If you haven't already read part one, then check that out first. Aside from the overview in part one, here are some other key points I took away from PRI's Postural Respiration.

*The diaphragm often gets stuck acting as a postural muscle instead of a respiratory muscle when things are out of whack/position. Position needs to be restored and diaphragm needs to restore its respiratory function.

*Right hemidiaphragm pushes air into the left lung and left into the right lung. Since we favor our right hip and have our liver on the right, we have an easier time getting air into the front of our left chest wall and a harder time getting it into our right anterolateral chest wall (mentioned this in part one). We need to get air into our left posterior mediastinum (posterior thorax) and right chest wall better. An important component of making this happen is developing our left abs (obliques) to help balance out the stronger right diaphragm.

*We often need to hypoinflate left ribs and hyperinflate right ribs; maximize exhalation on left and inhalation on the right and alternate.

*Neutrality is found when the diaphragm is contracting without the expense of extension and there are smooth transitions between left and right during gait. (Someone with an anterior tilted pelvis and hyperlordosis in the low back will tend to extend excessively to breathe, leading to unwanted back stress).

*Underneath every symmetrical movement is an asymmetrical challenge. I.e even if you are doing barbell squats bilaterally, there is still a war going on between left and right underneath that double leg squat. This supports my belief that bilateral and unilateral training should have a good balance in a program to keep things in check as doing only bilateral work will ultimately lead to an overpowering side (can you guess which one).

*Positions proceed patterns. To change a pattern, we need to reposition first. For example, if a muscle is not firing correctly or a muscle is inhibiting another muscle, we need to check position first because without proper positioning, neuromuscular patterning/firing will be off. If we restore position and THEN there is a neuromuscular problem, we can deal with it. Same story with movement in general. Until we get control of our pelvis and ribs, movement won't be ideal.

*The sphenoid, sacrum and sternum are the base points that all positioning branches off of.

*Modern day ergonomics lock us into the patterns mentioned earlier. We need to get out of them.

*Since the left brain has more responsibilities for speech and language and controls the opposite side of the body, the right upper extremity becomes dominant with communication, development and growth. This pattern needs to be balanced with neurologic and muscular activity on the left.

*The normal imbalances mentioned need to be regulated by reciprocal function with walking, breathing and turning. When they are not, weakness, instability and musculoskeletal pain often results. “Balancing muscle activity around the sacrum (pelvis), the sternum (thorax) and the sphenoid (middle of the head) through a PRI approach best positions multiple systems of the human body for appropriate integrated asymmetrical function.” This quote is taken from the PRI manual and sums up a real good point. It is a matter of being positioned well enough to work effectively in our normal asymmetrical state. This is what neutral means. Many people (including myself at first) get confused when they talk about neutral. Neutral does not mean symmetrical. It means being able to control and function optimally with the normal asymmetries that our body has and is supposed to have while avoiding overcompensations, pain and performance detriments.

*Being out of position can often stem from neurological reasons. For example, if you experience some kind of trauma whether it be an injury, an event such as a car accident or abuse, your body will generally go into sympathetic fight or flight mode.  When you go sympathetic, your body has a good chance of falling deeper into these positional patterns mentioned earlier.  So, you might be out of position (i.e. left AIC pattern or PEC pattern) as a result of your fight or flight response.  I actually have a client who was doing well improving her left AIC/right BC pattern (shifted right, pelvis rotated left side forward, poor apical expansion on the right, left rib flare, etc.) and getting rid of pain nicely.  She then got into a car accident and she went backwards, getting back into her old habits again. This was most likely a sympathetic response from the accident.  A month after the accident doing the appropriate exercises and drills, she is better than ever.  It is a very fascinating phenomena.

*Everything from vision to in uterine position can influence asymmetrical habits and patterns. Take someone who has had Lasik eye surgery and you will probably see some changes in muscle tone in their back, balance and certain patterns since their brain now has a changed sensory input with the improved vision and depth perception.

*A flat thoracic spine will result in an unstable scapula. Until flexion is restored, many scap exercises will not be as effective. In my experience and past learning, its usually been about improving thoracic extension. Many people actually do need better thoracic flexion.

*We need to get serratus anterior, low trap and tricep functioning optimally so that we can reach without excessive spinal/trunk rotation and maintain a stable position of our ribs and spine

*After digging into this stuff, I am amazed at how many people I see out in public standing on their right hips, with their left legs crossed into external rotation and/or right legs crossed into adduction/internal rotation, right shoulders lower and so forth.  These patterns start to emerge right in front of your eyes.  The assessments I have been doing (didn't cover this specifically in this article) continue to follow suit with much that the base courses cover as well. 

In conclusion, it was a great course and on top of the things mentioned here, I picked up some great manual techniques and exercises to help facilitate better breathing function in people. I look forward to exploring the rest of their courses and deepening my understanding of the complex and asymmetrical body that we as humans live with.  There is always so much to learn.

If you'd like to dig deeper, I'd highly recommend looking up stuff by Bill Hartman, Zac Cupples, Patrick Ward and Eric Oetter to name a few.  They all have some brilliant insight with this material and have been studying it longer than I.  Of course, you can also go to the source at posturalrestoration.com  Thanks for reading.

