Jason's Blog

  • Right hip pain is a very common complaint and can be very debilitating preventing you from walking and enjoying the things you love to do. There are lots of things that could be irritated with right hip pain. There are also lots of things that could be causing your right hip to hurt, and it may not be your right hip's fault. Read this blog from Jason as he describes what is going on with right hip pain and why you may actually need to look at the left side of your body to actually treat it.

  • Read about Jason's upcoming talk at this years NATA Convention

  • As Jason prepares for another talk he will be giving soon he is revisiting some basics on pelvis and rib-cage position. As he prepares, this blog came back to mind for him so we'e like to repost it for you to revisit as well. If you'd like a pdf version of this article let us know.

  • Earlier this year Jason presented at the National Strength and Conditioning Association (NSCA) Coaches Conference. The presentation is now available online.

  • Jason discusses how the hip is often the overlooked source of knee pain.

  • Straight out of the Hruska Clinic(TM), Jason Masek's third article will be published in the Co-Kinetic (formerly known as SportEX) April 2016 issue, as well as online at https://co-kinetic.com/#_l_5w. Here is a preview!!

  • Yusuke Namba spent some time in the Hruska Clinic over the last several months and discusses his experience while at the clinic.

  • Jason demonstrates how activating a left ischiocondylar adductor and left abdominal wall eliminates right rib and intercostal wall pain. Check out his latest video blog.

  • Washington Mystics' Head Athletic Trainer Visits the Hruska Clinic

    You’re going to Nebraska again? What’s in Nebraska? These are the questions I was asked by my players, friends and family. Yes, I was visiting Lincoln, Nebraska for the third time in four months. After taking all three home study courses and five different live seminars from PRI, I was still missing something. I was not connecting the dots between what I had learned and what I needed to do, so I decided to spend a week at the Hruska Clinic to observe the treatment approach put into practice. The trip was exactly what I was looking for; it was amazing!

    Going to the Hruska Clinic every day and seeing Ron, Lori, Torin, Dave and Jason actually treating and evaluating patients was fascinating. Observing them, and experiencing the PRI clinic staff go out of their way to explain what they were doing and why they chose specific treatments and exercies, was exactly what I needed. I had my “Ah-Ha!” moment when all the training clicked, and I became comfortable and confident with what I had learned. I finally knew what I need to do in PRI evaluations and treatments. The trip was invaluable for clarifying my studies and moving me from simply knowing to actually understanding.

    My co-workers may say that I am drinking the PRI Kool-Aid, but after traveling the world and learning from the best osteopaths, chiro-practitioners and physical therapists, I am a firm believer that PRI should be the first technique used in treatment—similar to building a good foundation for a house. It is clear to me that without achieving neutrality, our subsequent treatments won’t be successful. I am so happy that I chose to take the final step of observing at the clinic.

    Navin Hettiarachchi

    Head Athletic Trainer
    Head Strength and Conditioning Coach
    Washington Mystics

  • Caitlin Daubman discusses her fifth week at the Hruska Clinic

    Week 5: “Life is Short , smile while you still have teeth.”

    This week was filled with patients visiting the Hruska Clinic from all over the United States. They traveled from as far as Massachusetts, Virginia, and Louisiana to stay the week in Lincoln in hopes of finding a solution to their complex health history and primary limitations due to pain. These patients were referred to us by the PT’s or ATC’s in their area for a second opinion or assistance with progressing their current program. Jason Masek’s experience in assessing and treating patients with cranial asymmetries as well as temporal-mandibular dysfunction was helpful for all of these patients. Each of these patients had a different primary complaint (hip pain, shin pain, headache, foot pain); and each of the patients had been through many different treatment approaches (injections, chiropractic, orthodontia, acupuncture, pharmaceuticals, or instructions to simply rest). However, none of these patients found lasting resolution of the pain.

    Jason evaluated them and none of them were neutral. Repositioning exercises were completed and patients were still not neutral. Footwear was corrected and reevaluation showed the same L AIC or PEC patterns. Therefore, something else was holding them out of neutral and locking them into their pattern. Another interesting piece of information was that these patients either were presently in braces or had just finished orthodontia repositioning their bite. Jason discovered that the issues for these patients was stemming from their bite. These patients had limited or suboptimal occlusion between maxillary and mandibular teeth due to cranial torsions or an elevated palate. Jason took them out of their bite through the use of an oral splint, and reevaluation showed the patient finally achieved neutrality! It was amazing that simply removing the patient’s normal reference centers (their bite), the patient easily transitioned to neutral.

    Treatment options for these patients included using oral splints during exercises to achieve neutrality and work the excessively weak and underutilized musculature that had been neglected for so long while being in L AIC or PEC patterns. The progress at the pelvis would be limited by the permanence of their TMJ/cranial positioning. Communication between physical therapist and orthodontist began and allowed for integration of a new plan of care for the patient. Treatment options included braces being removed or wires snipped temporarily, oral splints designed, and ALF’s were applied for palatal expansion in patients with symptomatic cranial torsions.

    To some, this may seem like very intense or excessive measures to take for a future treatment plan. However, these patients have been through it all and the next step suggested to them by their healthcare professions have been more invasive or permanent treatments (nerve blocks, piriformis release, jaw surgery, teeth extraction, plantar fascia release). Conservative care is an investment, and one that pays off in the patient’s future to achieve a successful outcome utilizing and optimizing your body’s natural anatomy and function.

  • Caitlin Daubman discusses her fourth week at the Hruska Clinic

    Week 4: “Never put off till tomorrow what you can do today.”

    This well-known phrase can be dangerous as many people have internalized it as a way of life.

    Like many of you, I know all too well the guilty feeling that accompanies being idle. However, I will aim to highlight the effects on our body when we operate like this, and methods to change it. We all have numerous stressors that bear heavy loads on us day to day. In order to deal with these, we feel compelled to keep up with the race. We operate in over-drive. There is a familiar feeling of fatigue- waking up from restless nights where sleep is interrupted by one’s own snoring, or jolting awake from halted breath, jaws sore from clenching, with panting breath and heart racing. You may be one of the many whose body demands a cup of coffee to get you through the morning hours before the ‘afternoon yawns’ set in. All throughout the day, your heels don’t touch the ground and you likely aren’t aware if you are even breathing - if you are, you can’t feel it.If you cannot identify with these as a reflection of your life, then thankfully YOU are doing something right! YOU are the person that the majority of society would like to resemble. As a PRC or PRT, you have probably heard these complaints from your patients/clients.

    Last week I had the opportunity to sit in with Jason Masek and Ron Hruska as they saw some interesting patients. These patients were young females which Ron and Jason discovered to be orthostatic insufficient or dysautonomic. They presented with chief complaints of distal extremity pain but also mentioned headaches, dizziness, and fatigue. Their gait cycles were fast short strides lacking heel strike and trunk rotation. In essence these women felt and moved as if they were weightless. These women- like many other future patients out there- are operating in over-drive. Their ribs are elevated, they are over-inflated, and their ANS has adjusted to match this over-active system. Ron and Jason helped them find the ground using purposeful movements powering forward by pushing with the LE’s, and they taught them how to breathe. After the PRI exercise interventions to embrace gravity and use the diaphragm with chest expansion to breathe, the patients were neutral and reported feeling better overall and feeling grounded.

    The Interdisciplinary Integration PRI © conference last week taught me a lot about this common issue in a growing patient population, and the methods to treat it. Using PRI techniques, we can play an important role in the management of symptoms that accompany orthostatic insufficiency and dysautonomia through: embracing gravity, exhalation, chest expansion, and the strength of the legs to power us on the journey!

  • Caitlin Daubman discusses her third week at the Hruska Clinic

    Week 3: Versatility

    The knowledge I have gained from the PRI Myokinematic Restoration course has been integrated to a deeper level this week. I have seen the therapists at Hruska Clinic prescribe PRI exercises to patients that are progressing to a high level and have greater ability to function with neutrality. A patient training for a marathon is able to run 8-9 miles before proximal hamstring pain sets in and then soreness persists afterward. Upon examination and testing, the patient was neutral and had sufficient hamstring and adduction strength. In my reasoning, the patient was neutral, had “hole control”, and was strong in most of the important areas. What could be the issue resulting in her pain onset only after so many miles?

    The PT noticed that the area contributing to the patient’s problem was the glutes. We learn in Myokinematics about the important role of the external rotation fibers of the Right gluteus maximus and the extension fibers of the Left gluteus maximus, while also the Gluteus minimus and medius for stabilizing the left. The right glute max needs to be a stronger pusher to allow facilitate transitioning of the body over to the left stance during gait, in doing so, it acts to rotate the sacrum toward the left during right stance/push-off. The left glute max needs to act as hip extensor to propel the body forward rather than a heavy reliance on the left hamstring muscle group.

