Review of Postural Restoration Institute Respiration Course

A few weekends ago I had the opportunity to take a Postural Restoration Institute (PRI) respiration course.  It was myself and about 7 physical therapists at the University of Michigan Pain clinic.  James Anderson was the PRI teacher.  He knew his stuff inside and out and was a great teacher, engaging and open to questions.  I had several, more on that later.

First, if your thinking on taking one, I would highly recommend it.  I study anatomy a lot and found myself learning and thinking about concepts in a new way.  As this was a respiration course the primary focus was on the diaphragm,  rib mechanics and how they influence the rest of the body.  I feel I gained great insight and better understanding to both of these anatomical concepts.  Surprisingly, none of the information about rib biomechanics are taught very well in chiropractic school.

PRI is built with the premise that the body is actually asymmetrical and that it's the sum of these asymmetrical parts working together in harmony that make us move and function well.  It's because of some of these asymmetries that we create known dysfunctional patterns that are labeled and treated in PRI.  I'm not going to get into their patterns and treatment methods, as that would take quite a lot of time, but basically the left front leg gets tight and is called an Anterior Interior Chain (AIC) which includes the diaphragm, psoas, rec femoris, TFL, vastus lateralis and biceps femoris.  Also, the right  upper arm gets tight, labeled Brachial Chain (BC) including the intercostals, deltoid, pec, Sibsons fascia, SCM, scalene and diaphragm.   Right rib hump on the back and left rib flare on the front is generally seen  (also 90% of scoliosis has this pattern)

The respiratory system is not symmetrical.  Right diaphragm is larger, thicker, has a larger central tendon, has thicker crural attachments to the lumbar spine and because of this creates a right rotated lumbar spine.  It's 1 to 1.5 vertebral levels deeper on the right and has a more dome shape on the right because it drapes over the liver.  Because of this it has better abdominal integration for opposition.  It can push better against the abs essentially.

The unique anatomy allows us to breath easier on the left and harder on the right.  So the right ribs become more locked down and the left ribs become blown out on the front.  We are a culture that is carrying dead air, we don't fully exhale.  All of this leads to dysfunctional patterns.

Some interesting anatomy.  Subclavius is the only scapular retractor on the front of the body.  When it gets tight, it can inhibit the lower trap and serratus anterior, two muscles that get inhibited a lot.  Thus, subclavius is an important muscle for respiration and shoulder function.

The diaphragm when dysfunctional actually becomes a paraspinal extensor.  If you don't use it and breath well, you will have a tight back.  Because of the described anatomy the right ribs become rotated under the scapulae.  This makes the scapula dysfunctional and will create shoulder impingement at times on the right shoulder.

One of the concepts that I have an issue with that was touched on in the seminar was the use of flexed positions in the lumbar spine to create a neutral spine.  They believe most people are locked in extension and to actually create a neutral spine, squats ect, must be done flexed.  Please reread that.  This concept attacks my paradigm.  I can understand the concept that we are both after a neutral spine.  Obviously no one is saying squat with hyper lordosis but to go the opposite and squat with a flexed spine to get to neutral, I'm not buying it yet.  I brought up McGills research and didn't really get much of a response on that, but we agreed we are after neutral.  I actually did a bunch of flexed exercises and to be honest, I had some radicular pain down my right glute and I haven't had any radicular pain in about a year and a half.  N=1 was a failure for me.  But, I don't believe I'm locked in extension.  So flexed spine for me was a flexed spine in my opinion.

The other concept that was touched on briefly was the use of an orthotic.  He pretty much came out and said if your not in a PRI orthotic all the work you are doing to solve dysfunction won't last.  Really?  I don't buy that one at all.  I'm a big believer that feet play a major role in how we move, but not that big....for everyone.  Need by need basis.  He was very down on the minimalist shoe for everyone.  I talked with a buddy doing PRI with himself and a few athletes and was told he has been doing great without the orthotic and is stronger then he has ever been.

Overall, I really enjoyed the PRI seminar. I truly believe I'm a better clinician having attended.  I'm working with diaphragms and having success with improving shoulder mechanics via the diaphragm.  They give a ton of exercises that can be used for your patients as homework.  I plan on attending more of their seminars in the future, so you can say I like their stuff.