlet?
The position of the pelvic inlet is the same as the position of the ipsilateral femur and opposite of the position of the ipsilateal pelvic outlet.
In a Left AIC, which pelvic diaphragm is chronically descended?
In a Left AIC, the left pelvic diaphragm is chronically descended, which is appropriate for right stance.
But we want it to be ascended when we're putting our weight on our left leg (i.e., in left stance). If it can ascend, then it can better support the organs.
The pelvic diaphragm refers to what four muscles?
The pelvic diaphragm refers to the pubococcygeus, puborectalis, iliococcygeus and coccygeus.
What are three muscles with help with L IP IR?
The iliacus, gluteus medius and hamstrings help with L IP IR.
What are three muscles that help with R IP ER?
The rectus femoris, sartorius and gluteus maximus help with R IP ER.
Knee position reflects "blank" position.
Knee position reflects inlet position.
Shifting the right knee ahead of the left knee (e.g., in a 90-90 Hip Shift) causes what muscular activity and what consequent changes in bone position?
Shifting the right knee ahead of the left knee causes the right rectus femoris and right sartorius to contract and pull the right inlet into flexion, abduction and external rotation (R IP ER).
This movement is the right-swing, which is part of the goal for treating a Left AIC.
In the PEC, what five muscles are excessively tight?
In the PEC, the latissimus dorsu, quadratus lumborum, posterior intercostals, serratus posterior and iliocostalis lumborum are excessively tight.
These muscles pull the pelvis forward (i.e., cause excessive anterior tilt) and the ribs flare.
In a PEC, how do the right and left iliums rotate on the sacrum?
In a PEC, both iliums are internally rotated on the sacrum.
Crudely expressed, in a PEC you want to facilitate what three muscles?
For PEC's you want to facilitate the hamstrings, adductors and abs. If you can adduct the femurs, then the outlet with abduct, which allows the pelvic diaphragm to ascend.
Adducting the femurs has what effects on the pelvic outlet and pelvic diaphragm?
Adducting the femurs abducts the pelvic outlet, which allows the pelvic diaphragm to ascend.
What's the difference between a PEC and a Patho PEC?
A Patho PEC is in the same pattern as a PEC, but they're maximizing joints for stability instead of using muscles. The Patho PEC is in end-range position and all their muscles are "off."
Explain what occurs in leg-whipping while running?
In leg-whipping, the left leg is planted and the right leg is adducted and internally rotated. The trunk would be rotated to the left, too. This positioning reflects the Left AIC pattern.
In a Standing Reach Test, you'd expect that a Left AIC can better reach their right or left toes? Why?
A Left AIC should be better able to touch their right toes in a Standing Reach Test. A Left AIC can't pull their left ilium back in order to reach their left toes. When they reach toward their right toes, the pelvis rotates toward the right, which is the pelvis' normal orientation in a left AIC.
The combination of what findings on the Standing Reach Test on the left foot and the Adduction Drop Test on the left side is pathological?
A negative test on the left foot in the Standing Reach Test and a positive test on the Adduction Drop Test on the left side is pathological.
The Standing Reach Test determines if the person can do what with their pelvis?
The Standing Reach Test determines if the person can perform a posterior pelvic tilt.
If a person has a negative Pelvic Ascension Drop Test, then they can do what with their ilium, femur and pelvic outlet?
If a person has a negative Pelvic Ascension Drop Test, then they can extend and adduct the ilium and femur, and abduct the pelvic outlet.
A Left AIC should have what findings on the Passive Abduction Raise Test? Why?
A Left AIC should have a positive finding on the right side and a negative finding on the left side. The right pelvic outlet is abducted, which restricts abduction of the femur.
When performing the Passive Abduction Raise Test, make sure that the person doesn't do what with their trunk?
When performing the Passive Abduction Raise Test, make sure that the person doesn't side-bend their trunk to compensate. Make sure the ilium doesn't move as the person abducts the leg.
A PEC should have what findings in the Passive Abduction Raise Test? Why?
A PEC should have negative findings on both sides in the Passive Abduction Raise Test because both outlets are adducted, which allows the femur to abduct.
A Patho PEC might have different findings.
An inability to get a 1 on the Functional Squat Test indicates what?
If a person can't a a 1 on the Functional Squat Test indicates that the person has a tight posterior mediastinum or tight butt syndrome (e.g., gluteus maximus, piriformis, coccygeus).
At a level two of a Hruska Adduction Lift Test, the person should feel what two muscles working? If they can't feel these muscles working, then how does that dictate your treatment?
At a level two of a Hruska Adduction Lift Test, the person should feel their left adductor and left gluteus medius. If they can feel their left adductor, but they can't feel their left gluteus medius, then you need to go after the left gluteus medius.
As a rule of thumb, in the Standing Wall Supported Reach, the arms should reach forward at the same angle as what?
As a rule of thumb, in the Standing Wall Supported Reach the arms should reach forward at the same angles as the thighs.
In the Standing Wall Supported Reach, how do you cue knee position and center of pressure on the foot?
In the Standing Wall Supported Reach, you want to cue the knees to track forward, but you want to make sure that their weight is on their heels.
You can spread the feet a little wide and turn the toes inward, too, which creates more femoral internal rotation and adduction.
Will PEC's be strong supinators or pronators?
PEC's will be strong supinators.
The distal fibers of the right glute max do what to the femur? The proximal fibers of the right glute max do what to the ilium on the sacrum?
The distal fibers of the right glute max externally rotate (and abduct? [possibly meant ER]) the femur, and the proximal fibers internally rotate the ilium on the sacrum.
Why is a PEC's chest wall expansion limited?
A PEC's chest wall expansion is limited because they're already at end-range inhalation. Their breathing is consequently shallow.
For a PEC, do you need to do reciprocal or alternating work first? Why?
For a PEC, you need to do reciprocal work before alternating work. They need to be able to reciprocate before they can even alternate.
If a patient can't feel their internal obliques and transverse abdominis working, then you probably need to inhibit either of which two areas?
If a patient can't feel their internal obliques and transverse abdominis working, then you probably need to inhibit either a neck or a back. Thus, you may need to use manual techniques, such as the Vault Hold or Infraclavicular Pump.
According to Lori Thomsen, what should you do after running? Why?
According to Lori Thomsen, running promotes extension, and closes off and tightens the mediastinum. After running, you should therefore open up the mediastinum by squatting and breathing, for example.
What does "AF" mean?
"AF" means acetabulo-femoral movement, which is the acetabulum moving on the femoral head.
When the left innominate anteriorly tips, what do the sacrum and tailbone do?
When the left innominate anteriorly tips, the sacrum orients to the right and tailbone orients to the left.
Why is ligamentous muscle important?
Ligaments don't grow back or heal. You can train muscles to compensate for the overstretched ligaments, which is especially important for hypermobility.
"Blank" muscle is especially important for hypermobility.
Ligamentous muscle is especially important for hypermobility.
The AIC is a "blank"-phase chain that drives the body into "blank" stance.
The AIC is a swing-phase chain that drives the body into contralateral stance. There isn't a stance-phase chain.
For example, the Left AIC drives you into right stance.
In a Left AIC, you'll injure the right hip due to what and you'll injure the left hip due to what?
In a Left AIC, you'll injure the right hip due to overuse and you'll injure the left hip due to compensation because of the dominance of the Left AIC.
The hamstrings are "blank"-phase muscles. What phase are you stuck in when the hamstrings are underactive?
The hamstrings are stance-phase muscles. When the hamstrings are underactive, you'll be stuck in swing phase.
Being on your heels activates what two muscle groups? Being on your toes activates what two muscle groups?
Being on your heels activates the hamstrings and abs. Being on your toes activates the quads and hip flexors.
What two ligaments limit excessive femoral external rotation?
The iliofemoral ligament and the pubofemoral ligament limit excessive femoral external rotation.
What are the two parts of the iliofemoral ligament?
The iliofemoral ligament has two parts: the medial bar and the lateral bar of the iliofemoral ligament.
What ligament limits femoral external rotation in hip extension?
The pubofemoral ligament limits external rotation in hip extension.
What ligament limits femoral external rotation in 90 degrees of hip flexion?
The lateral bar of the iliofemoral ligament limits femoral external rotation in 90 degrees of hip flexion.
What ligament limits internal rotation in full hip extension?
The ischiofemoral ligament limits internal rotation in full hip extension.