    For treatment, it was really interesting seeing the Retro Stair activity to work BOTH areas! The versatility and benefits of this exercise to the whole body make it one of my favorites: increase left AFIR, stretch left posterior capsule, facilitate combination of Left adduction with gluteal activation, inhibiting the back extensors and hip flexors; allow transitioning from left to/from right and strengthening the right to be a ‘pushing’ side.
    1. Left stair ascent: Shift into the left hip and focus on stability by lifting the right leg and holding the position before pushing up.
    a. Working Left Glute Max Extension fibers, Left Glute Med and Min
    2. Right stair ascent: Shift into the right hip and focus on strength by pushing into right AFER and left AFIR placing left foot on to the next step.
    a. Working Right Glute Max ER fibers

    Caitlin Hoag

  • Caitlin Daubman discusses her second week at the Hruska Clinic

    Week 2 :
    “If you don’t know it by now, you don’t know it.” - A phrase commonly delivered by those who are beyond the hurdles of graduate school, and also a phrase that I internalize so to promote my procrastination of studying. Rounding out my last year of PT school, the PT Boards are quickly approaching and I am knee deep in the most interesting clinical rotation here at Hruska Clinic. I have a genuine interest and motivation to learn PRI material and I am receiving many opportunities to do so every day. Simultaneously, I’m preparing and studying for the PT Boards from the knowledge base that has been built over three years. There are several points I noticed this week that are congruent between PRI and Board prep material, and some areas that diverge.

    Here are examples of each:
    1. Comparable: Pumps within the body that return blood back to the heart

    a. PRI: I observed Ron Hruska treating a patient with dysautonomia, specifically diagnosed with POTs. I learned along with the patient
    while he educated us on the areas of the body on which this patient needed to focus. Treatment methods for patients with dysautonomia and/or POTS are centered in:

    - Finding and embracing gravity
    - Strengthening the LE muscles to act as a pump for the body below the iliac crest
    - Utilizing the diaphragm as a pump above the iliac crest.

    b. Boards: I read these three points as they pertain to Venous circulation in the Cardiopulmonary section I studied that night. We know that these are the methods the body uses to return blood to the heart. However, I had been unaware of how to integrate this material into an examination and treatment plan for this patient population as Ron demonstrated.

    2. Contrasting: Hip mechanics and range of motion testing

    a. PRI: limited supine SLR unilaterally indicates an anteriorly tilted innominate. Hamstrings are elongated due to pelvis position pulling the attachment sites further apart; therefore it limits the available motion into hip flexion.

    b. Boards: limited supine SLR unilaterally indicates a posteriorly tilted innominate. Hamstrings are short, strong, and tight, pulling the attachment sites closer together and limiting the available motion into hip flexion.

    There are always opportunities for new learning, re-learning, or understanding concepts at a deeper level. What are some concepts/areas that you find particularly interesting and/or challenging between conventional PT and PRI?

    Caitlin Daubman

    DPT ’14, MHA ‘14

  • Hruska Clinic physical therapist Lori Thomsen discusses a recent article in April’s issue of Running Times, titled “It’s all in the Hips.”

  • Caitlin Daubman Discusses her first Week at the Hruska Clinic

    Week 1:

    I have completed my first of eight weeks as an intern at Hruska Clinic. This is my last internship before graduating with my DPT in May. It feels like I have come ‘full-circle’ as they say. After seven years, I am back in my home town learning from the very people that inspired me to pursue the profession of physical therapy. The only things I knew about PRI was what I experienced first-hand as a patient roughly 10 years ago. As a freshman in high school, I became determined to be a physical therapist so that I could treat and help others the way Ron and the professionals at Hruska Clinic helped me. I wanted to practice truly individualized treatment plans, instead of the traditional therapy practice which is dominated by symptom management and protocols.

    Day one at the clinic, Jason asked me what I knew about PRI. To say I knew ‘a little’ about PRI was an understatement. I understood the exercises I had been prescribed over the years and their purpose. However, to examine, evaluate, assess and plan a treatment from the perspective of the therapist was far beyond my understanding. My brain operates conventionally with the material that has been ingrained in my mind from three years of a rigorous PT curriculum. Presently, the Left AIC and PEC patterns are no longer foreign terminology to me as I am reading about them in Myokinematics and observing them in our patients daily. I understand the asymmetries and exercises that are given to the patients due to continued explanations from Jason and the other clinicians here. Right now, I am a sponge. My wheels are constantly spinning, critically thinking, mentally processing, and comparing what I knew to what I am seeing and learning here. I have a great deal more to learn and I am enjoying every opportunity to do so.

    It is an unbelievable experience. Working with all of the clinicians and their patients has allowed me to see a great variety. I will continue to grow in my understanding and hopefully become more competent with PRI throughout the course of this internship.

    Caitlin Daubman, SPT’14 MHA’14

  • Jason Masek provides great articles supporting Postural Restoration® Acetabular Femoral Movement

    I am currently putting together a manuscript on femoroacetabular impingement and recently came across these most recent published articles discussing how the orientation of the pelvis influences the acetabulum. Both of these articles provide the Postural Restoration® educated clinician with a valuable reference describing the relationship between pelvic tilt, acetabular orientation and its effect on femoral head coverage. I would encourage all individuals familiar with Postural Restoration® to take a very close look at these phenomenal written articles! I have provided excerpts of each article to entice those of you that are interested in reading the full article.

    The Cibulka article provides evidence to support Acetabular Femoral Internal Rotation (AFIR) and Acetabular Femoral External Rotation (AFER) concepts as it relates to Postural Restoration®. This article suggests that as one innominate bone moves backward the other moves forward. More specifically, a backward rotation of the left innominate would produce more acetabular femoral coverage of the left femoral head and a forward rotation of the right innominate would produce less femoral head coverage. Therefore, when the left innominate moves backwards it would place the femoral head in a relative internally orientated position (Acetabulum moving on a femur i.e. L AFIR) and a right innominate moving forward placing the right femoral head in a relative externally orientated position (Acetabulum moving on a femur i.e. R AFER).

    The influence of pelvic tilt on acetabular orientation and cover: a three-dimensional computerised tomography analysis.

    Dandachli W, Ul Islam S, Richards R, et al.

    Hip International. 2013 Jan-Feb; 23(1) :87-92.

    “Pelvic tilt in the sagittal plane influences apparent acetabular inclination, version and cover of the femoral head in the acetabulum.”

    “As the pelvis tilts forward, so the relative amounts of cover of the femoral head by the acetabulum change.”

    “Recognizing a pelvis that is significantly titled and not aligned in the anterior pelvic plane is important, and we have attempted to show how this would influence various parameters in terms of the relationship between the acetabulum and the femoral head.”

    Sacroiliac joint dysfunction as a reason for the development of acetabular retroversion: a new theory

    Cibulka MT

    Physiotherapy Theory Practice. 2013 Dec; 1-5

    “Changes in acetabular orientation can occur with alterations in pelvic tilt (anterior/posterior), and pelvic rotation (left/right).”

    “A unique feature that develops in patients with sacroiliac joint dysfunction (SIJD) is asymmetry between the left and right innominate bones that can alter pelvic tilt and rotation.”

    “an outward or backward rotation of the innominate bone would likely produce a more posterior and lateral orientation of the acetabulum; while an inward rotation of forward rotation of the innominate bone would likely produce an anterior and medial orientation of the acetabula.”

    “Rotation of the pelvis to the left mimics posterior or backward rotation of the left innominate bone and a relative anterior or forward rotation of the right innominate bone. Rotation of the pelvis to the left would also orient the left acetabulum in a more posterior direction (Levangie and Norkin, 2005) or retroverted direction.”

  • This article describes the various relationships that dental structures have in relation to whole body mechanics. Take a look at this article!!!

  • Sports Physiotherapist from England visits Nebraska and the Hruska Clinic

    Martin Higgins graduated in 2000 from Leeds metropolitan university. Martin works in private practice for Pro Sport Physiotherapy and has a specialist interest in low back pain and pelvic instability. He has worked in professional rugby for the last 14 years and currently is the Head of Physiotherapy at Leeds Rugby. Since 2011 he has also been the lead physiotherapist for Duffy Golf Fitness - a leading golf performance company working with European Tour golfers.

    Martin has been studying PRI via online study and wanted to visit the clinic to see PRI in practice first hand.
    ” My current clinical role involves working in professional rugby and golf. I am very fortunate to work alongside Kevin Duffy at Duffy Golf Fitness. He is one of the most innovative strength and conditioners working on the European Tour. In my private practice a high percentage of my case load is treating patients with chronic low back pain.

    At the PRI clinic Martin spent time with Jason Masek and also spent a morning with Ron and Heidi at the PRI vision clinic.

    ” It was an absolute privilege to spend time in one of the leading physiotherapy clinics in the world. The work that Ron and his team are doing is outstanding and it was a fantastic learning experience for me. It was great to work with Jason Masek, he does a great job of keeping a very complex science as simple as he can for his patients. One of the biggest things that I will take back to England with me after watching Jason in clinical practice is to try and keep things as simple as you can. Go for the basics of left AFIR, right apical expansion, gait and try to integrate PRI into standing activities as soon as possible.

    During the week, there was such a varied caseload and Jason treated patients of all ages.
    It was great to see the science of PRI in practice and with different patients at different stages of their rehabilitation.

    “When I graduated in 2000 I would never have thought that my career would take me to the American midwest! I had an amazing week with everyone at the clinic. I am not sure that the people of Lincoln know just what amazing therapists they have on their doorstep. For me, PRI has the most innovative and forward thinking physiotherapists in the United States if not the world. I am really looking forward to putting some of the clinical gems I learned during my time in Lincoln into my practice”

    Many Thanks again to Jason, Ron, Dave and all the team for making my week so memorable and I hope to be across again soon for more learning!

  • Joe Cicinelli provides his interpretation of the PRI squat and it’s relevance to strength training.

