骨盆底讲义

Pelvis Restoration – Home Study
An integrated approach to treatment of

patterned pubo-sacral pathomechanics
Day 1 Day 2
8:00 – 9:00 Introduction to the Pelvic Floor 8:00 – 9:00 Respiratory Influences on Pelvic Floor
Continued / Day One Review
9:00 – 10:00 Left Anterior Interior Chain (AIC)
and Posterior Exterior Chain (PEC) 9:00 – 10:00 Treatment of Pelvic Floor Dysfunction
Influence on the Pelvis  Left AIC
10:00 – 10:15 Break 10:00 – 10:15 Break
10:15 – 12:00 Left AIC and PEC Influence on the 10:15 – 12:00 Treatment of Pelvic Floor Dysfunction
Pelvis (Cont’d)  Left AIC Case Study
12:00 – 1:00 Lunch (on your own) 12:00 – 1:00 Lunch (on your own)
1:00 – 2:00 Left AIC and PEC Influence on the 1:00 – 3:00 Treatment of Pelvic Floor Dysfunction
Pelvis (Cont’d)  PEC
 PEC Case Study
2:00 – 3:00 Examination Tests and Assessment
 Standing Reach Test 3:00 – 3:15 Break
 Adduction Drop Test
 Pelvic Ascension Drop Test 3:15 – 5:00 Treatment of Pelvic Floor Dysfunction
 Passive Abduction Raise Test  Pathologic PEC
 Functional Squat Test  Pathologic PEC Case Study
 Hruska Adduction Lift Test
3:00 – 3:15 Break
3:15 – 5:00 Respiratory Influences on the Pelvis

POSTURAL RESTORATION INSTITUTE®
5241 ‘R’ STREET

LINCOLN, NE 68504
402-467-4111
The materials and information provided to you during this

conference are protected under the copyright laws of the
United States and the methods taught are considered to be
trade secrets and proprietary property of Postural
Restoration Institute, LLC. The materials, power point
presentations and methods may not be copied and or
otherwise communicated or distributed to any third party
without the express written permission of Postural
Restoration Institute, LLC. Audio visual recording of the live
presentations at the conference by or through any means is
prohibited.
Date of last revision: October 9, 2012
Copyright  2010-2013 Postural Restoration Institute® ii

Table Of Contents
SECTION ONE
Anterior Interior Chain (AIC) .............................................................................................2
Left AIC Pelvic Inlet .........................................................................................................11
Left AIC Pelvic Outlet ......................................................................................................14
Left AIC Summary ............................................................................................................19
Goals for Left AIC Pelvic Outlet and Inlet .......................................................................20
Posterior Exterior Chain (PEC) ........................................................................................25
PEC Pelvic Inlet ................................................................................................................27
PEC Pelvic Outlet .............................................................................................................28
Goals for PEC Pelvic Inlet and Outlet ..............................................................................31
Patho PEC Pelvic Inlet ......................................................................................................34
Patho PEC Pelvic Outlet ...................................................................................................36
Goals for the Patho PEC Pelvic Inlet and Outlet ..............................................................38
Pelvic Floor Restoration Tests ..........................................................................................40
Pelvic Floor Functional Relationships ..............................................................................51
Pelvic Respiration .............................................................................................................52
Left AIC Treatment Considerations ..................................................................................66
PEC Treatment Considerations .........................................................................................76
Patho PEC Treatment Considerations ...............................................................................83
SECTION TWO: APPENDIX

Myokinematic Restoration Repositioning .........................................................................2
PEC and Patho PEC Repositioning .....................................................................................4
Pelvis Restoration Repositioning ........................................................................................6
Pelvis Restoration Non-Manual Techniques
Right Rectus Femoris and Sartorius .......................................................................8
Left Obturator and Iliococcygeus .........................................................................10
Left Iliacus ............................................................................................................18
Right Gluteus Maximus ........................................................................................23
Integration .............................................................................................................31
Pelvis Restoration Inhibition Techniques
Left Anterior Inlet .................................................................................................39
Right Anterior Outlet ............................................................................................42
Right Posterior Inlet ...............................................................................................43
Left Posterior Outlet .............................................................................................45
Bilateral Anterior Inlet and Bilateral Posterior Outlet ..........................................47
Pelvis Restoration Manual Techniques ............................................................................51
PRI Sexual Positions .........................................................................................................54
PRI Positioning Handout ..................................................................................................57
PRI Breathing Techniques ................................................................................................61
Pelvic Floor Disorders ......................................................................................................65
Treatment Considerations for Isolation of Pelvic Floor and Transverse Abdominis .......67
Research Support ..............................................................................................................68
Copyright  2010-2013 Postural Restoration Institute® iii

COMPOSITE OF COURSES
Myokinematic Restoration – An Integrated Approach to Treatment of
Patterned Lumbo-Pelvic-Femoral Pathomechanics
Chain Position → Facilitate Inhibit
Anterior Interior Chain (AIC) Hamstrings, Ischiocondylar Adductor, Tensor Fascia Latae, Adductor Magnus,
Gluteus Maximus, Anterior Gluteus Psoas, Piriformis, Vastus Lateralis
Medius/Minimus, Posterior Gluteus
Medius/Minimus, Abdominal Obliques
Pelvis Restoration – An Integrated Approach to Treatment of Patterned Pubo-Sacral

Pathomechanics
Anterior Interior Chain (AIC) Pelvic Inlet: Pelvic Inlet:
Proximal Iliacus, Sartorius, Rectus Thoracic Diaphragm, Internal and External
Femoris Obliques, Paravertebrals
Pelvic Outlet: Pelvic Outlet:
Proximal Obturator, Iliococcygeus, Adductor Magnus, Hamstrings
Puborectalis, Pubococcygeus, Gluteus
Maximus, Piriformis, Coccygeus
Postural Respiration – An Integrated Approach to Treatment of

Patterned Thoraco-Abdominal Pathomechanics
Anterior Interior Chain (AIC) Hamstrings, Ischiocondylar Adductor, Tensor Fascia Latae, Adductor Magnus,
Gluteus Maximus, Anterior Gluteus Psoas, Piriformis, Vastus Lateralis
Medius/Minimus, Posterior Gluteus
Medius/Minimus, Abdominal Obliques
Brachial Chain (BC) Lower Trapezius, Middle Trapezius, Adductors (Pec Major), Scapulothoracic
Triceps, Triangularis Sterni, Serratus IR (Pec Minor), Latissimus Dorsi
Anterior
Posterior Exterior Chain (PEC) Internal Obliques/Transversus Abdominis, Paravertebrals, Quadratus Lumborum
External Obliques
Cervical-Cranio-Mandibular Restoration – An Integrated Approach to Treatment of

Patterned Temporomandibular & Cervical Dysfunction
Temporomandibular Cervical Chain Levator Scapulae, Co-activation of Capitis, Temporalis, Upper Trapezius,
(TMCC) Cervical Colli and Internal Sternocleidomastoid
Obliques/Transversus Abdominis,
External Obliques, Lateral Pterygoids
www.posturalrestoration.com
Copyright  2010-2013 Postural Restoration Institute® iv

COMPOSITE OF COURSES
As related to Left AIC, Right BC, Right TMCC Pattern
Myokinematic Restoration – An Integrated Approach to Treatment of

Patterned Lumbo-Pelvic-Femoral Pathomechanics
Left Anterior Interior Chain (AIC) L AF Hamstrings, L AF Ischiocondylar L Tensor Fascia Latae, R FA Adductor
Adductor, R AF Gluteus Maximus, L FA Magnus, L Psoas, L FA Piriformis, R AF
Anterior Gluteus Medius/Minimus, R FA Piriformis, R Vastus Lateralis
Posterior Gluteus Medius/Minimus, L
Abdominal Obliques
Pelvis Restoration – An Integrated Approach to Treatment of Patterned Pubo-Sacral

Pathomechanics
Left Anterior Interior Chain (AIC) Pelvic Inlet: Pelvic Inlet:
L Proximal Iliacus, R Sartorius, R Rectus R Thoracic Diaphragm, R Internal and
Femoris External Obliques, L Paravertebrals
Pelvic Outlet: Pelvic Outlet:
L Proximal Obturator, L Iliococcygeus, L R Adductor Magnus, R Hamstrings, L
Puborectalis, L Pubococcygeus, R Gluteus Piriformis, L Coccygeus, L Gluteus
Maximus, R Piriformis, R Coccygeus Maximus
Postural Respiration – An Integrated Approach to Treatment of

Patterned Thoraco-Abdominal Pathomechanics
Left Anterior Interior Chain (L AIC) L Diaphragm R Anterior Neck
Right Brachial Chain (R BC) B Lower Trapezius, B Middle Trapezius, L HG Adductors (Pec Major), R
R Triceps, L Triangularis Sterni, B Scapulothoracic IR (Pec Minor), R
Serratus Anterior Latissimus Dorsi
Posterior Exterior Chain (PEC) L Internal Obliques/Transversus B Paravertebrals, R Quadratus Lumborum

Abdominis, R External Obliques
Cervical-Cranio-Mandibular Restoration – An Integrated Approach to Treatment of

Patterned Temporomandibular & Cervical Dysfunction
Right Temporomandibular Cervical B Levator Scapulae, Co-activation of B L Posterior Capitis, R Temporalis,
Chain (R TMCC) Cervical Colli and L Internal R Upper Trapezius, R Sternocleidomastoid
Obliques/Transversus Abdominis, R
External Obliques, L Lateral Pterygoids, L
Anterior Temporalis
Copyright  2010-2013 Postural Restoration Institute® v

BRACHIAL CHAIN (BC)
There are two brachial polyarticular muscular chains lying over the anterior pleural and
cervical area. These chains influence cervical rotation, shoulder dynamics and apical
inspirational expansion. They are composed of muscle that attaches to the costal
cartilages and bone of ribs 4 through 7 and xiphoid to the posterior, inferior occipital
bone, anterior, inferior mandible and coracoid process of scapula. These two tracks of
muscles, one on the left side of the sternum and one on the right, are anterior to the
medial and upper mediastinum and upper thoracic cavity and are composed of the
triangular sterni, sternocleidomastoid, scalene, pectoralis minor, intercostals and
muscles of the pharynx and anterior neck. They provide the support and anchor for
cervical-cranial orientation and rotation and rib position. The right brachial chain
muscle is opposed by the right posterior back muscles (PEC), lower trap, serratus
anterior, and external rib rotators, in addition to the left internal abdominal obliques.
The brachial chain muscle on the left is opposed by the left posterior back muscles
(PEC), lower trap, serratus anterior, external rib rotators, and right internal abdominal
obliques.
ANTERIOR INTERIOR CHAIN (AIC)

There are two anterior interior polyarticular muscular chains in the body that have a
significant influence on respiration, rotation of the trunk, ribcage, spine and lower
extremities. They are composed of muscles that attach to the costal cartilage and
bone of rib 7 through twelve to the lateral patella, head of the fibula and lateral
condyle of the tibia. These two tracts of muscles, one on the left side of the interior
thoraco-abdominal-pelvic cavity and one on the right, are composed of the
diaphragm and the psoas muscle. With the iliacus, tensor fasciae latae, biceps
femoris and vastus lateralis muscles this chain provides the support and anchor for
abdominal counter force, trunk rotation and flexion movement.
Copyright  2010-2013 Postural Restoration Institute® vi

THE LEFT ANTERIOR INTERIOR CHAIN PATTERN
Individuals experiencing symptoms at the knee, hip, groin, sacral-iliac joint, back, top of shoulder, between the
shoulder blades, neck, face, or TMJ, will demonstrate inability to fully adduct, extend or flex their legs, on one or
both sides of their body. They usually have difficulty in rotating their trunk to one or both directions and are not
able to fully expand one or both sides of their apical chest wall upon deep inhalation. Cervical rotation,
mandibular patterns of movement, shoulder flexion, horizontal abduction and internal rotation limitations, on one
or both sides will also compliment the above findings. Postural asymmetry will be very noticeable, with one
shoulder lower than the other, and continual shift of their body directed to one side through their hips.
The pattern that is most often prevalent involves the left anterior interior chain, the right brachial chain and the
right posterior back muscles (PEC) of the body. The left pelvis is anteriorly tipped and forwardly rotated. This
directional, rotational influence on the low back and spine to the right, mandates compulsive compensatory
movement in one or more areas of the trunk, upper extremities and cervical-cranial-mandibular muscle. The
greatest impact is on rib alignment and position, therefore influencing breathing patterns and ability. It is very
possible that respiratory dysfunctions, associated for example with asthma or daily, occupational, repetitive, work
positions, can also influence pelvic balance and lead to a compensatory pattern of an anteriorly tipped and
forwardly rotated pelvis on the left.
Other common, objective findings secondary to compensatory physical attempts to remain balanced over this
unlevel pelvis include elevated anterior ribs on the left, lowered, depressed shoulder and chest on the right,
posterior rib hump on the right, overdeveloped lower right back muscle, curvature of the spine and asymmetry of
the head and face.
This particular pattern of neuromuscular imbalance is enhanced and generated usually at early ages of
development in the pre-adolescent and adolescent years. Since the fibers from our diaphragm that attach to the
front of the low spine and our diaphragm in general is stronger on the right, we all have a tendency to shift and
rotate our spine to the right sooner and more often than to the left. The liver also assists this directional pull on
the spine and pelvis because it keeps the right larger diaphragm better positioned for respiratory activity. We do
not have a liver on the left side. The left diaphragm leaflet is much smaller and does not have the advantage to
pull the ribs up and out upon inhalation, so there is a tendency to relax the left abdominal wall. Consequently,
these abdominal muscles on the left become weak.
This pattern complements our right dominance of extremity use, our daily shifting of weight to the right and
overcompensating patterns of activity above and below our pelvic floor. Airflow for example, will generally
move more easily into the left chest wall than into the right because of the rotational influence of the ribs, as
previously described. Lack of underlying structural support exists on the right that does not exist on the left due to
pericardium position. Rotation of the upper trunk to the left will generate less activity on the neck when in this
pattern because of this dynamic, respiratory, structural phenomena. However, rotation of the upper trunk to the
right limits air movement into the left chest wall. This created torque on soft tissue, secondary to movement on
an imbalanced foundational structure, usually results in chronic muscle overuse, inflammation and pain, such as
one would see in someone diagnosed with fibromyalgia or scoliosis.
Copyright  2010-2013 Postural Restoration Institute® vii

Basic Concepts of the Postural Restoration Institute®
By: Ron Hruska, MPA, PT
The human body is not symmetrical. The neurological, respiratory, circulatory, muscular and vision
systems are not the same on the left side of the body as they are on the right, and vice versa. They have
different responsibilities, function, position and demands on them. This system asymmetry is a good
thing and an amazing design. The human body is balanced through the integration of system
imbalances. The torso, for example, is balanced with a liver on the right and a heart on the left.
Extremity dominance is balanced through reciprocal function; i.e. left arm moves with right leg and vice
versa.
Postural Restoration Institute™ (PRI) trained therapists recognize these imbalances and typical patterns
associated with system disuse or weakness that develops because of dominant overuse. This dominant
overuse of one side of the body can develop from other system unilateral overuse. For example, if the
left smaller diaphragm is not held accountable for respiration as the right is, the body can become
twisted. The right diaphragm is always in a better position for respiration, because of the liver’s
structural support of the right larger diaphragm leaflet. Therefore, the left abdominals are always
important to use during reciprocal function, such as walking, to keep the torso balanced.
Keeping the right chest opened during breathing is also challenging since there is no heart muscle inside
the right side of the chest. Standing mainly on the right lower extremity to offset the weight of the left
upper torso, assists in moving the pelvis forward on the left and the shoulder complex down on the right.
This asymmetry compliments the special functions of the two sides of the brain. Although the two sides
(hemispheres) of the brain share responsibilities for some functions, each hemisphere has its own
“specialties”. Each hemisphere controls the opposite side of the body. The left brain has more
responsibilities for speech and language and thus the right upper extremity becomes a dominant
extremity in communication, growth and development. PRI trained therapists recognize when this
normal pattern is not balanced sufficiently with left extremity neurologic and muscular activity.
When these normal imbalances are not regulated by reciprocal function during walking, breathing or
turning, a strong pattern emerges creating structural weaknesses, instabilities, and musculo-skeletal pain
syndromes. 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. All PRI trained therapists incorporate reciprocal
function to reduce ‘leading’ with the left pelvis and right arm, and respiratory function to maximize
airflow in and out of the right lung.
Vision, occupational demands, in-uterine position, etc. can all influence asymmetrical tendencies and
patterns. Humpback whales bottom-feed on their right side, lemurs tend to be lefties when it comes to
grabbing their grub, toads use their right forepaw more than their left, chimpanzees hold a branch up
with the left hand and pick the fruit with their right hand, and humans usually balance their center of
gravity over their right leg for functional ease and postural security. PRI trained therapists recognize the
more common integrated patterns of human stance, extremity use, respiratory function, vestibular
imbalance, mandibular orientation and foot dynamics; and balance these patterns, as much as possible,
through specific exercise programs that integrate correct respiration with left side or right side inhibitory
or facilitory function.
Copyright  2010-2013 Postural Restoration Institute® viii

Pelvis Restoration
Anterior abdominal wall: internal view
Pelvic Floor & Respiratory Influences on Gait
*Looking at the patient from the front
*Looking at the patient from the back
1
Copyright © 2010-2013 Postural Restoration Institute®
Pelvis Restoration
Left Anterior Interior Chain (AIC)

Diaphragm, Psoas, Iliacus, TFL, Vastus Lateralis, Biceps Femoris
1) The diaphragm pulls the dorsal (thoracic) spine up and forward.
2) The psoas, joined by the iliacus, pulls the lumbar spine and the pelvis down and forward.
3) These two forces pull the dorsolumbar spine forward, increasing lumbar lordosis (hemi-
lordosis), anterior pelvic tilt, and active lumbar extension (hyperinflation).
4) Biomechanically the diaphragm is positioned to advance the rib cage “up”, at its normal
length (phasic) and decrease diaphragmatic respiratory effectiveness since it becomes more
tonic as postural muscle. Thus symmetry, form and function of thorax are challenged and
challenging.
5) Any lengthening, untwisting, compensation, pain or exertion can cause respiratory blockage
upon inhalation (posterior mediastinal expansion is usually restricted upon exhalation
secondary to torsional influence of contralateral diaphragm).
6) As a result of ilium anterior rotation, the femur is biomechanically oriented inward and
torsional demands on the psoas as an ineffective femoral external rotator and the vastus
lateralis and biceps femoris as antagonistic hip stabilizers, increases.
Optimal Sub-Optimal
AIC  AIC 
Copyright  2010-2013 Postural Restoration Institute® 2

Pelvis Restoration
Pelvic Inlet
Borders: ASIS, sacral base,

pubic symphysis
Pelvic Outlet
Borders: Ischial tuberosities,

coccyx, pubic symphysis
Elsevier. Drake et al: Grays anatomy for students – www.studentconsult.com

Pelvis Restoration
Anterior View of an Anterior &

Forward Positioned Left Innominate
*Left Anterior Inlet

Ilium and pubis are forwardly rotated
and anteriorly tipped (flexion).

Ilium and pubis are externally
rotated.
*The titles have changed since the filming of the home study course. Please refer to your course
manual for the correct titles used.

Pelvis Restoration

Ilium and pubis are abducted =
inlet abduction.

Left ilium and pubis are forwardly
rotated and anteriorly tipped, abducted
and externally rotated = L IP ER (ilio-
pubo external rotation).
L IP ER = L AF ER (acetabular femoral external rotation)

L IP ER = R IP IR (ilio-pubo internal rotation)

Pelvis Restoration
Posterior View of an Anterior &

Forward Positioned Left Innominate
*Left Posterior Inlet

Ilium is moving into internal
rotation on the sacrum = L IS IR
(ilio-sacral internal rotation).
L IS IR = L IP ER
*Left Posterior Outlet

Sacrum is moving into internal
rotation on the ilium = L SI IR
(sacral-ilio internal rotation).

Pelvis Restoration
*Left Anterior Outlet

Ischium and pubis are
extended.

Ischium and pubis are
internally rotated.

Pelvis Restoration

Ischium and pubis are adducted =
outlet adduction.

Ischium and pubis are extended,
adducted and internally rotated
= IsP IR (ischio-pubo internal
rotation).
L IsP IR of the outlet = L IP ER of the inlet

Pelvis Restoration
*Femoral and
Acetabular
Influence with Left
AIC Position
Abducted and externally
rotated actively to the
acetabulum = FA ER
(femoral acetabular
external rotation).

