Posted 01/30/2012
Lori and Jen just got back from checking out the new 2012 shoes at the Lincoln Running Company. Click Here to see which ones would be the right fit for you!
Leave your comments for Lori below, or send her an email !
Posted January 30, 2012 at 3:36pm by Lori Thomsen.
Tagged With: biomechanics, Cross Training, PRI Concepts, Products, Running • 0 Comments
Posted 01/27/2012
Flag of Hong Kong
PRI, the science of the physical therapy approach developed right here in Lincoln by Ron Hruska, is going global! Not only has it been taught to health professionals all over the United States, the Postural Restoration Institute has also had classes in South Korea and Poland. Now, James Anderson will be traveling to Hong Kong to teach and share the approach that is practiced every day with our patients here at the Hruska Clinic. For more information on the science and all the courses offered, check out the Postural Restoration Institute’s website!
Flag of South Korea
Flag of Poland
Posted January 27, 2012 at 3:10pm by Becky Fisher.
Tagged With: PRI Concepts • 0 Comments
Posted 01/20/2012
As you may or may not know I am a fairly recent transplant here to Lincoln. I grew up in Colorado Springs, CO. Obviously here Big Red football dominates but as I was growing up John Elway and the Denver Broncos was where we invested our loyalties. I still have to root for the Broncos and this year has been fun. Whatever your opinions of their quarterback Tim Tebow are, he has been the big story in Denver and throughout the NFL. A new word has entered our culture because of Tim. Tebowing. It is the act of getting down on one knee and praying, usually with head bowed on a hand or fist as Tim frequently does on the football field. It is now an internet craze where people will have their picture taken in that position in random locations. Google Tebowing for some fun pictures.
Recently, I have come up with a word for an activity that we like to do in the clinic with our exercises. Smunching. Or smunch for short. I looked it up online to see if it has other meanings and apparently it is used by a group in Phoenix to describe eating a Saturday morning brunch. So I guess I can’t trademark it. I like it though. Smunching. It just rolls off the tongue. To me it is part smush and part crunch and describes a movement where you bend your trunk sideways bringing your ribs down toward your pelvis. As therapists we call it side-bending or thoracic abduction. It requires a contraction of your lateral abdominal oblique muscles and is something we encourage on the left side with PRI exercises. Left lateral abdominal muscles (including internal obliques and the transverse abdominis) are very important, wonderful, and yet too often underused muscles that can make or break someone’s success or recovery with a PRI program. They are the next muscle that I want you to be able to feel. Can you feel it? Smunch. How about now.
It is not exactly news that abdominal muscles are important for “core stability” or back stability. What is often missed in traditional exercise or rehab programs is the need to address and correct differences in the position, function and use of muscles on the right and left side. Our philosophy here at the Hruska Clinic identifies and describes a normal, asymmetrical pattern of function. If you have not read much about that I recommend reading some of our other blogs here or on the Postural Restoration Institute website. This pattern describes a tendency to stand and shift our weight more on our stronger, dominant, stable right leg than our left leading to a tendency for the pelvis to drop forward on the left and orient or point to the right. Imagine if there were headlights on the front of your hip bones. In this pattern our headlights tend to point more into the ditch than into oncoming traffic. However, in order to reach with our more dominant right arm and look at oncoming traffic with our eyes we will rotate our upper body back to the left to compensate. When this pattern becomes too active or strong we can run into trouble.
The last 2 blogs I have done described using the left inner thigh and left glute med to line the pelvis back up and get our headlights pointing straight ahead. Unfortunately what has happened above the pelvis in that pattern (the need to always rotate the spine left) has had some impact on function above the pelvis and needs to be addressed. As our spines rotate to the left to reach with our right hand to drive our car, or use the mouse of our computer, or realign our bodies with the direction we want to walk, the rib cage rotates into a position where the right ribs come down toward the pelvis and are anchored with right abdominals, while the left ribs are rotating up and away from the pelvis. The left abdominals are not working and being lengthened which decreases their advantage to work even if we wanted them to. These left abdominal muscles then become weak in their ability to do several important things for us. They lose their ability to stabilize the pelvis on the left side so it won’t drop more forward. They lose their ability to laterally bend the trunk to the left (smunching to the left if you are paying attention). And probably most importantly they lose the ability to pull the left lower rib cage down and stabilize it so the left diaphragm muscle has an advantage to contract and pull air efficiently into your lungs (maximize the ZOA on the left side for you therapists). The left abdominal obliques, and the ability to smunch or get into thoracic abduction to the left, is of utmost importance to make sure the hard work your left inner thigh and left glutes are doing for your pelvis continues to work, as well as to help correct the compensation your upper body has had to do because of the normal positional shift of the pelvis to the right. The abdominals are what is going to integrate or coordinate what your lower body and upper body are doing so they can work together to do things like walk, and run, and go up and down stairs, and breathe, or do any reciprocal activity without excess strain or falling back into old patterns. In our normal pattern the right ribs and muscles are already smunching so we need to really emphasize the left side to create a functional balance.