    Implementing the PRI Squat in Strength Training
    When the PRI squat and barbell back squat are understood and integrated, this squat duo can be a powerful tool to regulate the autonomic nervous system for improved governance of adaptation. Both squats adaptive intentions are equally important in developing a healthy and resilient body.
    The PRI squat is a biomechanical position to consequently yield an autonomic response. Global extensor tone is inhibited as the pelvic floor sinks underneath a posterior tilted pelvis to effectively achieve a zone of apposition. This squat position places the diaphragm at postural ease as respiratory expansion is carried out in the posterior mediastinum. In humans, this squat position most likely extends as far back as the very beginning of transition into bipeds and possibly earlier. The PRI squat is the fundamental human position of defecation and rest.

    The back squat has been around since the birth of the barbell. It is the foundation of most strength training programs and possesses great ability to build maximum strength and, when programmed appropriately, any other desired change in energy metabolism. During the descent of a back squat, the pelvic floor remains in neutral relation to the lumbar spine as the weight is distributed through both calcaneal bones and across both arches. The spine is effectively locked within a neutral zone (neither flexion nor extension) to preserve the position of the central tendon of the diaphragm and optimal stabilization of proximal musculature. Maximal squat depth is realized when further descent creates accessory spine movement compromising force transfer through the kinetic chain. When loaded, this marked loss of “super-stiffness” has the potential for increased injury risk. Compromising a neutral zone can increase the stress applied to the ANS telling the brain to increase fatigue, thus reducing performance.

    When applying the PRI squat and back squat to the same exercise program, intentions of adaptation must be made clear to the athlete/patient. The PRI squat plays the role of the parasympathetic “off switch” and becomes a post-exercise appraisal of barbell technique. The back squat plays the role of the sympathetic “on switch” and serves the purpose of creating a hormone response and training the rate and capacity of energy production within the desired alactic, lactic, and aerobic systems. A primary goal of the back squat is force production! Even back squatting in a neutral zone can drive an athlete further away from neutrality because of the sympathetic state of the ANS. The big question becomes, “Can the athlete shut this sympathetic extensor tone off?”
    If an athlete presents with a 5/5 PRI squat and subsequently loses this ability after a set of back squatting, barbell technique may have to be addressed. If this same athlete continues to have difficulty with a full PRI squat, the athlete’s “off switch” is compromised. There is a depression in vagal tone potentially leading to an increased resting heart rate and blood pressure, along with suppression of anabolic hormones and the immune system. Continuing to back squat them may add more fuel to the sympathetic fire. Not being able to PRI squat can reduce the athlete’s adaptive reserves. Strength is signaled under the sympathetic umbrella and built under the parasympathetic. Post-training PRI squats can prime the PNS to jump start the powerful recovery capacity of the aerobic system.
    When applying these two squat techniques in exercise prescription, care must be taken to assess the individual’s baseline fitness level. Perception and exertion are unique to each person’s ANS. A PRI squat could impart a strong sympathetic stimulus to a de-conditioned athlete or serve as a prerequisite to a pistol squat. To a neutral athlete that back squats 500lbs, a PRI squat is rest. In athletics and the general population, the importance of developing force production and the capacity and rate of energy production are desirable adaptations to cope with the stressors of life. If a neutral person that can squat 300lbs moves a 30lb end table, the amount of stress on the physiological system is low. If a neutral person with limited strength development moves this same end table, this may be a relatively high stressor. The larger the physiological buffer zone, the further the person’s ANS is from sympathetic overdrive and loss of neutrality. If neutrality is a position of rest, it can be further maintained through greater amounts of stress because of the trained elevation in stress threshold.
    It would be irresponsible to allow athletes to step on the field or court against an opponent that has substantial advantage in the development of capacity and rate of energy and force production. Just as it would be irresponsible for these same athletes to walk off the field or court without being given the opportunity of neutrality. Both the back squat and PRI squat serve as powerful autonomic regulators for the same purpose of health and resiliency. Athletes/patients need guidance from educated coaches and health practitioners to pursue peak performance and the highest quality of life.

  • Joe Cicinelli’s First Week at the Hruska Clinic!

    My name is Joe Cicinelli and I am starting my second year in the DPT program at Washington University in St. Louis. I am fortunate to have the opportunity to spend time at the Hruska Clinic during my summer “break.” I would like to take the time to briefly recap my first week with all the great PRI therapists and potentially provide you with information that does not circulate within the pages of all the PRI course manuals. One big takeaway after my first week at the Hruska Clinic is patient perception is underappreciated and underutilized in the clinic. Ron’s communication with patients is not only to recap their past medical history, but to actually evaluate the patient’s perception of their own body. “Do you trust your ankles? How do you feel about your back?” He is interested in their neuroception! (For all you Polyvagal enthusiasts out there!)

    Freshmen college volleyball players were assessed to reduce the risk of a future injury. Most injury-riddled athletes out there would be envious of the amount of information these girls received about their bodies. Unfortunately, many overhead athletes know a R BC pattern by an older medical term—SLAP tear! Ron did a terrific job giving and taking away neutrality with the girls to show them the power of PRI exercises on their entire body’s postural orientation.Try convincing a teenager that feeling the ground with their left foot matters when coming out of a deep squat. It’s a little easier when they gain 35 degrees of R HG IR after 2 reps! I continue to be fascinated by the mindboggling speed the CNS can recognize and alter systemic postural positioning. Continuing to highlight communication, the unique tie that I see between all the PRI therapists at the Hruska Clinic is that they are skilled at creating analogies for all PRI jargon out there. Patient education=patient results. All therapists do an outstanding job of letting the patient know that their lack of awareness of their body position is NOT their fault. It is a PRI therapist’s responsibility to help patients rekindle their relationship with left stance.

    Although not a shocker to most PRI therapists, the cranium and feet can rule the entire body! Orthotics can drop arms into HG IR and flat plane splints can adduct hips. Lori Thomsen seems to be the Queen of PRI Approved shoes! Don’t let something as simple as poor footwear or oral appliance hold you back. An IC adductor can only do so much with pes planus. PRI Vision is the most powerful experience I have ever witnessed to achieve neutrality. The PEC patient I observed “melted” into AF IR on the right hip followed by the left. All she did was walk down the hall with glasses! I observed this patient go from PEC/B BC to L AIC to neutral in sequential fashion. The patient’s R TMCC pattern was the last to resolve. Dr. Heidi Wise made one lens modification and it flipped the R TMCC switch off.

    The integrative model that PRI exemplifies has surpassed my expectations for what is possible in the conservative management of patients.

  • How is Breathing Similar to an Accordion? Read Jason’s Latest Blog to Find Out!

    Over a year ago I wrote a blog called “let’s get squared away”. This blog discussed the positional influence the pelvis and the rib cage had on the breathing process. I would like to expand upon the breathing process as it relates to air pressure and energy expenditure.

    The muscles we use to breathe change the space and pressure inside your body to accommodate your breathing. Air likes balance, air will rush out of areas of higher pressure into areas of lower pressure in an effort to achieve balance. This is referred to as Boyle’s law. Boyle’s law is an experimental gas law which describes how the pressure of a gas tends to decrease as the volume of a gas increases. What this means is that as the pressure increases, the volume will decrease; or as the pressure decreases, the volume will increase. We see Boyle’s law in action when we breathe. During inhalation the volume of the chest is increased and as a consequence the pressure in the lungs falls and air is drawn in. Conversely when we exhale the volume of the chest is reduced; the pressure in the lungs increases and air is forced out.

    From a mechanical standpoint when you breathe in your diaphragm contracts and is pulled downward, it is making room for the lungs to expand. Outside your body, the air pressure is greater and air is drawn in when you inhale. Thus, the diaphragm lowers the internal air pressure and increases the volume of air in the chest cavity allowing you to expand your lungs. When your diaphragm relaxes, it moves up, the rib cage contracts, the lungs collapse, the cavity inside your body gets smaller the air is pushed up and out your body when you exhale.

    When an accordion is pulled apart, it creates a large space and/or volume within it. Air rushes in from the outside of the accordion into the accordion making a sound. In the reverse manner when the accordion is closed and/or pushed back together it creates a lot less space and more air pressure. The pressure within the accordion increase and thus air is forced out and again making sound. The flow of air in and out of the accordion is similar to the process of breathing. We expand our chest and lungs as we inhale causing air to flow into our lungs to equalize the pressure. When we exhale the volume of air within the chest decreases and the air pressure increases and air is forced out. In order to play the accordion most efficiently, it makes logical sense that the accordion be pulled apart fully and closed fully to allow the most amount of notes to be played in one cycle of movement (open/close). Granted, at different ranges of this movement cycle the pitch of notes will vary depending upon the pressure exerted on the accordion. For example the more you pull the accordion apart the lower the pitch, likewise the more you close the accordion the higher the pitch. If you were to play an accordion in a more closed position, it would require one to make more cyclic movements to allow the notes to be produced against an increased pressure. This would most likely cause your arms to get quite tired very quickly. Whereas if you were to play the accordion from a fully pulled apart to a fully closed state you will be able to produce more notes against a lower amount of pressure and not allow your arms to get as tired.