What is the "closed-packed" (i.e., secured) position of the hip?
The closed-packed (i.e., secured) position of the hip is extension, adduction, and internal rotation.
What is the angle of optimal articular congruence for the hip?
The angle of optimal articular congruence for the hip is "frog legs" (i.e., flexed, externally rotated and abducted).
Why might someone with hypermobility have excessive tone?
If someone has hypermobility, then they might have excessive tone in order to attempt to control their large range of motion.
In how many degrees of hip flexion are the hip ligaments loosest?
The ligaments are most loose at ninety degrees of hip flexion.
Why does the left leg look shorter and the right ASIS seem to be more inferior than the left ASIS in a Left AIC?
The left leg appears shorter in supine because the left innominate is anteriorly tipped and moved upward. The right ASIS looks inferior to the left ASIS because the left innominate moved upward. If the left leg doesn't appear short, then the left hip is loose and there's pathology.
Can a Left AIC do a split better with the left leg or right leg in front? Why?
If it's easier for them to a split with the other leg in front, then what is the pathology?
In a Left AIC, it's easier to do a split with the right leg in front because the right hip has a better straight leg raise.
If it's easier on the left, then the ischiofemoral ligament is blown out.
What is PRI's understanding of femoral acetabular impingement (FAI)?
FAI: bony deformities can develop at the hip because of the person's pattern. The forces at the hip joint cause bone growth in the stressed places. You can minimize the impact of the bony deformities by changing acetabular position.
The ischiocondylar adductor is a ligamentous muscle for what ligament?
The ischiocondylar adductor (adductor magnus) is a ligamentous muscle for the pubofemoral ligament.
The gluteus medius is a ligamentous muscle for what ligament?
The gluteus medius is a ligamentous muscle for the iliofemoral ligament.
What are the top three anti-gravitational external rotators? What are the three most powerfully positioned external rotators?
The top three anti-gravitational ER's: gluteus max, biceps femoris, and obturator.
The most powerfully positioned ER's: gluteus max, obturator, and psoas. The psoas becomes more dominant—we get anterior tipped, flexed hips, and extended backs.
What are the top three anti-gravitational internal rotators? What are the three most powerfully positioned internal rotators?
The top three anti-gravitational IR's: adductor magnus, anterior gluteus medius, and semimembranosus and semitendinosus.
The most powerfully positioned IR's: TFL, anterior glute medius and adductor magnus. The TFL, which is a hip flexor, becomes more dominant, which causes hip flexion and back extension.
The vastus lateralis becomes overactive when what two muscles become inactive?
The vastus lateralis becomes overactive when the hamstrings and adductors become inactive.
Knee pain can be due to hyperactivity in what muscle rather than an underactive VMO?
Knee pain can be due to a hyperactive vastus lateralis rather than an underactive VMO.
In a closed kinetic chain, the vastus lateralis has what two functions in addition to being a knee extensor?
In a closed kinetic chain, the vastus lateralis also acts as an internal rotator and an abductor.
Why do you get vastus lateralis overactivity on the left? On the right?
The reason you get VL overactivity on the left is due to instability and underactivity of the hamstrings and adductors.
The reason you get VL overactivity on the right side because the right hip is in internal rotation and adduction, so the VL internally rotates and, because it's an abductor, prevents further adduction.
Facilitating what two muscles as abductors can shut off the right vastus lateralis? Which is a better abductor?
Using the right gluteus maximus and right gluteus medius as abductors can shut off the right vastus lateralis, which is overactive as an abductor. The gluteus medius is a better abductor than the gluteus maximus.
"The Left AIC is a return to 'blank blank' for stability and control."
The Left AIC is a return to primitive reflexes for stability and control. It becomes more prominent when bone growth exceeds muscle growth.
What is the difference between the anterior gluteus medius and the posterior gluteus medius?
The anterior gluteus medius is an internal rotator and the posterior gluteus medius is an external rotator. Both are abductors.
Is the obturator internus an internal or external rotator?
The obturator internus is an external rotator.
Explain why "both obturartors have problems" in a Left AIC?
In a Left AIC, both obturators have problems. The left obturator is in active insufficiency because the left hip is anteriorly tilted and externally rotated, and the right obturator is in passive insufficiency because the right hip is extended and internally rotated.
Expressed another way, the left obturator is relatively short and the right obturator is relatively long.
How do you lengthen the left obturator internus?
How do you shorten the right obturator internus?
To lengthen the left obturator, you need to internally rotate the left femur and extend the left hip, so you activate the left ischiocondylar adductor as an internal rotator and the left glute maximus as a hip extensor.
To shorten the right obturator, you need to externally rotate the right femur and flex the hip, so use the glute maximus as an external rotator, lengthen the adductor and use the adductor as an external rotator.
What two muscles affect the length of the obturator internus?
Adductor magnus and gluteus maximus affect the length of the obturator internus.
What indicates optimal obturator function?
To determine if the obturator function is optimal, perform a Hruska adduction lift test. A score of three or greater indicates optimal obturator function.
What are the three tiers of "hole control" (i.e., control of the acetabulum)?
The gluteus maximus and obturator surround the acetabulum from the inside and outside. They contribute to first tier hole control (i.e., control of the acetabulum). Second tier control is the glute medius/minimus and iliacus. The last tier is hanging out on the adductors and gravity—they're stuck in their right hip using their right adductors.
What should a PEC score on the Hruska Adduction Lift Test?
A PEC should score double zeros or double ones on the Hruska Adduction Lift Test.
Don't internally rotate until you've done what to the femur? Why?
Don't internally rotate until you approximate to seat the femur in the acetabulum. You need to get the femoral head in its socket before you can internally rotate it, otherwise you'll compensate. Thus, do an adductor pullback to use the IC adductor to get the femur in the socket before you work on internal rotation.
What two muscles do you need to feel when you raise your knee off the table in the Hruska Adduction Lift Test in order to score a 2/5?
If you don't feel both your adductor and glute medius (i.e., inner thigh and outer hip) when you raise your knee off the table in the Hruska Adduction Lift Test, then you score a 1/5 and not a 2/5. The adductor and glute medius need to be coordinated to score a 2.
If a person has high arches when their feet are off the ground and their arches collapse when they bear weight on their feet, then they will benefit from what?
If a person has high arches when their feet are off the ground (e.g., sitting on the edge of a table) and their arches collapse when they bear weight on their feet, then they will benefit from shoes with adequate calcaneal support so that their arches don't collapse.
When doing a Left Sidelying Right Glute Max, you should feel it in what two or three muscles?
When doing a Left Sidelying Right Glute Max, you're trying to work right external rotation, so you should feel it in the right glute max, right adductor magnus (the external rotation component) and possibly right hamstring.
You don't want to feel it in vastus lateralis. You're also shutting off the adduction component of adductor magnus (i.e., the frontal plane component).
Don't stretch the hip flexors until you've done what with the femoral head? Why?
Don't stretch hip flexors until you've approximated the hip (i.e., get the femoral head in the acetabulum) because you'll otherwise be stretching out the anterior ligaments.
Even still, be very judicious when stretching the hip flexors (i.e., it's often bad to stretch the hip flexors).
According to PRI, you should score at least a "blank" on the Hruska Adduction Lift Test before returning to training. Why?
Before you return to training, get at least a 2 on the HALT. Otherwise, your will perform your training in a compensatory manner that'll do more harm than good.
What's the difference between using a box or bench for supine 90-90 exercises and using a wall?
When doing 90-90, using a shelf or box under the feet instead of the wall may help fire the hamstrings, but it'll fire the distal hamstrings and calves that flex the knees rather than the proximal hamstrings that extend the pelvis. You can use the shelf or box if the person isn't feeling any hamstring, but you don't want the person to rely on the distal hamstrings, so use the wall as soon as possible.
According to James Anderson, PRI uses what system to modulate, regulate and integrate the nervous system?
According to James Anderson, PRI uses the respiratory system to modulate, regulate and integrate the nervous system. We want to enhance the performance of the nervous. We want to inhibit aberrant sympathetic tone in the nervous system the impairs performance.
What sits atop the left hemi-diaphragm that flattens the left-diaphragm?
The pericardium sits atop the left hemi-diaphragm, which flattens the left hemi-diaphragm.
Until you get the air out of the left chest wall, what happens to the right arm and what happens to trunk rotation?
Until you get the air out of the left chest wall, your right arm will remain stuck and you can't get into right trunk rotation.