Many of our exercises emphasize smunching on the left side by either reaching the left hand down towards your feet, arching the left side up when lying on the left, or even passively just positioning you to bend your trunk to the left. You should be able to feel it. But what if you can’t. Probably the most common reason for not being able to feel it in any position is a tendency to use your left back extensor as the muscle to smunch. It will bend your spine to the left but will also extend your back. If you are smunching and you feel your back make sure you round your back a little more and keep it rounded as you smunch. As we talked about earlier the abdominal muscles pull your ribs down which is what happens when you exhale or breathe out. If you hold your breath or are in a state of inhalation your abdominal muscles will have a harder time contracting so another trick is to fully exhale and feel your ribs go down. We will even use balloons or straws to resist the exhalation to feel the abs work. The key is then to try and maintain that feeling as you use your diaphragm to breathe in. If you lose your smunch when you breathe in we are never going to get anywhere. Sometimes when lying on your left side it can help to roll up a towel and put it under your left side to give yourself a feeling of where to smunch. In standing or squatting if you let your back extend and your pelvis drop forward you will stop feeling your abs and the back will take over. Think about reaching your knees forward as you squat to keep the pelvis tucked and abs on.
I can only hope that smunching (to the left) will become as much a craze as Tebowing has. But until we get a polarizing athlete to do more smunching I think Tim will have a definite edge. I personally am still going to try and see if we can make it a craze one patient at a time. If you all get creative feel free to send or post some smunching pictures and maybe we can start this craze and help people all at the same time!
Smunching for exercise…
Smunching while reading…
Smunch-bowing???
Questions for Torin? to send him an email. Or write your comment below!
Posted January 20, 2012 at 1:43pm by Torin Berge.
Tagged With: Abdominals, Breathing, Diaphragm, PRI Concepts, Thoracic Abduction, Zone of Appostition (ZOA) • 1 Comment
Posted 01/12/2012
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. (Figures 1 & 2)
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.
Leave a comment for Jason! Or to send him an email.
Posted January 12, 2012 at 3:08pm by Jason Masek.
Tagged With: Breathing, Diaphragm, Exhalation, Fixed Point, PRI Concepts, Respiration, Ribcage • 0 Comments
Posted 01/10/2012
In my last blog I wrote about feeling the love of the left inner thigh muscle with PRI exercises to help with our ability to shift our body weight to the left to achieve and keep a neutral position of our pelvis. If you missed it, feel free to read it here. Hopefully you were able to feel your left inner thigh while shifting your weight from side to side as you stood in line buying (or returning) those last minute Christmas gifts. I also hope that the abundance of holiday music like “I’m dreaming of a White Christmas” or “Jingle Bell Rock” on the radio and in the stores helped clear the chorus of “Can you feel the love tonight?” from your mind.
As we shift (get it?) into a new year I want to shift to a new muscle for this blog. One of the next muscles that we usually emphasize with our programs is the left gluteus medius, or glute med. This muscle has several important functions that are desirable in having success with a PRI program. These include turning the thigh bone (femur) in (internal rotation), and probably more importantly stabilizing the pelvis over the head of the femur once we have achieved the proper shift into the left hip with the left inner thigh (adductor) muscle. This is especially important in standing positions and walking to allow us to keep that proper weight shift to the left and not revert back to the overactive tendency to stay shifted to the right side. If the glute med is ineffective, due to improper position, or weak, your ability to maintain a neutral pelvis with upright activity or walking will be challenged. That is why our exercises will progress from just finding and feeling the left glute in a lying down position gradually to an upright position when your therapist feels you are strong enough. If this is progressed too quickly and the left glute is not felt or strong enough pelvic neutrality will be lost and our program will stall and so will your recovery. So let’s make sure you can feel it…
If the glute med is appropriately working, it should be felt on the side and back of your hip behind your hip bone (think of your left back pocket), not in front. If you do not feel that muscle work when we want it to there are a few hints that we give to help you feel it. First of all you need to be able to fully shift into your left hip with your left inner thigh, so if you cannot feel your left inner thigh you will be challenged to feel your left glute med work properly. Therefore, all of the issues that can prevent you from feeling your left inner thigh may prevent you from feeling your glute. This includes things like hip capsule flexibility, right inner thigh over use, and lack of right chest wall mobility. See my previous blog if you need reminders. There are a few other issues I want to high-light specific to the left glute med.
