This series is all about my experiences at this years Boston Sports Medicine Performance Group seminar. In it I will be sharing with you my notes from each of the lectures I attended, the big lessons I took away and what I think we can learn as coaches from them.
In part 1 I covered Professor Robert Sapolsky’s keynote presentation on human stress response. In this instalment I will be talking about Dr James Anderson’s presentation on the role of the diaphragm in sports performance and postural restoration institute at large.
Presentation 2: Dr James Anderson
For the uninitiated here is my (poorly informed) explanation of what PRI is: postural restoration is a system of physical therapy which emphasises the role of posture and joint positioning in creating mobility and stability in the relevant segments throughout the body. The theory goes that if the body is poorly positioned, we compensate by asking big, mobilising muscles to take on the role of smaller, stabilising muscles which robs joints of their mobility.
By repositioning these joints (using the respiratory musculature as the foundation of this change), we create stability in the right areas using the correct muscles, in the process freeing up the big muscles to do their job.
- Performance athletes is largely about explosive extension (of the hips, knees, ankles, elbows and shoulders).
- A big problem with athletic populations is that they are already in positions of extension in the thoracic spine before they perform this athletic movements. Extension plus extension equals hyper extension.
- Hyper extension in the thoracic spine exerts pressure on posterior mediastinum- a part of the thorax which when pressured creates an increase in the sympathetic tone of the autonomic nervous system (responsible for the fight or flight mechanism)- this is not a good thing.
- Athletes typically go into thoracic hyper extension to utilise the accessory respiratory muscles (intercostals, sternocleidomastoids etc.) to make up for their lack of ability to properly use the diaphragm during breathing. This creates rigidity in the thoracic spine, reducing mobility.
- Proper breathing mechanics can reduce the load on accessory muscles, reduce thoracic hyperextension and reduce sympathetic tone (a good thing in reducing chronic physiological stress, increasing capacity to mobilise against stress, and creating joint mobility. For a simple example of how this works reach overhead as far back as you can with a big breath held in your chest, then repeat it whilst exhaling out using your diaphragm. Hey presto, new mobility.
- Creating movement is all about inhibition rather than activation. The body typically has all the movement it needs, it is just not able to access it because of overactive muscles or poor positioning elsewhere within the body. Dr Anderson demonstrated this in a couple of interventions during the presentation and it certainly looked impressive.
- To create movement: identify overactive musculature, re-set nervous system tone, work through new range to reprogramme the movement pattern.
At this point Dr Anderson started to go way over my head, talking about asymmetry in the positioning of the diaphragm, how the ribs of each side of the body move independently of one another, how breathing can influence gait pattern etc. It was some seriously detailed anatomy and motor control obviously targeted at physical therapists only.
A video example of using PRI techniques to increase thoracic rotation:
Lessons I took away from the presentation
I found the presentation both interesting and thought provoking. However in reading up on the postural restoration institute online and speaking to more qualified people than myself at the seminar, there are a few common criticisms of PRI which can be applied to this presentation:
There was no peer reviewed evidence (that I am aware of) to support the claims made about the movement/role of the diaphragm in mobility and stability elsewhere in the body. Likewise there is no evidence to document the long term effectiveness of PRI interventions on meaningful data e.g. injury rates.
If the claims are basic and simple to understand (like the bullets I listed above) then I am happy to give something a try without evidence. However when getting into really detailed concepts or large claims, I would like to see more evidence to back it up- not necessarily peer reviewed, but at least something. I may be wrong and this may just be another case of best practice being years ahead of research. Time will tell.
An additional concern is that whilst PRI techniques may create impressive improvements in mobility in a clinical setting- lying down on a couch, relaxed, under the influence of a persuasive practitioner- do these changes actually stick? What happens when the athlete is stood up, under fatigue, in motion and with their mind on other things? Do these changes actually translate to the real world? If not, then does the intervention actually work? This is also a major criticism of the FMS, of which I am a fan. However in the defence of FMS it is stood up and the athlete receives no coaching on movement technique.
Lastly in the pursuit of repositioning athletes and getting them back to an “ideal” positioning of the various segments of the spine do we not risk throwing out the baby with the bathwater? For example in the PRI model, the lumbar hyperextension seen in many high level sprinters would be a no-no. However there is decent evidence to suggest that this posture increases tension in the hamstrings during hip extension and increases stride length. Rather than hurting performance, it is probably a sporting adaptation that actually helps performance. Should we be messing with this?
At the very least though this presentation his reaffirmed the need for me to focus on good breathing mechanics in my athletes, to understand the role of the thoracic spine on multiple other joints throughout the body, and to emphasise inhibition of overactive muscles rather than activation of inhibited muscles in the pursuit of better joint mobility and stability.