If the left hemi-diaphragm contracts from a flattened position, then it pulls a person into "blank" trunk rotation.
If the left hemi-diaphragm contracts from a flattened position, then it pulls a person into left trunk rotation. The person is consequently stuck in left trunk rotation and can't get into right trunk rotation.
The Right AIC works with the "blank" BC.
The Right AIC works with the Left BC. The relationship is contralateral, not ipsilateral.
In a Left AIC, Right BC, the left anterior rib flare is matched by a "blank" posterior rib flare.
In a Left AIC, Right BC, the left anterior rib flare is matched by a right posterior rib flare.
According to James Anderson, which is more important: getting air out of the left wall or getting air into the right chest wall?
According to James Anderson, it's more important to get air out of the left chest wall than it is to get air into the right chest wall, though the latter is still important.
The normal scoliotic pattern is what pattern?
The normal scoliotic pattern is the Left AIC, Right BC pattern.
Respiration drives "blank" changes that drive "blank" changes.
Respiration drives neurological changes that drive biomechanical changes.
According to James Anderson, what causes right shoulder impingement? Improving what will improve right shoulder internal rotation?
Right shoulder impingement occurs because the right scapula is abducted and anteriorly tipped, which is due to faulty rib positioning. Improving the zone of apposition on the left side improves right shoulder internal rotation.
According to James Anderson, what three muscles are often overdeveloped and hypertonic in swimmers?
According to James Anderson, swimmers often have overdeveloped and hypertonic pecs, lats and hip flexors.
Why can proper breathing improve hamstring flexibility?
Proper breathing can improve hamstring flexibility because the AIC chain runs from the diaphragm to the lateral knee.
"Biomechanics is a representation of 'blank' tone."
"Biomechanics is a representation of autonomic tone."
The right serratus anterior can quiet what two muscles?
The right serratus anterior can quiet the right scalenes and right internal obliques.
How does the serratus anterior rotate the scapula?
The serratus anterior externally rotates the scapula.
With regards to gait, the Pelvic Ascension Drop Test determines what? What does the Passive Abduction Raise Test determine?
The ascension drop test determine if you can get into stance phase on the ipsilateral side. The abduction raise test determines if you can get into swing phase on that side.
What is the definition of "neutral" in the 2014 Advanced Integration manual?
Neutral: the human body posture is in a position in which a set of muscles (left AIC, right BC, and right TMCC) is disengaged.
The subscapularis is analogous to what muscle of the pelvis?
The subscapularis is analogous to the left ischiocondylar adductor. Both are typically underused internal rotators.
What muscle typically dominates the function of the subscapularis?
The latissimus dorsi typically dominates the function of the subscapularis.
Both are internal rotators of the humerus, but the latissismus is much bigger and stronger than the subscapularis.
What is ischemia?
Ischemia is inadequate blood supply to an organ or part of the body (especially the heart).
The right lower trapezius is analogous to what muscle of the pelvis?
The right lower trapezius is analogous to the left hamstring. The right lower trapezius posteriorly tilts the right scapula, while the left hamstring posteriorly tilts the left innominate.
What is respiratory sinus arrhythmia (RSA)?
RSA is the increase in heart rate during inhalation and the decrease in heart rate that follows during exhalation.
What is reduced RSA? What does it indicate?
In reduced RSA, is a small difference in heart rate between inhalation and exhalation (i.e., low HRV). It indicates high sympathetic output and stress.
From a brain-centric perspective, what do the amplitude of the high frequency band (HF) of heart rate variability (in the frequency domain) and RSA (in the time domain) measure and indicate?
The amplitude of the high frequency band of heart rate variability and RSA are indicators of vagal tone and of the prefrontal cortex's capacity to inhibit subcortical sympatho-excitatory stress responses.
Higher HF power or RSA correlate with what?
Higher HF power or RSA correlate with a better capacity to adapt to the environment and induces a calm, but alert state. They are also markers of cardiovascular health and autonomic homeostatic control.
RSA amplitude seems to reach a maximum at a respiration rate of about how many breaths per minute? Why?
RSA amplitude seems to reach a maximum at a respiration rate of about six breaths per minute, likely because at that rate breathing occurs at a resonance frequency of the cardiovascular system, caused by the rhythm in heart rate produced by the baroreflex (spontaneous oscillations in blood pressure that are reflexively compensated for by changes in heart rate) (Giardino et al. 2003; Song and Lehrer 2003). At resonance frequency, RSA and baroreflex effects mutually stimulate each other, causing very high oscillations in heart rate, thereby stimulating modulatory effects of both processes, and apparently increasing the power of modulatory processes in the cardiovascular system.
How do states of relaxation and stress affect the inhalation-to-exhalation ratio, respectively?
Several studies have documented that states of relaxation and stress induce decreases and increases in the inhalation-to-exhalation ratio, respectively.
What is the relationship between nasal blood vessels and nasal airflow? What are the implications?
Nasal blood vessels influence nasal airflow. Thus, nasal airflow is regulated by autonomic and central controls.
Right unilateral forced nostril breathing is associated with an increase in tone from what branch of the autonomic nervous system?
Right unilateral forced nostril breathing is associated with a generalized increase in sympathetic tone.
An increase in volar galvanic skin resistance suggests what change in autonomic tone?
An increase in volar galvanic skin resistance suggests a decrease in sympathetic activity.
What is the high frequency (HF) band of heart rate variability mainly related to?
The high frequency (HF) band of HRV is mainly related to efferent vagal activity (i.e., parasympathetic tone).
What does the LF/HF ratio correlate with?
The LF/HF ratio is correlated with sympathovagal balance.
What is the definition of vision?
"The deriving of meaning and the directing of action as a product of the processing of information triggered by a selected band of radiant energy." (Robert Kraskin)
Vision is not just what we see, it is what drives us to make decisions. It is a skill that we develop as we age.
What is the definition of sight?
Sight is the clarity of our visual field, which is slightly different from vision.
Having more clarity is not necessarily better, since there are many things that we see that we do not take into account and process.
What is myopia? What does it cause in the system?
Myopia is nearsightedness. We see better near as space is constricted. It leads to system-wide extension.
What is hyperopia? What does it cause in the system?
Hyperopia is farsightedness. We see better far than near. Space expands and leads to system flexibility at low levels.
What is astigmatism?
Astigmatism is like scoliosis of the eyeball. Details are distorted in one direction more than others due to asymmetrical torque on the eyeball.
What is presbyopia?
In presbyopia, the lens can't focus as well due to normal loss of flexibility as we age.
What is (visual) accommodation?
In accommodation, the ciliary muscle tightens to focus on close objects. Chronic over-accommodation may create artificial myopia because it becomes difficult to turn off the ciliary muscle.
What characterizes the ambient visual pathway?
Seeing the periphery.
What is the focal visual pathway?
Seeing detail, clarity.
What is (visual) convergence? What is associated with it?
In convergence, the eyes moved inward to close on a target. Convergence is associated with extension and "tightness."
What is (visual) divergence? What does excessive divergence suggest?
In divergence, the eyes move away from each other to watch a target move far away. Excessive divergence reflects system instability and possible hypermobility somewhere.
In the right-lateralized pattern, how do the eyes typically accommodate to best perceive the environment? What is the consequence?
The left eye becomes more focal, and the right eye likes to be more ambient. This unilateral functioning leads to less left-sided visual space perception.
Why might it be beneficial to cue a person to be consciously aware of the space and wall in their left peripheral vision while doing standing exercises balancing on the left leg?
It may be necessary to make sure that the person is consciously aware of the space and wall in their left peripheral vision while doing standing exercises balancing on the left leg. If the brain doesn't recognize the reference of the space on the left side, there is no purpose for balancing on the left leg and learning a new pattern of left stance won't happen successfully.
What often happens in the windup phase for a Left AIC right-handed pitcher?
There tends to be an increase in right AF IR during the windup phase. There is overactivity of the right quadratus lumborum and right adductor magnus, which promotes excessive right lateralization. The right posterior glute medius is relatively inhibited.
The pitcher may over-rotate their pelvis to the right, which may cause a positional timing dysfunction that will affect the subsequent delivery.
What is an important reference center during the windup phase for a right-handed pitcher? Why?
The right medial longitudinal arch because it prevents excessive right AF IR. Excessive right AF IR in the windup phase may cause positional timing dysfunction.
