The Postural Restoration Institute (PRI) has exploded onto the scene and changed the world of physical preparation more then any other system in recent memory. More strength and conditioning coaches are talking about cornerstone principles of PRI such as respiration, joint position, the power of the nervous system, and the natural asymmetries of the human body then ever before. Though the rise in popularity of PRI has had a positive impact on the world of physical preparation, it was originally developed as a therapeutic system, and the question still remains: how do we incorporate these powerful principles and activities into a strength and conditioning program without losing sight of our role? This article will disclose exactly how coach Cody Plofker and I incorporate PRI into the training of athletes and clients at Parabolic Performance and Rehab.
The Postural Restoration Institute (PRI) is a therapeutic system based on the natural asymmetries of the human body, the impact of joint position on muscular action, the use of respiration as a window into the autonomic nervous system, and the power of the nervous system to govern human output.
Perhaps no system in recent memory has had as powerful an impact on the world of strength and conditioning as PRI. Social media has provided physical preparation professionals unprecedented access to some of the industry’s most elite practitioners, who time and time again produce content touting the benefits of PRI.
PRI has exposed coaches to functional anatomy, the tri-planar nature of muscles, breathing and repositioning activities like the ever-popular 90/90 hip lift, and importance of joint position when discussing muscular action. It has showed us the power of the central nervous system, the impact that control of proximal structures like the ribcage and pelvis can have on surrounding joints and structures, and the importance of variability in all systems of the body. While these concepts are in no way exclusive to PRI, it has given us a new prism through which we can view human movement.
Undoubtedly, PRI has had a resoundingly positive impact on me as a coach. Nothing else I have learned in my short tenure as a full-time strength and conditioning professional has had as profound an impact on the way I coach, the way I program, and my approach to working with the human organism as PRI.
PRI has opened many coach’s eyes to an entirely different way of approaching human movement. However, some who recognize the power of the system are nonetheless unsure of how it can be applied in a strength and conditioning setting.
As strength and conditioning professionals, it is our duty to create physiological and structural adaptations in our clients to help them meet athletic, health, and/or body composition goals. Clients expect to lift heavy weights, jump, throw medicine balls, sprint, run, and in general perform movements aimed at helping to improve physical qualities that will support performance and/or aesthetic measures. It is not our job, nor do these individuals want, to spend their entire time training with us lying on their backs or on their sides focusing on activating a muscle and breathing.
While I firmly believe that its growth in popularity can only positively impact our industry, many questions remain about PRI.
1) I don’t treat pain, and I never claim to treat pain. How do we implement PRI into our setting and programming without straying from our lane as strength professionals?
2) How do we ensure that we don’t fall into the trap of devoting all our time to trying to get our athletes and clients “neutral,” when we are really there to improve physiology and structure through hard training?
3) Where, when, and how many PRI activities are appropriate to include in a training program?
4) How do PRI principles and activities apply to a strength and conditioning program?
If we are able to answer these questions and apply a deeper understanding of PRI as a SYSTEM, and not just a set of activities involving diaphragmatic breathing, then I believe it is not only appropriate in the world of strength and conditioning, but can have a profoundly beneficial impact on the performance and health of athletes and clients — as well as the way we, as coaches, teach movement.
The most direct way that we utilize PRI with our athletes and clients is by implementing specific breathing, activation, and positional activities in corrective exercise programs.
Most of the people we work with, especially elite athletes, present with many of the same patterns and positional limitations. So with few exceptions, we start many people out with two to three relatively simple activities that will give us the best bang for our buck.
The initial goal is to get people out of an extension posture, decrease sympathetic tone, teach control of the ribcage and the pelvis, and restore the ability to use the diaphragm for respiration rather then as a postural muscle. By doing this in non-threatening positions of flexion and posterior pelvic tilt, we restore variability to the system and inhibit extensor tone that nearly everyone presents with.
The cornerstone positions we come back to time and again to achieve the initial goal of getting clients out of extension and to teach a more optimal breathing pattern are 90/90, with feet elevated on a wall and all fours.
The 90/90 hip lift is the first PRI exercise we teach to all clients, and is the baseline by which we create context for more complex PRI activities. More importantly, it allows the individual to develop kinesthetic awareness with a great deal of feedback from the ground and an understanding of what it feels like to actively control the ribcage and pelvis. This in turn allows me as a coach to refer them back to the 90/90 position and the feeling they had there when I am cueing them and teaching them position later.