    In regards to breathing the same principle applies. If you fully inhale and exhale, you will be the most efficient. Breathing efficiency depends upon the muscles used and the position in which these muscles are placed. When we talk about breathing muscles we refer to primary and accessory muscles. The diaphragm and internal intercostals are considered the primary muscles of inspiration. The accessory muscles are those of the upper chest and neck that assist in elevating the rib cage to expand the rib cage and allow more air into the chest cavity. The diaphragm is responsible for 70% of the work during quiet breathing; the remaining 30% is carried out by neck and chest muscles that are attached to the ribcage. Using accessory muscles leads to chronic over-breathing. It acts very similar to the accordion, if you to breathe from your neck and chest muscles you are only breathing within a certain range against an increased pressure causing the muscles of the neck and chest to become overworked and ultimately very tired. Whereas if you were to breath in fully and breathe out fully you will be most efficient. Therefore an opened accordion represents optimal efficient breathing. A closed accordion represents dysfunctional breathing and energy expenditure.

    Unfortunately, sometimes we have no choice but to be a dysfunctional breather do to the position we are placed. Remember that the position of your pelvis will affect the position of your spine and rib cage. The combination of an elevated chest (rib cage) and an anteriorly tilted pelvis is a common posture that severely compromises the capability to attain proper stabilization of the pelvis and ribcage. As a result of this position, normal pelvis, rib cage, and diaphragm biomechanics are disrupted, and subsequently, the entire function of the diaphragm is altered. The back muscles use this fixed point as an opportunity to contract and further arch the spine. This fixed position of an elevated rib cage and forward tilt of the pelvis results in increased lower back tension as well as increased activity of the upper accessory respiratory muscles of the neck in attempt to get more air into the lungs. Furthermore, this prevents the diaphragms ability to return to a relaxed resting position during the exhalation phase of breathing.

    Difficulty breathing usually originates from restricted movements of breathing and usually from incomplete exhalation. Individuals who exhale incompletely as a result of ribcage and pelvic position habitually have an expanded chest, high shoulders, and a shortened neck. The expanded chest results from the rib cage being in a state of inhalation due to the pelvis being forwardly tilted and the rib cage being elevated.

    Playing the accordion and the breathing process are both similar in fashion. The position in which you play the accordion ultimately determines the amount of energy expended throughout your arms. Likewise, the position of your pelvis and rib cage also determines the amount of energy expended throughout your neck and upper chest. Let’s be both an efficient accordion player and breather!

  • Position and Function Part II - Jason’s second in a three part series on the squat is here!

    Functional movements are similar to activities you perform in your everyday activities. A functional movement is the ability to move the body with proper muscle and joint function for effortless, pain-free movement. Squatting is a total body functional movement pattern. Squatting is an activity which is commonly applied in sport, recreation, and often utilized while performing numerous everyday activities. It has been proposed that the ability to perform a bodyweight squat at or below 90° of knee flexion with proper symmetry and coordination is a good indicator of movement quality.(1-2) The concept of a movement screen is based on the premise that optimal movement exists; that is, movement that occurs without pain or discomfort and involves proper joint alignment, muscle coordination, and posture.(2) Another important concept to consider is that the body is not made up of individual segments but is an integrated system of joints and muscles that work together to create movement. Nowhere is this more evident than in the action of squatting. The squat requires movement in three sets of joints: the hips, the knees, and the ankles. It also requires stabilization of the torso. To maintain a squat, your center of mass (either the barbell or your body) must be directly above the middle of your feet while you lower your hips to the ground. Often times the structural integrity of the body is compromised because the components are out of alignment. If one segment in the body is out of alignment, the other movement segments have to compensate in attempts to balance the weight distribution of the dysfunctional segment. The position of your pelvis in part acts to determine the leverage available to each of it’s attaching muscles, those that control the hips and lower back as well as those that control the knee. The purpose of this blog is to describe the movements that are required to squat and deviations that occur will be discussed in a later blog. Let’s break down the squat!

    When broken down into its components, the eccentric and concentric contractions associated with squatting break the movement into two very distinct phases, the descent and the ascent. By being aware of both the eccentric and concentric movements in a squat, you can recognize the multiple muscles and joints that are involved. Concentric and eccentric are also terms used to describe the phase of a movement. The concentric phase is the phase of the movement that is overcoming gravity or load, while the eccentric phase is the phase resisting gravity or load. During the squatting movement, the concentric phase is the up phase where gravity is overcome, and the eccentric phase is the downward phase where gravity is resisted. Moreover, an eccentric motion is one in which a muscle is lengthened during contraction, whereas a concentric motion is one in which a muscle in shortened during contraction. In terms of a squat, the eccentric movement occurs in the downward phase of the squat motion as you control the movement. During that phase, the muscles in the legs are lengthening to slow the pace of descent. A concentric contraction is one in which the muscle length decreases to perform a movement. In a squat, this would be the lifting phase of the squat as you stand back up.

    The squat is essentially a balancing act. An individual’s ability to lift or control one’s body weight is dependent upon the angles of joints which connect the bones and the muscles acting upon them. It is the change of these angles that makes limbs move. These angles are controlled by gravity and muscles, which often oppose each other. Since the bony attachments for muscles to not change, the angles at which the muscles act on the bones must change to provide the desired movement. In terms of a squat, the downward and/or eccentric movement requires a coordinated movement of flexion upon the hip, knee and ankle. Likewise, during the upward and/or concentric movement requires a coordinated movement of extension upon the hip, knee and ankle. In terms of joint angles, flexion refers to decreasing the joint angle; in contrast, extension refers to increasing the joint angle. Therefore, during the downward phase of the squat, the angles upon the hip, knee and ankle decrease and during the upward phase of the squat, the angles upon the hip, knee, and ankle increase.

    In my next blog, I will discuss how position influences the function of the bi-articular muscles. I will describe the concepts of active and passive insufficiency as it relates to the squatting movement and deviations that may occur at the hip, knee, and ankle. Feel free to leave any comments or questions…

    1. Cook, G. Athletic body in balance. Champaign, IL Human Kinetics, 2003.
    2. Kritz, M., Cronin,J., Hume, P. The Bodyweight Squat: A Movement Screen for the Squat Pattern. Strength & Conditioning Journal: Feb. 2009 - Vol 31 - Issue 1 - pp 76-85.

  • “Position” and “Function” - Jason explains some key terms and concepts in his latest blog…

    In my previous blog I discussed the hamstrings influence on an anterior pelvic tilt. I also discussed the influence that pelvic position had on the function of the spine above it and the femur (thigh bone) below it. Before I go into detail about how the hamstrings play an important role in executing a proper squat I felt it would be important to go over several anatomical and biomechanical terms. These terms will provide us with a greater appreciation of how “position” can affect “function”. Here are some terms and concepts in which I feel are important to comprehend:

    Bi-Articular Muscle:
    Bi-articular muscles are defined as muscles that act across two joints. More specifically, in the lower half of the body the bi-articular muscles are the hamstrings, rectus femoris of the quadriceps group, erector spinae (back muscle) and the gastrocnemius (calf). The hamstrings and the rectus femoris cross both the hip and knee joint, whereas the gastrocnemius crosses both the knee and ankle joint. The erector spinae cross both the spine and the pelvis. The function of these muscles is often complex and depends on both position and the activity of the other muscles at their respected joints. Bi-articular muscles are not long enough to allow full range of motion simultaneously at both joints. If one of the two joints is moved to the end of its range of motion, the attempt to move the second joint to the end of its range will stretch the bi-articular muscle closest to the second joint. For example, the hamstrings attach above the hip and below the knee. Once the knee is pulled tight to the chest, it is not possible to fully extend or straighten the knee because the hamstrings are too short. Attempting to extend the knee, however, will stretch the lower hamstrings. To stretch the upper hamstrings, extend the knee and rotate the pelvis forward as the trunk flexes.

    Active Insufficiency:
    Active insufficiency results from the inability of a muscle to contract by more than a fixed amount. For example, most people can flex their knee to bring their heel close to their buttock, if their hip is flexed; because the upper parts of the hamstrings are lengthened and the lower part is shortened. However, one is normally unable to fully flex the knee when the hip is extended. This is because with hip extended; the hamstrings are already shortened, meaning that there is insufficient “shortening” potential remaining in the hamstrings to then fully flex the knee.

    Passive Insufficiency:
    Passive insufficiency is the inability of a muscle to lengthen by more than a fixed percentage of its length. For example, most people need to bend their knees in order to touch their toes. This is because the hamstrings (which span the hip and knee joints) cannot lengthen enough to allow full flexion at the hip joint without also pulling the knee joint into flexion. For the same reason, it is easier to pull your thigh to your chest if your knee is bent than it is with your knee straight. This limitation is called passive insufficiency.

    Concurrent Movement/Shift:
    The concept of the concurrent shift applies to bi-articular muscles within the kinetic chain during weight bearing activities. This movement pattern allows the muscles to maintain a relatively constant length tension relationship at both joints as they go through a range of motion. A good example of how this concept applies is to discuss how the rectus femoris and hamstring muscles function during the squat.

    During the descent phase of the squat, the knee and the hip flex together. While the knee flexes, the hamstrings’ attachment site at the knee, act concentrically to control anterior translation (movement forward of the shin bone) of the tibia, while the hamstrings’ attachment site at the hip act eccentrically to control the flexion of the hip as you move downward. Likewise, the rectus femoris’ attachment site at the knee acts eccentrically to control the forward displacement of the upper torso as the body is lowered and the attachment site at the hip acts concentrically to allow the hip to move forward as the upper torso is lowered.