Pelvis Restoration
Left AIC Position Summary
Left Pelvic Inlet

L IP ER / L IS IR
 Flexed
 External rotation
 Inlet abduction
Pelvic floor
positionally
descended
Left Pelvic Outlet

L IsP IR / L SI IR
 Extended
 Internal rotation
 Outlet adduction

Pelvis Restoration
left AIC Pelvic Inlet
R L
See Netter Plate 250
Illustrated by the Elizabeth Cunningham for the Postural Restoration Institute®

Pelvis Restoration
LEFT AIC PELVIC INLET
Right Left
Base of Sacrum
P
ASIS ASIS
Pubic Symphysis

Pelvis Restoration
Opposition Muscles of the Left AIC Pelvic Inlet
Left Iliacus
Attachments: Iliac crest, iliac fossa, pelvic surface of sacrum and anterior SI ligaments to
tendon of psoas major, lesser trochanter and femur distal to it.
Actions: Left inlet adduction with IP IR.
Right Rectus Femoris

Attachments: AIIS and groove above rim of acetabulum to proximal border of patella &
patella ligament to tuberosity of tibia.
Actions: Right pelvic inlet IP ER.
Right Sartorius
Attachments: ASIS & anterior part of iliac crest to superior part of medial tibia.
Actions: Right pelvic inlet IP ER.
Left Gluteus Medius

Attachments: External surface of ilium and oblique ridge OA lateral surface of greater
trochanter of femur.
Actions: Left IS ER with left IP IR of the pelvic inlet.
Right Gluteus Maximus

Attachments: Ilium posterior to posterior gluteal line, dorsal surface of sacrum and coccyx
and sacrotuberous ligament.
Actions: Right IS IR with right IP ER of the pelvic inlet.
Internal Oblique
Attachments: Lat. inguinal ligament, ant. iliac crest, lumbar apon. of thoracolumbar fascia,
lower border of ribs 9-12 with apon. to linea alba, pubis and pectineal line.
Action: Assist with IR of ribs & opposition to diaphragm and left pelvic inlet extension.
Transverse Abdominis
Attachments: Inner surfaces of cartilages lower 6 ribs, intedigitating with diaphragm, costal
fibers; thoracolumbar fascia, internal lip of iliac crest and lateral 1/3 of inguinal ligament.
Action: Assist with IR of ribs & opposition to diaphragm and left pelvic inlet extension.

Pelvis Restoration
Left AIC Pelvic Outlet
R L
See Netter plate 340
Illustrated by the Elizabeth Cunningham for the Postural Restoration Institute®

Pelvis Restoration
LEFT AIC PELVIC outlet
Right Left
Pubic Symphysis
A
Ischial Ischial
Tuberosity Tuberosity
P
Coccyx

Pelvis Restoration
Opposition Muscles of the Left AIC Pelvic Outlet
Left Pubococcygeus
(puboanalis, pubovisceral & pubovaginalis)
Attachments: Pubic bone and fascia of obturator internus to anococcygeal ligament.
Action: Left pelvic floor ascension with outlet abduction.
Left Puborectalis
Attachments: Dorsal surface of pubic bone, fascia of obturator to anococcygeal body and
slings around rectum and anal canal.
Action: Left pelvic floor ascension with outlet abduction.
Left Obturator Internus

Attachments: Pelvic surfaces of ilium and ischium, obutrator fascia to medial surface of
greater trochanter of femur.
Actions: Left outlet abduction with IsP ER.
Left Iliococcygeus
Attachments: Arcus tendinosous of lev ani and anococcygeal ligament.
Action: Left outlet abduction with IsP ER.
Right Piriformis
Attachments: Anterior surface of sacrum & sacrotuberous ligament to superior border of
greater trochanter of femur.
Actions (Right Side): Pelvic outlet SI IR with IsP IR.
Right Coccygeus
Attachments: To spine of the ischium to caudal portion of sacrum and coccyx; supports
pelvic viscera.

Attachments: Ilium behind posterior gluteal line and sacrotuberous ligament to iliotibial
band and gluteal tuberosity of femur.

Pelvis Restoration
Accessory Muscle and Ligaments of the Pelvic Outlet
Left Hamstring
Attachments: Ischial tuberosity and linea aspera and lateral supracondylar line of femur
Lateral side of head of fibula; medial surface of superior part of tibia; posterior part of medial
condyle of tibia; reflected attachment forms oblique popliteal ligament (to lateral femoral
condyle).
Actions: Left pelvic outlet IsP ER.
Left Adductor
Attachments: Adductor part; inferior ramus of pubis, ramus of ischium to gluteal tuberosity,
linea aspera, medial supracondylar line.
Hamstrings part: Adductor tubercle of femur to ischial tuberosity.
Actions: Left femur adduction with outlet IsP ER.
Anococcygeal ligament and Arcuate Tendon

Pelvis Restoration
Neuro-Muscular Facilitation Goals

for the Left AIC Patient
Pelvic Inlet
Rotators
Left Right
IP IR IP ER
 Iliacus  Rectus femoris
 Gluteus Medius  Sartorius
 Hamstring  Gluteus maximus
Extension
 Left IO/TA’s
Adduction
 Left Iliacus
Pelvic outlet
Rotators
IsP ER IsP IR
 Hamstring  Rectus femoris
 Sartorius
 Gluteus maximus
 Piriformis
 Coccygeus
Flexion
 Left Hamstring
Abduction
 Left Obturator
 Left Iliococcyeus

Pelvis Restoration
Left AIC Summary
LEFT Inlet IP ER = IS IR = Outlet IsP IR = AF ER
RIGHT Inlet IP IR = IS ER = Outlet IsP ER = AF IR

Pelvis Restoration
GoALS FOR PELVIC OUTLET & INLET IN LEFT AIC

Reciprocal and Alternating Pelvic Floor
Left AIC
Pelvic Inlet Pelvic outlet
R L R L
Sacral Base Pubic Symphysis
IS IR IsP IR
P A
IS ER IsP ER
OFF OFF
ON ON
Ischial
ASIS ASIS Ischial
Tuberosity
Tuberosity
ON ON
OFF OFF
IP ER SI IR
A P
Pubic Symphysis Coccyx
IP IR SI ER
Alternating
Right AIC
R L R L
IS IR IsP IR Pubic Symphysis
Sacral Base
P A
IS ER IsP ER
OFF OFF
ON ON
Ischial Ischial
ASIS ASIS
ON ON
OFF OFF
IP ER SI IR
A P
IP IR SI ER

Pelvis Restoration
Facilitation of Right AIC Pattern for a Reciprocal

& Alternating Pelvic Floor
Pelvic INLET: Right AIC
R L
Sacral Base
P
OFF
ON
ASIS ASIS
ON
OFF
Right Anterior Inlet
rectus femoris = A
Pubic Symphysis
sartorius =

Pelvis Restoration

Pelvic INLET: Right AIC
R L
Sacral Base
P
Left Posterior Inlet
OFF iliacus =
ON
ASIS ASIS
ON
OFF
A
Pubic Symphysis

Pelvis Restoration

Pelvic Outlet: Right AIC
L Left Anterior Outlet

R
Pubic Symphysis puborectalis =
A
pubococcygeus =
obturator internus=
iliococcygeus =
OFF
ON
Ischial Ischial
ON
OFF
P
Coccyx

Pelvis Restoration

Pelvic Outlet: Right AIC
R L
Pubic Symphysis
A
OFF
ON
Ischial Ischial
ON
OFF
Right Posterior Outlet

P
coccygeus = Coccyx
piriformis =
gluteus maximus =

Pelvis Restoration
Pelvic Outlet & Inlet Imbalances as a Result of PEC

*Behind every PEC is a Left AIC pattern.
Posterior Exterior Chain (PEC)

Latissimus Dorsum, Quadratus Lumborum, Posterior Intercostals, Serratus Posterior,
Iliocostalis Lumborum
1) Includes multifidus, spinalis longissimus and semispinalis fascia and muscle. Multifidus
muscle is much more developed in thoracic area and originates from transverse processes as
it crosses 4 vertebrate upwards to attach to spine of vertebrate.
2) Enhances “flatness” of the thoracic spine, lumbar lordosis, sacro iliac strain spondylolisthesis
and scoliosis.
3) Acts as accessory respiratory muscles and restricts lower lobe expansion.
4) Restricts proper position and form of AIC.
5) “Opens up” the pericostal cavity.
6) Unilateral tightness restricts trunk rotation and sidebending to contralateral direction and
influences a posterior cranium rotation and forward head posture.
7) Unilateral tonicity often associated with ipsilateral AIC restriction and contralateral
quadratus lumborum tonicity.
Optimal PEC Sub-Optimal PEC

Pelvis Restoration
Anterior view of PEC pattern
Posterior view of PEC pattern

Pelvis Restoration
PEC Pelvic Inlet
Right Left
Sacral Base
(anterior sacrum flexed)
P P
ASIS ASIS
A A
Pubic Symphysis

Pelvis Restoration
PEC Pelvic outlet
R L

Pelvis Restoration
PEC Pelvic outlet
Right Left
Pubic Symphysis
A A
Ischial Ischial
P P
Coccyx
(posterior sacrum extended;
coccyx flexed)

Pelvis Restoration
PEC Position Summary
Pelvic Inlet
Bilateral IP ER / IS IR
 Anterior sacrum
flexed
Pelvic floor
positionally
descended,
hypertonic
and
inflexible
Pelvic Outlet
Bilateral IsP IR
 Posterior sacrum
extended
 Coccyx flexed

Pelvis Restoration
GoALS FOR PELVIC OUTLET & INLET IN PEC


Sacral Base
R (anterior sacrum flexed) L R Pubic Symphysis L
P P A A
IsP IR IsP IR
PEC
OFF OFF OFF OFF
Ischial Ischial
ASIS ASIS Tuberosity Tuberosity
ON ON ON ON
IP ER IP ER
A A P P
(posterior sacrum
extended; coccyx flexed)
Reciprocal
P P A A
IsP ER IsP ER
Facilitation
& ON ON
Integration ON ON
of abs with
posterior
pelvic tilt &
proximal
OFF OFF OFF OFF
adductors
IP IR IP IR
A A P P

Pelvis Restoration

R L R L
P
P
IS IR IS ER IsP IR IsP ER
OFF OFF
ON
ON
Reciprocal
Reciprocal
Right
AIC
ON
ON
OFF OFF
IP ER IP IR SI IR A SI ER
A
Alternating
IS ER
IS IR IsP ER IsP IR
P
P
OFF
ON OFF
ON Reciprocal
Reciprocal
Left
AIC
ON
ON
OFF
OFF
A
A
IP IR IP ER
SI ER SI IR

Pelvis Restoration
Anterior view of patho PEC pattern
Posterior view of patho PEC pattern

Pelvis Restoration
Pelvic Outlet & Inlet Imbalances

as a Result of PATHO PEC
Patho PEC Pelvic Inlet

Right Left
Sacral Base
(anterior sacrum flexed)
P P
ASIS ASIS
A A
Pubic Symphysis

Pelvis Restoration
PEC Pelvic outlet
R L

Pelvis Restoration
PATHO PEC Pelvic outlet
Right Left
Pubic Symphysis
A A
Ischial Ischial
P P
Coccyx
(posterior sacrum extended;
coccyx flexed)

Pelvis Restoration
Patho PEC Position Summary
Pelvic Inlet
Bilateral IP ER / IS IR
 Anterior sacrum
flexed
Pelvic floor
positionally
descended,
bulged, and
has high
resting tone
Pelvic Outlet
Bilateral IsP IR
 Posterior sacrum
extended
 Coccyx flexed

Pelvis Restoration
GoALS FOR PELVIC Inlet & outlet IN Patho PEC


Sacral Base
R (anterior sacrum flexed) L R Pubic Symphysis L
P P A A
IsP IR IsP IR
Patho
PEC OFF OFF OFF OFF
Ischial Ischial
ASIS ASIS
OFF OFF OFF OFF
IP ER IP ER
A A P P
(posterior sacrum
extended; coccyx flexed)
Reciprocal
P P A A
IsP ER IsP ER
ON ON
ON ON
Facilitation
of abs with
posterior
pelvic tilt &
adductors OFF OFF OFF OFF
IP IR IP IR
A A P P

Pelvis Restoration

R L R L
P A
IS IR IS ER IsP IR IsP ER
OFF OFF
Reciprocal
ON ON
Reciprocal
Right
AIC
ON ON
OFF OFF
IP ER A IP IR SI IR P SI ER
Alternating
P A
IS ER IS IR IsP ER IsP IR
OFF OFF
ON ON
Reciprocal
Reciprocal
Left
AIC
ON ON
OFF OFF
IP IR A IP ER SI ER P SI IR

Pelvis Restoration
Pelvic Floor Restoration Tests
1. Adduction Drop Test
2. Standing Reach Test (SRT)
3. Pelvic Ascension Drop Test (PADT)
4. Passive Abduction Raise Test (PART)
5. Functional Squat Test
6. Hruska Adduction Lift Test

Pelvis Restoration
Adduction Drop Test

The patient lies on his or her side with the lower leg and hip flexed (90 degrees). Stand behind
the patient and passively flex, abduct and extend the hip to neutral while maintaining 90 degrees
of knee flexion. Passively stabilize the pelvis from falling backward and allowing femoral
internal rotation to occur. Make sure the top innominate is positioned directly over the bottom
innominate so the frontal plane starting position does not give any false positives (top innominate
too cephaled) or false negatives (top innominate too caudal).
A positive test is indicated by a restriction from the anterior-inferior acetabular labral rim,
transverse ligament, and piriformis muscle or impact of the posterior inferior femoral neck on
posterior inferior rim of acetabulum that does not allow the femur to adduct; possibly secondary
to an anteriorly rotated, forward hemipelvis. Usually seen on the left in a Left AIC oriented
patient.
Positive Negative
* Reflective of an osseous restriction from the acetabular labral rim.

Pelvis Restoration
Standing Reach Test
Position
1) Patient stands upright with knees fully extended and arms at side of trunk.
2) Ask patient to align feet with each other so they are parallel.
3) Make sure clothing is unrestricted.
4) Keep shoes on.
Mechanics Without Hip Shift

1) Ask patient to reach down toward floor as arms move forward and hips move back.
2) Instruct patient to keep back rounded in attempting to touch toes with fingertips.
3) Encourage the patient to exhale as they reach toward the toes.
4) Measure distance from fingers to floor in inches.
Mechanics With Hip Shift

1) Ask patient to reach down toward floor as right fingers overlap left fingers, arms move forward
and as hips move back.
2) Instruct patient to keep back rounded in attempting to touch left toes with both left and right
fingertips, while shifting left hip back.
3) Encourage the patient to exhale when reaching toward the toes with knees fully extended.
4) Measure distance directly in front of left toes from fingers to the floor in inches.
5) Repeat procedure on other side by asking patient to reach down toward floor and right toes,
accordingly.
Left AIC: Inability reflects:

• Lack of right anterior left posterior inlet
• Lack of left anterior and right posterior outlet
• Hyperactivity of left anterior and right posterior inlet
• Hyperactivity of right anterior and left posterior outlet
PEC: Lack of bilateral posterior inlet and bilateral anterior outlet. Hyperactivity of bilateral
anterior inlet and bilateral posterior outlet.
*ability to touch toes with + Adduction Drop Test & + PADT = Patho PEC

Pelvis Restoration
Pelvic Ascension Drop Test (PADT)
The patient lies on their side with the top and lower hips and knees flexed to 90 degrees.
The patient is then instructed to actively bring the top leg back to neutral while maintaining 90
degrees of knee flexion, and to touch their knee to the mat. This represents a negative test.
A positive test is indicated by the inability of the active leg’s pelvic floor to ascend secondary to
the left outlet’s inability to abduct.

Pelvis Restoration
PRI Identification for Pelvic Floor Dysfunction

Left AIC Repositioning Techniques
+ Left Adduction Drop Test
+ Left PADT
1. 90-90 Supported Hip Lift with Hemibridge
2. Right Sidelying Respiratory Left Adductor Pull Back
3. Left Sidelying Resisted Right Glute Max
– L Adduction Drop Test / + L PADT = Pelvic Floor Dysfunction

– L Adduction Drop Test / – L PADT = Myokinematic Restoration Program
PEC and Patho PEC Repositioning Techniques

+ Bilateral Adduction Drop Test
+ Bilateral PADT
1. Modified All Four Belly Lift
2. Standing Wall Supported Reach
3. 90-90 Hip Lift in Passive FA IR with Balloon
– B Adduction Drop Test / + B PADT = Pelvic Floor Dysfunction

– B Adduction Drop Test / – B PADT = Myokinematic Restoration and Postural
Respiration Program

Pelvis Restoration
Passive Abduction Raise Test

The patient lies on his or her side with their bottom knee and hip flexed at 70-90°. Their top
knee and hip will remain straight (0-degrees). Passively stabilize the patient’s innominate with
one hand as the other hand passively moves their leg into abduction. Standing behind the patient
usually provides more examiner biomechanical comfort in lifting the leg. Patients with tight right
intercostal walls and short and strong right adductors will demonstrate limited passive abduction
when compared to the other side. Usually the examiner will feel lateral buttressing of the femoral
head on the lateral superior acetabulum as the femur is abducted. When right thoracic abduction
or sidebending occurs, discontinue the test.
A positive test is indicated by a restriction on one or both sides that does not allow sufficient
abduction secondary to lack of outlet adduction. Usually seen on the right side especially if Left
Adduction Drop Test is positive in a Left AIC oriented patient or a patient has a right Hruska
Adduction Lift Test of less than a 3.
A positive test is indicated if the values of the affected side increase after proper PRI techniques
are performed but the values of the contralateral side do not decrease. These techniques could
include: Right Sidelying Adductor Pull Back, Supine Hooklying Adductor Magnus Inhibition,
Standing Supported Left Lateral Dips, Standing Supported Right Squat with Left Hip
Approximation.
 Patients with tight right intercostal walls and short and strong right adductors will
demonstrate limited passive abduction when compared to the other side.
 Usually the examiner will feel lateral buttressing of the femoral head on the lateral superior
acetabulum as the femur is abducted.
 When right thoracic abduction or sidebending occurs, discontinue the test.

Pelvis Restoration
Functional squat test
LEVEL  1
Ability to initiate a squat by slightly bending knees while trunk remains in
flexion. Inability reflects lack of posterior pelvic rotation and hyperactive back
extensors.
Left AIC: Inability reflects hyperactivity of left anterior and right posterior inlet.
PEC: Inability reflects hyperactivity of pelvic bilateral anterior inlet.
LEVEL  2
Ability to begin squatting, moving bottom back and knees forward while trunk
remains in flexion. Inability reflects lack of femoral adduction, hyperactive
hip flexors, and overactive FA ER’s.
L AIC: Inability reflects hyperactivity of right anterior and left posterior outlet.
PEC: Inability reflects hyperactivity of pelvic bilateral posterior outlet.
LEVEL  3
Ability to squat bringing bottom below knee level while keeping heels down
and trunk flexed. Inability reflects tight intercostals and hyperactive anterior /
posterior tibialis.
L AIC: Inability reflects lack of left IO’s & TA’s and left posterior mediastinum
expansion.
PEC: Inability reflects a lack of bilateral IO’s & TA’s and posterior
mediastinum expansion.
LEVEL  4
Ability to squat keeping heels down, trunk flexed and bottom to heels.
Inability reflects hyperactive quads and gastroc-soleus.
L AIC: Inability reflects lack of integration of IO’s & TA’s with pelvic
right anterior and left posterior inlet and left anterior and right
posterior outlet.
LEVEL  5
Ability to maximally squat keeping heels down and trunk flexed while keeping
center of gravity through heels. Inability reflects lack of maximal AF IR and
synchronized mechanics of diaphragm and pelvic floor respiration.
L AIC: Inability to achieve maximum posterior pelvic tilt with maximum

pelvic floor ascension.
* Ability to achieve a full squat with + Adduction Drop Test and +
PADT = Patho PEC

Pelvis Restoration
squatting
Reports of a low incidence of genuine stress incontinence in Chinese women led to dissection of
Chinese female cadavers, from low socio-economic groups in Hong Kong (Zacharin 1977).
The findings showed:
 The levator ani muscle complex was much better developed than in occidentals.
 A thicker muscle mass that extended further laterally.
 Connective tissue was noticeably dense and strong.
 It was concluded that the low incidence of stress incontinence was due to tissue quality,
possibly due to hard work, minimal obesity and squatting (Sapsford 2001).
Advantages of Squatting
 Makes elimination faster, easier and more complete.
 Protects the nerves that control the prostate, bladder and uterus from becoming stretched.
 Seals the iliocecal valve, between the colon and the small intestine.
 Relaxes the puborectalis muscle.
 Uses the thigh to support the colon and prevents straining.
 Reverses hemorrhoid development, as shown by published clinical research.
 Decreases pressure on the uterus when using the toilet. This helps prepare for a more
natural delivery.
 Decreases posterior lordotic forces on abdominal wall.
 Mid-Zone of pelvic floor is placed in a position to provide horizontal structural support

for adequate ZOA position.
 Decompresses lumbar-thoracic vertebrate while maximizing diaphragmatic effectiveness

on thoracic expansion upon inhalation.