For example, once I teach someone to posteriorly tilt his or her pelvis by activating the hamstrings and to use a strong, full exhale to activate their abdominals and draw their ribcage down, that individual can now take what they’ve learned and apply it to a push-up, a squat, or even an acceleration drill. Instead of trying to teach an individual how to exhale and use his abdominals to control the ribcage, I can say, “Hey remember when we were in the 90/90 position on the wall and I told you to exhale and crush my hand? Do that.”
This is a much more efficient and effective way to coach someone, rather than having to constantly teach new skills in high-threshold environments. Once the client understands the position, he or she can now carry it over to other, more complex exercises in the training program.
The all-fours belly lift is one of the most popular corrective exercises we implement in our programming, and a great way to restore flexion of the thorax, posterior pelvic tilt, and teach clients to expand the ribcage posteriorly throughout proper breathing patterns.
We use all-fours to teach the individual to reach with the extremities, effectively putting the client in a position of global flexion, and allowing for restoration of the zone of apposition, or the area of the lower ribcage that directly apposes the diaphragm. Without a zone of apposition, the diaphragm cannot function effectively as the primary muscle of respiration.
While 90/90 and other PRI activities also aim to restore a ZOA, all-fours belly breathing is a very effective entry-level exercise for those who struggle to control the ribcage and pelvis.
Additionally, in this position we can restore the position of the curved scapula on the congruent thorax by moving the thorax back to the scapula. This positioning and facilitation of muscles like the serratus anterior is paramount to maintaining shoulder mobility and health.
In this position, we have the client focus on reaching through the floor with arms and legs while tucking the tail. He or she takes deep breaths to fill the upper back with air, and exhales fully to facilitate the abdominals and move further into a position of flexion. All- fours is one of the most effective ways to inhibit excessive tone of extensor muscles like the lumbar erectors and lats that we have.
All-Fours Belly Lift
If we have worked with an individual for an extended period of time, or they present with specific movement deficiencies, we may progress them to a more targeted PRI activity.
Due to the natural asymmetries of the human body (liver on the right, heart on the left, larger, more domed right diaphragm with larger central tendon and lower attachment to the lumbar spine) most people fall into the pattern known as the left anterior interior chain. Without getting too far into the details of exactly what muscles comprise this chain, the result of our natural asymmetries and our need to breathe and manage gravity is that the left AIC becomes facilitated, causing the pelvis to anteriorly tilt on the left and rotate towards the right. Additionally, the left ribcage is flared in the front and externally rotated. This creates what is known as the left extension posture.
Due to being stuck in these positions, certain muscles become chronically toned and over-active while others become inhibited. For example, with the pelvis anterior tilted on the left and rotated to the right, we become stuck in a state of acetabulum on femur (AF) internal rotation, where our right adductor is chronically activated. While this sounds incredibly complex, all it really means is that we are locked into right stance phase and left swing phase of gait.
This can present a problem when we lack the variability to create true reciprocal action and move into stance phase and swing phase on both sides.
For example, many of our NFL combine athletes have come to us with complaints about excessive tightness or tension in their right groin and pinching to the inside of their hip. In this case, we may move them to a more targeted activity like a right sidelying left adductor pullback.
Now I once again want to make clear that we are not attempting to treat pain. However, impingement is more often than not a problem associated with position rather then true pathology, and this position is often caused by excessive tone and lack of variability. Therefore, more often then not, if we restore position, inhibit overactive muscles and facilitate inhibited muscles, we can remove the feeling of pinching simply by having the athlete learn to move themselves out of the position.
The right sidelying adductor pullback is a can’t-miss PRI activity, as it nearly guarantees activation of the appropriate muscle. Here we lay the individual on his or her right side and place a bolster between the feet to put the hip into a state of internal rotation.
Then, using what is essentially RNT (Reactive Neuromuscular Training), we cue the individual to pull the left hip back and actively adduct it. This action facilitates the left ischiocondylar adductor magnus, which pulls the pelvis back to the left into acetabulum on femur internal rotation. In this position we have the athlete or client take long, slow breaths in through the nose and out through the mouth.