    During the ascent phase of the squat, the knee and hip extend together. While the knee extends, the hamstrings’ attachment site at the knee acts eccentrically to counteract the concentric activity of the rectus femoris during knee extension while the hamstrings’ attachment site at the hip acts concentrically to extend the hip. Likewise, the rectus femoris’ attachment site at the knee acts concentrically to extend the knee and the rectus femoris’ attachment site at the hip acts eccentrically to control extension of the hip.

    Thus, this concept applies during both the ascent and descent phase of the squat resulting in a simultaneous “concurrent” concentric and eccentric contraction at the opposite ends of each respective muscle. Concurrent movement therefore avoids passive and active insufficiency of the hamstrings and rectus femoris by neither shortening nor stretching both ends of either muscle, but rather, having one end lengthen as the other shortens and vice versa in the other muscle.

    In this blog I have described four anatomical and biomechanical terms, and will be putting these terms/concepts to use in my next blog when I describe the squat motion and how these four terms apply.

  • Jason's new blog explains the Hamstrings Influence on an Anterior Pelvic Tilt...

    Often times I hear my patients complain about how tight they are, more specifically how tight their hamstrings are. Furthermore these individuals often times struggle to bend over to touch their toes, and it seems that everyone’s advice is to stretch those tight hamstrings! Most often individuals think their hamstrings need to be stretched because they have a sensation of tightness. However, there are two types of tightness; mechanical and neurological. It is important to differentiate between the two and understand why stretching the hamstrings oftentimes won’t fix the problem, and why there may be a need to strengthen the hamstrings, as they play an important role in stabilizing and positioning the pelvis.

    Mechanical tightness occurs when a muscle is positioned in a constant shortened state, which causes the muscle to become physically shorter and increasingly tight over time. Neurological tightness, on the other hand, occurs from a muscle being consistently elongated in a lengthened position for an extended period of time. When a muscle is placed in a lengthened position, it receives additional signals from the brain, which is thought to be a protective response from the body to prevent the muscle from being stretched too far and thus these increased neural signals is what creates the sensation of tightness.

    In April 2012 I blogged about the anterior pelvic tilt. The anterior pelvic tilt occurs when the pelvis tilts toward the front of the body. From a mechanical/structural component, an anterior pelvic tilt causes some muscles to be tight and others to be lengthened. More specifically, the muscles in the front of the pelvis become shortened because they are positioned in a shortened state and the muscles in the back of the pelvis, hamstrings, become lengthened due the pelvis being tipped forward. With time, this leads to the neurological tightness which is often misunderstood. The tightness an individual feels is one’s body trying to protect the individual from overstretching. Therefore, stretching more doesn’t solve anything. In fact, it may only worsen the problem. Instead there is a need to focus on strengthening the hamstrings to help counteract this anterior pelvic tilt and restore proper pelvic position. Furthermore, the lower back is in a state of hyperlordosis and appears to be tight due the fact that the back muscles are overactive in attempt to bring the upper body back into an upright position.

    From a clinical standpoint, “tight” hamstrings do not necessarily mean short hamstrings, and therefore does not mean stretching is the right thing to do. Often times an individual will have a limited straight leg raise (a common objective test used during movement screens which consists of lying on one’s back with both legs straight, and then the examiner actively raises one leg as far as they can) due to the sensation of tightness of the hamstrings. A common misconception is that the hamstrings appear to be short and tight and need to be stretched. On the contrary, the hamstrings are actually lengthened and tense secondary to the pelvis falling forward and need to be strengthened to return the pelvis to a more neutral/optimal position. Often times patients with low back pain are often told to stretch their hamstrings to relieve the sensation of tightness/discomfort. In response to stretching of the hamstrings, the pelvis may tilt even further forward and the lower back muscles may become tighter to keep the body upright. It is important to think less about an individual muscle or muscle group as it relates to the sensation of tightness, and instead think in terms of the position in which the muscle is held!

    Let’s take a closer look at the straight leg raise. Think back to the anterior pelvic tilt which places our lower back in an arched position, or what clinicians call lumbar lordosis. When the clinician lifts the leg for the straight leg raise, the hamstring becomes taut at an earlier point then it should because the muscle is already pre-lengthened due to the position of the pelvis (anterior pelvic tilt). In other words, the leg won’t go as far because it’s already being stretched before it even moves. Positionally, the tightness may be felt in the hamstrings but the hamstring is not shortened—it is lengthened! It may be related instead to the position of the pelvis or anterior pelvic tilt.

    Although many individuals may claim they cannot touch their toes due to their hamstrings feeling “tight”, stretching these already lengthened hamstrings may bring about potential injuries to the pelvis, lower back, and knee. Instead, one needs to focus on strengthening the hamstrings to reposition the pelvis to a more neutral position in order to restore proper mechanics around the pelvic girdle. The position of the pelvis plays a vital role in how the spine above it and the femur (thigh bone) below it will function. It would be fair to say that an abnormal position of a structure will result in an abnormal movement of that respected structure. This is why for my next blog I am going to go into a little more detail regarding how the hamstrings play an important role in executing the proper squat.

  • Jason’s new blog recommends a book for all PRI clinicians - check it out!

    I recently came across a book “Back Pain: A movement problem”, written by an Australian physiotherapist; Josephine Key. “Back Pain: A movement problem” is a book that would assist Postural Restoration clinicians concerned with the evaluation and management of the movement related problems seen in individuals with lumbo-pelvic-femoral and thoracic disorders. It suggests an integrative approach of postural movement dysfunction which are commonly related patterns observed within the field of Postural Restoration. This is a great book for anyone who practices PRI. As a PRI clinician I found the book to be very clear and practical and it provided an abundance of remarkable illustrations. I highly recommend this book to every PRI clinician’s library!

  • Jason’s latest blog addresses the effect of Postural Restoration on Athletic Performance -

    Over the past several years, a sizable body of discussion has developed within the field of athletic training, chiropractic, and strength and conditioning professionals pertaining to Postural Restoration. These discussions include the diaphragms role, rib cage position, strength, power, and flexibility as well as a comprehensive blogs explaining how Postural Restoration concepts and techniques are utilized to allow these professionals to more effectively teach exercise techniques and design training routines for their athletes/clients/patients. A small body of research has even been directed toward more thoroughly understanding Postural Restoration:
    The Value of Blowing Up a Balloon
    Bilateral Functional Thoracic Outlet Syndrome in a Collegiate Football Player
    Managing a Female Patient with Left Low Back Pain and Sacroiliac Joint Pain with Therapeutic Exercise: A Case Report

    Although the extensiveness and understanding of the existing Postural Restoration concepts and philosophy is inspiring, it is by no means complete within the world of athletic rehabilitation and performance. As a Physical Therapist at the Hruska Clinic, one of my passions is finding research/information that supports the Postural Restoration Institute. What I have discovered in the last several months is very impressive regarding the information posted on these sites and the information that these professionals have discussed within their blogs. I applaud these individuals for a job well done! I would encourage other athletic training, chiropractic, and strength and conditioning specialists to take a look at these sites:

    IFAST and IFAST Physical Therapy
    David Lasnier
    Eric Cressey
    Kevin Neeld
    Jeff Cubos
    Mike Reinold
    VT Peak Performance

  • The Air We Breathe and Its Influences- Jason’s new blog stresses the importance of this movement…

    Breathing is often ignored because individuals do it twenty four hours a day, seven days a week, 365 days a year, every day of our lives. Breathing is the most underappreciated of all human movements. Since breathing is a human movement pattern, it can be mechanically altered by a combination of factors. Breathing plays an important role in its influence on movement quality, stability, and posture. If breathing is normal or “functional,” posture and stabilization will be maintained in a healthy manner. Conversely, if breathing is abnormal or “dysfunctional,” it not only affects posture and stabilization, but can also create countless of other health issues. On average, we breathe 20,000-24,000 times a day. Any problems we have in breathing are therefore multiplied 20-24,000 times every day.

    Breathing affects every system of our bodies to include but not limited to our cardiovascular, respiratory and musculoskeletal systems. Many individuals have misconceptions about breathing and consider it the bodily process of inhalation and exhalation; the process of taking in oxygen from inhaled air and releasing carbon dioxide by exhalation. The movement of respiratory gases into and out of the lungs has many implications. The human body has 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. These cavities include the cranium, thorax, and lumbo-pelvic-femoral complex. This dynamic displacement of air defines the active movement that occurs during breathing and muscular activity.

    Breathing is the origin of all movement patterns. Because it is one of our most frequent behaviors, any disturbances that create and/or inhibit these pressure gradients to occur between the cranium, thorax, and/or lumbo-pelvic-femoral complex will lessen its efficiency and places a strain on the body’s ability to adapt. The manner in which individuals breathe affects their appearance and function of these cavities, and predicts the level of discomfort an individual may experience throughout their lifetime from both a physical and psychological standpoint.

    My forthcoming blogs will discuss the influence of air within these respected cavities and their influences on each other.

    I appreciate any questions or comments you might have…

  • Let’s Play Ball!! Jason’s new blog addresses kids, baseball, and pitch limits…

    This is the time of year that I often get asked “how many pitches or innings should my young pitcher throw?”. The question is pretty straight forward, but the answer involves many variables that need to be considered. The debate about setting pitching limits has been going on for a long time. Most youth leagues have a limit based on innings pitched, but many think the limit should be based on pitch count. It is unfortunate that this situation can’t regulate itself, but sometimes when winning and losing becomes important, adults may lose sight of the big picture and push their players too far.