The muscle on the side of your hip in front of the hip bone (the tensor fascia lata, or TFL) will commonly try to help internally rotate your thigh bone instead of your glute if it (the glute) is in an improper position or weak. If the pelvis is forward, as is common on the left side, the TFL becomes better positioned than the glute to turn the thigh bone in and becomes overactive. It also will flex the hip and pull the pelvis further forward limiting the ability to keep the pelvis in a neutral position. This is not what we want, so the TFL is not a muscle we want to feel with any exercise that requires turning the left thigh bone in. So if you feel the front of your hip working when you turn your left thigh bone in we need to do something to stop that. First of all we need to make sure you are in the proper position (fully shifted into your left hip, left knee/hip back behind your right). Then, in order to shut off the TFL, we sometimes will cue an active isometric contraction or muscle squeeze into hip adduction and/or extension by either squeezing the left knee down into the right or pushing the left thigh back into a chair or door frame prior to rotating the thigh bone in. This should help.
Another important thing that may help is to make sure that your left ribs are fully pulled down with your left abdominal wall (full left ZOA for you therapists out there) to achieve full stability on your left side and maximize the proper position of the left pelvis and glute. This will be highlighted more in my next blog.
As we stated above the left glute med is important for hip stability in standing and walking positions. Once you have adequate strength in a lying down or seated position we need to get you to feel the left glute work in a standing position. The most important factor is to make sure that you have achieved a proper standing hip shift back into your left hip with your left hip back, your right hip forward (pelvis pointing to the left) with weight on your left leg (left AFIR position) and without extending your back. If you are not in that position your glute will not be in the proper position and you will not feel your left glute work as effectively as possible. One of the cues in stance that we use for this is similar to the left adductor in that we want you to feel your right shoe arch when standing and shifting to the left to inhibit the right adductor and allow the pelvis to fully shift to the left. This is one of the reasons why proper footwear and foot position is so important with upright activity. Don’t transition to a single leg activity on the left leg until you are fully engaged and into the proper position or your glute and program will be challenged.
If you are doing your exercises at home and cannot get your left glute to engage or your front hip to relax during exercises aimed for your left glute med be sure to let your therapist know so they can help you find a way to feel it. And hey, no corny song that will get stuck in your head this time. Besides, the only one I could come up with for the glute was Sir-Mix-A-Lot’s “Baby Got Back…” Oops… sorry.
Questions for Torin? to send him an email. Or write your comment below!
Posted January 10, 2012 at 3:57pm by Torin Berge.
Tagged With: • 0 Comments
Posted 12/29/2011
P.A.S.S. the Competition running clinic will be held on Saturday, February 4, 2011! Don’t miss this clinic, with cutting edge information you won’t find in traditional running magazines.
Sponsered by Hruska Clinic, Restorative Physical Therapy Services, this clinic is designed for the runner looking to improve performance, hit PR’s, and to avoid injuries. A unique and powerful approach to running in relationship to Position, Agility, Strength and Speed will be provided through demonstration, exercises, training programs, and nutrition education. Lori Thomsen, MPT, PRC and Bridget Easely, R.D. (who recently qualified for the Olympic trials in January 2012!), are the speakers for this course.
Click here for more information! To email Lori, …
Posted December 29, 2011 at 11:18am by Becky Fisher.
Tagged With: Events, Running • 0 Comments
Posted 12/22/2011
Often I have patients who enjoy lifting weights ask me: “When can I squat again?” They ask because they’ve been educated to know that a large part of the reason they’re in our clinic seeking treatment is because they have a forwardly tilted pelvis and a strong tendency to arch their backs backward, and that doing resisted squats with a barbell on their shoulders will make it difficult to get out of this position. This is because when they do squats with a barbell on their shoulders, they have to arch their backs, which is not something we want when going through a PRI physical therapy program. I think many postural restoration therapists would tell a weight lifter that they should NEVER perform a resisted squat. As a former power-lifter, a former patient at the Hruska Clinic, and now a certified PRI therapist at the Hruska Clinic, I have a slightly different perspective, though don’t misunderstand what I am about to say. Don’t tell people that Dave at the Hruska Clinic says its okay to squat, if you don’t inform them of the parameters REQUIRED before I allow them to squat.
