I am a current doctor of physical therapy (DPT) student at Duke University with a tremendous interest in PRI, and more specifically, incorporating PRI concepts into powerlifting. I currently work as both a client and assistant coach. He’s had me look at a few of his athletes, and I have a history of L AIC/R BC patterning as well. I’m curious if you’re able to keep your clients neutral before and after lifts, or to what degree you’ve been able to successfully incorporate PRI. I’m just starting to dig into this a little bit more… I know that conceptually, merging these two ideas is tough to do and I was encouraged when I saw someone doing it.
I’d love to hear a little bit more about how you’ve managed to make this work, and how you’ve explained this particular approach with your clients.
Again, I’m encouraged to see others pursuing these avenues simultaneously. Thanks for your time, hope to hear back from you soon.
When this question came through our inbox at CP Eric asked if I wanted to tackle an answer. I am by no means an expert of PRI (Postural Restoration Institute) concepts, but I would consider myself better versed than most. Mainly because of the opportunities I have had to attend two of their courses, a well enough job at keeping up to date with what I’ve learned, and more than anything – the good fortune I have had to discuss this approach with people far more intelligent than myself.
Lastly, I am emerged in an atmosphere in which we carry out PRI principles within our programming on a day-to-day basis.
As many of you who have attended a PRI course know, once you take their approach into account you start looking at everyone just a little differently. I am no exception to this, and not a day goes by that I don’t watch people stand, walk, and lift, with just a little more detail.
So what is this PRI stuff?!
Here it is right from the source: click me
In a nutshell, the theory bases itself of the idea that it’s perfectly normal to be, well, not normal. Or to say, the human body is not symmetrical, and the inherent asymmetries of our anatomy lend themselves to some pretty predictable patterns.
To highlight some of these patterns from the article linked above:
– Dominant overuse of one side of the body.
– Differentiating sizes of our two diaphragms. Left being smaller than the right.
– Advantageous usage of the right diaphragm due to the liver placement on that side, and it’s role as a structural supporter of the larger right diaphragm leaflet.
– Difficulty in keeping the right chest wall open during breathing due to the lack of a heart muscle on that side of the chest.
– Asymmetry of the pelvis, due to the tendency to stand mainly on the right side. This essentially moves the pelvis forward on the left and the shoulder girdle down on the right.
Moving forward, the folks at PRI view the body as a collective inter-working of muscular “chains,” or polyarticular chains to be exact.
Polyarticular chains are defined as: “A muscular chain is a set of polyarticular muscles that follow each other and overlap in the same direction with no break in continuity.” – Francis Mezieres (Adapted from Postural Respiration – An Integrated Approach to Treatment of Patterned Thoraco-Abdominal Pathomechanics)
The Brachial Chain’s (BC) most influenced soft tissues are the:
– Anterior-Lateral Intercostals
– Deltoid-Pectoral Muscle
– Sibson’s Fascia
– Triangulraris Sterni
Here is a look at both an optimal and sub-optimal BC positioning.
The Anterior Interior Chain’s (AIC) most influenced soft tissues are:
– Biceps Femoris
Here is a look at both an optimal and sub-optimal AIC positioning:
Due to the aforementioned asymmetries we all possess there are a few classification for the re-organizing of these chains.
There is both a Left BC, and Right BC as well as a Left AIC and Right AIC. When the muscles on either side of the BC or AIC more greatly influence our positioning we are categorized as either or Left or Right BC/AIC.
In the picture above you will see me standing in such a way that I have influenced both my brachial chains (BC), and Anterior Interior Chains (AIC).
This pattern is the most commonly seen result of our asymmetries when left unattended. This is referred to as a Right BC, Left AIC pattern, as mentioned in the original inquiry.
A Right BC is characterized by:
– Limitation in Right Humeral-Glenoid Internal Rotation
– Limitation in Left Humeral-Glenoid Horizontal Abduction
– Limitation in Left Humeral-Glenoid Flexion
A Right BC may have full ranges of motion in these tests, which is a red flag for various pathologies, instability, and hyper mobility)
Furthermore someone presenting as a Right BC will likely have:
– limited right chest wall flexibility, and inability to inflate the right chest wall when breathing (right lung expansion).
– limited function of their left diaphragm due to map-positioning
– an increased demand on their right diaphragm for respiration and left diaphragm for postural/structural stabilization (both compensatory).
– limited flexion of the thorax
A Left AIC is definitely more involved.