    The attitude behind any pitch limit is to protect the kids, but the most crucial protection should come from the common sense of the coach and the parents. If pitch counts or innings pitched are not regulated, the accountability goes back to the parents and coaches. It would be unfortunate think that a parent would allow a coach to hurt his or her child’s arm at a young age for the sake of winning a game or a tournament.

    Remember, whether you coach a “select” team or a recreational team, youth baseball shouldn’t be all about winning. It should be about developing baseball players, teaching the game and having fun. While winning certainly is more fun than losing, greater importance should be placed on the concept of maturing good baseball players and good people over winning at all costs.

    The best way to make the appropriate decision is by following the information about pitching limitations that already is available, as well as relying on your instincts. The abuse of a young pitcher’s arm only becomes an issue when an overemphasis is placed on winning. If this is the case, it is the parents’ responsibility to discuss the situation with the coach.

    The USA Baseball Medical & Safety Advisory Committee has developed the following recommendations for limits with youth pitchers. These recommendations include closely monitoring the number of pitches that are thrown in a game and throughout the season. In spite of the existence of such recommendations, injuries continue to be a common among the younger athletes.

  • What exactly is a Tilted Pelvis? Jason explains in his newest blog…

    What is a tilted pelvis? A pelvic tilt is actually a fairly common postural problem. A pelvic tilt occurs when the pelvis tilts in one direction. There is an anterior pelvic tilt in which the pelvis tilts towards the front of the body and there is a posterior pelvic tilt in which the pelvis tilts towards the back of the body. The anterior pelvic tilt is generally the most common. Pelvic tilts are owed to muscle imbalances. In other words, certain muscles may not be working properly and other muscles may be working too much. Structurally, an anterior pelvic tilt can cause some muscles to become tight and others to be lengthened.
    The back muscles and hip flexors become shortened in length when the body has an anterior pelvic tilt. Furthermore, when the back muscles and hip flexors shorten, the abdominal and hamstring muscles become lengthened. A common misconception is that the hamstrings appear to be short and tight and need to be stretched. On the contrary, the hamstrings are actually lengthened and tense secondary to the pelvis falling forward and need to be activated to return the pelvis to a more neutral position. Often times patients with low back pain are often told to stretch their hamstrings to relieve their discomfort. In response to stretching of the hamstrings, the pelvis may tilt even further forward and the lower back muscles may become tighter to keep the body upright.
    Today I looked at the anterior pelvic tilt and how this position may affect your body. An anterior pelvic tilt can not only be an impairment to your posture but it can place undue stress on muscles, joints and your breathing to name a few. Your problems may range from a constant achy lower back to countless debilitating symptoms throughout your body. With a few exercises from a PRI therapist you can help correct your tilt and have a more balanced pelvis.

  • Jamb’n the Jaw - Jason’s new Blog compares your jaw to a door that won’t close!

    Have you ever tried to close a door and find that the door wouldn’t close? Why is it that we always slam the door hoping that doing so will solve the problem? All of us have had a door that doesn’t shut right, where the door runs into the door frame. Individually, a door and a doorframe can be proficiently put together but if they are not made to match each other in size, the two will never work together. To understand how a door functions, it is important to know what pieces go into a typical door system and the role that each plays.
    The door jambs are the vertical sections of the door frame, which acts as a support for the remainder of the frame, as well as the door itself. Each door frame has two jambs used to mount the frame to the surrounding wall. The hinge jamb is the side where the hinges are installed, and the strike jamb is the where the door latches into the strike plate. Hinges are the metal plates mounted on the door frame that anchors the door to the frame and allows the door to open and close freely. The strike plate is the metal plate installed in the door jamb that receives the latch or lock when door is closed. The top horizontal member of the frame that connects the two vertical jambs is called the header. The lower horizontal member of the frame that supports the entire door system is called the sill.
    The structures that make it possible to open and close a door are very similar to opening and closing one’s mouth. Indeed there is a mechanical relationship between the upper and lower jaw bones, the teeth, and the temporomandibular joints. To understand how a mouth opens, it is important to know the anatomy of the mouth and the role that each plays.
    TMJ stands for “temporomandibular joint” otherwise known as the jaw joint. The joint is formed by the temporal bone of the skull (temporo) with the lower jaw (mandible) hence temporomandibular. There is one temporomandibular joint on each side of the skull located in front of each ear. The upper and lower halves of this joint are separated by an articular disc. The temporomandibular joint is the most unique joint in the human body as it is two joints in one. It is unique in that one joint directly influences the function of the other joint. The two joints function as one unit since they both move one single bone, the mandible. Each side cannot operate independently as both joints are joined to the same bone.
    Think of your jaw as a door that is on hinges. If your door is crooked, it is going to add excessive stress to the hinges and it is not going to shut correctly. If you modify the door to make it look less crooked it is still going to have stress on the door and possibly not shut all the way causing further wear and tear to the door itself. On the contrary, if you have a door that is straight and a door frame that is bent you may still have a door that does not shut correctly. The next few blogs will discuss the various relationships that may be encountered when attempting to open and close one’s mouth using the door analogy.

  • Let’s Get “Squared Away”! Jason’s blog talks geometry - not really, but sort of… Check it out!

    The saying “squared away” means that one is in an adequate position for whatever has to be done next. This saying has nothing to do with something actually being squared in shape or form. It means: everything is in order; everything is arranged/ positioned and taken care of. On the other hand, when you look at the human body, you can shape it by creating or arranging it to determine its form. Postural Restoration Institute® concepts/principles are governed by posture, position and patterns. In every moment we are shaping our bodies into a posture that corresponds to the demands placed upon it. Something that arranges and repeats itself in a predictable way is a pattern. The body is shaped by how we use it and patterns govern how we function. We all fall into patterns which create postures that reflect our body’s overall shape and/or position.
    Geometry is a term concerned with the study of basic shapes. Shapes are used to suggest meaning and organization. It’s sometime easier to picture the human body as an arrangement of geometric shapes. The body’s shape affects the body’s posture, position and patterns. A trapezoid and a square are two common shapes. In this blog I will illustrate how the body grows more accustomed to the shape of a trapezoid and, by implementing Postural Restoration Institute® concepts we can reshape it into a square. It is this shape-changing ability that is most relevant to breathing, because without this movement, the body cannot breathe at all. To understand how the diaphragm causes this shape change, I will examine its shape and location in the body, where it’s attached, and what is attached to it, as well as its action and relationship to the other muscles of breathing. This geometrical relationship is important to recognize, not only to distinguish the body’s overall shape, but for another reason: so that we can understand how the body functions in regards to its overall position! Successful function, of course, expresses itself in a particular shape. In order to understand this relationship, we will start with the basic anatomy, function, and mechanics.

    For starters, the pelvis is directly connected to the spine. Therefore, the position of your pelvis will affect the position of your spine and rib cage. The combination of an elevated chest (rib cage) and an anteriorly tilted pelvis is a common posture that severely compromises the capability to attain proper stabilization of the pelvis and ribcage. In an ideal world, the ribcage and the pelvis should be relatively horizontal and/or parallel to each other for efficient breathing to occur. The importance of breathing cannot be overemphasized. On average you breathe about 24,000 times per day. Postures can contribute to proper breathing as well as cause breathing restrictions you hope to eliminate. Yet how much attention are you giving to your breath as it relates to the position of your pelvis and your rib cage? As an example, the diaphragm contracts approximately 24,000 times a day and ultimately changes the position of the pelvis and rib cage with each breath. Even the smallest restriction of movement, whether it is the pelvis or the rib cage, can result in a significant consequence, as the diaphragm is stressed 24,000 times a day! Fortunately, this cumulative affect works both ways. In other words, not only can changing the position of the pelvis affect rib cage position, but likewise, rib cage position can affect pelvic position. Let’s look at some of the structural implications of the positioning of the pelvis and how it relates to the rib cage.
    Let’s say the pelvis is a bowl and the bowl is full of water. A forward pelvic tilt would tilt the bowl forward spilling the water out in front; likewise, a backwards pelvic tilt would tilt the bowl back spilling the water out the back. Dysfunction in your pelvis will “spill over” and create a dysfunction in your spine. Any dysfunction in your spine will create a dysfunction in your rib cage. Therefore, a forward tilt of your pelvis would elevate the front of your ribcage; likewise a backward tilt of your pelvis would lower the front of your rib cage.
    Now let’s take a look at how the muscles that affect the position of your pelvis and rib cage and put it together. Remember that a muscle has at least two attachment sites. When a muscle contracts, it shortens, bringing the two attachment sites closer together. The muscles that attach to the front of the pelvis and the upper leg are called the hip flexors. When they contract they bring the leg closer to the front of the pelvis. This muscle would either lift the leg or they would tip the front of the pelvis down when they contract. Muscles that attach to the back of the pelvis and back also tip the front of the pelvis down when they contract. These paraspinal muscles can be chronically tight and your pelvis therefore could be chronically tipped forward into an anterior tilt.