What often happens in the stride phase for a Left AIC, Right BC or Superior T4 Syndrome right-handed pitcher?
The tonic right adductor magnus, tonic right quadratus lumborum, and restricted anterior-inferior hip capsule may decrease stride length. (Stride length is ideally approximately 83 percent of the pitcher's height.)
There'll often be delayed or insufficient activity of the right posterior gluteus medius (AF abduction) and right inferior gluteus maximum (AF external rotation). Insufficient right AF abduction often means that there'll be insufficient right thoracic adduction.
What happens if the thrower allows his throwing-side elbow to pass over his shoulder?
If the thrower allows his elbow to pass over his shoulder, then the positional lack of HG-IR due to the BC pattern, humeral retroversion, and posterior capsule contracture causes excessive anterior scapular tilting. This excessive anterior scapular tilting inhibits the lower trapezius and serratus anterior during maximum external rotation and the acceleration phase. (The activity of the lower trapezius and serratus anterior is vital to reduce load and torsion on the throwing arm.) With this scapular dyskinesia, the subscapularis is also delayed, which causes increased external rotation, since the subscapularis is not in position to create proper humeral centration.
What is the primary source of dysfunction in the cocking phase of throwing? What muscles are especially important during this phase, and why?
The primary source of dysfunction during the cocking phase of throwing is insufficient positional timing of contralateral rotation between the pelvis and trunk. As the pelvis begin to rotate toward home plate, the trunk must maintain optimal contralateral trunk rotation with use of the lower trapezius, internal oblique, and bilateral serratus anterior.
If the lower trapezius, internal oblique, and bilateral serratus anterior are lost at maximum HG-ER, then humeral torque is left unopposed in a suboptimal position, which creates pathological instability and force through the shoulder and elbow.
What is the beginning and end of the acceleration phase of pitching?
The acceleration phase begins at maximum HG ER and ends at ball release.
What often accounts for breakdown in throwing mechanics in the acceleration phase of pitching?
Breakdown in throwing mechanics during the acceleration phase of pitching is typically due to timing and positional dysfunction in earlier phases of throwing. This dysfunction causes the thrower to compensate for the altered movement pattern in order to make the throw.
What muscles and positions are critical in the acceleration phase of throwing?
The lead glove arm and posterior mediastinum are critical in the acceleration phase of throwing. The lead glove arm is the anchor in order to promote proper timing between lead leg AF IR and contralateral trunk rotation, along with proper trunk flexion toward the plate. The serratus anterior allows the lead rib cage to internally rotate for contralateral trunk rotation.
As the throwing arm begins to accelerate from the position of maximum HG ER, the subscapularis is critical to maintain joint centration in the acceleration phase.
What often happens if a pitcher can't get adequate trunk rotation position and timing (as is often the case in a BC or T4 pattern)?
If a person has difficulty getting adequate trunk rotation position and timing, then the thorax will often extend to compensate, which places more shear force and load on the elbow and shoulder.
During the follow-through/deceleration phase of pitching, the rotator cuff decelerates the arm primarily by doing what?
During the follow-through/deceleration phase of pitching, the rotator cuff decelerates the arm primarily by resisting distraction.
In the follow-through/deceleration phase of pitching, what three movements help dissipate the energy developed to accelerate the ball and reduce distraction forces at the shoulder?
Flexing the trunk, flexing the support knee, and allowing the arm to continue along its path of movement across the body assist in dissipating this energy and reducing distraction forces on the shoulder.
Movement dysfunctions in the follow-through/deceleration phase of pitching are typically due to what?
Movement dysfunctions in the follow-through/deceleration phase of pitching are typically due to poor positioning and timing in earlier phases of pitching.
What combination of three movements at the wrist and shoulder engage the serratus anterior?
Wrist flexion, pronation, and internal rotation engage the serratus anterior.
What combination of three movements at the wrist and shoulder engage the lower trapezius?
Wrist extension, supination, and external rotation engage the lower trapezius.
What are the keys for a right-handed pitcher in the windup phase?
Activating the right gluteus medius in the frontal plane to inhibit the right adductor and right QL.
What are the keys for a left-handed pitcher in the windup phase?
Loading the left leg properly in left AF IR and engaging the left abdominals to "stay back."
What are the keys for a right-handed pitcher in the stride phase?
Achieving adequate stride length and inhibiting the right adductor and right QL in order to get proper right AF abduction and right thoracic adduction.
What are the keys for a left-handed pitcher in the stride phase?
Inhibiting the Left AIC, Right BC pattern so that they don't rotate into early right AF IR and left trunk rotation. Keeping their left oblique engaged so that they can maintain left rib internal rotation in order to "stay back."
What are the keys for a right-handed pitcher in the cocking phase?
Properly rotating into left AF IR while maintaining right trunk rotation and getting out of the right anterior-inferior hip capsule to properly rotate the hips.
What are the keys for a left-handed pitcher in the cocking phase?
Properly controlling right AF IR while maintaining left trunk rotation. (Left posterior mediastinum.)
Preventing back extension compensation by ensuring that the left psoas major works in the transverse plane as a rotator (and not in the sagittal plane as a hip flexor) to rotate the pelvis to the right.
What is the key for a right-handed pitcher in the acceleration phase?
Maintaining left AF IR in a state of flexion and use the left abdominal wall.
What is the key for a left-handed pitcher in the acceleration phase?
Delaying opening up your trunk too early.
What is the key for right- and left-handed pitchers in the follow through/deceleration phase?
Maintaining AF IR in a balanced position with appropriate trunk flexion.
What does the Quadruped Reciprocal TS/ST Stability Test assess?
The Quadruped Reciprocal TS/ST Stability Test assesses thoracic movement and stability beneath the scapula, and scapular movement and stability on the thorax.
The test reflects respiratory mechanics, rib cage movement, and the lower trapezius and serratus anterior muscle integration required for properly sequenced overhead rotational performance.
The Quadruped Reciprocal TS/ST Stability Test is named for which side?
The Quadruped Reciprocal TS/ST Stability Test is named for the side the block is placed under (e.g., if the block is under the patient's left knee, then the test is the Left Quadruped Reciprocal TS/ST Stability Test).
What are the six steps of the Quadruped Reciprocal TS/ST Stability Test?
Step One: Have the patient exhale to lower ribs down and in with the knees level.
Step Two: Have the patient maintain rounded back and shift non-block knee down to the surface.
Step Three: Instruct the patient to raise the opposite arm off the surface.
Step Four: Ask the patient to raise arm into HG scaption.
Step Five: Ask the patient to turn palm upward to the ceiling.
Step Six: As the patient to flex elbow to 90 degrees and externally rotate arm into the cocking position.
What does a score of a one on the Quadruped Reciprocal TS/ST Stability Test indicate?
The patient has the ability to shift into ipsilateral AF IR and contralateral trunk rotation. In addition, the ability to maintain thorax position during inhalation indicates adequate posterior mediastinum expansion to maintain ipsilateral ZOA.
What must not happen when you remove your opposite hand from the surface in the Quadruped Reciprocal TS/ST Stability Test in order to score at least a two? What does an inability to do those things indicate?
You must be able to remove your opposite hand from the surface without contralateral scapular retraction/downward rotation or contralateral trunk rotation. An inability reflects ipsilateral TS/ST serratus anterior weakness and ipsilateral abdominal weakness.
What does an inability to achieve a level five in the Quadruped Reciprocal TS/ST Stability Test indicate?
An inability to maintain the arm in the scapular plane with full supination and HG ER reflects a lack of latissimus dorsi and/or pec minor inhibition, or weakness of the lower trapezius and teres minor/infraspinatus.
What does the PRI Seated Functional Trunk Integration Test assess?
The PRI Seated Functional Trunk Integration Test assesses the orientation of the spine and diaphragm in the transverse plane as well as the dominant pattern of trunk rotation versus pelvic rotation. The test also assesses the positional ability to properly reciprocate the pelvis and trunk for functional transverse plane activities (i.e., dissociate in the transverse plane).
What's an important cue for the PRI Seated Functional Trunk Integration Test?
Tell the patient to move slowly.
What are ideal values for the PRI Seated Functional Trunk Integration Test?
At least sixty degrees of trunk rotation in each direction in AF neutral.
At least thirty degrees of right trunk rotation in left AF IR, or left trunk rotation in right AF IR. Ideally, these values are similar.
There should be ninety degrees of left trunk rotation in left AF IR as well as ninety degrees of right trunk rotation in right AF IR--that's deleceration and follow-through.
