The past few weeks I have been chipping away at Postural Restoration Institute’s online CEU course, Myokinematic Restoration. For those that are unfamiliar with the course you can find out more info on their website.
There were a few things that led me to take this course. One, after talking to some practitioners that have taken the course it did confirm that I likely fall into the typical left AIC pattern discussed throughout the course. Lots of people assume as a physio my body must be functioning perfectly, but any physio will tell you that we are all far from it. In fact, often we are hyperchondriacs when it comes to how our bodies are feeling. Secondly, over the years of practice I have noticed a lot of patients present fairly similarly when it comes to their potential imbalances around the pelvis. For both these reasons, I decided it was time to take the plunge.
Overall, I thought the course was very good. The presenter on the online course was a very good speaker and knew his information inside and out. As a Kinetacore instructor I was very impressed with his presenting skills and ability to make the complex simple. Probably my favourite part of the whole course was the detailed review of biomechanics. In a world of pain science and biomechanics doesn’t matter to practitioners anymore, it was a breath of fresh air to get down to the nitty gritty of biomechanics and how it may relate to function without being overly complex. Notice I said function and not pain. The detailed review of how different pelvic positions may impact certain muscle function and vice versa was excellently presented and I would recommend the course mostly just for that.
I know a while ago I wrote about how pelvis alignment doesn’t matter, but the summary of that post still holds true despite the potential confusion of this post where we discuss why it may matter. In summary, that article says that your pelvis can go out of alignment, but it likely doesn’t matter and if we did want to correct it, it would come down to improving our ability to load our distal extremities and regain balance through our core/thorax anyway. Another key point is that practitioners aren’t putting you back into place with any techniques, we are really just restoring movement and function through your hips, extremities, pelvis, and thorax and hoping to create a window of opportunity for you to then move properly and teach you the patient how to re-load your body to function a bit better.
Before I get down into some more detailed info I will briefly list the few negatives of the Online course:
- Not being able to ask questions. Definitely have a few questions I wish I could have asked in person that I wasn’t able to get answered right away. Luckily, I originally posted this blog and then someone emailed me promptly to answer them! So I have taken the questions down now. Great customer service
- Though I do think this stuff matters I do still think a majority of patients just need an overall better S&C plan in their lives and an increased awareness of their loading/movement strategies during day to day life. I see this being useful for patients that may clearly fall into the pattern (like myself) and/or have ongoing issues that seem to correlate to muscular imbalances around the pelvis. I do not think this is the be all and end all that may have come across in the course presentation.
- The second half of the course seemed a little harder to follow as a lot of it was the instructor going around answering peoples questions in lab and also reviewing exercises out of the manual. It could have just been me though as I always am not the best in-lecture listener. They do recommend doing this course with a partner, I didn’t so that is partly my fault. I would recommend doing this course with someone if possible to play around with the assessment and exercises as it goes along.
I won’t talk about the details of the course too much, but above you can see a picture about what maybe an exaggerated Left AIC pattern may look like. In summary some of the muscular positions may look like this:
- Tight abductors/external rotators pushing us to the right
- Tight hip flexors/erectors
- Lengthened hamstrings and adductors
- Lengthened abdominal wall
- Lengthened abductors/external rotators
- Tight adductors causing internal rotation of femur
- Shortened hamstrings, lengthened hip flexors
- Because of decreased gluteal/external rotation function, more passive sitting into joint capsule
- Crunched up abdominal wall/QL
The goal of PRI is basically to get us sitting into our left hip capsule more, by utilizing the left adductors and hamstrings, and right external rotators. More on that in future posts.
Some of the things I liked most about the PRI course:
- A focus on rotation.
If you have read my blogs before you probably know I am a big fan of viewing the body in terms of rotational ability at each joint. From midfoot, subtalar, proximal/distal tib-fib joints, tibiofemoral, femoroacetabluar etc. I am a big believer that often times our dysfunctions that may lead to pain often lie in the transverse plane assessment of the body. The sagittal and frontal planes are still very important and too little movement in these planes can lead to excess motion in the transverse plane which is important to note as well. The PRI course does a good job explaining how the lack of or excessive rotation in certain areas may be dysfunctional for performance and potentially result in pain. It aligned with my already pre-disposed thought process…..of course I loved that!
- An explanation for some of the things I have noticed clinically
Decreased ability to feel left abdominal wall contract?
Decreased left hip IR?
Decreased right hip ER?
The body tends to shift so you stand on your right leg more dominantly?
More pronation on left foot, more supinated on right foot?
Perhaps the sense that your left glute doesn’t fire as well as your right glute? Could be the other way, but typically I find more people struggle with left glute activation.
These are all findings I can often see on a lot of people. If you notice any of these in your assessments it may be a worthwhile course to take to form a better understanding as to why a lot of people may present that way.
- Focus on muscular activation to correct imbalances
So clearly PRI believes that pelvic imbalances exist and are important to function and pain. As I mentioned earlier, no practitioner is putting you back into place, if you feel out of whack it is really going to come down to re-training your body how to LOAD properly!! No matter if you are the most pain science focussed therapist out there I think you could benefit from learning PRI’s theories and exercises. Heck, if you hate manual therapy and think therapy should only be exercising I would recommend it even more!! If you are going to correct how your pelvis is positioned and loading than you are going to have to retrain certain motor patterns and firing strategies to do so. PRI does a great job of this and I am looking forward to playing around with all the exercises in the book. Even if you think correcting imbalances around the pelvis doesn’t matter because everyone is imbalanced there are still a lot of great exercises to help with various muscle activations and inhibitions which I think most of us can agree on could be helpful for everyone. I definitely think you can implement PRI principles without being a fear mongering therapist and focus on overall function and movement ability of the individual still.
- Activate to Inhibit
Similar to the note above and really a lot of what FRC talks about too, is you can’t just stretch or foam roll a neurologically tight muscle. In easy to explain terms these are the muscles that continue to be tight no matter how much you stretch or foam roll them basically and have a certain taughtness to them that is different than a muscle that could have developed some tension through exercise or daily life. To calm these muscles down and get them to relax it’s often a much more complicated game than smash and stretch the area. Often these areas might actually need to do some isometric work (PAILs) to get them to calm down, or sometimes we need to try to activate other areas to get that area to calm down. PRI is all about the latter, which I think is important that this continues to be an emphasis in the rehab fields.
- Looking at things from the opposite perspective
This last point I think is important too as typically when we think of joint movements, in particular around the hip, we think of the femur moving on the acetabulum. In PRI however, there is a large focus on Acetbaulo-Femoral (AF) motion, where the acetabulum moves on the femur. This is of course important because in close chain activities, like the stance leg of gait, the pelvis is going to be what moves around the femur. So by focussing different exercises on AF motion vs purely FA motion it can allow us to restore motion about the pelvis in a more functional way than just cranking some banded exercises of FA motion.
Overall it was a very good course and I would recommend it to most practitioners mostly for the detailed review of biomechanics, but also for the overall theory, a new perspective where you can pick and choose what you want to use and not use, and some great exercises to regain function around the pelvis.
I’ll post again in a week or so with a review of some exercises after I play around with them a bit more. Thanks for reading guys and if you have any questions let me know!