Pelvis Restoration
Hruska ADduction Lift Test

This test is used as a myokinematic measurement with each grade reflecting muscle position, strength,
and neuromuscular ability. The test is named for the leg, which is placed on the examiner’s shoulder.
(Patient is lying on their left side with right ankle placed on examiner’s shoulder  “Right” Hruska
Adduction Lift Test.)
Position
1) Patient sidelying – back rounded
2) Uppermost lower extremity resting on therapists shoulder (neutral hip, extended knee)
3) Lower leg in flexed position
4) Maintain pelvis in a neutral position (do not allow upper pelvis to rotate forward or
backward)
Mechanics
1) Step 1: ask patient to raise ankle of flexed lower leg to upper knee
2) Step 2: have patient raise flexed lower knee while keeping ankle to the knee
3) Step 3: patient will then raise lower hip while maintaining the above positions
4) Discontinue test at the step patient is unable to perform
Grading Criteria
LEVEL  0
Inability to raise lower ankle off mat or table. Obturator weakness

of flexed extremity.
Weakness with extended extremity right anterior inlet and inability

to inhibit right anterior outlet (inhibition of right outlet abduction).
LEVEL  1
Ability to raise lower ankle to upper knee. Inability reflects either

weakness of FA external rotators or AF stability of active
extremity.
Inability to inhibit left posterior outlet (inhibition of left outlet

adduction) and inability to inhibit left anterior inlet.
LEVEL  2
Ability to raise lower knee and ankle. Inability reflects instability

of AF and weakness of adductor magnus and obturators or an
anterior tilted and forwardly rotated pelvis with accompanying FA
IR weakness secondary to long position of ischiocondylar adductor
and short position of gluteus minimus, medius and TFL.
Weakness with flexed extremity left posterior inlet and left anterior
outlet.

Pelvis Restoration
LEVEL  3
Ability to maintain above position while lifting lower hip off table
slightly. Inability reflects weakness of FA stabilizers on extended
extremity including the short head of the biceps femoris and
adductor magnus and possibly bilateral AF stabilizers including
muscles of the pelvic diaphragm and lower gluteus maximus.
Weakness with extended extremity right posterior outlet.
LEVEL  4
Ability to raise hip completely off mat or table to level of

patients shoulder and examiner’s shoulder. Inability reflects
lack of core lumbopelvic femoral strength and more than
likely the internal obliques on side of the flexed leg and
external obliques on side of the extended leg.
Weakness with flexed extremities IO’s & TA’s and integration with right anterior and left posterior pelvic
inlet and left anterior and right posterior pelvic outlet. Reflects Right AIC pattern.
LEVEL  5
Ability to raise hip above level of the patients shoulder and equal
to examiners shoulder. Inability reflects patient’s strength and
neuromotor proprioceptive skills to shift hips.
Demonstrates lack of alternating synchronized integration

of pelvic floor and respiratory mechanics.

Pelvis Restoration
Pelvic Floor Restoration TeSts

In relationship to Left AIC, PEC and Patho PEC
PRI Tests for Left AIC
Standing Reach Test > 0”

Adduction Drop Test + left
Pelvic Ascension Drop Test + left
Passive Abduction Raise Test + right
Functional Squat Test < 3/5
Hruska Adduction Lift Test < 3/5 right
PRI Tests for PEC
Standing Reach Test > 0”

Adduction Drop Test + bilateral
Pelvic Ascension Drop Test + bilateral
Passive Abduction Raise Test - bilateral
Functional Squat Test < 3/5
Hruska Adduction Lift Test < 3/5 bilateral
PRI Tests for Patho PEC
Standing Reach Test 0”

Adduction Drop Test + bilateral
Pelvic Ascension Drop Test + bilateral
Passive Abduction Raise Test + OR - bilateral
Functional Squat Test > 3/5
Hruska Adduction Lift Test < 3/5 left

Pelvis Restoration
Pelvic Floor Functional Relationships

+ L *PADT + Standing Reach Test
(L AIC reflects lack of pelvic R anterior and L posterior inlet and L
anterior and R posterior outlet and hyperactivity of L anterior and R
posterior pelvic inlet and R anterior and L posterior outlet)
(PEC reflects lack of B posterior pelvic inlet and B anterior pelvic outlet
& hyperactivity of B anterior pelvic inlet and B posterior pelvic outlet)
– Standing Reach Test

(Patho PEC reflects pelvic inlet & outlet with long and tonic muscles in
the pelvic inlet and outlet)

(left forwardly rotated innominate)
– Left Adduction Drop Test

(left outlet adduction hypertonicity)
+ Right Pelvic Ascension Drop Test (PADT)

(Note: Posterior Exterior Chain or PEC)
+ L *PADT
+ Right Passive Abduction Raise Test
- L Add Drop (right outlet abduction; left outlet adduction)
– Right Passive Abduction Raise Test

(right outlet adduction; left outlet adduction)
- L *PADT + Right Passive Abduction Raise Test

(right outlet abduction, left outlet abduction)
+ L *PADT Functional Squat Level 1-3

(L AIC reflects lack of pelvic R anterior and L posterior inlet and L
anterior and R posterior outlet and hyperactivity of L anterior and R
posterior pelvic inlet and R anterior and L posterior outlet)
(PEC reflects lack of B posterior pelvic inlet and B anterior pelvic outlet
& hyperactivity of B anterior pelvic inlet and B posterior pelvic outlet)
Functional Squat Level 4 & 5

(Patho PEC reflects pelvic inlet & outlet with long and tonic muscles in
the pelvic inlet and outlet)
*Pelvic Ascension Drop Test

Pelvis Restoration
Synchronous Respiratory Influences

on the Pelvic Floor
Research shows…
• Pelvic floor and abdominals are continually active during all phases of respiration.
• Voluntary activity of abdominals increases pelvic floor muscle activity.
• IO and TA contractions are more closely coupled with pelvic floor activity.
• Strong pelvic floor muscle contraction = more efficient co-contraction of abdominals and
most efficient during mid and end phase of exhalation.
• Pelvic floor muscle strength correlates with increased forced expiratory volume, flow and
forced vital capacity.
DysSynchronous Respiratory Influences

on the Pelvic Floor
Research shows…
• Pelvic floor descension is associated with increased levels of IAP (valsalva manuever,
abdominal bracing) and global activation of pelvic floor muscles, abdominals & chest wall.
• External obliques predominantly recruited with abdominal bracing.
• Overuse of EO’s, rectus abdominis noted in nulliparous women with SUI.
• Decreased diaphragmatic motion, increased descent of the pelvic floor, increased minute
ventilation and respiratory rated were noted in painful patients and active straight leg raise
(ASLR).

Pelvis Restoration
Respiratory Influence in the Left AIC
• Left anterior ribs flared and externally rotated.
• Left diaphragm is linear and more posturally oriented.
• Left IO/TA’s are weak.
• Left anterior thorax is hyperinflated.
• Left posterior mediastinum is limited.
• Right anterior chest wall expansion is limited.
• Left pelvic floor is descended = state of inhalation.
Left AIC Pelvic Inlet
 Separates thorax from pelvic floor

 Conduit for airflow regulation

Pelvis Restoration
Left AIC Pelvic Outlet
R L
Right Left
Pubic Symphysis
A
e i
E
I P Coccyx

Pelvis Restoration
Left AIC Pelvic Floor Outlet Goals

Right Left
Left AIC Pubic Symphysis

A
e i
E
I P Coccyx
Alternating
Right Left
Right AIC
Pubic Symphysis
A
i e
E
I
Coccyx P

Pelvis Restoration
Respiratory Influence in the pec
• Bilateral anterior ribs are flared and externally

rotated.
• Bilateral diaphragm is linear and posturally

oriented.
• Bilateral IO/TA’s are long and weak (abdominal

bulge) Continual state of inhalation and exhalation
is passive.
• Bilateral anterior chest wall expansion is limited.
• Bilateral pelvic floor is descended, hypertonic, and

inflexible = state of inhalation.
PEC Pelvic Inlet
R L

Pelvis Restoration
PEC Pelvic Outlet
R L
Pubic Symphysis
A
Right Left
I I
e e
P
Coccyx

Pelvis Restoration
PEC Pelvic Floor Outlet Goals

Pubic Symphysis
A
I I
Right Left
PEC
e e
P
Reciprocal
Coccyx
Pubic Symphysis
A
E E
I I P
Coccyx
Pubic Symphysis
A
Right AIC i e
Reciprocal
Reciprocal
E I
P
Coccyx
Alternating
Pubic Symphysis
A
Left AIC e i
Reciprocal
Reciprocal
I E P
Coccyx

Pelvis Restoration
Respiratory Influence in the Patho PEC
• Bilateral anterior ribs are flared and externally

rotated.
• Bilateral diaphragm is linear and posturally

oriented.
• Bilateral IO/TA’s are long and weak.
• Rectus abdominis is eccentrically tight and

strained.
• Continual state of inhalation and exhalation is

passive.
• Bilateral anterior chest wall expansion is

limited.
• Bilateral pelvic floor is descended, bulged, and

has high resting tone = state of inhalation.
Patho PEC Pelvic Inlet
R L

Pelvis Restoration
Patho PEC Pelvic Outlet
R L
Pubic Symphysis
A
Right Left
I I
i i
P
Coccyx

Pelvis Restoration
Patho PEC Pelvic Floor Outlet Goals

Pubic Symphysis
A
I I
Patho PEC Right Left
i i
P
Coccyx
Pubic Symphysis
A
I I
PEC
e e
P
Coccyx
Reciprocal
Pubic Symphysis
A
E E
I I P
Coccyx

Pelvis Restoration
Patho PEC Pelvic Floor Outlet Goals
Pubic Symphysis
A
Right AIC i e
Reciprocal
Reciprocal
E I
P
Coccyx
Alternating
Pubic Symphysis
A
e i
Reciprocal
Reciprocal
Left AIC
I E P
Coccyx

Pelvis Restoration
Apical Expansion Test
Patient lies in supine with knees flexed to flatten the lumbar spine. Patient inhales through nose,
upon exhalation guide left rib cage down. Hold ribs down as patient attempts to fill opposite
chest wall. Repeat on opposite side.
A positive test for the Left AIC pattern is indicated when the patient is unable to draw air into the
right thoracic chest wall as easily as on the left, through patient report or tester observation.
Limitation in expansion of the right thoracic-apical chest wall reflects right rib internal rotation
orientation with accompanying left rib external rotation orientation secondary to possible
compensation of thoracic rib cage to the left as a result of thoracic “spinal” orientation to the
right.
L AIC Pelvic Floor Patient: Inability of the right anterior chest wall to expand is reflective of
the right anterior outlet being in a state of abduction. The pelvic floor ascended (exhalation).
The right anterior inlet in a state of extension. This position forces air to be pushed into the
right posterior outlet and posterior mediastinum.
PEC Pelvic Floor Patient: Inability of the bilateral anterior chest wall to expand is reflective of
the anterior bilateral pelvic outlets being in a state of adduction. The pelvic floor descended
(inhalation). The bilateral anterior inlets are in a state of flexion. This position has maximal
inhalation in the anterior pelvic outlet and anterior chest wall; therefore the chest cannot expand
further.

Pelvis Restoration
Posterior outlet mediastinum expansion test

Place patient on their right side. Keep the knees and hips at 90-degrees and their back rounded.
Place a towel roll under their side if needed to help maintain neutral alignment of thorax. Place
one hand on patients left posterior mediastinum and the other hand on lateral/anterior rib cage.
Assess for ribcage mobility upon inhalation. Repeat for other side.
Left AIC Pelvic Floor Patient: A positive test for a Left AIC pattern is when the patient is unable
to fill their left posterior mediastinum in a right sidelying position. Inability of the left posterior
mediastinum to expand is reflective of the left anterior outlet being in a state of adduction. The
pelvic floor descended (inhalation). The left pelvic inlet in a state of flexion. This position
forces air to be pushed into the left anterior outlet and left anterior chest wall, reducing air flow
to the left posterior mediastinum and left posterior outlet.
PEC Pelvic Floor Patient: A positive test for a PEC pattern is when the patient is unable to fill
the left or right posterior mediastinum in bilateral sidelying positions. Inability of the posterior
mediastinums to expand is reflective of the bilateral pelvic outlets being in a state of adduction.
The pelvic floor descended (inhalation). The bilateral inlets in a state of flexion. This position
forces air to be pushed into the bilateral anterior outlets and anterior chest wall, reducing
airflow to the bilateral posterior mediastinum and posterior outlets.

Pelvis Restoration
functional Relationships
+ L Pelvic + L Posterior Outlet

Ascension Drop Test Mediastinum Expansion Test
+ R Apical Expansion
Test
(tight right anterior chest wall, left posterior mediastinum, left posterior pelvic outlet)
+ B Pelvic + B Posterior Outlet

Ascension Drop Test Mediastinum Expansion Test
+ B Apical Expansion
Test

Pelvis Restoration
Treatment Considerations
Left AIC Pelvic Floor Algorithm
Test Results
+ Standing Reach Test (inability to touch toes)
+ Left Pelvic Ascension Drop Test (PADT)
+ Right Passive Abduction Raise Test
<3/5 Functional Squat Test
<3/5 Hruska Adduction Lift Test
+ Left Posterior Outlet Mediastinum Expansion Test
+ Right Apical Expansion Test
Myokinematic Restoration Repositioning

90-90 Supported Hip Lift with Hemibridge
Right Sidelying Respiratory Left Adductor Pull Back
Left Sidelying Resisted Right Glute Max
All Tests Negative All Tests Positive - Left Add Drop

+ Left PADT
Myokinematic Further Assessment

Restoration Program Needed Pelvic Floor Program
(maximize hemi 90-90 position)
- Pelvic Floor Ascension Test

3/5 Hruska Adduction Lift Test
Upright Left Single Leg Frontal

Plane Static & Dynamic Control
(left outlet abduction)
Upright Right Single Leg Frontal

Plane Static & Dynamic Control
(right outlet adduction)
Seated Left Pelvic Outlet

Ascension Control
Reciprocal Alternating Activity

Pelvis Restoration
Left AIC Pelvic Floor Hierarchy

(–) Left Adduction Drop Test and (+) Left Pelvic Ascension Drop Test
1. Turn “on” right anterior pelvic inlet via IP ER (rectus femoris and right sartorius).
a. 90-90 Supported Left Hip Shift with Right Rectus Femoris and Sartorius
b. Supine Hooklying Supported Right Rectus Femoris and Sartorius
c. Supine Hemi Extension with Alternating Respiratory Rectus Femoris and Sartorius
(Right Rectus Femoris and Sartorius only)
a b c
Notes:
2. Turn “on” left anterior pelvic outlet via IsP ER (left puborectalis and left pubococcygeus)
with left inlet IP IR. Turn on left iliococcygeus and left obturator via left adductors.
a. Right Sidelying Respiratory Left Adductor Pull Back
b. Right Sidelying Respiratory Left Adductor Pull Back with Passive Left FA IR
c. Left Sidelying Knee to Knee
b c
a
Notes:

Pelvis Restoration
3. Turn “on” left posterior pelvic inlet via IP IR/IS ER (left iliacus and left gluteus medius).
a. Right Sidelying Supported Left Glute Med
b. Right Sidelying Supported Hemi 90-90 with Left FA IR
c. Right Sidelying Hemi 90-90 with Left FA IR
d. Right Sidelying Hemi 90-90 with Left FA IR and Left Quad
a b c d
Notes:
4. Turn “on” right posterior pelvic outlet via SI IR (coccygeus, piriformis and glute max via
glute max).
a. All Four Right Glute Max
b. Left Sidelying Supported Right Glute Max with Right Hip Extension and Right FA ER
c. Left Sidelying Supported Right Glute Max with Hip Extension and FA Abduction
d. Left Sidelying Supported Right Glute Max with Hip Extension and FA Abduction and Left
FA Adduction
e. Left Sidelying Hemi 90-90 with Left IO/TA, Right Glute Max and Left Adductor
f. Left Sidelying Right Extended FA Abduction and Left Abdominal Co-Activation
a b c
d e f
Notes:

Pelvis Restoration
5. Upright left single leg frontal plane control (left outlet abduction via left iliacus and left
obturator & iliococcygeus) if Hruska Adduction Lift Test 3/5.
a. Standing Respiratory Left AF IR with Resisted Left Arm Pull Down and Left Knee
Flexion
b. Standing Wall Supported Reach with Left AF IR
c. Standing Wall Supported Left Knee Flexion with Resisted Right Glute Max
d. Standing Wall and Chair Supported Respiratory Left AF IR with Left IO/TA Integration
e. Standing Supported Respiratory Left AF IR with IO/TA and Right AF ER
f. Left Stance Reciprocal Step Through
a b c d e f
Notes:
6. Upright right single leg frontal plane control (right anterior outlet adduction via right glute
max).
a. Standing Supported Right Knee Flexion with Left Hip Approximation
b. Standing Supported Right Knee Flexion with Left Hip Extension
c. Standing Supported Right Glute Max with Left Hip Approximation and Left FA IR
d. Standing Supported Right Knee Flexion with Weighted Left Hamstring and Right Trunk
Rotation
e. Standing Wall Supported Right Knee Flexion with Left Glute Med and Right Trunk
Rotation
a b c d e
Notes:

Pelvis Restoration
7. Seated Pelvic Floor Ascension Control

a. Seated Supported Left AF IR/FA IR (left iliacus)
b. Seated Resisted Bilateral Arm Pull Down #1 (bilateral anterior inlet and posterior outlet
inhibition)
c. Seated Resisted Bilateral Arm Pull Down #3 (left obturator and iliococcygeus)
d. Seated Resisted Left AF IR/FA IR with Balloon (left iliacus)
e. Seated Left AF IR/FA IR with Right Quad (left iliacus)
a b c d e
Notes:
8. Reciprocal alternating activity (Integration).

a. Left Stance from the Left AIC Pattern with Right Trunk Rotation
b. Heel Stair Descents
c. Retro Walking
d. Decline Retro Walking
a b c d
Notes:

Pelvis Restoration
Left aic inhibition techniques

1. Inhibition of left anterior inlet via left inlet IP IR to promote extension.
a. Standing Supported Passive Left AF IR with Right Trunk Rotation
b. Late Left AIC Stance with Right Arm Reach
c. Seated Supported Respiratory Left AF IR/FA IR with Intercostal Pulley Inhibition
a b c
Notes:
2. Inhibition of right anterior outlet via IsP IR to promote right outlet adduction.
a. Supine Hooklying Adductor Magnus Inhibition
b. Right Sidelying Respiratory Left Adductor Pull Back
c. Left Sidelying Right Extended FA Abduction and Left Abdominal Co-Activation
d. Standing Supported Left AF IR with Right FA Abduction
a b c d
Notes:

Pelvis Restoration
3. Inhibit right posterior inlet via IP ER to promote right inlet abduction.

a. All Four Right Glute Max
b. Modified All Four Inferior Glute Max, Adductor Magnus and Quadratus Femoris Stretch
c. Left Sidelying Supported Right Glute Max with Right Hip Extension and Right FA ER
d. Left Sidelying Supported Right Glute Max with Hip Extension and FA Abduction
a b c d
Notes:
4. Inhibition of left posterior outlet via IsP ER to promote left outlet abduction.
a. All Four Right Arm Reach
b. Left Sidelying Left Ischial Femoral Ligamentous Stretch with Left FA Adduction
c. Standing Supported Left Posterior Outlet Inhibition
d. Standing Posterior Capsule Stretch
a b c d
Notes:
5. Promote squatting.
a. Reverse Squatting
b. Full Functional Squat
a b
Notes:

Pelvis Restoration
Si instability
L AIC Pelvic Inlet Position Review
(L) = IP ER / IS IR = inlet abduction = SI compression
outlet adduction
femoral abduction
(R) = IP IR / IS ER = inlet adduction = SI distraction
outlet abduction
femoral adduction