If a person cannot perform a full functional squat (See photo 1) without cheating, and without falling over, they have absolutely no business squatting with a barbell on their shoulders. I also feel it is important for a person to be able to touch their toes (See photo 2) without straining and without stretching their hamstrings before they can squat. The reason is because if you can’t do a full functional squat or touch your toes then you still do not know how to live without depending on your back and you’re only going to make matters worse if you squat with a barbell on the shoulders.
After my patients have reached these parameters, I still make suggestions as to what they could do to work their legs aggressively while minimizing back activity. I suggest squatting on a platform holding dumbbells (See photos 3-5). If you look at the pictures provided you’ll see that my back is rounded as I perform this squat with the dumbbells. Try to do controlled reps…you don’t have to go super slow, but don’t rush through them either. You should also keep your weight through your heels and don’t rock forward over your toes. This will help you get a great sense of your quads and glutes working. Taking short breaks (30-45 seconds rather than, say, several minutes) between sets will help to intensify your workout. Another option for working the legs would be walking lunges (See photos 6-7). I would suggest that you be sure your heels strike the ground before your toes or forefoot, and maximize pushing your weight through your heels rather than your toes/forefoot throughout the exercise. The key to keeping your back activity to a minimum is to stay rounded through your back. Try reaching for or touching your toes as you do this. If this doesn’t sound like much of a challenge, try walking a hundred yards this way…go get on a local football field and see how your quads and glutes feel afterward. If you’re trying to minimize your reps and maximize your leg strength say for football consider hip sledding, seated leg presses or supine (on your back) leg presses as you’ll be less likely to overuse your back compared to squatting with a barbell on your shoulders.
With this all said (not forgetting that you ALWAYS need to be able to perform a full functional squat and be able to touch your toes) I do feel for a select few individuals (i.e. a football lineman come to mind) squatting is an appropriate exercise. Few others in my opinion really have a need to squat with a barbell on their shoulders. If you truly can perform a quality functional squat without compensation, can touch your toes, and you decide to do barbell squats, you’d better frequently be checking to see if you can maintain these parameters or you’re increasing your risk for injury.
Photo 1
Notice with the functional squat, my knees/legs are not rotated out but rather they are forward and parallel to each other. Also my back is rounded and my heels are down.
Photo 2
With the standing reach test, my legs are straight, my back is rounded, and some, but not all of my movement is coming from my hips, yet I am able to touch the floor.
Photo 3
Photo 4
Photo 5
As seen in photos 3-5, squatting can be done holding onto weights for the purpose of being able to better stay rounded through your back than you can do if you place a barbell across your shoulders. You may not be able to handle as much weight this way, but try increasing the number of reps and reducing the wait time between sets. Many people would argue that this is more of a deadlift than a squat. In any case, holding the dumbbells rather than a barbell reduces the chances of extending through your back.
Photo 6
Photo 7
I prefer a walking lunge where you’re reaching towards the floor as shown rather than holding the trunk erect because you’ll be less inclined to use your back. You’ll get a great leg and butt workout while keeping your back muscles relaxed.
Posted December 22, 2011 at 3:13pm by David Drummer.
Tagged With: Squat, Weightlifting • 2 Comments
Posted 12/21/2011
I recently joined a new gym to begin my training for the Lincoln ½ marathon coming up in May. I definitely prefer to run outside, however the snow, ice, and freezing cold temperatures keep me confined to the gym in the winter months. O the joys of living in Nebraska, however the Husker football easily off-sets the weather!
A recent trend in exercise equipment in almost every gym is to have a television screen mounted directly to the piece of equipment (see picture below). Most people love this new feature because they can choose what they want to watch and directly plug their headphones into the treadmill and listen to the television program. As much as I enjoy watching television, I would prefer to run on a treadmill, elliptical or stair stepper without a screen 12 inches in front of my face because I feel better physically….this however is not an option at my gym (every piece of equipment has a television screen).
So, why am I concerned about working out with a television screen directly on the machine?
1) Staring at a television screen 12 inches in front of you causes your body to extend (your back to arch backwards). This results in compensatory activity of mechanics involving your trunk, hips, knees, etc. leading to possible injuries throughout your body.