More often than not in my experience, the feeling of excessive tension in the right groin and the pinching the athlete was experiencing in the front of the right hip clears up instantly. Simply by restoring variability to the system and rotating the pelvis back to the left, we get the individual off the right hip and free up room so that the impingement no longer occurs.
Right Sidelying Left Adductor Pullback
Another example of a more complex but extremely effective PRI activity is the left sidelying right glute max. The glute max is the king of the pelvic floor, and vitally important in the PRI system. The left glute max is well positioned (due to the left AIC) to perform external rotation while the right glute max is well positioned for extension.
In order to help gain control of the pelvis, pull the femur into the acetabulum, and put us into a position of acetabulum on femur external rotation on the right side (so that we can be in acetabulum on femur internal rotation on the right side), we need to facilitate the right glute max.
Without this valuable muscle, stress is placed on surrounding tissues that often become chronically toned and may create discomfort in surrounding joints.
In essence, this muscle is responsible for supporting the repositioning and correction of the position of the pelvis on both sides, and can have an incredible impact on the motor control and movement quality of those who learn to facilitate it and breathe while holding the position.
To perform the left sidelying right glute max have the client lie on their left side with both feet elevated on a bolster and a light miniband around the knees. Have the individual begin by pushing the hips into the floor and side bending to the left. Next, with the left heel and right medial arch pressing into the wall, the individual pushes his or her right knee in front of the left, effectively rotating the pelvis to the left. It is critical to understand that this push of the right hemi-pelvis forward is the driving force behind facilitation of the right glute max in this activity. Then, the client externally rotates the right hip while maintaining all points of contact with the wall. He or she will maintain this position and take a long, full breaths.
Left Sidelying Right Glute Max
The key that we have found in utilizing actual PRI breathing and repositioning activities is to pick two to three that are going to give the most return on investment unless there is a specific reason to perform a more complex or advanced exercise. The process of performing these activities should take a grand total of five minutes, and should in no way interfere with the training session as a whole. In fact, when properly taught and implemented, not only do these activities have a positive and immediate impact on the way athletes and clients move and feel, but also they create context through which coaches can more effectively and efficiently cue the individuals they are working with into optimal positions and movement patterns.
Teaching Traditional Lifts
The greatest impact that PRI has made on me as a physical preparation professional is in the way that I view and teach position and movement.
As a former college football player and current weightlifter, I was always taught that in everything we did the key was to sit the hips back and arch the back as hard as possible to bring the chest up. I was also taught that the safest, most stable position for the shoulder blades was a “packed” or retracted position, and was warned not to let my shoulders fully protract or upwardly rotate. I was also taught that flexion was essentially the devil, and that if I ever rounded my back I’d be setting myself up for a lifetime of disc injuries and pain.
I carried these ideas around with me for years, just as I now realize many of my clients and athletes do.
What PRI has given me is a far greater understanding of functional anatomy, an appreciation for the importance of flexion, and an entirely new perspective from which I now view and judge the quality of human movement.
I now see that though extension is important and valuable in certain situations, we do not need to use extensor tone in everything we do, and in fact, we are more often than not causing our own movement restrictions and limitations through a simple lack of understanding of how joint position dictates muscular action.
A prime example of this is my NFL Combine athletes. These are individuals who just left a collegiate strength and conditioning setting and spent the last four to five years of their careers learning a certain way of lifting. One of the biggest challenges (or so I thought) of getting these athletes to buy into our training program is to teach them to perform lifts and movements they have been doing for years in a way that is potentially different then the way they were taught.
The most common flaws we see in this population include an alarming reliance on extensor tone in all movement patterns, lack of ribcage and pelvic control, and an inability to display mobility and stability of the scapula.
Not one of these athletes comes to us without complaining that their back is always tight and their hips and shoulders feel restricted. There is something terribly wrong with this picture.
The cues of “chest up,” “big back,” and “hips back” have moved on from the realm of cues to the point where they are actually being taught as technique in the weight room and on the field. It is vital that strength and conditioning coaches understand that a cue is a relationship between a coach and an athlete, NOT A TECHNIQUE.
My goal is to take these athletes that have been taught that extension and retraction are the only viable and safe strategies to lift heavy weights and give them more options. If we can teach them to create proximal stability using appropriate musculature, then these already elite athletes will be able to display more distal mobility and power, with less pain and chronic tone in muscles.