Pelvis Restoration
SI Instability Treatment Hierarchy

for Left aic Patients
1. Inhibit right posterior inlet adduction via right IP ER position with right gluteus maximus and
right iliacus (abduction).
a. 90-90 Supported Left Hip Shift with Right Iliacus
b. Supine Supported Right Iliacus
c. Standing Supported Left Knee Flexion with Right Psoas and Iliacus, Right Trunk
Rotation and Right FA ER
d. Seated Supported Left AF IR with Right Iliacus and Right FA ER
a b c d
2. Turn “on” left anterior pelvic outlet via left IsP ER (left puborectalis and left pubococcygeus)
with left inlet IP IR. Turn on left iliococcygeus and left obturator via left adductors and left
posterior inlet via IP IR / IS ER
a. Right Sidelying Respiratory Left Adductor Pull Back
b. Left Sidelying Knee To Knee
c. Left Sidelying IO/TA and Left Adductor with Right Glute Max
d. Left Sidelying Left Ischial Femoral Ligamentous Stretch with Left Adduction
a b c d
3. Turn “on” right posterior pelvic outlet via right SI IR (coccygeus, piriformis, and glute max
via glute max).
a. All Four Single Leg Right Glute Max
b. Left Sidelying Supported Right Glute Max with Right Hip Extension and Right FA ER
c. Left Sidelying Supported Right Glute Max with Hip Extension and FA Abduction
d. Standing Supported Right Glute Max with Left Hip Approximation and Left FA IR
a b c d

Pelvis Restoration
left AIC Case Study

Notes

Pelvis Restoration
PEC Pelvic Floor Algorithm
Test Results
+ Standing Reach Test (inability to touch toes)
+ Bilateral Pelvic Ascension Drop Test
- Bilateral Passive Abduction Raise Test
< 3/5 Functional Squat Test
< 3/5 Hruska Adduction Lift Test
+ Bilateral Posterior Outlet Mediastinum Expansion Test
+ Bilateral Apical Expansion Test
Repositioning Technique
Modified All Four Belly Lift
Standing Wall Supported Reach
90-90 Hip Lift in Passive FA IR with Balloon
All Tests Negative All Tests Positive - Bilateral Adduction Drop

+ Bilateral PADT
Myokinematic Further Assessment Pelvic Floor Program

Restoration & Postural Needed (maximize all four position with inlet extension
Respiration Program via IO/TA’s)
Hruska Adduction Lift Test 2/5

Left AIC Pelvic Floor Program
Upright Left Single Leg Frontal Plane Control

Upright Right Single Leg Frontal Plane Control

Seated Left Pelvic Outlet Ascension Control

Pelvis Restoration
PEC Pelvic Floor Hierarchy

(–) Bilateral Adduction Drop Test and (+) Bilateral Pelvic Ascension Drop Test
1. Maximize diaphragmatic respiratory function.
a. Supine Hemi Extension with Alternating Respiratory Rectus Femoris and Sartorius
b. PRI Breathing Techniques – (See appendix)
c. PRI Manual Techniques - (Postural Respiration course)
2. Maximize inhibition of left anterior inlet and left posterior outlet.

a. 90-90 Respiratory Left Hip Shift
b. 90-90 Supported Left Hip Shift with Respiratory Left FA IR
c. 90-90 Supported Alternating Crossover with IO/TA
a b c
*If patient has difficulty performing PRI activities in 90-90 position, consider step #2 activities
under Patho PEC treatment.
3. Achieve Hruska Adduction Lift Test level 2/5 before initiating Left AIC Pelvic Floor
program.
4. Turn “on” right anterior pelvic inlet via IP ER (right rectus femoris and right sartorius).
5. Turn “on” left anterior pelvic outlet via IsP ER (left puborectalis, left pubococcygeus) with
left inlet IP IR. Turn “on” left iliococcygeus and left obturator via left adductors.
a. Right Sidelying Respiratory Left Adductor Pull Back with Balloon

Pelvis Restoration
6. Turn “on” left posterior pelvic inlet via IP IR/IS ER (left iliacus and left gluteus medius).
a. Right Sidelying Hemi 90-90 with IO/TA and Left FA IR
b. Right Sidelying Right Apical Expansion with Left FA IR
a b
7. Turn “on” right posterior pelvic via outlet SI IR (coccygeus, piriformis and glute max via
glute max).
8. Upright left single leg frontal plane control (left outlet abduction).
a. Standing Supported Left AF IR with Left IO/TA and Resisted Right Posterior Glute Med
9. Upright right single leg frontal plane control (right outlet adduction).
10. Seated pelvic floor ascension control.
11. Reciprocal alternating activity.

a. Four Point Gait with Mediastinum Expansion
b. Modified Two Point Gait with Left AF IR
c. Two Point Gait with Left IO/TA
d. Two Point Gait with Right Glute Max
a b c d

Pelvis Restoration
Pubalgia
(Could also include coccydynia, levator ani syndrome, vulvodynia,
prostatodynia, proctolgia fugax)
PEC Pelvic Inlet Position Review
(B) = IP ER / IS IR = inlet flexion, abduction, ER = outlet IsP IR

(extension, adduction, IR) femurs to abduct and actively
externally rotate
* Eccentrically lengthened and overworked rectus abdominus and short and tight paravertebrals
secondary to pelvic inlet flexed position. Lengthened adductors secondary to IP IR of the outlet
creates a shearing at the symphysis pubis.

Pelvis Restoration
Pubalgia hierarchy
1. Inhibit anterior inlet and posterior outlet via IO/TA’s.
a. Standing Wall Supported Resisted Reach
b. Squatting Bar Reach
c. Full Functional Squat
d. Seated Bar Reach
a b c d
2. Maximize pelvic inlet extension with IO/TA’s with posterior pelvic tilt.
a. Modified All Four Belly Lift
b. All Four Swiss Ball Belly Lift
c. All Four Belly Lift
a b c
3. Maximize left posterior outlet expansion with left inlet IP IR and extension.
a. All Four Right Arm Reach
b. All Four Right AIC Pelvic Floor Respiratory Crawl
c. Left Sidelying Knee to Knee
d. Right Sidelying Supported Hemi 90-90 with Left FA IR
e. Standing Supported Passive Left Hip Approximation
a b
c d e

Pelvis Restoration
4. Maximize reciprocal activity with IO/TA’s.

a. Left Stance from the Left AIC Pattern with Right Trunk Rotation
b. Walking Stick Program
c. Heel Stair Descents
a b c

Pelvis Restoration
PEC Case Study

Notes

Pelvis Restoration
Pathologic PEC Pelvic Floor Algorithm
Test Results
– Standing Reach Test (touches toes)
+ Bilateral Pelvic Ascension Drop Test
+ OR - Bilateral Passive Abduction Raise Test
> 3/5 Functional Squat Test
< 3/5 Hruska Adduction Lift Test
+ Bilateral Posterior Outlet Mediastinum Expansion Test
+ Bilateral Apical Expansion Test
Repositioning Technique
- Bilateral Adduction Drop

All Tests Negative All Tests Positive + Bilateral PADT
Maximize exhalation with IO/TA with posterior

Myokinematic Further Assessment pelvic tilt
Restoration & Postural Needed
Respiration Program
Pelvic Floor Program
(maximize all four position with inlet extension via
IO/TA’s)
Consider
Interdisciplinary
Integration Hruska Adduction Lift Test 2/5
Left AIC Pelvic Floor Program
Upright Left Single Leg Frontal Plane Control

Upright Right Single Leg Frontal Plane Control

Seated Left Pelvic Outlet Ascension Control

Pelvis Restoration
Patho PEC Pelvic Floor Hierarchy

(–) Bilateral Adduction Drop Test and (+) Bilateral Pelvic Ascension Drop Test
1. Maximize diaphragmatic respiratory function.

a. 90-90 Hip Lift in Passive FA IR with Balloon
b. Supine Hemi Extension with Alternating Respiratory Rectus Femoris and Sartorius
c. PRI Breathing Techniques - (see appendix)
d. PRI Manual Techniques - (Postural Respiration course)
e. PRI Manual Pelvic Floor Techniques
a b
2. Maximize exhalation with IO/TA’s with posterior pelvic tilt and small movement in mid-
zone.
a. Modified All Four Belly Lift
b. All Four Swiss Ball Belly Lift
c. All Four Belly Lift
d. All Four Resisted Right Glute Max
e. Wall Supported Passive FA IR with Balloon
a b c
d e
3. Follow PEC Hierarchy (starting at step #2).

Pelvis Restoration
Pec and patho pec inhibition techniques

1. Inhibition of bilateral anterior inlet and bilateral posterior outlet.
a. Standing Wall Supported Reach
b. Standing Wall Supported Resisted Reach
c. Squatting Bar Reverse Reach (with pole) – Level 2-3
d. Full Functional Squat
e. Seated Bar Reach
a b c
d e

Pelvis Restoration
TREATMENT CONSIDERATIONS
For Left AIC, PEC, and Patho PEC
Patient is able to achieve “neutrality” (negative PRI tests)

and feeling 80% better.
Considerations
1. Work on reciprocal left inlet IP IR/outlet IsP ER with inhalation and “mid zone” with
exhalation with PRI exercise techniques.
Right Sidelying Respiratory Left Adductor Pull Back with Standing Respiratory Left AF IR with Resisted
Passive Left FA IR Left Arm Pull Down and Left Knee Flexion
Exhale Inhale Inhale Exhale
Wall Supported Respiratory

Left AF IR
Inhale Exhale

Pelvis Restoration
2. Work left inlet IP IR/outlet IsP ER with PRI Kegel.
PRI Kegel:
 Performed when patient is neutral with PRI tests and Hruska Adduction Lift scores
are 3/5.
 Can be performed supine, sidelying, sitting, or standing.
 Patient shifts into left inlet IP IR/outlet IP ER and adducts the femur.
 Once patient feels their left inner thigh they are instructed to pull their pelvic floor
“up and in” (Kegel).
 Hold for 1 to 5 seconds and relax Kegel. Continue this Kegel sequence for 5 reps
while maintaining left inlet IP IR/outlet IP ER position.
Right Sidelying Respiratory Left Right Sidelying Supported Hemi Standing Supported Left AF IR
Adductor Pull Back 90-90 with Left FA IR with Right FA Abduction
3. Work in seated position with left inlet IP IR/outlet IsP ER with ability to feel left ischial
tuberosity.
4. Internal work.
5. Hormonal imbalances (mood swings, headaches, decreased sexual response, bloating,

cramping, anxiety, sleep disturbances, mental fuzziness, vaginal or bladder infections,
incontinence).
6. Diet (partially hydrogenated and hydrogenated oil, high sugar foods, dairy, grains).
7. Psychosocial Issues (abuse, trauma, sexual dysfunction, depression, anxiety).

Pelvis Restoration
Patient is able to achieve “neutrality” (negative PRI tests)

but they cannot maintain neutral.
Considerations
1. Correct diaphragmatic breathing with PRI exercise techniques and functional activity?
2. May need to focus on inhibition techniques longer than you think.
3. Can the patient find and feel the muscles correctly with PRI exercise techniques (especially
abdominals!)?
4. Are you progressing your patient too aggressively with PRI techniques? Small movements
sometimes are best.
5. Does your patient have a “reference center” to inhibit Left AIC or PEC throughout the day
with functional activity?
6. Appropriate footwear with adequate calcaneal and arch support (running shoes without
lateral calcaneal give work best).
7. Hypermobility. Patient may need additional support until adequate strength is acquired.
When the aforementioned considerations are not effective, interdisciplinary integration may be
indicated.

Appendix – Pelvis Restoration
APPENDIX
Myokinematic Restoration Repositioning .....................................................................................2

PEC and Patho PEC Repositioning .................................................................................................4
Pelvis Restoration Repositioning ....................................................................................................6
Pelvis Restoration Non-Manual Techniques
Right Rectus Femoris and Sartorius ...................................................................................8
Left Obturator and Iliococcygeus .....................................................................................10
Left Iliacus ........................................................................................................................18
Right Gluteus Maximus ....................................................................................................23
Integration .........................................................................................................................31
Pelvis Restoration Inhibition Techniques
Left Anterior Inlet .............................................................................................................39
Right Anterior Outlet ........................................................................................................42
Right Posterior Inlet ...........................................................................................................43
Left Posterior Outlet .........................................................................................................45
Bilateral Anterior Inlet and Bilateral Posterior Outlet ......................................................47
Pelvis Restoration Manual Techniques ........................................................................................51
PRI Sexual Positions .....................................................................................................................54
PRI Positioning Handout ..............................................................................................................57
PRI Breathing Techniques ............................................................................................................61
Pelvic Floor Disorders ..................................................................................................................65
Treatment Considerations for Isolation of Pelvic Floor and Transverse Abdominis ...................67
Research Support ..........................................................................................................................68
Terminology Key for Technique Descriptions

(See Appendix for Examples)
R = Right L = Left B = Bilateral
AF = Acetabular Femoral FA = Femoral Acetabular TR = Trunk Rotation
IR = Internal Rotation ER = External Rotation
ADD = Adduction ABD = Abduction
FLEX = Flexion EXT = Extension
Letters preceding “/” = Position Letters following “/” = Action
When no “/” exists = Action  = Next step
IP inlet = ilio-pubo IsP outlet = ischo-pubo
IS inlet = ilio-sacral SI outlet = sacral-ilio

Appendix – Myokinematic Restoration Repositioning Techniques
Myokinematic Restoration Repositioning
90-90 Supported Hip Lift with Hemibridge

1. Lie on your back with your feet flat on a wall and
your knees and hips bent at a 90-degree angle.
2. Inhale through your nose and as you exhale through
your mouth, perform a pelvic tilt so that your tailbone
is raised slightly off the mat. Keep your low back flat
on the mat. Do not press your feet flat into the wall
instead dig down with your heels.
3. Maintain the pelvic tilt with your left leg on the wall
and straighten your right leg.
4. Slowly take your straight right leg on and off the wall
5. as you breathe in through your nose and out through
your mouth. You should feel the muscles behind
your left thigh engage.
6. Perform 3 sets of 10 repetitions.

1. Lie on your right side with your feet on a wall with your hips and knees at a 90-degree angle, ankles
and knees together and your back rounded. Place a pillow under your head and keep your back and
neck relaxed.
2. Place an appropriate size bolster between your feet and a towel between your knees. Your left knee
should be lower than your left hip and ankle.
3. Push your right foot into wall.
4. Begin by inhaling slowly through your nose as you pull back your left leg.
5. Exhale through your mouth as you squeeze your left knee down into the towel for 3 seconds.
6. Inhale again as you pull back your left leg further. You should begin to feel your left inner thigh
engage.
7. Exhale and squeeze your left knee down.
8. Continue the sequence until you have completed 4-5 breaths in and out. Attempt to pull back your
left leg further each time you inhale.
9. Relax your knees back to the starting position and repeat the sequence 4 more times.

Appendix – Myokinematic Restoration Repositioning Techniques
Left Sidelying Resisted Right Glute Max

1. Lie on your left side with your hips and knees bent at a 60-90-degree angle.
2. Place your ankles on top of a 3-5 inch bolster and place your feet firmly on a wall.
3. Place tubing around both thighs slightly above your knees.
4. Shift your right hip forward until you feel a slight stretch or pull in your left outside hip.
5. Keeping your feet on the wall, raise your right knee keeping it shifted forward. You should feel your
right outside hip (buttock) engage.
6. Hold this position while you take 4-5 deep breaths, in through your nose and out through your mouth.
7. Relax and repeat 4 more times.

Appendix – PEC and Patho PEC Repositioning Techniques
PEC and Patho PEC Repositioning

(Bilateral Anterior Inlet and Bilateral Posterior Outlet Inhibition)

1. Position yourself on your hands and knees with your back rounded.
2. Maximally round your spine by arching your back upward, as you roll your pelvis back so that your
bottom tucks under you.
3. Shift your body weight forward so your nose is over your fingertips. You should feel your outer
abdominals.
4. Raise your left hand off the floor as you maintain a rounded trunk position. Don’t let
your trunk turn or twist when you lift up your hand. You should feel your right
abdominal wall engage when you pick your left hand up.
5. Hold this position while you take 4-5 deep breaths, in through your nose and out
through your mouth.
6. Lower your left hand to the floor and take your right hand off the floor. You
should feel your left abdominal wall engage when you pick your right hand up.
through your mouth.
8. Relax and repeat both sequences.

1. Stand facing away from a door, and place your heels 7-10 inches from the wall.
2. Stand up straight with a ball between your knees and feet shoulder width apart.
3. Bring your arms out in front of you as you round out your back, performing a
pelvic tilt so your lower back (mid-back and down) is flat on the wall.
4. Squat down slightly as you squeeze the ball.
5. Keeping your lower back flat on the wall, inhale through your nose.
6. As you exhale through your mouth, reach your arms forward and down so your
upper back comes off the wall (your lower back should stay flat on the wall).
7. Hold your arms steadily in this position (reach), as you inhale through your nose
again and expand your upper back. You should feel a stretch in your upper back.
8. Exhale and reach further forward. You should feel the muscles on the front of
your thighs and outer abdominals engage.
9. Repeat this breathing sequence for a total of 4-5 deep breaths, in through your
nose and out through your mouth.
10. Slowly stand up by pushing through your heels, keeping your lower back flat on
the wall.

Appendix – PEC and Patho PEC Repositioning Techniques

1. Lie on your back with your feet flat on the wall and your hips and knees bent at a 90-degree angle.
Move your feet out so they are wider than your hips.
2. Place a 4-6 inch ball between your knees.
3. Inhale through your nose and as you exhale through your mouth, perform a pelvic tilt so that your
tailbone is raised slightly off the mat. Keep your low back flat on the mat. You should feel the
muscles on the back of your thighs engage.
4. Inhale through your nose and slowly blow up the balloon, pause 3 seconds and don’t let the air flow
out of the balloon by placing your tongue on the roof of your mouth.
5. Keeping the tongue on the roof of your mouth, inhale through your nose and relax your pelvic tilt.
6. Then slowly blow out into the balloon as you perform the pelvic tilt and pause 3 seconds.
7. Continue this breathing sequence for 4 to 5 breaths, performing the pelvic tilt on each exhale and
relaxing on each inhale.
Exhale Inhale

Appendix – Pelvis Restoration Repositioning Techniques
Pelvis Restoration Repositioning

Left Sidelying Knee to Knee
1. Lie on your left side with your hips and knees bent at a 90-degree angle, your feet on the wall, knees
together and back rounded. Place a pillow under your head and keep your back and neck relaxed.
2. Place a small bolster underneath your ankles.
3. Push your bottom foot into the wall.
4. Lift up or turn “out” your upper thigh.
5. Then lift up or turn “in” your lower thigh to the point of touching your upper thigh. You should feel
your left inner thigh and left outer hip (buttock) engage.
6. Hold your left thigh up to your right thigh while you take 4-5 deep breaths, in through your nose and
out through your mouth.
Shift right knee forward and repeat above. Shift right knee back and repeat above.
Right Sidelying Supported Hemi 90-90 with Left FA IR

1. Lie on your right side with your right hip and knee bent at a 90-degree angle and your right foot
placed on the wall.
2. Keep your left hip neutral and place your left knee on a bolster so that it is below the level of your left
hip.
3. Place your right arm or a pillow under your head and keep your back and neck relaxed.
4. Press your right foot into the wall.
5. Press your left knee down into the bolster feeling your left inner thigh engage.
6. With your right foot pushing into the wall and your left knee down, slowly raise your left lower leg
up towards the ceiling. You should feel the muscle on your left outer hip (buttock) engage.
7. Slowly lower and raise your left lower leg 10 times while keeping your left outer hip (buttock) muscle
engaged.