2) Being locked into a visual stimulus this close and straight ahead of you results in focal vision, and eliminates your peripheral vision. Focal vision is your narrow, straight ahead vision (think of tunnel vision). Peripheral vision, which is the awareness of what is around you to your left and right helps to facilitate flexion of your body 
, whereas focal vision is associated with increased extension tone. Ideally I love for my patients to look around when they run (you should be aware of your surroundings, both to the left and right, rather than staring at the ground or something directly ahead of you).
3) Visual and audio stimulation can increase sympathetic activity of the central nervous system which also leads to increased extension tone.
So, I challenge you to avoid watching a television program next time you are working out. Your back, knees, hips, etc. may thank you! Maybe have it on, but only occasionally glance at it. Or glance at televisions around the area that are not so close to you. Try to look around the room or the gym. I find it enjoyable to look around the gym and analyze individual’s posture and mechanics, therefore taking my eyes of the television is not too difficult for me!
Posted December 21, 2011 at 9:47am by Jennifer Gloystein.
Tagged With: biomechanics, compensatory activity, focal vision, peripheral vision, Running • 2 Comments
Posted 12/07/2011
I typically get my blog ideas for clinical experiences, and over the past week, I had a couple patients who were having trouble with their home exercise program that I had given them. Both patients were experiencing upper back/neck tension with the exercise shown below. This exercise should relieve tension (not cause it) when performed correctly. Therefore, I further analyzed the patient’s performing this activity. In both cases, the problem was that they were not exhaling correctly. One individual was exhaling with “pursed” lips, while the other was exhaling very quick and forcefully.
Those who have been to our clinic know that breathing is important with every exercise you do! Respiration is the foundation of the science of the Postural Respiration Institute™. Exhalation is the focus of today’s topic. There are several reasons why we emphasize patient’s breathing correctly with our activities, but most importantly to appropriately using the diaphragm as a respiratory muscle rather than a postural stabilizer, to help us get into a “neutral” or flexed position, and to minimize use of accessory (neck) muscles to help breathe on the next inhalation.
I had to teach both these patients to exhale correctly, and when doing so they had no tension in their upper back or neck performing the exercise. The exhalation phase of breathing should be about three times longer than the inhalation. If one does not fully exhale all the air, then “dead air” remains in the chest wall, your ribcage remains elevated and externally rotated, and muscle tension develops in your neck and shoulders. We sometimes use a spirometer to measure the amount of air you can exhale, which is often decreased. If you never get all the air out of your body, you cannot fully inhale because space in the lungs in being occupied by the “dead air”. Not only is this important for decreasing muscle tension, but air exchange controls oxygenation of our body. When we inhale, we supply our body with oxygen, and with exhalation we eliminate carbon dioxide. If you have “dead (non-oxygenated) air” in your chest wall, you cannot fully re-oxygenate on inhalation, and you may be fatigued easily, get out of breath with simple activities such as going up a flight of stairs, get headaches, not sleep well or wake up tired after a full night of sleep.
To help these two patients over the past week, I really encouraged a full exhalation. I am often saying “Blow all the air out, every last bit drop of air that you have in your lungs.” I often utilize tools such as a straw, party favor or balloon to help the patient realize they are getting the air out, as well as provide a small amount of resistance which engages the abdominals and assists with pulling their ribcage down into a depressed and internally rotated position assisting them to get all the air out. So, please consider, have you (and/or your patients) been exhaling correctly (and fully) with PRI activities?
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Posted December 7, 2011 at 10:49am by Jennifer Gloystein.
Tagged With: Balloon, Breathing, Diaphragm, Exhalation, Headache, PRI Concepts, Respiration • 2 Comments
Posted 12/06/2011
The Hruska Clinic is proud to announce that Jen Gloystein and Dave Drummer are now Postural Restoration Certified! Certification is a result of advanced training, extraordinary interest and devotion to the science of postural adaptations, asymmetrical patterns and the influence of polyarticular chains of muscles on the human body as defined by the Postural Restoration Institute™. The certification process of both clinical and analytical examination took place on December 5th and 6th at the Postural Restoration Institute™ under the direction of Ron Hruska and James Anderson. There are now 79 therapists nationwide recognized as Postural Restoration Certified - this includes Jason Masek and Lori Thomsen, also on staff with us. Congratulations!
Hruska Clinic Restorative Physical Therapy Services
5241 R Street, Lincoln, Nebraska 68504
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