Two prime examples of how we incorporate PRI principles into the teaching and cueing of traditional strength training exercises are the push-up and the squat.
Many people teach the push-up by cueing a “flat back,” having the athlete lower the chest, then push up until the arms are straight, often leaving the shoulder blades slightly retracted or even actively telling the athlete to keep them pulled back even at the top of the movement.
Pushup Without Reach – Suboptimal
The concept of reaching is very important in the PRI system. I discussed the need for reaching in depth here (https://dsstrength.com/why-you-must-reach/) but the key is that when we reach without appendages we create flexion and master our zone of apposition. Without a zone of apposition, the diaphragm cannot work as a muscle of respiration because it is never able to return to its resting length. Like all other muscles in order to contract optimally, the diaphragm must begin at its resting length. In a chronically shortened state, the diaphragm (especially the left) becomes a postural muscle.
Since we need to breathe to survive, other muscles take up the slack and help to pull air into our bodies. These include upper traps, scalenes, lats, lumbar erectors, and pecs among others. These secondary muscles are not meant to be primary muscles of respiration, and become chronically toned as a result of having to take up the slack for the diaphragm. In order to restore the diaphragm to its role as a muscle of inspiration, we must master the zone of apposition. In order to master the zone of apposition, we must find flexion. Reaching helps us find flexion.
Additionally, one of the most overlooked and vital aspects of shoulder health is full mobility and stability of the scapula. In order for the scapula to move properly we need to properly position the thorax so that the curved scapula can rest on a congruent surface and facilitate important muscles like serratus anterior and lower trapezius, which play a significant role in protraction and upward rotation.
The push-up gives us an incredible opportunity to work on both of these things while also tying in a great deal of anterior core stability, IF PERFORMED PROPERLY.
In order to get the most benefit from the push-up while also putting our athletes in optimal position to activate pertinent musculature, we cue athletes to begin in a push-up position with the “belt buckle tucked to the nose,” legs locked, ribs drawn down, back rounded, and hands actively REACHING through the floor.
During the lowering phase of the push-up, this position must be maintained as the athlete actively “pulls” the chest down to floor by retracting the shoulder blades. Then, while again maintaining proximal stability, the athlete must push hard through the ground and reach, creating flexion of the thoracic spine and retracting the thorax to the scapula.
This action not only gives us a desirable outcome from a biomechanical perspective, but also greatly increases the demand for stability and the level of difficulty of the push-up. Many people pass over this basic bodyweight strength exercise thinking that it is too easy, but when executed properly it can be an invaluable way to build strength, hypertrophy, and endurance of upper body musculature while improving shoulder health and proximal control.
Push-up With Reach – Optimal
The squat is another pattern where our coaching is heavily influenced by the PRI system.
Many coaches still believe that allowing the knees to move forward over the toes is going to cause damage to the knees, and therefore, they cue their athletes to sit back into their hips as far as possible. Additionally, so the athlete doesn’t fall forward, these coaches also cue their athletes to bring their chest up and arch their back.
This hip dominant squat creates a number of problems. First and foremost, it is important to understand that the stress being placed on the body during any movement HAS to go somewhere. If it doesn’t go to the knees then it is going to go somewhere higher up the chain, and that place is likely the lumbar spine. While many coaches claim that sitting back puts the stress on the hips, most athletes can’t sit back and maintain control of their pelvis, which causes them to fall into anterior pelvic tilt and excessive lumbar lordosis. From this joint position it is impossible to use glutes and hamstrings to properly drive hip extension, as they are not positioned well to contract.
Next, the lumbar erectors become short and toned, as they take over the job of the glutes and hamstrings to create “fake” hip extension under far greater stress then they are meant to handle. This is why many athletes complain of tightness and pain in their lower backs during squats and deadlifts. Joint Position dictates muscle action, and we can’t use the prime movers of our lower extremities if we can’t create proximal stability and align joints properly.
Finally, though the hamstrings and abs are often neglected when talking about the squat, we feel that they are vitally important to maintaining proper position so that prime movers can do their jobs.