What does the Standing Eversion AF Abduction with Trunk Rotation Test measure?
The Standing Eversion AF Abduction with Trunk Rotation Test measures the ability to position, inhibit, and properly integrate eversion with adductor magnus inhibition while maintaining contralateral trunk rotation for functional uncompensated movement patterns during the stride phase of throwing.
What are the six steps in the Standing Eversion AF Abduction with Trunk Rotation Test?
Step One: Have patient stand with hips abducted at approximately sixty percent of body height. Ask patient to exhale and perform a posterior pelvic tilt with rib internal rotation.
Step Two: Have patient evert the trail foot into the floor without allowing femoral internal rotation. Allow the lead leg's knee to flex.
Step Three: Patient will then rotate their pelvis toward the lead leg, which shifts them into AF-IR.
Step Four: In this position, have the patient cross their arms and rotate their trunk contralaterally.
Step Five: Instruct the patient to reach forward with their lead arm and retract the ipsilateral ribs. You may want to have them internally rotate, pronate, and flex the wrist of the reaching arm to better engage the ipsilateral serratus anterior.
Step Six: Ask patient to abduct the trail side arm to ninety degrees and externally rotate with the scapula retracted.
How is the Standing Eversion AF Abduction with Trunk Rotation Test named?
The Standing Eversion AF Abduction with Trunk Rotation Test is named for the side of the everting foot.
What does a score of a zero on the the Standing Eversion AF Abduction with Trunk Rotation Test indicate?
A score of a zero on the the Standing Eversion AF Abduction with Trunk Rotation Test (i.e., inability to achieve thoracolumbar flexion and rib internal rotation with hip abducted to approximately sixty percent of body height) indicates overactive adductors and back extensors.
What does an inability to score a one on the Standing Eversion AF Abduction with Trunk Rotation Test indicate?
An inability to score a one on the Standing Eversion AF Abduction with Trunk Rotation Test (i.e., maintain trunk flexion and AF abduction with trail foot eversion) indicates a lack of adductor magnus inhibition.
What does an inability to score a two on the Standing Eversion AF Abduction with Trunk Rotation Test indicate?
An inability to score a two on the Standing Eversion AF Abduction with Trunk Rotation Test (i.e., rotate pelvis toward lead leg AF IR with trail leg AF ER while maintaining ankle eversion) indicates a lack of lead foot AF IR and/or trail foot AF ER in an abducted state with eversion and adductor magnus inhibition and gluteus maximus control.
What does an inability to score a three on the Standing Eversion AF Abduction with Trunk Rotation Test indicate?
An inability to score a three on the Standing Eversion AF Abduction with Trunk Rotation Test (i.e., cross arms over chest then rotate trunk in contralateral direction) indicates lack of contralateral trunk rotation while maintaining proper pelvic position with ankle eversion.
What does an inability to score a four on the Standing Eversion AF Abduction with Trunk Rotation Test indicate?
An inability to score a four on the Standing Eversion AF Abduction with Trunk Rotation Test (i.e., reach forward with lead arm to perform TS rib retraction/ST scapular protraction) indicates a lack of trunk rotation and posterior mediastinal expansion of the ipsilateral thorax.
What does an inability to score a five on the Standing Eversion AF Abduction with Trunk Rotation Test indicate?
An inability to score a five on the Standing Eversion AF Abduction with Trunk Rotation Test (i.e., abduct and externally rotate humerus with scapular retraction while maintaining trunk rotation with cervical rotation back toward lead arm) indicates a lack of trunk rotation with ST lower trapezius integration or cervical/visual compensation.
According to the PRI Integration for Baseball manual, what are the six treatment considerations for a Right Superior T4 Syndrome patient?
Left ZOA, left AF IR, left posterior mediastinum, left trunk rotation activities, left lower trapezius and left serratus anterior, and right serratus anterior.
Describe the typical position of the lower trapeziuses in the Left AIC/Right BC pattern. Discuss the spinal and scapular attachments, and how they affect position and function.
As the thorax counter rotates to the left, the scapulae commonly rotate about a vertical axis into internal rotation on the right and external rotation on the left. This position lengthens the right low trap as the right scapula internally rotates and moves away from the spine, and shortens the left low trap as the left scapula externally rotations and moves toward the spine. In this position, the spinal attachment of the shorter left low trap feeds this pattern by maintaining or possibly turning the right-oriented spine further to the right (TS). The scapular attachment of the left low trap assists with rotation of the upper thorax back to the left as the left scapula is externally rotated and pulled toward the spine (ST). The longer and biomechanically challenged right low trap is unable to help orient the spine back toward the left (TS) or to assist with right upper trunk rotation (ST).
The spinal attachments assist help orient the spine in the transverse plane (TS). The scapular attachments assist with upper trunk rotation (ST).
Explain what occurs to the spinal and scapular attachments of the serratus anterior in Superior T4 Syndrome.
If the right scalenes externally rotate the right upper ribs, then the right upper ribs will elevate and the anterior attachments of the upper part of the right serratus anterior will lengthen. The lower right ribs are internally rotated, which lengthens the anterior attachments of the inferior fibers of the right serratus anterior.
The common scapular adaptation to the deflated and restricted right thorax is the internally rotated scapula, with the medial border positioned posteriorly. This position lengthens the scapular attachment of the right serratus anterior.
Because of this positional discord, reaching with the right serratus doesn't appropriate rotate the ribs (TS) or stabilize the medial border oft eh right scapula (ST), but instead causes the patient's original pattern of left upper trunk rotation to occur.
Why does a Superior T4 patient test positive for bilateral BC activity? Why does the patient have restricted trunk rotation in both directions?
A Superior T4 patient tests positive for bilateral BC activity because the underlying Right BC still exists on the right and the upper aspect of the Left BC engages when the left upper ribs move into depression and internal rotation with rotation of the upper thoracic spine back to the right.
The upper thoracic spine will not rotate to the left because of this respiratory compensation and the lower thoracic spine will not rotate back to the right as a result of the underlying Right BC pattern. The patient is therefore restricted with trunk rotation in both directions, but for different reasons.
What should initial repositioning and retraining focus on for a Superior T4 Syndrome patient?
Initial repositioning and retraining for a Superior T4 Syndrome patient should focus on left upper trunk rotation (occurring on top of a lower trunk that is rotating right) on left stance pelvic position.
What is one reason why there is a tendency to relax the left abdominal wall?
There is a tendency to relax the left abdominal wall because the left diaphragm leaflet is much smaller and does not have the advantage to pull the ribs up and out upon inhalation. Consequently, the left abdominal musculature tends to become weak.
Explain how the lateralization of functions in the brain affects lateralization of extremity usage.
The left brain has more responsibilities for speech and language, and thus the right upper extremity becomes a dominant extremity in communication, growth, and development.
How does the heart muscle affect airflow?
The heart muscle facilitates airflow into the left chest. The absence of heart muscle in the right chest makes it difficult to keep the right chest opened during breathing.
Standing mainly on the right lower extremity to offset the weight of the left upper torso assists in moving the pelvis forward on the left and the shoulder complex down on the right.
Describe the asymmetry is the lobes of the right and left lungs. What is the functional consequence of this asymmetry.
There are three lobes of lung in the smaller right mediastinum in order to maximize aveolar air exchange when exhalation activity across the longer left abdominal wall is sufficient to allow a favorable pressure gradient drawing air into the right chest wall.
The left lung has only two lobes because the larger left mediastinum can more easily achieve a favorable pressure gradient to draw air into the left chest wall for alveolar air exchange due to the naturally shorter position of the right abdominal wall, the dominant respiratory influence of the right hemi-diaphragm, the position of the liver on the right side, and the rib kinematics that occur across the left side with left thoracic rotation.
Explain how the right hemi-diaphragm's pull on the lumbar vertebrae affects the vertebrae's and pelvis' orientation.
The dominant pull of the diaphragm's larger and deeper crura on the right of the anterior lumbar vertebral bodies tends to rotate the lumbar spine to the right in the transverse plane into a right oriented base position for the spinal column.
The right oriented spine position causes the sacrum and pelvis to rotate to the right with the left half of the pelvis tilting forward into a position that tends to activate the left hip flexors. The left psoas major further contributes to the right oriented spine position because it rotates the lumbar spine to the right, just like the dominant right side of the diaphragm does. The relatively flatter and descended left hemi-diaphragm does not have the mechanical advantage to rotate the lumbar spine to the left.