(This picture will make sense later)

I recently took a great course put on by the Postural Restoration Institute (PRI) called Postural Respiration (actually a few months ago; its just taken me forever to get to this article with my oh so crazy schedule).  PRI holds multiple courses that deal with analyzing, treating and dealing with imbalance in systems of the body. The main idea behind their practices is the fact that the human body is asymmetrical by nature. No human being is meant to be perfectly identical side to side. Some main facts about our static design show this: We have a liver in our right abdominal cavity, a larger hemi-diaphragm on the left, a pericardium and heart that is on the left and three lobes on our right lung versus two on our left. Because of these major static asymmetrical design components, we develop dynamic asymmetries that come about with our everyday functions.

We tend to favor and stand on our right hip with our left pelvis rotated forward (right hip becomes adducted/internally rotated and left becomes abducted/externally rotated), crunch down on our right trunk/ab wall, and rotate our upper thorax to the left to counteract the pelvic rotation to the right, creating left anterior rib flare and right posterior rib hump. They classify specific patterns that we fall into as Left AIC (anterior interior chain), PEC (posterior exterior chain), BC (brachial chain, usually right bc) and other patterns up into the head/neck/face and vision. I'm not going to get into details of these for the purposes of this article but they basically specify certain chains of muscles that are overactive or inhibited with different positions we get stuck in, in most cases right being different than left.

Continuing on, with our liver on the lower right and heart on the upper left, we tend to get air into our left chest wall better than our right. We have more lymphatic drainage on the left. Left and right parts of the brain control different sides and areas of the body. The list goes on. We are asymmetrical animals. This is normal.


Ok so what is the purpose of analyzing and treating people then if this is normal?


With these asymmetries present, we still need to have the ability keep things “in check” and function effectively for activities of daily living and sport. Looking at gait (they base everything off of this), we need to reciprocally get into and out of our left and right hip with adequate rotation and movement of our thorax, ribs and extremities. Right hip and left arm move/work together, left hip and right arm together, etc. etc. Problems come about when we lose the ability to keep things in check and can no longer get out of that right hip and fully into the left as we move. We get stuck on the right and in a half assed attempt to make the left work, we jack the left hip out of place and activate stabilizers on the right side excessively to try and stay upright and functional. This carries up to multiple compensations in the abdominals, thorax, shoulders, head, neck, face and eyes and down to the knees, ankles and feet.

At the root of all of this is our breathing; our diaphragm function. Breathing is what controls everything else in the body. If our breathing is off, something else is pretty much guaranteed to suck. If something else sucks, then you better believe that even something else is going to start sucking. You get the idea. When our pelvis is out of position (left side forward, shifted right) our thorax rotates the opposite way in an attempt to get ourself somewhat centered. When this happens, our right ribs tend to get stuck in a state of exhalation and our left ribs in a state of inhalation (look at rib flare). When we don't get air into our right chest wall due to this occurence, our right shoulder gets out of position and compensations, pain and injuries can then occur there, such as losing internal rotation on the right shoulder and losing horizontal abduction on the left shoulder. This is not a situation where “stretching” would be needed to gain internal rotation. Simply repositioning the ribs and sternum and restoring airflow into the right chest wall will allow IR to return on its own. I have gotten multiple clients back to full IR without touching their shoulder since I've started experimenting with this stuff.


Again, breathing function and mechanics are at the root of all of this. Many people, in our society especially, tend to get stuck in a hyper inflated state of constant tension, never fully exhaling and never fully relaxing. Their brains get stuck in sympathetic fight or flight mode, leading to excess tension in muscles, nerves and organs throughout the body; hello back and neck pain. Instead of having a zone of apposition (ideal alignment between ribs, pelvis and diaphragm to get optimal airflow with inhalation and exhalation), many develop a “zone of anxiety" where hyperventilation and panic lives. Without proper breathing, our brains freak out and start causing chaos in our muscles, nerves, joints and movement. Restoring full exhalation allows us to get back towards parasympathetic, rest and relax mode or at least somewhere closer to the middle.



Parasympathetic (Rest & Relax)----------Sympathetic (Fight or Flight)


Some people just need to breathe, period. Some need to get air into their right chest wall better. Some need to stop using their neck muscles to breathe. Some need to stop breathing with all belly and get their sides and back involved. Some need a combination of all of these things. Bottom line is: breathing is the key to many, many things that are kind of a big deal. You know, like brain function, blood ph levels, emotional stress, organ function, movement, joint alignment and position, walking, fatigue, sports performance, pain, relationships, sex, crushing heavy weights. Cool things like that!

So, if your pelvis and ribs are out of position, breathing will be off and if your breathing is off, pelvis and ribs will probably have an easy time being out of position, and if all of this is happening, other things are going to suck. Restore position, restore breathing and you will be golden (and less things will suck).


This is just the surface of a nutshell of what is all covered with these courses and their research and study. Specific assessments, treatments and exercises are used to identify exactly what issues someone is having (that is usually causing pain) and to improve the problem at hand and get people back to neutral. (Neutral meaning we can function effectively without excessive compensation; there will still be some natural, normal asymmetries no matter what).  In my next post, I will go over some other key points that I took away from the course.