Instead of cueing “hips back,” we actually cue our clients to “tuck their belt buckles toward their noses,” or “pull their back pockets toward their heels.” These external cues for posterior pelvic tilt help the individual understand that they should be actively pulling the pelvis under throughout the movement. We then instruct the client to sit straight down, allowing the knees to track forward and the hips to naturally move back slightly. However, even as the hips move back we teach to try to keep the hamstrings and abdominals engaged to maintain a more neutral ribcage position.
Here’s why this is important: Part of the hamstrings and quadriceps cross both the hip and the knee joint. Their roles are the inverse of each other. The hamstring extends the hip and flexes the knee while the quadriceps flexes the hip and extends the knee. When one of these muscles lengthens, the other one must shorten. Now, when we sit back in a hip hinge style squat, we lengthen the hamstrings through deep flexion of the hips. Conversely, deep flexion of the hips causes the shortening of the quadriceps. At the same time, in this hinge-style squat, because the hamstrings are at length, they can’t contract to keep the pelvis from anteriorly tilting. When the pelvis anteriorly rotates, the lumbar spine goes into further extension. The result is a quad and lower back dominant movement that leads to chronic tone in and potentially pain in and around these areas.
When we squat with a more vertical torso position, with the pelvis more optimally aligned under the torso and the hamstrings and abdominals activated, we put the stress where it is meant to be — on the prime movers of our lower extremities. The hamstrings, glutes, quadriceps, lumbar erectors, and abdominals can now all do their jobs in a more harmonious fashion, which leads to more effective, pain-free squatting.
Correct Squatting Pattern
Poor Squatting Pattern With Too Much Hip Hinge
Teaching/Cueing Traditional Warm-up Activities
Another area where I believe strength and conditioning professionals can benefit from implementing PRI into their coaching and teaching is during the warmup/physical preparation period.
The warmup period is a valuable time for coaches to teach kinesthetic awareness, develop motor control, and improve the way athletes move. Unfortunately, many times, it simply becomes a free-for-all where the only end product is that the athletes increase their core body temperature.
While increasing core body temperature is certainly one important aspect of a warm-up period, coaches are missing out on a golden opportunity to teach athletes how to activate muscles, control joints, and develop movement patterns in a dynamic environment by only focusing on getting their athletes sweating.
Many of the same positions and focuses that we have when cueing and teaching traditional strength training exercises also apply to our dynamic warmup/activation period.
The goal is to take what the athlete has learned through our cognitive and kinesthetic development in PRI activities and now apply it to more dynamic movements to prepare the individual for training.
In each exercise or pattern, we’re going to cue the athlete to breathe throughout the movement, using a full exhale to draw the ribcage down and activate the abdominals. We’re also going to tell them to tuck their belt buckle to their nose and posterior tilt the pelvis. We tell them to have their whole foot find the floor, and to reach with their appendages. Again, the goal is to take what we have taught them and carry it over to the practice and execution of more dynamic movements.
For example, the inchworm is a classic dynamic warmup exercise that I feel most people waste. It is not a way to stretch the hamstrings. It is, however, a relatively challenging anterior core stability drill that requires the athlete to control the ribcage and the pelvis in what is essentially a long plank position. It also provides an opportunity for the individual to understand what it feels like to actively reach through the ground, moving the shoulder blades through a cycle of protraction and upward rotation.
I see far too many people performing this exercise incorrectly by dropping their hips and/or extending the lumbar spine in the long plank position, or allowing their shoulder blades to be pushed back as they allow the thorax to extend.
To further challenge the anterior core and the upward rotators of the scapula, try performing reverse inch worms. Walking the hands back to the feet really cues the athlete to push away from the ground with each hand while the backwards movement increases the challenge to anterior core stability and the individual’s ability to exhale fully to control the ribcage.
Reverse Inchworm With Focus on Ribcage and Pelvic Control
Selecting Appropriate Exercises/Loading Patterns
Though we utilized regression, progression, and lateralization long before I began implementing PRI principles into my programming, PRI has given me a lens through which I can more accurately and effectively fit the exercise to the athlete and not the other way around.
Selecting the appropriate loading pattern can make a huge difference in the success of the athlete or client. Too many times, strength and conditioning coaches fall into the trap of thinking that squat means barbell back squat, or that deadlift means barbell deadlift. I see athletes all the time, at all levels of sport, performing exercises that are far too advanced for them, or that they lack the requisite motor control, mobility, or positional awareness to perform.
