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Treating Superior T4 Syndrome using the Gluteus MediusWe received a question about treating Superior T4 syndrome using the gluteus medius. James Anderson, MPT, PRC did a great job explaining the rationale behind this: When I took the Myokinematic Restoration class you said to email you about some information on Superior T4 syndrome. You mentioned working your glute med’s for Superior T4’s. Please read a handout I put together on Superior T4 syndrome. Click HERE! The reason I said the glute medius was such a big deal with the T4 patients is because of all the things that must be in place in order for the glute medius to be properly felt during single leg stance. In other words, the Adductor Pull Back must have been well coordinated with proper breathing to clear out the right BC while it approximated the left femur up into the acetabulum. In fact, your Adductor Pull Back should have restored full right HG IR to ensure that the left ZOA has been restored and the right BC has been inhibited. The deliberate left hip approximation is a precursor for left posterior hip capsule stretching, which is often needed prior to the glute medius being able to properly work when doing single leg left AF and FA IR training. Also of note, if the right thigh does not stay positioned ahead of the left thigh during single leg left AF IR training (like the Retro Stairs), then you are probably not maintaining the needed left AF IR state to keep the left glute medius active during single leg stance training. I hope this helps clarify what I said about the glute medius. And I hope the T4 document is helpful as well. But remember, if the left hip does not do all of the above described items, your left hip comes out of place and the base of your spine will orient towards the right (something you’ll struggle to overcome with just upper half exercises).
Question about the Standing Serratus Stomatognathic Squat
**To review the exercise technique mentioned below, click here! I was reviewing the blog section and I saw that the Standing Serratus Stomatognathic Squat can be used to determine bite position. When I took The Cervical-Cranio-Mandibular Restoration course, we did not discuss this technique. Could you give me some information? The first picture is taken with her weight through her heels and her scapulas supported by the wall. Her levator scapulaes, upper traps and SCM’s are relaxed. Her thoracic lumbar and cervical lordosis will be placed in the end range of her normal lordotic range of these 2 areas of her spine. Her teeth should be able to make uniform contact on both sides of her mouth and through the posterior teeth. The last picture shows the end range of normal thoracic and cranial flexion. She should be able to touch her teeth evenly on both sides and through her posterior teeth. If she cannot feel uniform closure in both of these positions she may need a splint to re-orient or support her occlusion and cervical-cranial imbalances. An open bite on one side is indicative of possible frontal plane asymmetry at the cranium or cervical spine. If she can’t touch front teeth together (incisor to incisor and then close with good posterior molar contact and then back to incisor to incisor, etc) in the first or last position as reflected by the above 1st and last pictures, cranial mandibular, cranial cervical and cranial thoracic muscle cannot rest during resting bite, regardless of cranial or cervical position or the degree of cranial or cervical flexion or extension. This is why I did not talk about this bite issue in great detail. It will be reviewed and discussed in greater detail at the Orthognathic Dentistry and PRI integration course this fall. There is still plenty of room to register for the Orthognathic Dentistry and PRI Integration course. PRI will be sponsoring Dr. Michael Hoefs, DDS and Ron Hruska, MPA, PT. Reservations are required for this unique course offering, specifically designed for teams of physical therapists and dentists. In order to attend, team registration must be received before Friday, September 24th. Please CONTACT US to register!
Technique of the Week
We have posted a new Technique of the Week! Ron Hruska discusses the reasoning behind the Supine Weighted Tricep Curls. This technique can be found in the Right Low Trap and Tricep section of the 3rd Edition Non-Manual Techniques. Check it out HERE!
Recent RequestWe received a request from a therapist involved in a Pectus Carinatum clinic. She asked us “which PRI activities would we use to treat Pectus Carinatum”. We have formulated a list of our favorite activities: Supine Hooklying T8 Extension Sternal Positional Stretch Supine Hooklying Restorative Synchronized Resisted Glute 90-90 Hip Lift with Balloon PRI Wall Squat with Balloon Standing Un-Resisted Wall Reach 80-80 Chair Seated Left Arm Reach Standing Resisted Wall Reach All of these activities can be found on our 2nd and 3rd Edition Non-Manual Techniques CD Rom!
New Technique of the Week
We have posted a new “Technique of the Week”! Check it out!
Standing Serratus Stomatognathic Squat
The Standing Serratus Stomatognathic Squat is a brand new activity that is being introduced in the Cervical-Cranio-Mandibular Restoration course! This activity is not only used for a home program, it is also used to help the clinician determine bite position! Learn all about this activity in our next Cervical-Cranio-Mandibular Restoration course being offered in Lebanon, NH!
Right Adductor Hyperactivity
Have any of you ever noticed this wear pattern on the left shoe? If you have, this is a good indicator of right adductor hyperactivity. When the right adductor is overly hyperactive, the left heel will come out of the shoe when beginning to initiate the swing phase. Another good indicator of right adductor hyperactivity will be no right arm swing. These patients will need a right adductor magnus inhibition program along with verbal cues to maintain heel contact with gait!
Helpful HintMichael Mullin, ATC, LAT, PTA from Portland, Maine recently sent us this helpful hint to use with our patients that enjoy running! I just had a patient come back to see me and she stated: “I just returned from Everest and it was the hardest thing I have ever done in my life. There were times when I was having a really hard time breathing above 17,000 feet, and without oxygen, you are trying to find air. There were others that needed to be evacuated, but I practiced the diaphragmatic things you taught me about full exhalation and re-oxygenation and I swear it saved me—literally saved my life when I did not think I was going to make it”. I have been having my runners work on a breathing cycle with quite good results: inhaling on 2 strides and exhaling on 3 strides. This reinforces not only good respiratory control and reducing hyperinflation, but it also allows them to push off on exhalation on alternating legs to maintain symmetry.
New Technique of the Week!
Read all about Seated Reciprocal Quad Sets with IR HERE! This technique can be found on the 2nd Edition CD Rom in the Left Gluteus Medius section!
Exercise Correction - Two Point Stance
If any of you use the Two Point Stance activity found on the 2nd Edition Non-Manual Techniques CD-Rom you may want to make this correction on your handout! Roberta Delfun, PT, PRC found a mistake on the original exercise! When performing this technique in left sidelying, the right arm should move back on INHALATION and come forward on EXHALATION. The first row of pictures has the 2nd and 3rd picture reversed. To print a new copy, click here!
Great Question!
We recently received this question: Here is our response:
Can You Do This?
Can you achieve a Level 5 Functional Squat grade while also keeping your low traps engaged? Learn more about this new activity in our Impingement and Instability course! Our next course will be in August right here at PRI! To register, click here!
New Technique of the Week
Check out our latest “Technique of the Week”! To read all about it click here!
Integrating PRI and The McKenzie MethodWe recently received an email asking us how to integrate the McKenzie method with PRI. We were so excited to answer this question! To read our response click here!
PRI Repetition RecommendationsIf you have been to a PRI course before and are using PRI Non-Manual Techniques, you have probably noticed a common theme through each technique. Almost every technique instructs the patient to “hold for 4-5 deep breaths in through the nose and out through the mouth and relax and repeat 4 more times”. So…why 4-5 breaths in and out, why 5 times? To read the rationale behind this, click here!
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