    The hamstrings, gluteals, and abdominal muscles work together to tilt your pelvis backwards. The hamstrings and gluteals have attachments on the pelvis and upper legs. When they contract they pull the back of the pelvis down towards the backs of the legs, while the abdominal muscles pull the front of the pelvis upwards. Ideally there should be a balance between the muscles that tilt the pelvis forward and the muscles that tilt the pelvis backwards, especially when upright.
    The diaphragm interconnects your rib cage, spine, and pelvis. Because of these relationships the diaphragm is significantly influenced by posture and continuously influences breathing. When viewing from the side, the diaphragm looks like a big upside-down letter “J” that forms a floor across the lower rib cage. The diaphragm is connected in the front, along the sides of your lower ribs, and also along the front side of your spine. The intercostal muscles are the muscles between each of your ribs. There are two types of intercostals. The external intercostals are responsible for pulling the rib cage up and out during inhalation. The internal intercostals are the muscles of exhalation; they pull the ribcage down and in.
    The pelvis and its direct attachment to the spine is the determining factor for the shape of the diaphragm, and must be supported by the muscles that attach to the rib cage and the pelvis. Therefore, when the rib cage changes shape, so does the diaphragm. For this reason, inhalation suggests a forward tilt of the pelvis, facilitating spinal extension and thus positioning the diaphragm more towards the shape of an upside-down letter “L”. Whereas, exhalation suggests a backward tilt of the pelvis and facilitates spinal flexion, thus positioning the diaphragm more towards the shape of an upside-down letter “J”. (Figures 3 & 4) Breathing is rhythmic. The rhythmic movement of your diaphragm is constantly changing from an upside-down letter “J” to an upside-down letter “L” with every inhalation and exhalation you take during the breathing cycle.
    On inhalation, the diaphragm muscle contracts, and pulls the bottom of the lungs downward causing them to fill, while the ribs flare upwards and outward to the sides. When the external intercostals pull the rib cage upwards and outward the upside-down “J” flattens into an upside-down letter “L”. On exhalation, the internal intercostals and to some degree the abdominals pull the rib cage down and inwards restoring the diaphragm to its original position of an upside-down letter “J”.
    During inhalation, the diaphragm flattens into an upside-down letter “L” as it descends and meets the resistance of the abdominal muscles and abdominal contents. The diaphragms activity depends on the position of the spine and rib cage, which forms a “fixed point”. The term “fixed point” implies which attachment site of a muscle that remains “fixed” or stationary and allows the opposite attachment site of the muscle to freely move. As with all muscles, the type of movement the diaphragm produces will depend on which end of the muscle is stable and which is mobile. If the rib cage is in the inhalation position, with the sternum and ribs elevated, the activity of the diaphragm is impaired. This particularly affects the lumbar section of the spine. Due to the diaphragm’s attachment to the front of the spine, every subsequent breath you take now pulls your pelvis into a forward tilt. Breathing is then limited to the upper rib cage, which is pulled upward by the accessory respiratory muscles of the neck.

    As a result of this position, normal pelvis, rib cage, and diaphragm biomechanics are disrupted, and subsequently, the entire function of the diaphragm is altered. The back muscles use this fixed point as an opportunity to contract and further arch the spine. This fixed position of an elevated rib cage and forward tilt of the pelvis results in increased lower back tension as well as increased activity of the upper accessory respiratory muscles of the neck in attempt to get more air into the lungs. Furthermore, this prevents the diaphragms ability to return to a relaxed resting position during the exhalation phase of breathing.

    Mechanical relaxation is the process by which the muscle actively returns, after contraction, to its initial length and load. The diaphragm, like every other muscle in our body, likes a proper resting length. The diaphragm contracts and relaxes continuously throughout life and must return to a relative constant resting position at the end of each inhalation-exhalation cycle. Muscles function the best when close to an ideal length (often their resting length). When muscles are stretched or shortened beyond this (whether due to the action of the muscle itself or by a sustained position or posture) the force generated by the muscle decreases.
    An elevated rib cage affects respiratory musculature function by causing the muscles to operate in an undesirable position and by flattening the curvature of the diaphragm. If the rib cage remains fixed in an upward position, the diaphragm’s mechanical purpose is obviously compromised. The diaphragm does not have the length and force to allow the rib cage to move through its full range of motion required for a full breath. The diaphragm’s shape changes from an upside-down letter “J” to an upside-down letter “L” as a result of the undesirable positioned rib cage and pelvis.

    Difficulty breathing usually originates from restricted movements of breathing and usually from incomplete exhalation. The muscles include the diaphragm, abdominal, and neck musculature that hold the rib cage in an elevated state. As a result, individuals exhale incompletely.
    Individuals who exhale incompletely as a result of ribcage and pelvic position habitually have an expanded chest, hanging belly, high shoulders, and a shortened neck. The expanded chest results from the rib cage being in a state of inhalation due to the pelvis being forwardly tilted and the rib cage being elevated. The hanging belly comes from a diaphragm that, being always partially contracted and more towards the shape of an upside-down letter “L”, pushes the abdominal contents down and out of their normal position; the high shoulders come from contracted “shortened” neck musculature lifting the upper ribs in a chronic attempt to get more air into the lungs.

    Now let’s get “squared away”! The diaphragm’s mechanical action and respiratory advantage depends on its relationship and anatomic arrangement of the pelvis as it relates to the rib cage. As stated earlier, when you inhale your rib cage elevates while the front of your pelvis tilts forward. Using the upper pelvis and lower rib cage as reference points, this inhalation position resembles the shape of a trapezoid. Likewise, as you exhale your lower rib cage is pulled down while the front of your pelvis tilts backward resembling the shape of a square. Using the Postural Restoration Institute® non-manual techniques you can guide the rib cage and diaphragm into a position where the diaphragm regains proper mechanical advantage to efficiently contract and can rest, resembling the shape of an upside-down letter “J” rather than an upside-down letter “L”. (Figures 3 & 4) The muscles often recruited to maintain the diaphragm, rib cage, and pelvis in the proper position include the abdominal obliques, hamstrings, and gluteal.

    Allowing the diaphragm, rib cage, and pelvis to be literally “squared away” will allow these structures to obtain an adequate position/shape for whatever has to be done next, thus allowing normal breathing mechanics to occur. When the diaphragm, rib cage, and pelvis are positioned properly, correct breathing patterns are simplified, producing a more adequate posture. The ideal posture for diaphragmatic function occurs when the pelvis is level and the chest isn’t sticking out or elevated. This results in improved movement with greater strength, power and endurance.

  • Jason tells us “A Little Bit More about NEUTRAL”... Check out his new blog!

    Every day at the Hruska Clinic and across the country, PRI trained Physical Therapists assess and determine whether or not their patient is neutral. Neutral can be used in various contexts. I will provide you with everyday occurrences in which the word “neutral” is used and I will then use these examples of how it relates to the human body. By definition, neutral is:
    - The condition of being disengaged in contests between others.
    - State of taking no part on either side.
    - Indifference.
    - Being mutually acceptable to both sides.

    All phenomena is defined in relation to its opposite. How do we understand the idea of hot without cold, forward without reverse? Hot and cold are different points on a spectrum of an understanding of what we might call “temperature”. Forward and reverse are different points on a spectrum of an understanding of what we might call “motion”. Thus things always come in pairs. Neutrality, on the other hand, lacks the bias towards one of these opposites. Automobiles have a neutral gear, you are neither moving forward nor backward. Likewise, warm suggests you are neither hot nor cold!! We are constantly seeking a balance between these opposites-they are always moving—there is never a time when they stop. Notice I didn’t say anything about resolving this balance. If there was perfect balance, there would be no motion. When these opposites are managed to obtain the best of both conditions, the conflict between these opposites is converted into symmetry. Let me reit¬erate again how important this is: it’s the constant seeking of balance between opposites that creates our lives as we know it.
    We know that we cannot always be neutral in everything we do All too often we end up judging our every thought, emotion, and action as positive or negative. Some individuals have strong opinions or positions on current events or topics; some individuals are liberal where others may be conservative. Other examples that can be related to this include war, euthanasia, taxes, abortion etc. When we look around, there are many examples in which we tend to hold a strong position or bias towards something whether it is right or wrong. That’s a matter of opinion!
    So where does “neutral” fit in? Considering the multiple interpretations of the word, I will go out on a limb as a PRC therapist and state “Our patients never obtain complete neutrality!” Wow! What do I mean by this? We as physical therapists are constantly trying to determine whether or not our patient is “neutral”. To truly be “neutral” would mean that the balance point would always meet in the middle; you are neither here nor there kind of thing. How often do you suppose this happens? I will pose another question; do you think our bodies are always in a position of neutrality? There are various movements and positions that we place our body in on a daily basis, we flex and extend, we adduct and abduct, we inhale and exhale. We never just stop in the middle with these movements. To move from one extreme range of motion to the other requires the presence of a mid-point or what I refer to as neutrality. Neutrality is the ability to accept a movement or position in the reflection of the other without conflict. Neutrality is a “range” and/or “zone” of movement; it is a “transitional position”. You can’t get from here to there without crossing the middle! So it comes as no surprise that good attracts bad, and bad attracts good. Likewise flexion attracts extension and adduction attracts abduction. We as humans all hold positions and/or bias whether we like to extend or flex, believe or disbelieve, and whether it is good or bad. And, to complicate matters, what is observed as “good” by some will be observed as “bad” by others. This cycle continues on and on!

    In summary, I spoke with my mentor, Ron Hruska, about this topic. As we discussed this topic we both concluded that “neutrality” in its real sense is a “transitional position”. Some patients may be biased towards a particular movement or position. Whether it is right or wrong we all have tendencies towards a matter of opinion, position, or movement pattern. We as PRI therapists must accept the fact that our patients may never be able to achieve “neutrality”! It is our job to allow our patients to experience this “mid-range” and/or “zone of neutrality” and not be biased towards one extreme over the other.

