Blog Entries by Jason Masek
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.
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Posted 11/28/2011
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…
Posted 02/07/2011
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.
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Posted 11/04/2010
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”!!!
Posted 08/19/2010
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.
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Posted 07/12/2010
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.
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More blog entries can be found in the archives…