Why is the Left AIC overactive?
On the more unstable left side, the muscles of the Left AIC are in a greater state of activation because of their position and the high functional demand continually placed upon them in that position. To maintain or achieve upright posture, this left chain has to compensate with chronic muscle overactivity to provide the required stability for single-leg function. These left hip flexors and lateral thigh muscles become overactive because both are working to stabilize the left half of the pelvis in a position that is biased toward hip flexion and external rotation.
Because the Left AIC is constantly trying to stabilize a side that is not in the proper position, normal reciprocal use of excitation and inhibition is lost.
What is the one muscle in the Right BC that becomes very active yet retains the ability to fully relax between contractions? Why?
The right hemi-diaphragm is the one muscle in the Right BC that becomes very active yet retains the ability to fully relax between contractions because of its established ZOA and support from the properly positioned right abdominal muscles in the left AIC pattern.
Acquisition of left hip internal rotation, adduction, and extension (Right AIC pattern) is needed to create...
Acquisition of left hip internal rotation, adduction, and extension (Right AIC pattern) is needed to create a neuro-reflexive and learned behavioral pattern that will enable reciprocal, subconscious, and appropriate late stance hip function and position.
What happens if the Right BC does not disengage?
If the Right BC doesn't disengage because of a neuro-reflexive pattern of overactivity, then the Left BC will not be able to reciprocally direct the upper thorax back into right rotation, which is the thoracic position associated with the desirable left stance position.
Sagittal anti-gravitational movement and control is better provided by which hip?
Sagittal anti-gravitational movement and control is better provided by the extended right hip than by the more flexed left hip.
Alternating reciprocal activity refers to what?
Alternating reciprocal activity refers to activity that moves through the full range of motion in both directions on both sides of the body.
What is the "ideal balanced response to gravity"?
The ideal balanced response to gravity is such that when vertical, the arrangement of the body segments is balanced around this "force line" with minimum energy expenditure and easy equilibrium in the system.
The further the body segments or body as a whole moves away from this line of gravity, the greater the demand for neuromuscular control.
With regards to the line of gravity and center of mass, when is the body most stable? When is the body most vulnerable to instability?
The body is most stable when segmental and global alignment are closer to the line of gravity and the center of mass is low.
The body is most vulnerable to instability when the body configuration moves outside the line of gravity and/or the center of mass is high.
What are the body's three cavities that are designed to aid in the movement of air and support the upright posture of our human structure based on the pressure differences between them?
The cranium, thorax, and lumbo-pelvic-femoral complex.
What happens to the center of gravity and the pelvis' position in the sagittal plane during inhalation? Why?
When you inhale, both sides of the body move into a state of inhalation by expanding and elevating the front of both sides of the rib cage as the center of gravity moves forward and both sides of the pelvis move into an anterior pelvic tilt.
This forward translation of the center of gravity is the result of the thorax (thoracic spine and rib cage) protracting forward when air is inhaled into the front of the chest and the thorax spine extends. This positional thoracic protraction, or anterior thoracic movement, will be maintained as long as a hyperinflated state of inhalation is maintained, with the pelvis positioned in an anterior pelvic tilt.
What happens in the frontal plane if the left chest is not deflated?
If the air in the left chest is not fully deflated, then any attempted to sidebend the thorax to the left will actually result in right thoracic abduction because the unexhaled air will push the thorax over to the right.
What is acetabular abduction? For what is it important?
When the pelvis laterally translates over moves across the frontal plane in one direction, the acetabulum will move away from midline, or abduct, in the direction the pelvis moves. This acetabular abduction away from midline is a requirement for proper positioning of the pelvis over the lower extremity for proper single leg stance control. The acetabulum must abduct out to provide proper position for the femur to adduct inward. The lateralized position of the pelvis (acetabular abduction) must be maintained so non-compensatory femoral adduction can be introduced during single-leg stance without compensation.
Acetabular abduction is also a requirement for proper positioning of the pelvis under the thorax. The pelvic posture needs to pair with the thoracic posture in the frontal plane so the center of gravity can properly lateralize in that direction with compensation. (As a rule of thumb, the nose should be over the ipsilateral big toe.) You need to have well-synchronized thoracic abduction with acetabular abduction in the same direction.
How do you create separation without compensation between the pelvis and thorax in the transverse plane? What does the inability to create this separation indicate?
To create separation without compensation between the pelvis and thorax in the transverse plane, you need to attain an ipsilateral Zone of Apposition over a properly positioned pelvis before attempting to rotate the thorax in the opposite direction.
The inability to create this separation indicates a poor breathing pattern that compromises the Zone of Apposition and/or overutilization of the back extensors to coordinate body rotation and transverse plane movement.
What occurs at the vertebrae and rib cage during right trunk rotation? What happens to air flow?
The right side of the rib cage externally rotates and the left side internally rotates. There is also a slight coupling of the vertebrae and ribs into left sideflexion (i.e., right thoracic adduction, left thoracic abduction).
The left side achieves a Zone of Apposition, which facilitates right apical anterior lateral expansion with left posterior mediastinum expansion.
If the lower and upper halves of the body can synchronize their movement in the sagittal and frontal planes, then where does separation in the transverse plane occur?
If the lower and upper halves of the body can synchronize their movement int he sagittal and frontal planes, then separation in the transverse plane occurs at the T8 mid-zone.
What are the two cavities of the thorax? What divides these two cavities?
The diaphragm divides the thorax into two cavities: one that houses the heart and lungs, and one that houses the organs, known as the thoraco-abdominal-pelvic cavity.
What muscles comprise the "intrinsic sleeve"?
The intrinsic sleeve is comprised of the transverse abdominus, diaphragm, pelvic floor, internal oblique, lumbar multifidi, interspinales, intertransversarii, psoas, and medial fibers of the quadratus lumborum. These muscles must balance low grade, sustained, tonic activity for upright posture with more phasic demands of respiration and reflex response to trunk and limb movement.
Note: the transverse abdominus, diaphragm, and pelvic floor, in particular, are activated in the anticipation of limb movement.
What are the two muscles that comprise the extrinsic sleeve?
The external obliques and rectus abdominis comprise the extrinsic sleeve.
Why is gait efficiency reduced when you lose the Zone of Apposition on one or both sides due to hyperactive superifical sagittal based muscle activity?
When you lose the Zone of Apposition on one or both sides due to hyperactive superficial sagittal based muscle activity gait efficiency is reduced. There is a disconnect between your thorax and pelvis, and a loss of synchronization for transverse plane integration. The loss of Zone of Apposition creates an inability to retract and internally rotates the ribs, which is the prerequisite for trunk rotation, arm swing, and noncompensatory pelvic/hip mechanics.
Sensory input and processing dictate "blank."
Sensory input and processing dictate movement.
What are the three categories of sensory receptors? What does each category do?
Exteroceptors, interoceptors, and proprioceptors.
Exteroceptors provide information about the external environment and respond to stimuli from outside the body (e.g., touch, pressure, light, temperature, etc.). These receptors give us a sense of the space around us.
Interoceptors provide information on the status of the internal organs and blood vessels (e.g., baroreceptors, degree of stretch of the urinary bladder).
Proprioceptors provide information about the position and posture of our body in space. They sense and respond to stimuli from muscles, tendons, ligaments, joints, connective tissue surrounding muscles and bones, and from the vestibular system. These receptors give us a sense of weight.
What is proprioception? What happens to our movement if there's inadequate proprioceptive input?
Proprioception is the sense of the position of your body, the relative position and action of neighboring parts of your body, and the strength of effort being employed in a movement. It includes the sensations of acceleration, force, heaviness, stiffness, and viscosity (i.e., the "quality" of a movement).
If there's inadequate proprioceptive input, then our movements will rely on momentum or unhealthy compensations, such as postural extension or neurological drive.
What is referencing?
Referencing is targeted proprioception. It means to "empower, assign, or entrust" a muscle, bone, or region of the body to facilitate a specific action. It provides a different perspective from which a new movement pattern can emerge.
What is grounding? Why is it important?
Grounding, which the PRI Integration for Fitness and Movement contends is our most important reference, provides a feeling of weight, a sense of the floor, and a feeling of the floor pushing back up. Grounding is sensed via plantar (bottom of the foot) proprioceptors and baroreceptors.