Appendix – Pelvis Restoration Repositioning Techniques
Standing Supported Respiratory Left AF IR with IO/TA and Right AF ER

1. Stand against a desk or counter, and place your left foot on a 2-inch block. Keep your weight through
your left mid-foot/heel.
2. Place your hands on the surface in front of you and round your back.
3. With your left knee slightly bent, shift your left hip back and pull your left knee in slightly. You
should feel the muscles on your left outer hip (buttock) and left inner thigh engage.
4. Sidebend your trunk to the left so that your left shoulder is slightly below your right shoulder. You
should feel your left abdominals engage.
5. Keeping your left hip back, slowly bring your right knee forward and up to the level of your right hip.
6. Inhale through your nose, and slowly exhale through your mouth as you bring your right knee slightly
forward.
7. Continue this breathing sequence for a total of 4-5 deep breaths.
Exhale

Appendix – Right Rectus Femoris and Sartorius Techniques
Right Rectus Femoris and Sartorius

90-90 Supported Left Hip Shift with Right Rectus Femoris and Sartorius
1. Lie on your back with your feet flat on a wall and your knees and hips bent at a 90-degree angle.
tailbone is raised slightly off the mat. Keep your low back flat on the mat. Do not press your feet flat
into the wall instead dig down with your heels. You should feel the muscles on the back of your
thighs engage. Maintain this position and a normal breathing pattern.
4. Shift your left knee down or right knee up so that your right knee is slightly above your left. Squeeze
the ball slightly with your left knee. You should feel your left inner thigh engage.
5. Maintaining the slight pelvic tilt with your left leg, raise your right leg off the wall.
6. Slowly bend and straighten your right knee 10 times, keeping your right knee above the left. You
should feel the muscles on the back of your left thigh and front of your right thigh engage.
Supine Hooklying Supported Right Rectus Femoris and Sartorius

1. Lie on your back and place a 2-inch block under both feet. Keep your back and neck relaxed.
2. Inhale through your nose and as you exhale through your mouth, press down with your heels and
perform a pelvic tilt so that your tailbone is raised slightly off the mat. Keep your low back flat on the
mat. Maintain this position. You should feel the muscles on the back of your thighs engage.
3. Continue to push down into the block with your left heel and maintain the slight pelvic tilt with your
left leg, as you straighten and bend your right knee 10 times. You should feel the muscles on the back
of your left thigh and front of your right thigh engage. Keep your low back flat on the mat during the
entire exercise.
4. Relax and repeat 2-3 more times.

Appendix – Right Rectus Femoris and Sartorius Techniques
Supine Hemi Extension with Alternating Respiratory Rectus Femoris and Sartorius
1. Lie on your back on the edge of a mat/bed with your left knee bent over the edge. Place a small towel
roll under your left thigh to keep your left low back flat. Also have a small towel roll available for
under your right thigh.
2. Keeping your left thigh down on the towel roll, raise your right leg up to a 90-degree angle at your
knee.
3. Inhale through your nose and slowly straighten your right knee.
4. Exhale through your mouth and slowly bend your right knee to a 90-degree angle.
5. Repeat this breathing sequence for 3 breaths in through your nose and out through your mouth.
6. Slowly lower your right thigh to the towel roll and raise your left leg up to a 90-degree angle at your
knee.
7. Inhale through your nose and slowly straighten your left knee.
8. Exhale through your mouth and slowly bend your left knee to a 90-degree angle.
9. Repeat this breathing sequence for 3 breaths in through your nose and out through your mouth.
10. Relax and repeat the entire activity 2 more times.
Inhale Exhale
Inhale Exhale

Appendix – Left Obturator and Iliococcygeus Techniques
Left Obturator and Iliococcygeus

1. Lie on your right side with your feet on a wall with your hips and knees at a 90-degree angle, ankles
and knees together and your back rounded. Place a pillow under your head and keep your back and
neck relaxed.
2. Place an appropriate size bolster between your feet and a towel between your knees. Your left knee
should be lower than your left hip and ankle.
3. Push your right foot into wall.
4. Begin by inhaling slowly through your nose as you pull back your left leg.
5. Exhale through your mouth as you squeeze your left knee down into the towel for 3 seconds.
6. Inhale again as you pull back your left leg further. You should begin to feel your left inner thigh
engage.
7. Exhale and squeeze your left knee down.
8. Continue the sequence until you have completed 4-5 breaths in and out. Attempt to pull back your
left leg further each time you inhale.
9. Relax your knees back to the starting position and repeat the sequence 4 more times.
Right Sidelying Respiratory Left Adductor Pull Back with Passive Left FA IR
1. Lie on your right side with your feet on the wall, hips and knees at a 90-degree angle. Place a small
folded towel between your knees.
2. Keep your back rounded and place your left foot on the wall with your left ankle much higher than
your left knee.
5. Inhale through your nose and slowly pull your left hip back feeling a stretch in your left outer hip
(buttock).
6. Exhale through your mouth and squeeze your left knee down into the towel, feeling your left inner
thigh muscle engage.
7. Continue this sequence until you have completed 4-5 breaths in and out.
9.
Exhale
Inhale

Right Sidelying Respiratory Left Adductor Pull Back with Balloon

1. Lie on your right side with your feet on the wall, hips and knees at a 90-degree angle. Place a small
folded towel between your knees.
2. Keep your back rounded and place your left foot on the wall with your left ankle much higher than
your left knee.
5. Inhale through your nose and slowly pull your left hip back, feeling a stretch in your left outer hip
(buttock).
6. Exhale slowly into the balloon as you squeeze the towel with your left knee, feeling your left inner
thigh muscle engage. Pause 3 seconds, placing your tongue on the roof of your mouth to prevent
airflow out of the balloon.
7. Without pinching the neck of the balloon and keeping your tongue on the roof of your mouth, inhale
again through your nose as you pull your left hip back further.
8. Exhale into the balloon as you squeeze the towel by pressing your left knee down. Pause 3 seconds.
9. Continue this sequence for 4-5 breaths, in through your nose and out through your mouth.
Exhale
Inhale

1. Lie on your left side with your hips and knees bent at a 90-degree angle, your feet on the wall, knees
together and back rounded. Place a pillow under your head and keep your back and neck relaxed.
2. Place a small bolster underneath your ankles.
3. Push your bottom foot into the wall.
4. Lift up or turn “out” your upper thigh.
5. Then lift up or turn “in” your lower thigh to the point of touching your upper thigh. You should feel
your left inner thigh and left outer hip (buttock) engage.
6. Hold your left thigh up to your right thigh while you take 4-5 deep breaths, in through your nose and
Shift right knee forward and repeat above. Shift right knee back and repeat above.

Left Sidelying IO/TA and Left Adductor with Right Glute Max
1. Lie on your left side with your left leg straight.
2. Place a 2-3 inch towel under your left side and 1-2 pillows under your head so that your neck is
slightly sidebent to the right.
3. Bend your right leg and cross it over your left leg.
4. Place your right foot slightly ahead of your left knee and drop the inside of your right foot toward the
mat so that you can feel the arch of your foot push into your shoe.
5. Push your left hip down into the mat so that your right hip moves toward the wall. You should feel
your left abdominals engage as you lift up away from the towel roll. With your right hand you can
feel your left abdominals engage. Do not engage your neck.
6. Keeping your right arch in contact with the mat, shift your right knee and hip forward and turn your
right knee out. You should feel your right outside hip (buttock) engage.
7. Keeping your left hip down and right knee turned out, turn your left leg in so that your toes are
towards the ceiling and pick your entire leg up. You should feel your left inner thigh engage.
Left Sidelying Left Ischial Femoral Ligamentous Stretch with Left FA Adduction
1. Lie on your left side with your right leg straight and
your left leg bent at a 60-degree angle.
2. Place a small bolster underneath your left knee and
your left abdominal wall.
3. Place your left foot flat on the wall and your right
foot on the wall. Turn your right foot/ankle out so
that your right arch is resting on the wall.
4. Keep right ankle, hip, and shoulder lined up.
5. Rotate your right hip forward until you feel a stretch
in your left outer hip (buttock). Your pant zipper
will be toward your left leg.
6. Keeping your right hip forward, lift your left knee
off the bolster. You should feel your left inner thigh
engage.
7. Hold this position for 4 to 5 breaths, in through your

Standing Respiratory Left AF IR with Resisted Left Arm Pull Down and Left Knee Flexion
1. Stand with your back to the door. Place tubing in
your left hand and secure the other end in a
door frame. Inhale Exhale
2. Shift your left hip back, bend your left knee
and pull your left knee in slightly. Keep your
weight though your left mid-foot/heel. You
should feel the muscles on the front of your left
thigh, your left outer hip (buttock) and left
inner thigh.
3. Reach towards the floor with your left hand
against the resistance of the band. You should
feel your left outer abdominal wall engage.
4. Raise your right knee up to the level of your
right hip.
5. Inhale through your nose and slowly squat
down by bending your left knee as you keep
the muscles listed above engaged.
6. Exhale through your mouth and slowly straighten your left knee.
7. Continue this breathing sequence for 4-5 deep breaths, in through your nose and out through your
mouth.
Wall Supported Respiratory Left AF IR

1. Stand against the wall with your feet 7-10
inches from the wall. Inhale Exhale
2. Round out your back, performing a pelvic
tilt so your lower back (mid-back and
down) is flat on the wall.
3. Place your hands on the inside of your
knees and slightly squat, keeping your
weight through your mid-foot/heels.
4. Inhale through your nose as you pull your
left knee behind your right. You should
feel the muscles on your left inner thigh
and left outer hip (buttock) engage. Your
right bottom and right lower back should
come off the wall slightly.
5. Exhale through your mouth as you return
your left knee back to the starting position
(your knees should be lined up).
6. Continue this breathing sequence for a
total of 4-5 breaths, in through your nose
and out through your mouth.

Standing Wall Supported Reach with Left AF IR

1. Stand 7-10 inches from a wall, and place a ball between your knees.
2. Place your bottom on the wall and slide down by slightly bending
your knees.
3. Round out your back as you perform a pelvic tilt so that your low
back is flat on the wall. Reach forward with both arms.
4. Shift your right knee forward and your left knee back so that your
right hip is off the wall. Keep 80% of your weight on your left
leg and 20% on the right. Keep both feet flat on the floor and the
weight through your heel/mid-foot.
5. You should feel the front of your left thigh, left inner thigh and
your left outer hip (buttock) work together.
6. If you don’t feel the front of your thigh engage, squeeze the ball
more with your left knee. If you don’t feel your left outside hip
(buttock), release the ball with your right knee and turn your right
knee out until you can find and feel your left outside hip
(buttock). Keep your right foot/arch firmly on the floor and the
majority of your weight through your left mid-foot/heel.
20% 80%
7. Hold this position while you take 4-5 breaths, in through your
Standing Wall Supported Left Knee Flexion with Resisted Right Glute Max
1. Stand with your feet shoulder width apart and tubing around your knees.
2. Place your right foot flat on the wall behind you.
3. Shift your right knee down and sidebend
your trunk to the left.
4. Maintaining the above position, press your
right foot/arch into the wall and rotate your
right knee out against the resistance of the
band. You should feel the muscles on the
outside of your right hip (buttock) engage.
5. Keeping your right knee turned out, begin
to squat down by bending your left knee.
Place your right hand on the wall for
stability. You should feel the muscles on
the front of your left thigh and left outer
hip (buttock) engage.
6. Hold this position while you take 4-5 deep
breaths, in through your nose and out
through your mouth.

Standing Wall and Chair Supported Respiratory Left AF IR with Left IO/TA Integration
1. Stand with your feet shoulder width apart and a
ball between your knees.
2. Place your right foot on the wall behind you,
and push your right foot back into the wall so
that your right hip comes forward slightly.
3. Shift your right knee down and squeeze the ball
with your left knee. You should feel your left
inner thigh and left outer hip (buttock) engage.
4. Sidebend your trunk to the left and press your
left arm down into the chair. You should feel
your left outer abdominals engage.
5. Maintaining the above position, begin to squat
down by bending your left knee as you inhale.
You should feel the muscles on the front of
your left thigh engage and left outer hip
(buttock) engage.
6. Exhale and slowly straighten your left knee, Inhale Exhale
keeping your left outer hip (buttock) and left
abdominal muscles engaged.
7. Continue this breathing sequence for 4 to 5 breaths.

1. Stand against a desk or counter, and place your left foot on a 2-inch block. Keep your weight through
2. Place your hands on the surface in front of you and round
your back.
3. With your left knee slightly bent, shift your left hip back and
pull your left knee in slightly. You should feel the muscles on
your left outer hip (buttock) and left inner thigh engage.
4. Sidebend your trunk to the left so that your left shoulder is
slightly below your right shoulder. You should feel your left
abdominals engage.
5. Keeping your left hip back, slowly bring your right knee Exhale
forward and up to the level of your right hip.
6. Inhale through your nose, and slowly exhale through your
mouth as you bring your right knee slightly forward.
7. Continue this breathing sequence for a total of 4-5 deep
breaths.

Standing Supported Left AF IR with Left IO/TA and Resisted Right Posterior Glute Med
1. Place one end of a piece of tubing in a door or around something
sturdy and the other end around your right ankle.
2. Stand on a 2-inch block with your left foot. Keep your weight
through your left mid-foot/heel.
3. Bend your right leg at a 90-degree angle with a ball between your
knees and your back rounded.
4. Shift your right knee down towards the floor, and sidebend your
trunk to the left. You should feel your left outer hip (buttock)
engage.
5. Squeeze the ball with your left knee. You should feel your left
inner thigh engage.
6. Press your left hand down into the chair and feel your left outer
abdominals engage.
7. Inhale through your nose as you turn your right thigh inward by
turning your right lower leg out against the resistance of the band.
Exhale through your mouth and hold the position, then inhale again and take your right lower leg out
a little further.
8. Continue this sequence for 4-5 deep breaths, in through your nose and out through your mouth.
Left Stance Reciprocal Step Through

Option A
1. Stand as in picture #1 with your left foot on a 2-4 inch 1 2 3
block. Be sure to look straight ahead during this activity.
2. Shift your left hip back and pull your left knee in slightly.
You should feel the muscles on your left inner thigh and left
outer hip (buttock) engage.
3. Sidebend your trunk to the left, feeling your left abdominal
wall engage.
4. Keeping your left outer hip (buttock) muscle engaged,
slowly bring your left arm and right leg back as your right
arm comes forward. Tap the ground with your right foot.
5. Pause, then slowly bring your right leg and left arm forward
as your right arm goes back. Tap the ground with your right foot.
6. Continue this sequence 10 times, keeping your left outer hip (buttock) muscle engaged.
Option B
1. Stand as in picture #3 with your left foot on a 2-4 inch block. Be sure to look straight ahead during
this activity.
2. Shift your left hip back, and pull your left knee in slightly. You should feel the muscles on your left
inner thigh and left outer hip (buttock) engage.
3. Sidebend your trunk to the left, feeling your left abdominal wall engage.
4. Keeping your left outer hip (buttock) muscle engaged, slowly bring your left arm and right leg
forward as your right arm goes back. Tap the ground with your right foot.
5. Pause, then slowly bring your right leg and left arm back as you bring your right arm forward. Tap
the ground with your right foot.
6. Continue this sequence 10 times keeping your left outer hip (buttock) muscle engaged.

Seated Resisted Bilateral Arm Pull Down #1

1. Sit in a chair facing the door with your feet flat
and your knees at hip level.
2. Round out your back and roll your pelvis back,
finding your “sit bones.”
3. Keeping your back rounded and feeling your “sit
bones,” pull your hands down to your knees.
You should feel your abdominal muscles engage.
breaths, in through your nose and out through
your mouth.
Seated Resisted Bilateral Arm Pull Down #3

1. Sit in a chair facing the door with your feet flat and your knees at hip level.
2. Round out your back and roll your pelvis back finding your “sit bones.”
3. Keeping your back rounded, shift your left knee so that it is behind your right. You should feel your
left inner thigh engage, and left “sit bone.”
4. With your left inner thigh engaged, pull your left hand down to the outside of your left knee while
slightly orienting your trunk and head to the left. You should feel your left abdominal wall engage.
5. Hold the position while you take 4-5 deep breaths, in through your nose and out through your mouth.

Appendix – Left Iliacus Techniques
Left Iliacus
Right Sidelying Supported Left Glute Med
1. Lie on your right side with your feet on a wall, hips and knees at a 90-degree angle and your back
rounded.
2. Place your lower arm or a pillow under your head and upper hand on the floor in front of you to help
stabilize your trunk.
4. Push your right foot into the wall.
5. Slide or shift your left hip back as far as you can without arching your back.
6. Press your left knee down into the ball. You should feel your left inner thigh engage.
7. Rotate your left thigh “in” by lifting your left lower leg towards the ceiling. You should feel your left
outside hip (buttock) engage.
8. Hold this position for 4-5 deep breaths, inhaling through your nose and exhaling through your mouth.

1. Lie on your right side with your right hip and knee bent at a 90-degree angle and your right foot
placed on the wall.
2. Keep your left hip neutral and place your left knee on a bolster so that it is below the level of your left
hip.
5. Press your left knee down into the bolster feeling your left inner thigh engage.
6. With your right foot pushing into the wall and your left knee down, slowly raise your left lower leg
up towards the ceiling. You should feel the muscle on your left outer hip (buttock) engage.
engaged.

Right Sidelying Hemi 90-90 with Left FA IR

1. Lie on your right side with your right hip and knee bent at a 90-degree angle, and keep your left hip
neutral. Place your right arm or a pillow under your head and keep your back and neck relaxed.
2. Place your left knee on a bolster so that it is below the level of your left hip.
3. Press your left knee down into the bolster. You should feel the muscles in your left inner thigh
engage.
4. With your left knee pressing down, slowly raise your left lower leg up towards the ceiling. You
should feel the muscle on your left outer hip (buttock) engage.
5. Then slowly lower and raise your left lower leg 10 times while keeping your left outer hip (buttock)
engaged.
Right Sidelying Hemi 90-90 with Left FA IR and Left Quad

1. Lie on your right side with your right hip and knee bent at a 90-degree angle. Keep your left hip
neutral and place it on a towel roll so that it is below your left hip. Place your right arm or a pillow
under your head and keep your back and neck relaxed.
2. Press your left knee down into the bolster. You should feel the muscles in your left inner thigh
engage.
3. With your left knee pressing down, raise your left lower leg up towards the ceiling. You should feel
the muscles in your left outer hip (buttock) engage.
4. Keeping the muscles on your left inner thigh and outer hip (buttock) engaged, slowly bend and
straighten your left knee 10 times. You should feel the muscles on the front of your left thigh engage.

Right Sidelying Hemi 90-90 with IO/TA and Left FA IR

1. Lie on your right side with your right hip and knee bent at a 90-degree angle. Keep your left hip
neutral and place your left knee on a bolster so that it is below the level of your left hip. Place your
right arm or a pillow under your head and keep your back and neck relaxed.
2. Inhale through your nose and exhale through your mouth as you reach your left arm down towards
your left knee. You should feel your left outer abdominal muscles engage.
3. Press your left knee down into the bolster. You should feel your left inner thigh muscle engage.
4. Continue pressing down with your left knee as you slowly raise your left lower leg up towards the
ceiling, feeling the muscle on your left outer hip (buttock) engage.
engaged.
Right Sidelying Right Apical Expansion with Left FA IR

1. Lie on your right side with your right leg ahead of your left leg, both knees bent at a 90-degree angle.
Straighten your right elbow and sink your right chest wall towards the mat.
2. Inhale through your nose and as you exhale through your mouth, reach forward with your left hand.
You should feel your left abdominal muscles engage and a stretch in your right chest wall.
3. Press your left knee down into the towel roll, feeling the muscles in your left inner thigh engage.
4. Slowly raise your left lower leg up, feeling the muscle on your left outer hip (buttock) engage.
5. Then lower and raise your left lower leg 10 times while keeping your left outer hip (buttock) and left
inner thigh muscles engaged.

Standing Respiratory Left AF IR with Resisted Left Arm Pull Down and Left Knee Flexion
(see Left Obturator and Iliococcygeus)
Standing Wall Supported Reach with Left AF IR

Standing Wall Supported Left Knee Flexion with Resisted Right Glute Max
Standing Wall and Chair Supported Respiratory Left AF IR with Left IO/TA Integration

Standing Supported Left AF IR with Left IO/TA and Resisted Right Posterior Glute Med
Left Stance Reciprocal Step Through

Seated Supported Left AF IR/FA IR

1. Sit in a chair with your knees at or above hip level. Place your right foot on a 2-inch block and left
foot on the floor.
2. Round out your back and roll your pelvis back, feeling your “sit bones.”
3. Press your right foot gently into the block. You should feel your right outer hip (buttock) engage.
4. Inhale through your nose as you pull your left knee behind your right. You should feel your left “sit
bone” on the chair and your left inner thigh engage.
5. Exhale through your mouth as you sidebend your trunk to the left. You should feel your left outer
abdominals engage.
6. Inhale through your nose and pull your left foot out to the side, keeping your foot on the ground.
7. Hold this position for 4-5 breaths, in through your nose and out through your mouth.

Seated Resisted Left AF IR/FA IR with Balloon

1. Sit on the edge of a table. Place small towel rolls under each thigh, a ball between your knees and a
band around your ankles.
3. Pull your left knee behind your right, feeling your left inner thigh muscle engage.
4. Press your left thigh down into the towel roll and turn your left lower leg out to the side as you
straighten your right leg. You should feel the front of your right thigh, back of your left thigh and left
outer hip (buttock) muscles engage.
5. Inhale through your nose and
slowly blow out into the balloon.
6. Pause for 3 seconds with your
tongue on the roof of your mouth
to prevent airflow out of the
balloon.
7. Keeping your tongue on the roof of
your mouth, inhale again through
your nose.
8. Slowly blow out into the balloon.
9. After the fourth breath in, pinch
the balloon neck and remove it
from your mouth. Let the air out of
the balloon.
Seated Left AF IR/FA IR with Right Quad

1. Sit on the edge of the table, and place small towel rolls under both thighs.
3. Shift or pull your left knee behind your right knee. You should feel your left inner thigh engage.
4. Press your left thigh down into the towel roll and turn your left lower leg out to the side. You should
feel the muscles in your left outer hip (buttock) engage.
5. Maintain this position as you straighten your right knee. You should feel the muscles in the front of
your right thigh engage.
6. Slowly bring your left lower leg in and out 10 times while keeping your left outer hip (buttock)
muscle engaged.