    I would appreciate any comments and insight regarding this matter…

  • The Gas Pedal and the Brake, Part Two… Jason’s blog continues on Autonomic Nervous System.

    Previously I discussed the cruise control mechanism of a car as it relates to the sympathetic and parasympathetic nervous systems. To understand what might happen if your autonomic nervous system is not working correctly, I will again consider the sympathetic nervous system as the accelerator and the parasympathetic nervous system as the brake. Let’s consider a common scenario of how to regulate the autonomic nervous system.

    Imagine pulling your car into your garage, you place the car in park, and you notice that the engine is idling at a faster than normal pace. You perceive that the engine is operating as if you were traveling at a speed of 65 mph, yet you are parked in your garage. It sounds as if your accelerator is stuck! You know that stepping on the brake is of no help since you are already in park. What do you do? You gently press down on the accelerator, the idling speed slightly increases, and then you gently let off the accelerator and “PAUSE” - suddenly your idling speed decreases.

    It is important to use management techniques that “quiet” the faster idling speed or high resting level of the autonomic nervous system. Breathing is one way to control the autonomic nervous system with a voluntary action. Imagine that you’re anxious and your engine is idling too fast. Your heart rate and breathing rate increases. One way to re-set your autonomic nervous system is to gently take a breath in and then blow the air out and “PAUSE”. This allows you to re-start the normal respiratory cycle.

    Breathing is a rhythmic process, a natural cycle containing two opposing parts. We breathe in cycles, inhaling and exhaling alternately. Without one of these, the other does not exist. What would you do if you had to make a choice between inhaling and exhaling? Breathing is not one or the other. Breathing has to be both—inhalation and exhalation. There are situations in life that we tend to be concerned with, yet we deal with these situations in one way or the other.

    As previously stated, the sympathetic and parasympathetic systems have opposite functions. When we are under stress, the sympathetic system raises our heart rate and respiration so that we can either run away from (flight) or “fight” whatever is threatening us. Generally, when the threat is dealt with, the parasympathetic system restores and/or slows down our heart rate and respiration. Breathing is one way to control the autonomic nervous system with a voluntary action.

    For example, if you were to continue to press on the accelerator, you would continue to increase your idling speed. Likewise, if you were to continue to breathe in at a faster rate, you would continue to breathe faster and faster. Your body senses the need for more oxygen upon every increasing breath however you have yet been unable to fully exhale the carbon dioxide from the previous breaths. This “PAUSE” allows you stop this cycle and restore the normal breathing rate. In the next blog I will discuss the polarity of breathing.

    Questions or comments for Jason? Click here to send him an email.

  • Jason’s latest blog discusses your body’s “cruise control” - Check it out!

    In my previous blog I discussed the two parts of the autonomic nervous system: the sympathetic and parasympathetic systems. As a way to understand how the sympathetic and parasympathetic nervous systems function in harmony, think of the analogy of a car’s cruise control. The function of a car (the human body) is to get you where you need to go. The sympathetic system is the accelerator and the parasympathetic system is the brake. You must have both in order to safely get to where you need to go. The accelerator excites the engine by burning gas, while the brake slows down and conserves burning of gas. You cannot get to your destination with only an accelerator, and you can’t stop your car without a brake. Using this analogy, you can see it would be more than a bit problematic if one or the other was not working.

    A driver sets the cruise control mechanism by pushing a button when the car has accelerated to some desired driving speed. The control mechanism then takes over and begins to constantly compare the car’s current speed with the desired driving speed. If the car slows down while going up a hill, the cruise mechanism automatically depresses the accelerator (sympathetic nervous system) and thus brings the car back up to the desired driving speed. Similarly, if the car begins to exceed the desired driving speed while going down hill, the mechanism releases the accelerator to slow down the car. Whenever the car is at the desired speed, the mechanism makes no changes. The accelerator and brake will work in opposition, in the sense that any perceived error, such as a drop in speed, produces action by the system to counteract the error by changing the output of the engine.

    In order to maintain health, you have to apply the brake pedal regularly in order to bring the speed of your car down and you may at times need to apply the accelerator to bring the speed of your car up. Obviously, the actions involved in performing the function of cruise control are far more complicated for the human version versus the car version, yet they are very similar.

    Overuse of the accelerator (sympathetic nervous system) as seen in the states of anger, anxiety and hostility sets off the parasympathetic nervous system (brake), reflecting the autonomic nervous systems attempt to achieve balance. In a simple yet reasonable analogy, the driver must somehow maintain his purpose of keeping the car traveling at a given “balanced speed”, but be prepared at any given time to abandon that purpose if any problem should arise.

    In my next blog I will discuss several different ways in which one’s autonomic nervous system may be malfunctioning, and the various symptoms that might become apparent. Please stay “tuned”!!!

  • The Gas Pedal and the Brake: Part I… Jason continues his blog using the analogy of the car…

    In the previous blog I discussed how the human body is comprised of many systems and how they all interact. Today I will discuss the autonomic nervous system.
    The human nervous system can be divided into several connected systems that function together. The human nervous system has two major divisions, the voluntary and the autonomic systems. The voluntary system is concerned mainly with movement and sensation. The autonomic system controls functions over which we have less conscious control or that happen automatically. These include the digestion of food, blood pressure, heart rate, and respiration. There are three parts to the autonomic nervous system: the sympathetic system, the parasympathetic system and the enteric system. For our purposes today, I will discuss the sympathetic, otherwise known as the “fight or flight” system, and the parasympathetic or “rest and repair” system and their interactions.
    The sympathetic and parasympathetic systems have opposite functions. When we are under stress, the sympathetic system raises our heart rate, blood pressure, and respiration so that we can either run away from (flight) or “fight” whatever is threatening us. Generally, when the threat is dealt with, the parasympathetic system restores and/or slows down our heart rate, blood pressure and respiration.
    Relatively few people today have a strong, balanced autonomic system. Most people favor their sympathetic branch. These people tend to be more outgoing, have strong type-A personalities, are aggressive, and have faster metabolisms. They tend to be more prone to anxiety, irritability, and nervousness. Parasympathetic individuals tend to be more laid back, have type-B personalities, are lethargic, fatigued, have slower metabolisms, and often times are prone to depression.
    As a way to understand how the sympathetic and parasympathetic nervous systems function together I will compare how automotive engineers have provided the same components in the car that are needed to prevent the car from running out of gas or overheating, and compare that with how the body is regulated with the help of the autonomic nervous system. My next blog will consider a common example of how the autonomic nervous system is regulated using the analogy of the car.

  • Are You in Control of Your “Car”? Jason Blogs About how your Body is Similar to a Car…

    There are many systems within the body that need particular guidance to optimize function. Let us assume that your body’s systems are comparable to a car. You have a new car, you expect it to run smoothly with minimal problems, which it does, for some time. You drive your car day in and day out, and it works. After a period time, you fail to provide proper care and your car starts to break down. It has a starting problem, it starts giving less mileage per gallon of gas, the paint starts to fade, the upholstery rips, and doors get dinged, so on and so forth. What do you do if your car gets old and starts giving you trouble? You buy a new one! As in this analogy, your car is actually your body. Unfortunately, you cannot change your body for a new one. You are stuck with it for your entire life. If your car starts having problems, you may have to push-start it every time you want to go somewhere. If people give you strange looks because your muffler is dragging, you have a flat tire, or you have various dents and door dings, you put up with it. If it costs a lot of money to provide you with temporary fixes, which won’t last but several months, you put up with it. How you wish you knew from the beginning that you were stuck with this car for life! You would have taken better care of the car! You would not have been stuck with a lemon! Likewise, you must take care of your body to prevent breakdowns. Unfortunately, your body has to carry on through the mechanical failures that life presents and get occasional fixer-uppers to continue working. In other words, you can’t replace your entire body because it is simply not possible!

    Similar to a car, there are several systems in the body that need to be assessed, watched, and trained in order to run in the best possible way day in and day out. A performance check on your car may reveal concerns with the fuel system, the engine’s horsepower, the aerodynamics, the chassis and suspension, the tire pressure of all four tires, the heat regulation, and a countless number of other systems in the car. Like a car, all systems of the body must be working together to optimize function. Having too much power without enough flexibility can lead to potential injury.

    Again using the car analogy, the musculoskeletal system (muscles and bones) is similar to the chassis, suspension, and wheels of a car, whereas the cardiovascular system can be likened to the car’s engine. The cardiovascular system is comprised of the heart, lungs, and blood pathways. It transports oxygen (i.e. gas) to the various parts of the body. Often times we are mainly concerned with the “engine” and how the car runs, and pay little attention to the car “body.” Rather than constantly trying to improve the cardiovascular system to handle higher workloads, why not also try to improve the musculoskeletal system? Then, when given a larger workload such as a long destination, you will get much better gas mileage because the musculoskeletal system is strong. This can be done by improving the car’s suspension, transmission, and wheels, as well as making sure that each is properly maintained and aligned so that the car will be more efficient at a given speed.

    This analogy will continue to be discussed over the next couple of months. The purpose of this discussion is to help you understand the interaction between systems. The importance of body systems and their relationship as it relates to mechanics will be discussed. Just as with the case of our car, we may need occasional tune-ups and adjustments to avoid injury and breakdowns.