Together with the vestibular and visual systems, a connection to the ground informs the brain where we are relative to the space around us and limits the need for neuro-reflexive extension movement patterns to keep us upright.
During what phase of gait are grounding requirements the greatest?
During mid-stance, in which the center of mass shifts forward and over to one leg, grounding requirements are the greatest.
During what phase of gait is the knee of the stance leg in the most flexion?
How does grounding affect the function of the scalenes?
Grounding, via its support of upright postural function, influences the pattern of muscle activity involved in breathing. Grounding permits upright postural function that, in turn, ensures that spinal muscles properly stabilize the cervical vertebrae. Muscles, such as the scalenes, are placed in a mechanically efficient position to lift the ribs for inhalation rather than pull the head down and forward. Grounding helps to inhibit compensatory cervical "pulling" (inhalation) and facilitate lower extremity floor "pushing" (exhalation).
Are muscles of inhalation tonic or phasic? What about the muscles of exhalation? What are functions of the phasic muscles?
Muscles of inhalation, including the respiratory diaphragms, intercostals, and scalenes, are more tonic. Muscles of exhalation, including the hamstrings, gluteals, and abdominals, are more phasic.
Phasic muscle activity provides greater proprioceptive input and a sense of the body's weight. Phasic muscles keep the tonic muscles from becoming hypertonic. Grounding, and the proper musculoskeletal positioning that it promotes, allows access to these phasic muscles.
How does unexhaled air contribute to "un-grounding"?
Air that is not fully exhaled holds the anterior chest wall up and contributes to un-grounding, like a hot air balloon lifting off. Without grounding, a person will feel unstable and imbalanced and may unconsciously revert to a breath-holding pattern and spinal extension for referencing.
Explain the two thorax patterns typically observed in people who are in an extension pattern (i.e., PEC's). What happens to the person's center of mass in each thorax pattern? What is the typical airflow pattern in each thorax pattern?
1) The thorax will elevate and turn upward into a hyperinflated posture, which creates the appearance of bilaterally lordotic posture with flatness of the thoracic curve. There will also be superior accessory apical breathing, airflow patterns that move superiorly with the diaphragms remaining in a tonic flat position, and the center of mass shifts back and up.
2) The thorax will displace backwards with the apical chambers remaining closed down. The thorax's displacement creates the appearance of excessive kyphosis, though it's the thorax counterbalancing the excessive anterior tipping and forward translation of the pelvis. The typical airflow pattern is excessive belly breathing with poor use of the diaphragm and poor flexibility of the rib cage. The center of mass shifts back.
How does the spine's position affect scapular function and management of internal abdominal pressure?
Loss of normal spinal curvature contributes to poorly positioned interscapular muscles, which affects the function at the shoulder and neck, and poorly positioned diaphragms to manage internal abdominal pressure.
What are the two notable muscles that posterioly tip the scapula?
The long head of the triceps and the lower trapezius.
How might poor sagittal plane movement cause pathology in the proximal girdles and ball and socket joints?
Poor sagittal plane movement leads to compromised central axial mechanics to flex and rotate. As a result, hypermobility will be created in the proximal girdles and ball and socket joints, which leads to pathology--the system needs to get flexion and rotation somewhere.
What is the set-up for the Supine Reach with Bar Over Feet? What are the six steps?
Set-up: Lie on your back with knees bent and feet flat on the floor. Hold a light-weight bar with your hands slightly wider than shoulder-width apart.
1) Fully exhale and reach the bar up toward the ceiling. Flatten your lower back into the floor.
2) Inhale into your back. Exhale again and pull your knees toward your chest. Reach over your knees as you slide the bar down the front of your shins.
3) Inhale again and as you exhale, try to reach further. Move the bar down your shins, past your ankles, and over your feet.
4) The head, neck, and shoulders may lift off the floor. Keep a light grip on the bar.
5) If you cannot go all the way around your feet, then hold at the farthest position you can go and breathe four or five times. With each exhalation, attempt to reach a little further. If you can go all the way over your feet, then hold at the bottom for four breaths and reach further away with each exhalation.
6) After the final exhalation, pause and return to the relaxed start position.
Note: If one half of the rib cage is more rigid, then the bar will not remain horizontal. The bar will dip lower on the restricted side. Try to keep the bar horizontal.
In the typical Left AIC, Right BC pattern, what is the position of the spine in the frontal plane below T8, between T8 and C7-T1, and above C7?
Below T8, the spine is bent to the left (i.e., it's in the "left hemisphere) to counter to the pelvis' and lower extremities' shift the right. Between T8 and C7-T1, the spine is bent to the right (i.e., right thoracic abduction). Above C7, the spine is side bent to the left (i.e., left cervical abduction).
When standing on the right leg in right stance, how should your center of mass be aligned?
When standing on the right leg in right stance, your center of mass should shift into the right hemisphere to organize posture around a central axis which passes through the orbit of the right eye, central tendon of the right diaphragm, central right hip, and right half of the pelvic floor. And vice versa for when you stand in left single-leg left stance.
Alternating function can occur when what is the case?
Alternating function can occur when one side is secure or stable enough to sense control needed to manage oppositon forces and anti-gravitational control.
The left invertors produce what movement?
The left invertors produce left AF adduction. The left invertors pair with the left AF adductors to pull us over to the left side.
What are the four key PRI tests for the frontal plane?
Adduction Drop Test, Passive Abduction Raise Test, Hruska Adduction Lift Test, and Hruska Abduction Lift Test.
According to the PRI Integration for Fitness and Movement manual, what must be established in order for transverse mobility to be used and well controlled?
In order for transverse mobility to be used and well controlled, there needs to be frontal plane strength well established below T8 through the hips and pelvis. This relationship explains why transverse plane preservation is last in the programming continuum.
According to the PRI Integration for Fitness and Movement manual, what are the four key PRI tests for transverse plane function?
Seated passive FA IR-ER, supine (or seated) trunk rotation, horizontal abduction, and HG IR-ER.
Why should the left shoulder be lower than the right shoulder when you perform right trunk rotation?
In proper right trunk rotation, left thoracic abduction and left rib internal rotation should occur, so the left shoulder should be slightly lower than the right shoulder.
In the PRI Integration for Fitness and Movement manual, what does "BTS" stand for?
BTS stands for Breathing, Thoracic posture, and Sensing position and the ground.
According to the PRI Integration for Fitness and Movement manual, what is the biological definition of adaptation? Why does an organism strive to adapt?
Adaptation refers to a change in structure, function, or behavior by which a species or individual improves its chances of survival in a specific environment. Adaptation is a natural, fluid, and on-going process. An organism strives to adapt to its physical and emotional behavior in response to the environment to satisfy its need for homeostasis (i.e., self-regulation or the active maintenance of constant conditions in the internal environment).
Explain the idea of inactive physiology and its potential significance.
The expression "inactive physiology" was proposed to emphasize that sitting has its own set of molecular, physiologic, and clinical consequences. (Andreo Spina: "Force is the language of cells, and movement is what you communicate.") They are separate from the responses caused by structured exercise, and thus exercise cannot "undo" the effects of too much inactivity.
It may therefore be beneficial to insert multiple periods of physical activity through the day. "Any type of brief, yet frequent, musculature contraction throughout the day may be necessary to short-circuit unhealthy molecular signals causing metabolic diseases."
According to the PRI Integration for Fitness and Movement manual, what the term "stress" refers to what?
"Stress" refers to inputs that are real or perceived threats to homeostasis.
Explain how stress affects the activity of the cortical centers and spinal reflex centers.
The nervous system governs our response to stress input via spinal reflex centers and/or cortical (brain) processing. Too much stress leads to an inappropriate pattern of behavior.
When the cortical centers are unable to efficiently respond to stress, spinal reflex centers will increase in activity and, eventually, become overactive. Increased tone, tightness, and hyperactivity of the stabilizing trunk muscles may occur due to lack of inhibitory activity of the reflex centers. This imbalance between the activity of higher cortical centers of the brain and spinal reflex centers creates abnormal accommodative dysfunction, of both our postural and sensory/proprioceptive (visual) systems. It is demonstrated as learned, embedded, inappropriate behavioral patterns of over-response to postural/movement challenges.
(The above information comes from pages six and seven of the appendix of the PRI Integration for Fitness and Movement manual.)Movement
People who are unable to modify breathing are left without what? Why?