Appendix – Right Gluteus Maximus Techniques

All Four Right Glute Max
1. Place a 1-2 inch folded towel under your left knee.
2. Position yourself on your hands and knees with your back rounded and your right side against the
wall.
3. Step forward with your right arm and right knee as you sidebend to the left. Keep your weight
forward and to the left. Your nose should be over your left index finger. You should feel your left
abdominals.
4. Maintaining this position, gently press your right knee into the wall. You should feel your right outer
5. Hold this position for 4 to 5 breaths, in through your nose and out through your mouth.
All Four Single Leg Right Glute Max

abdominals engage.
3. Go down on your left forearm and straighten your left leg behind you, keeping your left foot turned
in.
4. You should feel the muscles on your right outer hip (buttock) and the back of your left thigh engage.
5. Hold this position for 4-5 deep breaths, in through your nose and out through your mouth.

90-90 Supported Left Hip Shift with Right Iliacus

1. Lie on your back with your feet flat on the wall and your hips and knees at a 90-degree angle.
tailbone is raised slightly off the mat. Keep your back flat on the mat. Do not press your feet flat into
the wall instead dig down with your heels. Maintain this position. You should feel the muscles on the
back of your thighs engage.
3. Inhale through your nose as you shift your left knee down or right knee up. You should feel your left
inner thigh engage.
4. Exhale through your mouth as you lift your right leg off the wall, turning your right ankle in and right
knee out. Keep your right knee above the left. You should feel the muscles on the back of your left
thigh and front of your right hip engage.
5. Hold this position for 4 to 5 deep breaths, in through your nose and out through your mouth.
Supine Supported Right Iliacus

1. Lie on your back with your knees bent. Keep your back and neck relaxed.
2. Inhale through your nose and exhale through your mouth, performing a pelvic tilt so that your
tailbone is raised slightly off the mat. Keep your back flat on the mat. You should feel the muscles on
the back of your thighs engage.
3. Shift your left knee down or right knee up so that your right knee is slightly above the left knee.
4. Maintaining this position, pick your right foot off of the mat and bring your right knee forward
towards your chest. You should feel the muscles on the back of your left thigh and front of your right
thigh engage.
5. Turn your right lower leg inwards. Your ankle will turn in and your thigh will turn out.
6. Reach up to the ceiling with your left arm and towards the right. Your pelvis will be orienting
towards the left and your trunk will be orienting towards the right.

Left Sidelying Supported Right Glute Max with Right Hip Extension and Right FA ER
1. Lie on your left side with your left hip and knee bent at a 90-degree angle resting in front of you.
Place a pillow(s) under your right lower leg.
2. Reach your right hand forward towards your left knee so that your right hip moves forward over your
left hip.
3. Keep your right knee bent at a 90-degree angle and press your right foot/arch into the wall.
4. Keeping your right foot/arch on the wall, rotate your right thigh “out” by lifting your right knee
towards the ceiling. You should feel your right outside hip (buttock) engage.
5. Hold this position while you take 4-5 deep breaths, in through the nose and out through the mouth.
Left Sidelying Supported Right Glute Max with Hip Extension and FA Abduction
1. Lie on your left side with your left hip and knee bent at a 90-degree angle.
2. Keep your right hip neutral (aligned with your body) and place your right lower leg on several pillows
or an appropriate size bolster. Your right knee will also be at a 90-degree angle.
3. Press your left foot into the wall and press your right knee into the wall.
4. Maintain the above position and rotate your right thigh out towards the ceiling. Lift your right thigh
up towards the ceiling. You should feel your right outside hip (buttock) engage. Your right ankle
should not move off the bolster.
5. Hold position as you take 4-5 deep breaths, in through your nose and out through your mouth.

Left Sidelying Supported Right Glute Max with Hip Extension and FA Abduction and Left
FA Adduction
1. Lie on your left side with your left hip and knee bent at a
90-degree angle. Place a small towel roll under your left
abdominals.
2. Keep your right hip neutral (aligned with your body) and
place your right lower leg on several pillows or an
appropriate size bolster. Your right knee will also be at a
90-degree angle.
3. Press your left foot into the wall and reach your right knee
down towards the wall so that your left abdominals arch up
over the towel roll. You should feel your left abdominals
engage.
4. Maintain the above position and rotate your right thigh up
towards the ceiling. You should feel your right outside hip
(buttock) engage.
5. Now lift up your left knee off the table. You should feel your
left inner thigh engage.
6. Hold position as you take 4-5 deep breaths, in through your
Left Sidelying Hemi 90-90 with Left IO/TA, Right Glute Max and Left Adductor
1. Lie on your left side with your left leg in line with your body. Bend your right leg and place your
right foot in front of your left knee. Both knees should be bent at a 90-degree angle.
2. Place a small towel roll under your left abdominal wall and a pillow under your head. Keep your back
and neck relaxed.
3. Press your left hip down into the mat so that your right hip moves toward the wall. You should feel
your left abdominals engage as you lift up away from the towel roll.
4. Drop the inside of your right foot toward the mat so that you can feel the arch of your foot push into
your shoe.
5. Keeping your right arch in contact with the mat, shift your right knee forward and turn your right
knee up towards the ceiling. You should feel the muscles in your right outer hip (buttock) engage.
6. Maintaining the above position, lift your left knee up off the mat. You should feel the muscles in
your left inner thigh engage.
7. Slowly lower and raise your left knee 10 times while keeping your left inner thigh and right outer hip
(buttock) muscles engaged.

Left Sidelying Right Extended FA Abduction and Left Abdominal Co-Activation

1. Lie on your left side and place a 2-3 inch bolster under your left abdominal wall and 1-2 pillows
under your head so that your neck is slightly sidebent to the right.
2. Place a crate or a stool that is about 13 inches in height under your right ankle and bend your left
knee. Your right ankle hip and shoulder will be lined up.
3. Inhale through your nose and as you exhale through your mouth reach your right leg down toward the
wall and press your left hip down into the mat. You should feel your left abdominal wall engage as
you pull up away from the towel roll.
4. Attempt to pick your right foot off of the stool with your foot/ankle turned out to the side. You
should feel your right outer hip (buttock) engage.
Standing Supported Right Knee Flexion with Left Hip Approximation

1. Stand against a desk or counter, and place
your right foot on a 2-inch block.
2. Place your hands on the surface in front of
you and round your back.
3. Maintaining contact with your right arch,
begin to straighten your right knee as you
raise your left foot off the floor.
4. Keeping your left leg straight, hike your left
hip up above the level of your right as you
sidebend your trunk to the left. Your left
foot will be higher than your right. You
should feel your left inner thigh engage.
5. Keeping your left hip hiked, slowly begin to
lower your left foot toward the floor by bending your right knee.
6. Continue lowering your left foot until it is about an inch from the floor. You should continue to feel
your left inner thigh, along with the muscles on the front of your right thigh and right outer hip
(buttock) engage.

Standing Supported Right Knee Flexion with Left Hip Extension

1. Stand against a desk or counter, and place your right foot on a 2-inch block.
3. Maintaining contact with your right shoe arch, begin to straighten your right knee as you raise your
left foot off the floor.
4. Keeping your left leg straight, hike your left hip up above the level of your right. Your left foot will
be higher than your right. You should feel your left inner thigh engage.
5. Keeping your left hip hiked, bring your left thigh back and bend your left knee. You should feel the
muscles on the back of your left thigh engage.
6. Maintaining the above position, squat down by bending your right knee. You should feel the muscles
on the front of your right thigh and right outer hip (buttock) engage.
Option:
1. Perform steps 1-6.
2. Straighten your right knee as you keep your left hip hiked and knee bent.
3. Continue to squat up and down on your right leg 10 times.
Standing Supported Right Glute Max with Left Hip Approximation and Left FA IR
1. Stand against a desk or counter and place your right foot on a 2-inch block.
3. Maintaining contact with your right shoe arch, begin to straighten your right knee as you raise your
left foot off the floor.
4. Keeping your left leg straight, hike your left hip up above the level of your right. Your left foot will
be higher than your right. You should feel your left inner thigh engage.
5. Sidebend to the left and bend your left knee. You should feel your left abdominals and the back of
your left thigh engage.
6. Maintaining this position, slowly bring your left lower leg out to the side and back in 10 times feeling
your left outer hip (buttock) engage. You should also continue to feel your left inner thigh, back of
your left thigh and right outer hip (buttock) muscles engaged.

Standing Supported Right Knee Flexion with Weighted Left Hamstring and Right Trunk
Rotation
1. Place your right foot on a 2-inch block and a 3-5 lb.
ankle weight around your left ankle.
2. Place a dowel or stick in your left hand, and round
your back as you reach back with your right hand.
3. Maintaining contact with your right shoe arch, begin to
straighten your right knee as you raise your left foot
off the floor.
4. Keeping your left leg straight, hike your left hip up
above the level of your right. Your left foot will be
higher than your right. You should feel your left inner
thigh engage.
5. Keeping your left hip hiked, bring your left thigh back
and bend your left knee. You should feel the muscles
on the back of your left thigh engage.
6. Without letting your left hip drop, turn your left lower
leg out to the side. You should feel the muscles on
your left outside hip (buttock) engage.
7. Maintaining the above position, squat down by
bending your right knee. You should feel the muscles on the front of your right thigh and right
outside hip (buttock) engage.
Standing Wall Supported Right Knee Flexion with Left Glute Med and Right Trunk
Rotation
1. Stand with your feet shoulder width apart and place your left foot on the wall behind you.
2. Maintaining contact with your right shoe arch, shift your left knee up and round your back by
reaching forward with both arms.
3. Keeping your left knee shifted up, turn your left knee in. You should feel the muscles on the outside
of your left hip (buttock) and left inner thigh engage.
4. Maintaining the above position, squat down by bending your right knee as you reach forward with
your left hand and back with your right, always maintaining contact with your right shoe arch. You
should feel the muscles on the front of your right thigh and right outside hip (buttock) engage.

Standing Supported Left Knee Flexion with Right Psoas and Iliacus, Right Trunk Rotation
and Right FA ER
1. Stand against a desk or counter and place your left foot on a 2-inch block. Keep your weight through
3. With your left knee slightly bent, shift your left hip back and pull your left knee in. You should feel
the muscles on your left outer hip (buttock) and left inner thigh engage.
4. Sidebend your trunk to the left so that your left shoulder is slightly below your right shoulder. You
should feel your left abdominals engage.
5. Lift your right foot off the floor, and raise your knee up to the level of your hip.
6. Turn your right knee out and bring your right foot in maintaining the muscles on your left outer hip
(buttock) and left abdominals.
7. Begin to squat down by bending your left knee as you bring your right arm behind you. You should
feel the muscles on the front
of your left thigh, left outer
hip (buttock), left abdominals
and the front of your right hip
engage.
8. Hold this position while you
take 4-5 breaths, in through
your nose and out through
your mouth.
9. Relax and repeat 4 more
times.
Seated Supported Left AF IR/FA IR

(see Left Iliacus)

Appendix – Integration Techniques
Integration
2. Maximally round your spine by arching your back upward, as you roll your pelvis back so that your
bottom tucks under you.
abdominals.
4. Raise your left hand off the floor as you maintain a rounded trunk position. Don’t let
your trunk turn or twist when you lift up your hand. You should feel your right
abdominal wall engage when you pick your left hand up.
through your mouth.
6. Lower your left hand to the floor and take your right hand off the floor. You
should feel your left abdominal wall engage when you pick your right hand up.
through your mouth.
8. Relax and repeat both sequences 4 more times.
All Four Swiss Ball Belly Lift

1. Position yourself on your knees and place your elbows on an appropriate size ball.
2. Arch your back up towards the ceiling so that your trunk is rounded, and roll your pelvis back so that
your bottom tucks under you.
3. Keeping your trunk rounded, begin to shift your body weight forward as the ball rolls forward. Only
go out as far as you can without letting your back collapse. You should feel your outer abdominal
muscles engage.
4. Maintain this position while you take 4-5 deep breaths, in through your nose and out through your
mouth.

All Four Belly Lift

1. Position yourself on your hands and knees, and arch your back so that it is rounded.
2. Maintaining a rounded spine, raise knees off the mat so they are straight. Shift your body weight
forward so your nose is over your fingertips. You should feel your outer abdominals tighten.
3. Shift weight to your left side and raise your right hand slightly off the mat. You should feel your left
abdominal wall engage. Hold this position while you take 4-5 deep breaths, in through your nose and
(You could alternate this exercise by shifting your weight to your right side and raise your left hand
slightly off the mat and feel your right abdominals).
All Four Resisted Right Glute Max

1. Place a band around both thighs just above your knees and a 1-2 inch folded towel under your left
knee.
abdominals.
4. Maintaining this position, turn your right knee out against the resistance of the tubing. Keep your
right knee below the left. You should feel your right outer hip (buttock) engage.
5. Maintain the above position and move your right foot toward your left leg.
6. Hold this position for 4 to 5 breaths, in through your nose and out through your mouth.

All Four Right AIC Pelvic Floor Respiratory Crawl

1. Position yourself on your hands and knees with your left hand and left knee close to each other and
your right hand and right knee away from each other.
2. Breathe in through your nose and exhale through your mouth.
3. As you inhale through your nose, move your left hand forward and your right knee forward as you
move and orient your body to your left or the counterclockwise direction.
4. At the end of inhalation, your right hand and right knee should be close to each other as your trunk
remains sidebent to the left.
5. Begin to exhale through your nose as you move your right hand forward and your left knee forward
as you continue to move and orient your body to your left or the counterclockwise direction.
6. At the end of exhalation, pause 4 to 5 seconds and repeat sequence 4 more times.
Exhalation Inhalation
Exhalation Exhalation
Left Stance from the Left AIC Pattern with Right Trunk Rotation
1. Stand with a 3-4 foot dowel/walking stick in each hand and your left foot in front of your right, and
your right hand in front of your left.
2. Advance your right foot and left hand forward. Place the left stick down and then your right foot on
the floor. Keep the majority of your weight on your left leg throughout this entire exercise.
3. Round your back and slightly shift your left hip back (zipper over left toe) as you sidebend your trunk
to the left. You should feel your left outer hip (buttock) engage.
4. Inhale through your nose and push the stick into the floor with your right hand keeping your left
shoulder lower than your right. You should feel your left outer abdominals and the back of your right
shoulder engage.
5. Exhale through your mouth as you maintain this position.
6. Repeat this breathing sequence for 4-5 deep breaths, in through your nose and out through your
mouth.

Four Point Gait with Mediastinum Expansion

1. Keeping your left stick on the ground, bring your right stick forward and place it on the ground ahead
of you.
2. Keeping both sticks on the ground, step forward with your left foot (heel first).
3. Keeping your right stick on the ground and feet stationary, bring your left stick forward and place it
on the ground. Pause in this position (picture #3) for 4-5 deep breaths. Attempt to fill or expand your
left upper back with air on each inhalation.
4. Keeping both sticks on the ground, step forward with your right foot (heel first).
5. Relax and repeat the sequence 4 more times.
1 2 3 4
Modified Two Point Gait with Left AF IR

1. Keeping the left stick on the ground, advance the right stick and left leg forward together.
2. Place the right stick on the ground first and then your left foot (heel first).
3. Keeping the right stick on the ground, advance the left stick and right leg forward together. Pause in
this position (picture #3) for 4-5 deep breaths. Keep your left hip back, left knee slightly bent and
weight through your left mid-foot/heel. You should feel the muscles on the front of your left thigh
and left outer hip (buttock) engage.
4. Place the left stick on the ground first and then your right foot (heel first).
1 2 3 4

Two Point Gait with Left IO/TA

1. Holding the walking stick in your left hand (not on the ground), advance it forward with your right
leg. Keep your left hip and right arm back. You should feel the front of your left thigh and left outer
2. Place the walking stick on the ground first and then your right foot (heel first). Keep the majority of
your weight on your left leg. Keep your left hip and right shoulder back. Pause in this position
(picture #2) for 4-5 deep breaths. You should feel your left outer hip (buttock) and left abdominals
engage.
3. Keeping the walking stick on the ground, transfer your weight to your right leg, and advance your
right arm and left leg forward.
4. With the walking stick remaining on the ground, place your left foot (heel first) on the ground.
Transfer your weight over your left leg. Keep your right heel on the ground and maintain contact
with your right shoe arch as you shift your left hip back. Pause in this position (picture #4) for 4-5
deep breaths. You should feel your left outer hip (buttock) and left abdominals engage.
1 2 3 4
Two Point Gait with Right Glute Max

1. Holding the walking stick in your right hand and keeping it on the ground, advance your left arm and
right leg forward.
2. With the right stick remaining on the ground, place your right foot on the ground (heel first).
3. Transfer your weight to your right leg, and advance the walking stick and your left leg forward as
your left arm goes back. Pause in this position (picture #3) for 4-5 deep breaths. You should feel your
right outer hip (buttock) engage.
4. Place the walking stick on the ground first, then your left foot (heel first).
1 2 3 4

Heel Stair Descents

1. Stand at the top of the stairs and face backwards. Shift
your left hip back.
2. Round your back and begin to bend your left knee as you
bring your right leg behind you. Sidebend your trunk to
the left as you feel your left outer abdominals engage.
3. Continue to bend your left knee as you lower your right
leg to the step below, leading with your right heel, not
your toes. Hold this position for 3-5 seconds. You should
feel the muscles on the front of your left thigh, left outer
hip (buttock) and left abdominals engage.
4. Place your right heel down first and then your toes.
5. Lower your left leg down to the level of your right (or go
back to the top step). Shift your right hip back.
6. Round your back, and begin to bend your right knee as
you bring your left leg behind you. Sidebend your trunk to
the right as you feel your right outer abdominals engage.
7. Continue to bend your right knee as you lower your left leg to the step below, leading with your left
heel, not your toes. Hold this position for 3-5 seconds. You should feel the muscles on the front of
your right thigh, right outer hip (buttock) and right abdominals.
8. Place your left heel down first and then your toes.
9. Alternate each leg until you have reached the bottom of the steps.
10. Relax and repeat 1-2 more times.

Retro Walking
1. Stand with your feet shoulder width apart and place tubing around your ankles. This activity can also
be performed without a resistance band/tubing.
2. Round out your back.
3. Place your right foot forward and left arm forward, while your right arm is behind you.
4. Shift your left hip back and bend your left knee, keeping your weight through your left mid-foot/heel.
Sidebend your trunk to the left. You should feel your left outer hip (buttock) and left abdominals
engage.
5. Keeping your back rounded and left hip back, slowly bring your right leg out to the side and back
(making a half circle) with your right toes pointed straight ahead, as your right arm moves forward
and left arm back. Hold this position 3 seconds before placing your right foot on the floor. You
should feel your left outer hip (buttock), front of your left thigh and right outer hip (buttock) engage.
6. Place your right foot on the ground.
7. Shift your right hip back and bend your right knee, keeping your weight through your right mid-
foot/heel. Sidebend your trunk to the right. You should feel your right outer hip (buttock) and right
abdominals engage.
8. Keeping your back rounded and right hip back, bring your left leg out to the side and back (making a
half circle) with your left toes pointed straight ahead, as your left arm moves forward and right arm
back. Hold this position 3 seconds before placing your left foot on the floor. You should feel your
right outer hip (buttock), front of your right thigh and left outer hip (buttock) engage.
9. Repeat 4-6 steps backwards with each leg while inhaling through your nose and exhaling through
your mouth.