A big thing to consider when looking at a Left AIC is the positional and compensatory changes of both the pelvis itself and how the femur sits within the acetabulum. Basically, you will have changes which cause the acetabulum to move on the femur, and changes that cause the femur to move on the acetabulum.
A Left AIC is characterized by:
– The left acetabulum rotating forward on the left femur. Think anterior tilt.
– The right acetabulum rotating backwards on the right femur. Think posterior tilt.
– The left femur external rotated and abducted on the left acetabulum.
– The right femur internally rotated and adducted on the right acetabulum.
– Decreased left femur on acetabulum internal rotation on left side when compared to right side.
– Decreased right femur on acetabulum external rotation on right side when compared to left side.
– Limited right trunk rotation.
– An inability to adduct the left femur on the acetabulum. (possibly due to the positioning of the anteriorly rotated left acetabulum).
– An inability to extend left femur to neutral.
A Left AIC may have full ranges of motion in these tests, which is a red flag for various pathologies, instability, and hyper mobility)
So that was a lot…
I just wanted to give you some background so you can imagine what is at play in almost everyone’s body. Pretty crazy right. Needless to say, it’s not the pretty picture our A&P textbook drew it out to be.
So let’s refocus and discuss what’s going on – big picture and with one added piece to bring it all together.
Our body is asymmetrical, and because of that we are biased towards this off set patterning. But what got us there, and what’s the issue?
First, what got us there is mainly the function of our bodies need to keep a balance. Obviously not of our soft tissue structures, but of our vital systems and wiring. Our body is always striving to keep a status quo: blood pressure levels, heart rate, etc. It does that so it can help us in our single most important task. Staying alive.
In order to do that, we need to breathe first and foremost. The caveat is that because of the asymmetries in our BC’s and AIC’s we breathe ourselves further and further into these compensatory patterns. Why?
Look back, and we just discussed it. The differences in our diaphragmatic capabilities is one that we are more prone to dominantly using the right side to fill the lung on the left side. This will reorient our spines, which will reorient our head, which when we walk will reorient our hips as well. If we didn’t form these compensations, we wouldn’t be able to do a lot of what we do.
The issue is one of over use.
That is when these patterns start to cause pain and dysfunction. The bottom line is that I’m not sure we can ever be fully “neutral” and it seems we would be robbing ourselves of a lot of experiences if we didn’t allow our self to compensate to some degree.
To that end. PRI concepts can be best used as a source of management.
We can use their brilliant grasp of functional anatomy, and applied techniques to better position our structures so as to avoid unhealthy wear and tear in any prone areas.
So how do we incorporate these techniques in a performance based setting?
We get into better positions first, and then we train in them.
That’s done by incorporating PRI drills into our warm up first and foremost. Namely, a few positional breathing drills to reset the pelvis and rib cage, a few drills to promote getting into our left hip (adduction and internal rotation of the left femur), and some activation of the left ab wall and left trunk rotators.
It’s also done by influencing the exercises you already use to be a little biased, and cueing people better.
http://www.youtube.com/watch?v=NsBNk-Ls9MQ – Proper lunge technique
http://www.youtube.com/watch?v=-vLtWsTQzJk – Breathing in your cable chops
http://www.youtube.com/watch?v=tq0NeWr9y-E – Better Rip Positioning
Lastly, it’s about educating your athletes on how to change their parafunctional habits. READ ME
So we’re 1500 words in and you haven’t mentioned power lifting again.
For the most part we’re going to attack them the same way. Get to neutral, train in neutral.
In my eyes, most power lifters fall into a completely different chain, slightly different than what we have discussed. They are likely PEC’s or Posterior Exterior Chain types.
In short, they show the limitations of the Left AIC, Right BC types on both sides.
In working PRI concepts into their training I am going to focus on:
– Getting them out of extension first and foremost. Both in the gym and outside of it, have them do more positional breathing drills that promote dropping of the rib cage, and some flexion of the thoracic spine. This will get the abdominals working in respiration again and the anterior core firing. It will also help shut down the paraspinals and lats.
– Once we get them out of so much extension I would treat them like a typical Right BC and Left AIC as far as exercise choices.
– So as to not take away from time training I would promote more breathing at home, and just a few things in their warm up to get into better positions.
– Additionally, I would teach them how to not compensate in their lifting by positioning themselves better. I always start here:
– Stress the idea of management. It’s not feasible to get them to pass every PRI screen and still make progress in training at the same time. A little every day goes a long way.
For more from PRI visit their site: www.posturalrestoration.com