People unable to modify breathing are left without a key strategy for self-regulation. Breathing enables the human organism to adapt quickly to changing emotional and environmental conditions. By balancing parasympathetic and sympathetic activity, functional breathing modulates states of activity and rest needed to promote homeostasis.
According to Alan Watkins, the autonomic nervous system determines the degree of what? The neuroendocrine system determines the quality of what?
"The autonomic nervous system determines the degree of arousal. The neuroendocrine system determines the quality of our emotional experience."
The nervous will signal certain muscles to work based off what?
The nervous system will signal certain muscles to work based off their position in relation to other surrounding structures and how our bodies are orienting in space against loads and gravity. The function and role muscles have in movement are directly affected by position.
Movement patterns involve sequences of muscle activity that respond to what and are heavily influenced by what? How does this process work? How does stress affect this process?
Movement patterns involve sequences of muscle activity that respond to postural demands and challenges and are heavily influenced by cortical postural centers (visual-oculomotor and vestibular) and, to a lesser degree, spinal reflex centers.
The CNS constantly monitors the loads placed on the body through the information it receives from sensory receptors. The sensory input is perceived and interpreted by the CNS to determine which muscles to engage and which to inhibit to perform a movement efficiently with minimal deleterious effects to our joints and soft tissues. The CNS has a range of options to protect and promote function.
Under normal conditions, the higher cortical centers allow us to move with minimal attention and effort. However, under increasing stress (e.g., faulty position, too much load, or fatigue), spinal reflex centers increase in activity. The result is an increase in tone of the trunk muscles that stabilize and extend, and dyssynchronous patterns of muscle activity. Through repetition, these patterns are reinforced and become habits.
What links and controls the brachial chain and anterior interior chain?
Where is the proximal attachment of the iliacus? Where is the proximal attachment of the psoas?
The iliacus attaches at the ventral portion of the pelvis. The psoas attaches at the lumbar spine.
The sacrospinous ligament pulls the sacrum toward the ipsilateral "blank".
The sacrospinous ligament pulls the sacrum toward the ipsilateral hemipelvis.
What compensatory movement strategy to attain left stance causes the right iliolumbar ligaments to be stretched.
A Left AIC may turn the lumbar spine to the left while the pelvis stays oriented to the right. This movement may also contribute to spinal disc pathology.
What ligament blends with the hamstring?
The sacrotuberous ligament.
What effects does the quadratus lumborum have on the spine? On the pelvis? On the rib cage?
It extends, sidebends, and contralaterally rotates the spine. In rotating the spine and pelvis, it anteriorly tilts the ipsilateral hemipelvis.
It depresses the ipsilateral rib cage.
What are the two anterior hip ligaments?
The iliofemoral and pubofemoral ligaments.
What often indicates an overlengthened ipsilateral ischiofemoral ligament?
Excessive femoral internal rotation.
What is Jen Poulin's treatment strategy for people with excessive passive straight leg raises?
First, emphasize bilateral internal oblique and transverse abdominis (e.g., Swiss Ball All Fours Belly Lift). You can use standing supported exercises to mildly engage the hamstrings as a posterior pelvic rotator. Once the person is a three or greater on their lift scores, Jen uses prone hamstring activities—that's just her rule of thumb.
What happens in femur orientation? What happens in femur compensation?
In femur orientation, the femur follows the pull of its ligament, so it stays oriented with the hip. In femur compensation, the femur moves opposite the pull of its ligament.
Why might the left leg appear longer?
The left leg may appear longer if the left femur compensatorily externally rotates.
What is the first goal in gait for a Left AIC patient? What muscle do they need to engage?
The first goal for a Left AIC patient is to be able to functionally left heel strike by engaging the left hamstring. You progress through gait, beginning with left heel strike.
Where is the piriformis positioned relative to the glute max?
The piriformis lies beneath the glute max.
In a Left AIC pattern, what occurs at the left and right piriformis? What are the typical pathologies?
In a Left AIC, the left piriformis is short and strong in the transverse plane. A person may experience short FA piriformis syndrome. It's FA syndrome because the left femur is compensatorily externally rotated.
On the right side in a Left AIC, the piriformis tends to be long and weak, like the transverse fibers of the right glute max, which may be related to long AF piriformis syndrome.
Explain the lengths of the left and right obturator. What muscles correct the lengths and function of each?
The left obturator is in active insuffiency (i.e., short and weak). The right obturator is in passive insufficiency (i.e., long and weak).
The frontal plane left IC adductor and sagittal plane glute max put the left obturator internus in a neutral, mid-length position.
The transverse plane right glute max puts the right obturator internus in a neutral, mid-length position.
FA "blank" and "blank" rotation lengthen the obturatur internus.
FA adduction and internal rotation lengthen the obturator internus.
What is needed to engage at heel strike to decelerate anterior pelvic rotation and to posteriorly rotate the pelvis?
In a Left AIC pattern, what is typically the first soft tissue pathology to occur?
In a Left AIC pattern, excessive left femoral external rotation is typically the first soft tissue pathology which will occur.
What are the four phases of treatment in a Left AIC Myokinematic patient?
You reposition, retrain left stance, and finish with retraining right stance function to restore alternating reciprocal motion. You start by training the left leg in left AF IR, then the right leg in left AF IR (or right AF ER), then the left leg in right AF IR, and lastly the right leg in right AF IR. The end of the treatment process should be right stance training.
What in the Extension Drop Test indicates pathology?
Clunking or snapping at the hip in an Extension Drop Test indicates pathology.
If there's a difference between active and passive FA IR or ER of greater than seven degrees, then what should you do?
If there's a difference between active and passive FA IR or FA ER of greater than seven degrees, then you should emphasize strength and control (rather than inhibition).
How do you perform the Trunk Rotation test?
For the Trunk Rotation test, place your stabilizing hand on the lower ribs on the side contralateral to the movement of the legs. For example, if you bring the knees to the left (right trunk rotation), then place your hand on the right lower ribs. Sense the pressure of the right lower ribs when they externally rotate for right trunk rotation.
What does a zero on the Hruska Adduction Lift Test indicate? What should your treatment be?
The left obturator is in active insufficiency, so the person cannot use the left obturator internus to externally rotate further. If so, then you need to stretch and reposition the left obturator internus. It's common in patho Left AIC's, patho PEC's, and hypermobile people (e.g., clunkers).
Inability to get from a two to a three in the Hruska Adduction Lift Test may indicate poor what in the top leg? What muscles might you want to train?
Inability to get from a two to a three may indicate poor AF ER in the top leg. Train the inferior glute max, posterior glute med, and superior fibers of adductor magnus.
Level four and five in the Hruska Adduction Lift Test test what position and phase of gait?
Level four and five are left AF IR with right trunk rotation, which is late stance.
What phases of gait does the Hruska Abduction Lift Test assess?
It assesses early stance and late stance: heel strike into early stance and push off the back leg. It's similar to zero, one, and two of the Adduction Lift Test. It tests when both feet are on the ground, except for level five, which is when toe-off occurs.
A level five on the Adduction Lift Test correlates to what phase of gait?
A level five of the Adduction Lift test correlates to single-leg stance of late stance and swing phase. The person has FA IR on the stance leg with contralateral trunk rotation. It's the phase just before heel strike.
When the hemipelvis anteriorly rotates, how does its acetabulum move? How does this movement affect leg length?
When the hemi-pelvis anteriorly rotates, then the acetabulum will move superiorly and posteriorly. A non-patho Left AIC should therefore have the appearance of a shorter left leg. If the left leg appears longer, then it suggests that the left femur may be poorly seated in the acetabulum (i.e., the ball may be out of the socket anteriorly and inferiorly).
For people who experience excessive cramping in their left IC adductor and/or can't feel their anterior glute medius, you want to do what?
For people who experience excessive cramping in their left IC adductor and/or can't feel their anterior glute medius, you want to do an ipsilateral obturator stretch. It may be optimal to perform an ipsilateral posterior capsule stretch after.
You begin training alternating reciprocal activity at what level of the Hruska Adduction Lift Test?
You begin training alternating reciprocal activity (e.g., retro stairs, retro walking) at level four of HAdLT. You need to be able move optimally on both sides of the body—no compensations or faulty patterns on either side.
A right Hruska Adduction Lift Test of a one and limited left FA IR indicate you want to do what followed by what?
A Right HAdLT of a one and limited left FA IR indicate you want to do posterior capsule inhibition followed by left IC adductor engagement.
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