Decline Retro Walking
*Pictures reflect the end position of each phase of movement

Starting Position
 Stand with your right foot in front of you and your left foot
behind you with your feet shoulder width apart. The
weight of your body should be on your right foot.
 Bring your right arm behind you, and reach across the
midline of your body with your left arm. In this position
take a deep breath in.
1. As you exhale, begin to shift your body weight to your left as you
bring your right foot behind you, and reach across the midline of
your body with your right arm. Keep your back rounded as you
try to balance on your left leg.
 Picture #1 should reflect the end position of this
movement. Once in this position take a breath in.
ON
Starting Position
1
2. Exhale and shift your weight to your right leg as you bring your left leg behind
you and your left arm reaching towards your right toes. Lower your body closer
to the ground when shifting to the right leg by bending your right knee further
than before. Keep your back rounded as you try to balance on your right leg.
 Picture #2 should reflect the end position of this movement. Once in
this position take another breath in.
3. Exhale and shift your weight to the left leg as you bring your right leg behind you
and your right arm reaching towards your left toes. Lower yourself even further
to the ground than in step #2 by bending your left knee closer to the ground.
Keep your back rounded as you balance on your left leg.
 Picture #3 should reflect the end position of this movement. Once in
this position take another breath in. ON ON
2 3
4. Continue the sequence above until your left hand is touching

your right toes with your weight on your right foot and your
back rounded.
 In the final phase of movement, exhale as you shift to
your left, and bring your right leg behind you. Reach
across the midline of your body with your right hand
until you have touched your left toes. Keep your back
rounded as you try to balance on your left leg. Your
position should reflect picture #5.
ON 5. In this position take a deep breath as you exhale slowly, stand
ON up keeping your back rounded and your body weight on your
left foot.
4 5

Appendix – Left Anterior Inlet Inhibition
Left Anterior Inlet Inhibition

90-90 Respiratory Left Hip Shift
1. Lie on your back with your feet flat on a wall and your knees and hips bent at a 90-degree angle.
into the wall instead dig down with your heels. Maintain this position.
4. Inhale through your nose as you shift your left knee down and your right knee up. You should feel
5. Exhale through your mouth as you shift your left knee back up level with your right knee.
6. Continue this sequence for 4 to 5 breaths, in through your nose and out through your mouth.
Inhale Exhale
90-90 Supported Left Hip Shift with Respiratory Left FA IR

1. Lie on your back with your feet flat on a wall and your hips and knees bent at a 90-degree angle.
into the wall instead dig down with your heels. Maintain this position.
4. Shift your left hip down and your right hip up so that your right knee is slightly above your left knee.
You should feel your left inner engage.
5. Lift your left leg off the wall and slowly take your left lower leg out to the side as you inhale and
back in as you exhale. You should feel the muscle on your left outer hip (buttock) engage.
6. Continue this sequence for 4-5 breaths, in through your nose and out through your mouth.
Inhale Exhale

90-90 Supported Left Hip Shift with Right Rectus Femoris and Sartorius
(see Right Rectus Femoris and Sartorius)
Standing Supported Passive Left AF IR with Right Trunk Rotation

1. Stand facing a desk or a counter top.
2. Place a 2-inch block underneath your left foot.
3. Place your right foot on the ground slightly in front of your left. Position yourself so that the weight
of your body is distributed equally between both feet.
4. Round out your back and place both hands into the surface.
5. Shift your hips to the left.
6. Side-bend your trunk to the left bringing your left shoulder lower than your right.
7. Staying side-bent to the left begin to
orient your trunk to the right by
reaching across the midline of your
body with your left arm. You should
begin to feel your left abdominal wall
engage.
8. Hold this position while you take 4-5
deep breaths in through your nose and
out through your mouth, filling your
right chest wall with air.
Late Left AIC Stance with Right Arm Reach

1. Stand with your left foot on a 1-inch block with your
right leg behind you.
2. Round out your back and look straight ahead.
3. Bring your right hip forward or your left hip back,
shifting your weight forward and to the left, keeping
your weight through your left mid-foot/heel. Keep
your right heel on the ground and your left knee
slightly bent. Your chin and pant zipper should be
over your left foot. You should feel the muscles on
the front of your left thigh and left outer hip (buttock)
engage.
4. Bring your right arm up and reach your left arm down
at your side, sidebending to the left. You should feel
your left abdominals engage and a stretch through
your right chest wall.
5. Inhale through your nose and exhale through your
mouth as you reach forward and up with your right
arm. Continue this breathing sequence for 4-5 deep
breaths, in through your nose and out through your mouth,
attempting to fill or expand your right chest wall with air on inhalation.

Seated Supported Respiratory Left AF IR/FA IR with Intercostal Pulley Inhibition

1. Sit in a chair and place your right foot on a block so your right knee is level with or slightly higher
than your hip. Place your left foot on the floor. Hold onto a pulley in each hand.
2. Round out your back and roll your pelvis back, finding your “sit bones.”
3. Inhale through your nose and slowly pull your left knee behind your right. Press your left knee gently
into the ball. You should feel your left inner thigh muscle engage.
4. Exhale through your mouth and bring your left hand towards your left thigh as you sidebend your
trunk to the left. You should feel
your left outer abdominals engage.
5. Inhale through your nose and slowly
move your left lower leg out to the
side feeling your left outer hip
(buttock) muscle engage. Exhale
through your mouth.
6. Inhale through your nose and slowly
move your left lower leg out further
to the side. Exhale through your
mouth.
7. Continue this breathing sequence for
4-5 deep breaths, in through your

Appendix – Right Anterior Outlet Inhibition
Right Anterior Outlet Inhibition

Supine Hooklying Adductor Magnus Inhibition
1. Lie on your back with your feet on a 2-inch
block.
2. Place a bolster or an appropriate size pillow on
your right side.
3. Inhale through your nose and exhale through
your mouth, performing a pelvic tilt so that
your tailbone is raised slightly off the mat.
Keep your back flat on the mat. You should
feel the muscles on the back of your thighs
engage.
4. Maintaining a pelvic tilt, let your right knee
lower to the side until it reaches the bolster or pillows. You should feel a stretch across your right
inner thigh.
6. Let your left knee drop down to meet your right.
7. Keeping both legs together, slowly bring them upright as one unit.

Left Sidelying Right Extended FA Abduction and Left Abdominal Co-Activation

(see Right Gluteus Maxiums)
Standing Supported Left AF IR with Right FA Abduction

1. Stand against a desk or counter, and place your left
foot on a 1-2 inch block. Keep your weight through
2. Place your hands on the surface in front of you and
round your back.
3. Shift your left hip back, bend your left knee and pull
your left knee in slightly. You should feel your left
outer hip (buttock) and left inner thigh engage.
4. Sidebend your trunk to the left so that your left
shoulder is slightly below your right shoulder. You
should feel your left outer abdominals engage.
5. Maintaining the above position, turn your right
ankle out to the side, finding contact with your right
shoe arch.
6. Pick your right foot up and lift it out to the side. Squat slightly, keeping your right foot lower than
your left. You should feel the muscles on the front of your left thigh, left outer hip (buttock), left
inner thigh and right outer hip (buttock) engage. If you are unable to feel your right outer hip
(buttock) engage, then rest your right shoe arch on the floor.

Appendix – Right Posterior Inlet Inhibition
Right Posterior Inlet Inhibition

All Four Right Glute Max
(see Right Gluteus Maximus)

(see Integration)
Modified All Four Inferior Glute Max, Adductor Magnus and Quadratus Femoris Stretch
1. Position yourself on your hands and knees.
2. Bend your right knee and cross your leg in
front of your left thigh so that your right
ankle is in front of your left knee.
3. Lower yourself onto your forearms and
straighten your left leg.
4. Keeping your back rounded, continue to
reach back with your left leg until you feel
a stretch on the outside of your right hip
(buttock).
breaths, in through your nose and out
through your mouth.
*INCORRECT*
Do not roll your trunk to the right or let your
upper body come all the way down.
90-90 Supported Left Hip Shift with Right Iliacus

Supine Supported Right Iliacus

Left Sidelying Supported Right Glute Max with Right Hip Extension and Right FA ER
Left Sidelying Supported Right Glute Max with Hip Extension and FA Abduction

Appendix – Right Posterior Inlet Inhibition
Standing Supported Left Knee Flexion with Right Psoas and Iliacus, Right Trunk Rotation
and Right FA ER
Seated Supported Left AF IR with Right Iliacus and Right FA ER

1. Sit in a chair with your feet flat and your knees at
or slightly above hip level. If needed, place a
small book or block under your feet.
2. Round your back and roll your pelvis back,
finding your “sit bones.”
3. Inhale through your nose and pull your left knee
behind your right. You should feel your left “sit
bone” and the muscles in your left inner thigh
engage.
4. Exhale through your mouth as you sidebend your
trunk to the left. You should feel your left outer
abdominals engage.
5. Maintaining this position, bring your right ankle
in as your right knee turns out (make sure you
still feel your left “sit bone”). You should feel the
muscles on the front of your right hip engage.
6. Hold this position for 4 to 5 deep breaths, in
through your nose and out through your mouth.

Appendix – Left Posterior Outlet Inhibition
Left Posterior Outlet Inhibition

All Four Right Arm Reach
1. Place a 1-2 inch folded towel under your left knee.
abdominals.
4. Inhale through your nose and exhale through your mouth as you reach forward and to the left with
your right arm. You should feel your left abdominals engage and a stretch in your right back and
outer chest wall.
5. Repeat for 4-5 deep breaths, reaching a little further on each exhalation.

(see Integration)

(see Iliacus)

Left Sidelying Left Ischial Femoral Ligamentous Stretch with Left FA Adduction
Standing Supported Passive Left Hip Approximation

foot on a 2-inch block.
round your back.
3. Keeping your back rounded, attempt to place an equal
amount of weight through both legs as you shift your
left hip back and sidebend your trunk to the left. You
should feel the muscles on the front of your left thigh
and left outer hip (buttock) engage.
4. Hold this position while you take 4-5 deep breaths, in

Appendix – Left Posterior Outlet Inhibition
Standing Supported Left Posterior Outlet Inhibition

foot on a ½ to 1-inch block.
round your back (tuck your bottom).
3. Keeping your back rounded, shift your left hip back.
You should feel a stretch in your left back pocket
(buttock).
4. Squat down by bending both knees. Maintaining a
stretch in your left back pocket (buttock), pull your left
knee in slightly. You should feel the muscles on the
front of both thighs, your left outer hip (buttock), and
Standing Posterior Capsule Stretch

1. Place your left foot behind you on a 2 to 6-inch block or
step.
2. Keeping both feet flat, slowly shift your left hip back.
Keep your weight through your left mid-foot/heel.
3. Rotate your trunk to the left by reaching for your left
knee with your right hand. You should feel a stretch on
the outside of your left hip (buttock). Pull your left
knee in slightly and feel your left inner thigh engage.

Appendix – Bilateral Anterior Inlet and Bilateral Posterior Outlet Inhibition
Bilateral Anterior Inlet and Bilateral

Posterior Outlet Inhibition
(see Integration)
All Four Swiss Ball Belly Lift

(see Integration)
All Four Belly Lift

(see Integration)
All Four Resisted Right Glute Max

(see Integration)
Wall Supported Passive FA IR with Balloon

1. Stand against a wall with a ball between your knees and your
feet 7-10 inches from the wall. Spread your feet apart so they
are wider than your hips.
2. Round out your back as you perform a pelvic tilt, so that your
lower back is flat on the wall. Your upper back will be off the
wall.
3. Inhale through your nose and slowly blow out into the balloon.
4. Pause three seconds with your tongue on the roof of your mouth
to prevent airflow out of the balloon.
5. Without pinching the neck of the balloon and keeping your
tongue on the roof of your mouth, take another breath in through
your nose. You should feel your upper back expand as you
inhale.
6. Slowly blow out again as you stabilize the balloon with your
hand.
7. Do not strain your neck or cheeks as you blow.
8. After the fourth breath in, pinch the balloon neck and remove it
from your mouth. Let the air out of the balloon.
9. On the final exhale, slowly stand up by pushing through your
heels, keeping your lower back flat on the wall.

(see PEC and Patho PEC Repositioning)

Standing Wall Supported Resisted Reach

1. Place tubing securely in a door (slightly above
shoulder level).
2. Stand with your heels 7-10 inches away from
the wall.
3. Stand up straight with a ball between your knees
and feet shoulder width apart.
4. Place your hands through the loops of the tubing
with your palms facing down.
5. Straighten your arms out in front of you and
round your back, performing a pelvic tilt so
your lower back (mid-back and down) is flat on
the wall.
6. Squat down slightly as you squeeze the ball.
7. Inhale through your nose.
8. As you exhale through your mouth, reach forward and downward as your back stays rounded. You
should feel your outer abdominals engage.
9. Hold your arms steadily in this position as you inhale again and expand your upper back. You should
feel a stretch in your upper back.
10. Exhale and reach forward further with your arms.
11. Complete 2 more breaths in and out, reaching further each time you exhale.
12. Slowly stand up by pushing through your heels, keeping your lower back flat on the wall and your
abdominals engaged.
Squatting Bar Reach

1. Position yourself behind a door frame, and place the bar on the outside of the frame as pictured
above.
2. Keep your feet shoulder width apart and pointing straight ahead.
3. Round out your back as you tuck your bottom under you.
4. Keep your weight through your heels and hold onto the bar as you slowly squat down keeping your
back rounded. Squat as much as you can without letting your heels come off the floor.
5. Hold this position for 4-5 deep breaths in through your nose and out through your mouth. Attempt to
fill or expand your upper back chest wall with air on each inhalation.
6. On the final exhale, slowly stand up by pushing through your heels and keeping your back rounded.

Squatting Bar Reverse Reach

1. Hold onto a wooden pole across a door frame and find the best functional squat
position (bottom of pelvis to heel cords), while keeping your heels down and
knees inside your elbows. You may need to stand back up and re-position your
feet so you can get your bottom down as far as allowed.
2. Once you have positioned yourself in the most optimal squat position, take a
deep breath, in through your nose, and fill the back of your chest wall with air
while keeping your eyes up or level with the floor. Exhale through your mouth
as you lean back until all your air is out. Repeat this sequence of inhalation and
exhalation 3 to 4 more times, always allowing your heel cords, front of your
thighs/knees and your back muscles to relax and stretch.
3. After the fourth breath in, exhale and begin to stand up pushing down through
your heels and keeping your back rounded while sliding the pole up the door
frame as necessary to assist you in coming up.
4. Lower the pole and repeat the process 4 more times.
5. The goal is to perform the first 3 steps above with the pole at the level of your
ankle, with your elbows straight, with your knees in your chest and with the
bottom of your pelvis on your heel cords (PRI Squat Level Four or Five).
Once you’ve achieved the above goal, repeat the first three steps. After the
fourth breath in, reach forward with your hands as you exhale so that the pole
loses contact with the door frame. As you exhale, begin to stand up, pushing
through your heels and continuing to reach forward so that the pole doesn’t
touch the door frame.
Reverse Squatting
1. Stand away from a wall.
2. Squat down until your knees are maximally bent.
3. Reach forward with your hands as you attempt to maintain your bodyweight through your heels, not
your toes. Your back should be rounded and relaxed.
4. Keeping your hands reaching forward and your back rounded, slowly begin to raise your bottom up
by straightening your knees as you push through your heels.
5. Continue to stand up as your back stays maximally rounded. Once you are upright, your knees should
still be slightly bent.

Full Functional Squat

1. Stand away from a wall.
2. Squat down until your knees are maximally bent. Keep your heels down.
3. Rest your hands on the tops of your knees and attempt to maintain your bodyweight through your
heels, not your toes. Your back should be rounded and relaxed.
4. Hold this position for 4-5 deep breaths, in through your nose and out through your mouth. On each
inhalation, attempt to fill or expand your upper back with air.
5. Slowly stand up by pushing through your heels and keeping your back rounded.
Seated Bar Reach

1. Sit in a chair with your feet flat and your knees at or slightly above hip level.
2. Place a bar on the outside of a door frame and hold onto the bar slightly below shoulder level.
3. Inhale through your nose and exhale through your mouth as you round your back by taking up the
slack in your arms and rolling your pelvis back so your bottom is tucked under you. You should feel
a stretch across your back.
4. Hold this position while you take 4 to 5 breaths, in through your nose and out through your mouth.
Try to fill up the back of your chest wall with air upon each inhalation.
Seated Resisted Bilateral Arm Pull Downs #1


Appendix – Pelvis Restoration Manual Techniques
Left IP ER Inlet Inhibition
Position patient in a supine position with feet

supported on a 2-inch block. Have the patient
exhale through their mouth as they push
through their heels and perform a posterior
pelvic tilt (feel hamstrings).
Therapist to lightly place hands over lower

abdominal wall above the pubic symphysis.
As the patient exhales through their mouth,
provide a gentle upward pull away from the
pubic bone. This will assist abdominal wall to
sink and maximize a posterior pelvic tilt.
Maintain light, but firm contact as patient

breathes in and out taking up the slack with
each exhalation.

Left ISP IR Outlet Inhibition
Have patient lie supine with feet supported on

a 2–inch block. Therapist to stand on right
side of patient with their right hand on
patient’s right ASIS and left hand on patient’s
left lower ribcage.
As the patient exhales through their mouth

and performs a posterior pelvic tilt (push
through heels), assist with left rib cage
internal rotation by approximating hands.
Left hand is the primary mover.
Maintain light but firm contact as the patient

breaths in and out taking up the slack with
each exhalation.

Right IP IR Inlet Inhibition
Have the patient positioned prone over

pillows and with their feet supported. The
therapist should stand on the patient’s left
side with their right hand on the patient’s
right sacral base and their left hand on the
patient’s right lower ribs.
As the patient exhales through their mouth,

assist with approximation of hands by moving
the left hand towards the right. The right hand
stabilizes the sacral base and the left hand is
the primary mover.
Once hands are approximated, maintain light,

but firm contact as the patient breathes in and
out, taking up the slack with right lower ribs
each exhalation.

Appendix – PRI Sexual Positions
PRI Sexual Positions



Appendix – PRI Positioning
PRI Positioning Handout

Sitting Crossing Legs
 When in a seated
position keep your trunk
rounded and your knees
at or above hip level.
 For increased comfort,
place a small bolster
underneath your left
thigh and shift your left
knee back.
 When sitting with your legs crossed,

try to cross your right leg over your
left.
Sleeping Standing
 When standing, place

your right foot ahead
of your left and
attempt to keep your
body weight shifted to
the left.
 Attempt to keep your
right hip lower than
your left.
Reaching
 If you sleep on your left side we recommend you

place a pillow under your left side and one to
two pillows in between your knees. Shift your
right knee forward so it is ahead of your left.
 If you sleep on your right side we suggest  When reaching for an
placing a pillow under your right side and one to object, we suggest that
two pillows in between your ankles. Shift your you reach with your
left knee back so it is behind your right. left hand as you keep
your hips shifted to the
left.
Standing Up From a Chair
 When standing up from a chair, first

scoot to the edge of the chair and shift
your left knee behind your right.
 As you begin to stand up, start to turn
your trunk towards the left by reaching
with your right hand towards your left
knee. Your left arm will be behind you
helping push you up from the chair.
 Continue to stand up keeping your
trunk turned towards the left and your
left knee shifted behind your right.
.
Scoot Shift Turn Stand
Working at a Desk
 When working at a desk we

encourage you to keep your back
supported so that your trunk
remains slightly rounded
 When writing with your right hand,
sit with your trunk slightly side
bent to the left and keep your left
shoulder lower than your right.
 When writing with your left hand,
keep your trunk neutral and upright
as you support your right shoulder
and arm on the writing surface.
Getting Into Bed
 When getting into bed, we suggest

that you first sit on the edge of the
bed and shift your left knee behind
your right.
 Begin to lie down on your left side
as you simultaneously swing your
legs up to the bed.
 Roll to the right keeping your knees
bent.

Getting Into a Car

 When getting into a car, shift
your left knee behind your right.
 Keeping your left foot on the
ground, bring your right leg into
the car as you begin to orient
your trunk to the right.
 Lift your left leg into the car next
to the right.
Driving
 When driving a car, it is recommended that

you sit with your back supported so that your
trunk remains slightly rounded and shift your
left knee behind your right, turning your left
thigh inward.
Getting On a Bicycle
 When mounting a bicycle, stand on your left leg while holding onto the handle with your
left hand and the seat with your right hand.
 Lift your right knee in front of you creating a 90-90 position with your trunk and your
thigh.
 Bring your right leg over the middle and place your right foot on the ground.
 Pick your left foot up and position it in or on the left pedal.
 As you are placing your foot on the pedal, begin to bring your bottom back on the seat.