As strength and conditioning professionals, it is vital that we fit the exercise to the athlete, not the athlete to the exercise. Unless the individual is a Powerlifter or Olympic Weightlifter, there is no reason that they HAVE to perform any particular lift in the gym. The goal is to create physiological, structural and neuromuscular adaptations that will improve the athlete’s performance on the field.
This also applies to members of the general population, who may simply want to lose weight, build muscle, or improve their overall health.
It all begins through the creation of a continuum for each exercise. We pick a baseline, or zero point, as I like to call it, in the middle of the continuum. This basic movement competency will determine whether the individual is ready to progress this specific movement pattern, or whether they may need to regress and perform a less complex variation.
For example, in the case of the hip hinge pattern, we begin with a bodyweight hinge. If the individual can perform a bodyweight hinge by moving through the hips with a neutral spine, then I am confident that client is ready to be loaded in that movement pattern. If the person can’t, then they need to practice this pattern, improve mobility/stability, or receive some sort of assistance to help put them into the correct position. It’s a yes or no question, and if it’s not yes, then it’s no.
Once we’ve established a good hip hinge pattern, we begin by progressively loading the exercise. We may begin by loading a hip hinge pattern through either a kettlebell RDL/deadlift, or a dumbbell RDL. These are basic loading patterns that allow us to challenge the athlete or client’s hinge without requiring as much strength, stability, and technique as a barbell hinge or deadlift.
Next we utilize a trap bar deadlift. The reason for this is that the trap bar can be loaded much heavier then a dumbbell RDL or kettlebell deadlift, but because the load is to the side of the individual’s center of mass instead of in front, there is less demand on the lumbar spine and other stabilizing muscles to maintain position. Additionally, because the bar does not have to travel around the knees, the pattern can become a hybrid between a hip hinge and a squat.
Finally, we would come to barbell deadlift variations. Most of our athletes never get here, as we feel the trap bar is an extremely effective way to load the hip hinge without putting unnecessary stress on the individual’s spine, and more stress on the prime movers of the legs, where it needs to be.
Here is where PRI comes in. One of my NFL Combine athletes was struggling with trap bar deadlifts the other day. His technique, which had started out as adequate in the first weeks of program, had deteriorated significantly as the weights had gotten heavier. He was developing more and more extensor tone every time we deadlifted, and he could no longer maintain a neutral spine throughout the movement.
Before I could even say something to him, he walked up to me and said, “Coach all I’m feelin’ is back now.” In the past, I may have attempted to change his technique or cue him until I was blue in the face, but now I knew that would make no difference. His hip hinge strategy was one completely based on loading the lumbar spine and using his lumbar erectors to lift the weight. No amount of cueing him was going to change that in this moment, especially not at the weight he was trying to lift.
Instead of trying to hammer away with cues and more reps, I immediately cut the exercise from his program, and replaced it with an exercise that takes a few steps back on the continuum — the paused kettlebell RDL.
I had him hold a kettlebell between his legs, draw his ribs down and posteriorly tilt his pelvis to set himself in a neutral position. I then had him stand in front of a wall and told him to push his hips back into the wall as he lowered the kettlebell between his legs. I immediately saw the problem. He was trying to pull his chest up as high as he could, as that was how he was taught a deadlift must be performed. I told him to allow his shoulders to move forward as his hips move back, and keep his ribs tucked down the entire time.
Boom. After two reps he was sitting back into his hips in a good hinge pattern and maintaining a neutral spine. The difference was incredible. He immediately began shaking and sweating, and after finishing his set looked at me and said, “Oooo coach, I feel that all in my hamstrings and glutes.” Bingo.
If I had tried to have him continue to hex bar deadlift that day, cueing him to keep a neutral spine and push his hips back, we would have gotten nowhere. Instead, I altered the plan, and put him into a lower threshold exercise on the hip hinge continuum where he was able to focus on learning and internalizing good position and feeling the muscles we were looking to use.
Understand that all the teaching and cueing in the world won’t do any good if the athlete is not prepared for the exercise, or is limited by excessive tone in a certain area, as this athlete was. He had never effectively hinged at the hips nor had he used his hamstrings or glutes properly. He had always used his lumbar erectors instead of his glutes and hamstrings, and in order for him to continue to progress, my job as a coach was to have him take a step or two back first.
Hip Hinging With A Neutral Spine