Shortening of the internal intercostals and of the lateral abdominal musculature reduces ribcage dimension. Asymmetries of respiration The influence of the respiratory system is significant and often underlies or is complicit with scoliosis and other postural disorders. Summary: Over the course of her last few visits 21 visits total , JP was consistently reporting dramatic and steady improvement in her function.
Standing posture—stands on left leg, left knee hyperextension, left hip shifted to left, left pelvis positioned in swing phase AFER , right knee bent, minimal right weight bearing. The left psoas and iliacus muscles adaptively shorten as the left transverse abdominis and internal oblique muscles are stretched between their insertions on the anterior lower ribs and the now more distal iliac crest.
MD shifted off the right leg to avoid impingement pain. Efficient respiratory mechanics are dependent on neutral body position and muscle function [ 16 ].
The right AIC muscle chain is not constrained by underlying positional insufficiency, and it supports right stance well. The lateral spinal curve was eliminated in five physical therapy sessions of 1 hour each, over a 3-month period by addressing sagittal plane and respiratory dysfunction. Thus, the respiratory pattern is powerful in its contributions to posture. Balancing the frontal plane As the patient becomes stronger and more proficient at maintaining sagittal plane ribcage and pelvic alignment via hamstring and lateral abdominal integration, work begins on balancing muscles of the frontal plane.
As the mid and upper trunk turn leftward, opposite to the right rotation of the lumbar spine and pelvis, ribcage kinematics re-form the shape of the ribcage and its muscular attachments. The pelvic position further encourages the corrective left lateral abdominals, left acetabular femoral adduction, and internal rotation AFIR with right acetabular femoral abduction and external rotation AFER. It has to be understood that results from any further testing of range of motion, or strength, including core strength, would be based on their compensatory strategies. These AIC muscles include the left diaphragm, the left psoas major, the left iliacus, the left tensor fasciae latae, the left biceps femoris, and the left vastus lateralis. Sagittal plane repositioning is most easily achieved in supported positions.
Apposition refers to multiple layers of muscles with differing fiber orientation lying adjacent to one another. Transverse plane: Once the left respiratory zone of apposition was achieved to anchor left anterior rib flare, activities to strengthen right low trapezius and triceps were used to assist with thoracic spine derotation and rib cage balancing.
Fundamental PRI concepts The following fundamental concepts provide a new perspective on effective restorative techniques for treating scoliosis, other spinal dysfunctions, and postural disorders. The right upper quadrant is less full, housing three lung lobes. In her physiological attempts to feel stable, she resorted to end-range positioning via hyperextension. When the thoracic diaphragm descends for inhalation, the abdominal muscles and the muscles of the pelvic floor eccentrically lengthen to allow for visceral displacement caudally [ 16 ].
In stance phase, the pelvis and lumbar spine are rotated toward the stance leg. Consequently, this powerful muscle group is unable to perform its postural function of stabilizing the pelvis, especially during stance phase of gait. Registration is not required for this tour.
Compensatory muscle activity is less efficient, energy demands increase, and stress accumulates on poorly aligned joints. Chronic anterior ribcage elevation decreased diaphragmatic efficiency and resulted in the diaphragm acting as a postural extensor muscle. When the body is in its ideal or neutral alignment, diaphragmatic respiratory mechanics are optimized [ 16 ]. The left anterior ribcage flares, further weakening the overstretched left lateral abdominal muscles. Forward bend—visible left lumbar curve with slightly elevated right rib cage. This equates with musculoskeletal relative balance in a body, which is physiologically and functionally asymmetric.
These flares indicate hyperinflation of the left lung due to insufficiency of the left lateral abdominals. Muscle chain activity supporting left stance is weak. Retraining of alternate, reciprocal, upright gait is the ultimate goal.