PRI Right AIC Reciprocal Alternating Gait Recommendations
1. Lead with the left arm and the right leg when moving forward. Remember to move both
the left arm with the right leg and the right arm with the left leg.
2. Hit each heel as you strike the ground and try to push off with your great toes on each
side when your foot leaves the ground.
3. Wear shoes that have good arch support and find and feel your right arch with each step
you take on the right side.
4. Occasionally take a smaller step with the left leg than the right or a larger step with the
right leg than the left. Remember this would include moving the left arm forward more
than the right or the right arm backward more than the left.
5. Walk and weave. Move from the left side of the sidewalk to the right and vice versa.
6. When walking clockwise, remember to focus on feeling the right shoe arch and take a
greater swing with the left arm as the right leg moves forward and your body weight
shifts over the left leg.
7. When walking counter-clockwise, remember to heel strike and push off with the great toe
on the left side. As the right knee comes up, when the left foot is on the ground, move
the left elbow to the right knee slightly more and raise the right knee slightly higher than
you would on the other side.
Trunk
Trunk
Hips
Hips
R L
L R

Appendix – PRI Breathing Techniques
PRI Breathing Techniques

1. How should we breathe? Like a baby.
- The abdomen expands first, then the chest. Don’t use the neck!
- Breathe in through the nose and out through the mouth, or in and out through the nose for quiet
breathing 8 to 10 times per minute.
- When performing breathing exercises, exhale twice as long as inhaling to recruit abdominals.
Why?
- The bottoms of the lungs have a better blood supply, so there is good oxygen for the body.
- The diaphragm will get a lot of use, which prevents it from becoming tight and/or dormant.
- There will be less use of secondary respiratory muscles, and therefore less chance of neck pain,
headache, shoulder pain, and back pain.
- Posture improves as a result of all of the above. You will feel better.
2. Observation Breathing
- Position: seated with eyes closed and your feet flat on the floor and with your knees level with or
above the hips. Comfortable clothing.
- Observe or focus on your breathing, however, do not attempt to alter it.
- As you passively follow your breathing pattern of inhalation and exhalation, even as it may change,
try to note when each phase begins and ends. Allow yourself to completely relax.
3. Exhalation Breathing
- Position: sitting with feet flat on the floor and knees level with or above hips, or lying on your back
with knees raised and supported.
- Focus on your breathing, however, do not attempt to alter it.
- Concentrate on the exhalation phase of breathing only.
- Exhale through your mouth “haaaa…” or sigh as you exhale.
- Think of exhalation as the beginning of the breathing cycle.
4. Individual Breathing
- Position: lay on your back with knees raised and supported and with eyes closed.
- Focus on your breathing, however, do not attempt to alter it.
- Imagine upon inhalation that the universe is blowing air into your entire body. Imagine upon
exhalation that air is being “pulled” from your entire body.
- Continue in this manner for several breathing cycles.
5. Stimulation Breathing
- Position: sitting with eyes closed and your tongue placed on the alveolar ridge (soft tissue between
the teeth and the roof of the mouth).
- Keep your mouth closed, quickly inhale and exhale through your nose.
- Try to keep each phase short and equal. These quick short breaths will activate musculature at the
base of the neck.
- Attempt to breathe 2 cycles per second for a total of 15 seconds for the first session, then increasing
total time to eventually 1 minute.
6. Relaxing Breathing
- Position: sitting, on your back, standing, or walking.
- Place your tongue on the alveolar ridge. Maximally exhale making an “ah” sound. Close your
mouth and silently inhale while counting to 4. Do not exhale…hold for 4 seconds.

- Now exhale through your mouth with an “ah” sound for 8 seconds.
- Repeat this cycle 3 more times.
References:
1. Schiller D. The little zen companion. Workman Pub, 1994, p. 114.

2. Hendler S. The oxygen breakthrough – thirty days to an illness-free life. Pocket Books, 1989, pp. 85-
95.
3. Padus E. Your emotions and your health. Rodale Press Inc., 1986, pp.260-262.
4. Reid D, Dechman G. Considerations when testing and training the respiratory muscles. Physical
Therapy: 75(11), Nov, 1995.
5. Wells PE, Framptom V, Bowsher D. Pain management by physical therapy. Butterworth Heinemann,
1994, pp. 177-187.
6. Griffin J, Karselis T. Physical agents for physical therapists. Charles C. Thompson, 1982: pp14-15.
Breathing exercises were adapted and adjusted from the book “Spontaneous Healing” by Dr. Andrew
Weil. Published by Alfred A. Knopf Inc. 1995, pp. 204-207.
1. Yoga Deep Breathing

- Position: sitting.
- Exhale making an “ah” sound. Time yourself and try to increase the duration of exhalation each
time you do this exercise.
2. Vacuum Breathing
- Breathe normally for 1 minute as you exhale making a groaning sound and inhale attempting to
make the same groaning sound.
3. Yoga Deep Breathing

- Position: standing.
- Exhale through your nose. Attempt to keep your entire body very still with the exception of your
stomach and chest.
- Contract the sphincter muscles of the rectum by pulling them inwards and upwards.
- Quietly exhale & then immediately inhale deeply through your nose. Repeat 10 times.
4. Relaxation Breathing
- Position: on your back with eyes covered and knees supported.
- Breathe slowly & deeply relaxing each set of muscles individually from your head to toes.
- Then, concentrate on breathing into every muscle simultaneously.
- Repeat, concentrating on tensing your entire body and then gradually relaxing each muscle.
5. Purification Breathing
- Slowly exhale through left nostril, keeping the right nostril closed with your right thumb.
- Then close the left nostril with the right ring finger, open the right nostril and slowly inhale.
- Repeat this cycle trying to keep each phase equal in length.
- Then switch, exhaling through the right nostril and inhaling through the left.
Adapted from “Dance with Fear” by Paul Foxman.

Hruska Relief Position

(Based off the Brugger Relief Position)
1. Perch at the edge of your chair

2. Abduct (moves out to the side) and externally rotate (turn out) your legs.
3. Lift your sternum (breastbone) slightly
4. Tuck your chin in and look straight ahead
5. Supinate (turn out) your arms as you slowly inhale with your diaphragm through your nose
6. Feel your upper lateral chest wall open
7. Avoid using neck muscles
8. Repeat 2-3 times every 20-30 minutes when sitting
Supine Hooklying Synchronized Resisted Glute Max

1. Lie on your back with your feet placed on a 2-inch block.
2. Place a band around your knees.
3. Start with your knees together and place your arms at your side with your elbows bent at a 90-degree
angle.
4. Inhale through your nose as you turn your knees and hands out to the side keeping your elbows at
your side.
5. Exhale through your mouth as you bring your knees and hands back together slowly. At the end of
exhalation, perform a pelvic tilt so that your tailbone is raised slightly off the mat. Keep your back
flat on the mat.
6. Continue the sequence of inhalation while bringing your hands and knees out and exhalation bringing
your hands and knees in.
7. Perform a pelvic tilt at the end of each exhalation.
8. Concentrate on filling your chest more with each inhalation using your diaphragm not your neck.
9. Relax and repeat this sequence 4 more times.
INHALATION
EXHALATION

Supine Hooklying T8 Extension

1. Lie on your back with your feet on a 2-inch block.
2. Inhale through your nose and as you exhale through your mouth, push down with your heels and
perform a pelvic tilt so that your tailbone is raised slightly off the mat. Keep your back flat on the
mat. You should feel the muscles on the back of your thighs engage. As you are performing the pelvic
tilt reach towards the ceiling with both of your arms.
3. Maintaining the position of your arms and hips, inhale and fill your upper chest with air as you keep
your low back flat on the mat. Let your arms passively move towards your head as you inhale.
4. Exhale and let your lower ribs sink down keeping your arms and hips stationary.
5. Inhale again filling your upper chest with air and let your arms move further towards your head upon
inhalation.
6. Exhale and let your lower ribs sink down further and keep your low back on the ground.
7. Continue this sequence for one more breath in and out letting your arms move back further upon
inhalation without letting your ribs come up.
Flat Back Position Positional Goal
Extension Flexion
T1 Flexion T1
Extension
Extension Flexion
T8
T8
Flexion Extension
Extension Flexion
Gayman’s Technique
1. Sit in a chair keeping your back slightly rounded.
2. Look straight ahead with your eyes and place your tongue against the hard palate of your mouth just
behind your top teeth.
3. Keep your palms face up resting on your knees with your fingers above your thumbs.
4. As you inhale lift your toes up and as you exhale press your toes down. Allow your chest to expand
on inhalation without raising your shoulders and fall on exhalation.

Pelvic Floor Disorders

Stress incontinence - involuntary loss of urine following an abrupt elevation of the intra-
abdominal pressure. Leakage with cough, sneeze, lifting, exercise, etc.
Urge incontinence - loss of urine with a strong urge to urinate. Usually associated with frequent
urination.
Fecal Incontinence - involuntary loss of the stool.
Pelvic Floor Prolapse

 Vaginal Vault Prolapse - vaginal hernia.
 Cystocele - hernia of the bladder that protrudes into the vagina.
 Enterocele - hernia of the intestine through the vagina.
 Rectocele - hernia of the posterior vagina wall with the anterior wall of the rectum
through the vagina.
 Uterine Prolapse - uterine hernia.
Symptoms include: pain and pressure in the pelvis that is usually decreased lying down,
dyspareunia, bulge at vaginal opening, reoccurring bladder infections, difficulty emptying of
bowel and bladder, and constipation with rectocele.
Dyspareunia - painful intercourse.
Vulvodynia - Vulvar discomfort lasting longer than six months.

Symptoms include: burning, stinging, rawness and inability to penetrate vagina without
pain.
Vestibulodynia - pain at 3 o'clock and 9 o'clock inside vaginal vestibule. May be caused by
autoimmune sensitivity, ph imbalance, high levels of oxylate, chlamydia, human papilloma virus
and glandular disturbance.
Interstitial Cystitis - inflammation/ulcerations of the inner bladder.

Symptoms include: urgency and frequency with urination, nocturina, pain in supra-pubic
region, dull low back pain, and difficulty initiating or completely emptying bladder.
Proctalgia Fugax - sharp fleeting rectal pain that last seconds to several hours. Can occur with
menstration, defecation or during intercourse. Spasm of puborectalis muscle.
Coccygodynia - pain in the coccyx or gluteal when sitting. Spasm of piriformis or coccygeus
muscle.
Prostatodynia - Male chronic pelvic pain that can be bacterial or non-bacterial related.
Symptoms include: irritation with voiding, perineal discomfort, pain with sitting, low back
and groin pain and pain with ejaculation.

Vaginismus - inability to penetrate vagina. Hypertonic superficial and deep pelvic floor
muscles.
Levator Ani Syndrome - hypertonic pelvic diaphragm or pain generalized in the pelvic region.
Symptoms included: generalized pain, pressure, can refer pain to gluteals, coccyx, and
sacrum, overactivity of pelvic floor can lead to difficulty voiding or defecating. Typically
more prominate on the left side.
Tension Myalgia - pain, pressure and trigger points anywhere in the low back, coccyx, vagina,
and posterior thigh or pain with rectal or vaginal examination and pain with prolonged sitting or
standing.
Chronic Pelvic Pain - unexplained pelvic pain lasting longer than six months.
Anismus - pain in the rectum or anus; restricted opening of the anus.
Urethral Syndrome - urethral pain or burning with urination; associated with urgency and
frequency or hesitancy with voiding. Inability to relax the pelvic floor and sphincters.
Pudendal Neuralgia - consent burning or itching sensation of genitalia.

Symptoms include: vaginal dryness, dyspareunia, deep groin pain, difficulty walking and
bladder dysfunction.
BPH (benign prostate hypertrophy) - starts around age 40.

Symptoms include: urinary hesitancy, weak stream, dribbling or straining, hypertrophy of
the trigone of bladder and not diagnosed until symptoms become obvious.

Treatment Considerations for Isolation of Pelvic

Floor and Transverse Abdominis (TA)
Pelvic Floor Contraction

Urogential diaphragm
 Gently close your opening without a lift.
 Gentle and sub-maximal contraction.
 Consider seating on Swiss ball for various pressure points in perineum.
External Anal Sphincter

 Imagine that you are winking the anus.
Pelvic Diaphragm
 Attempt to stop the flow of urine.
 Attempt to hold back gas.
 Bring your sit bones together.
 Imagine drawing the pubic bone and coccyx together.
 Lift up and in on your pelvic floor as if you were drawing in a tampon or lifting up
testicles.
Pelvic Floor Relaxation

 Imagine drawing air in all the way down to your perineum with inhalation.
 Palpate perineal body and gently bulge out into your finger.
 Avoid Valsala maneuver.
Transverse Abdominis
 Imagine drawing your hip bones together.
 Gently lift your pelvic floor or testicles.
 Inhale through your nose and exhale through mouth by sighing out and feel your
abdominal muscles sink. Palpate muscles one inch medially from ASIS, muscles should
pull away from fingers with sigh of exhalation.
 Gently pull naval to your spine.
 Sub-maximal contraction without substitutions. Examples: pelvic tilting, abdominal
bulging and breathing holding.

Research Support
Anatomy & Physiology
1. Avery AF, O’Sullivan PB, McCallum M J. Evidence of Pelvic Floor Muscle Dysfunction in
Subjects with Chronic Sacro-Iliac Joint Pain Syndrome. Scientific Conference of the IFOMT,
Perth, pp.35-38, 2000.
2. Bo K. Pelvic Floor Muscle Training is Effective in Treatment of Female Stress Urinary
Incontinence, But How Does it Work? International Urogynecological Association:
2004:15:76-84.
3. Bo K, Sherburn M, Allen T. Transabdominal Ultrasound Measurement of Pelvic Floor
Muscle Activity when Activated Directly via a Transversus Abdominal Muscle Contraction.
Arch Phys Med Rehabil: 2001:82.
4. DeLancey J. Structural Support of the Urethra as it Related to Stress Incontinence: The
Hammock Hypothesis. Am J Obstet Gynecol 1994; 170: 1713-23.
5. Hulme J. Pelvic Pain and Low Back Pain. Phoenix Publishing. Missoula, 2002:
6. Hulme J. Beyond Kegels: Fabulous Four Exercises and More to Prevent and Treat
Incontinence. 2nd ed. Phoenix Publishing. Missoula, 2002.
7. Hodges PW. Is There a Role for Transverses Abdominal in Lumbo-Pelvic Stability? Manual
Therapy. 1999: 4(2): 74-86.
8. Lee, Diane. The Pelvic Girdle An approach to the Examination and Treatment of the Lumbo-
Pelvic – Hip Region. Churchhill Livingston, 1999.
9. Netter FH: Atlas of Human Anatomy. New Jersey, CIBA-GEIGY Corporation, 1992.
10. Neumann P. Pelvic floor and Abdominal Muscle Interaction: EMG Activity and IAP Int
Urogynecol J. 2002: 13: 125-132.
11. Nygaard I, Thompson F, Svengalis S, Albright J, Urinary Incontinence in Elite Nulliparous
Athletes. Obstetrics and Gynecology: 1994: 84: 2
12. Nygard Ingrid: Does Prolonged High Impact Activity Contribute to Later Urinary
Incontinence? A Retrospective Cohort Study of Female Olympians. Obstetrics and
Gynecology: 1997:90:5.
13. Pool-Gou dzwaard A, Dijke G, Gurp M, Mulder P, Snijders C, Stoeckart R. Contribution of
Pelvic Floor Muscle to Stiffness of the Pelvic Ring. Clinical Biomechanics 19 (2004) 564-
571.
14. Sapsford R. The Pelvic Floor – A Clinical Model for Function and Rehabilitation.
Physiotherapy December 2001; 87: 620-629.
15. Sapsford R, Hodges P, Richardson C. Co-activation of the Abdominal and Pelvic Floor
Muscles During Voluntary Exercises. Neurourol Urodyn 2001: 20: 31-42.
16. Shafik A. The Histomorphologic Structure of the Levator Ani Muscle and Its Functional
Significance. Int. Urogynecol J 2002: 13: 116-124.
17. Sultan A. Pudendal nerve damage during labour: prospective study before and after
childbirth. British Journal of Obstetrics and Gynaecology. January 1994, Vol 101:22-28.
18. Wallace K, Herman H. Female Pelvic Floor Function, Dysfunction and Treatment Level 1.
Prometheus Group, Minneapolis 2008.
19. Wijma J, et al. Perineal Ultrasonography in Women with Stress Urinary Incontinence and
Controls: The Role of the Pelvic Floor Muscles. Gynecologic and Obstetric Investigation, 32,
176-179.

Respiration
1. Abe T, Kusuhara N, Yoshimura N, Tomita T, Easton P. Differential Respiratory Activity of
Four Abdominal Muscles in Humans. J Appl. Physiol. 80(4): 1379-1389, 1996.
2. Chaitow L. Breathing Pattern Disorders, Motor Control and Low Back Pain J Osteopathic
Medicine, 2004; 7(1): 34-41.
3. Hodges PW. Looking Beyond the Pelvic Floor: An Integrated Clinical Approach to the
Assessment and Exercise Management of Continence and Low Back or Pelvic Pain.
Combined Sections Meeting Las Vegas, NV February, 2009.
4. Hodges PW, Sapsford R, Pengel LHM. Postural and Respiratory Functions of the Pelvic
Floor Muscles. Neurourol. Urodynma. 26:362-371, 2007.
5. Myokinematic Restoration – PRI Course Manual.
6. Perri M, Halford E. Pain and Faulty Breathing: A Pilot Study J Bodywork and Movement
Therapies 8: (4): 297-306, 2004.
7. Postural Respiration – PRI Course Manual.
8. Santos R, Bulbena A, Porta M, Gago J, Molina L, Duro J. Association Between Joint
Hypermobility Syndrome and Panic Disorder. Am J Psychiatry 1998: 155: 1578-1583.
9. Zone of Apposition References – Postural Respiration PRI Course Manual. Available online
www.posturalrestoration.com.
Treatment Considerations & Interdisciplinary Integration

1. Bo K. Pelvic Floor Muscle Training is Effective in Treatment of Female Stress Urinary
Incontinence, But How Does it Work? Internation Urogynecological Association: 2004: 15
76-84.
2. Bo K, Sherburn M, Allen T. Transabdominal Ultrasound Measurement of Pelvic Floor
Muscle Activity When Activated Directly or Via a Transverses Abdominis Muscle
Contraction. Arch Phy Med Rehbil: 2001: 82.
3. Deindl FM, Vodusek DB, Hesse U and Schusser B. Pelvic Floor Activity Patterns:
Comparison of Nulliparous Continent and Parous Urinary Stress Incontinent Women. A
kinesiological EMG study. British Journal of Urology (1994) 73, 413-417.
4. Hodges PW, Heijnen I, GAndevia S. Postural Activity of the Diaphragm is Reduced in
Humans when Respiratory Demand Increases. J Physiology (2001), 537.3, 999-1008.
5. Hodges PW, Sapsford R, Pengel LHM. Postural and Respiratory Functions of the Pelvic
Floor Muscles. Neurology and Urodynmaics 26: 362-371 (2007).
6. Isbit J. Nature Knows Best. 2008.
7. King PM, Myers CA, Ling FW, Rosenthal RH. Musculoskeletal Factors in Chronic Pelvic
Pain. J Psychosom Obstet Gynecol. 12 (1991), Suppl., 87-98.
8. Neumannn P, Gill V. Pelvic Floor and Abdominal Muscle Interaction: EMG Activity and
Intra – abdominal Pressure. Int Urogynecol J (2002) 13:125-132.
9. Nygard I, Glowacki C, Sallzma C. Relationship Between Foot Flexibility and Urinary
Incontinence in Varsity Athletes. Obstet Gynecol. 1996 Jun;87(6):1049-51.
10. O’Sullivan PB, Beales DJ. Changes in Pelvic Floor and Diaphragm Kinematics and
Respiratory Patterns in Subjects with Sacroiliac Joint Pain Following a Motor Learning
Intervention: A Case Series. Manual Therapy 12 (2007) 209-218.
11. Sapsford RR, Hodges PW, Richardson CA, et al. Co-Activation of the Abdominal and Pelvic
Floor Muscles During Voluntary Exercises. Neurouro Urodyn 2001: 20: 31-42.

12. Smith M, Coppieters MW, Hodges PW. Postural Response of the Pelvic Floor and
Abdominal Muscles in Women With and Without Incontinence. Neurology and
Urodynamics 26:377-385 (2007).
13. Smith M, Hodges P. Incontinence and Breathing Disorders are Associated with Development
of Back Pain. 10th World Congress on Pain; Sidney, Australia, 2005.
14. Thompson J, O’Sullivan P, Briffa N, Neumann. Difference in Muscle Activation Patterns
During Pelvic Floor Muscle Contraction and Valsalva Maneuver. Neurology and
Urodynamics 25: 148-155 (2006).
15. Urquhart DM., Hodges PW, Allen TJ, Story IH. Abdominal Muscle Recruitment A Range of
Voluntary Exercises. Manual Therapy 10 (2005) 144-153.
Muscular Skeletal Asymmetry and Influence on the Pelvic Floor

1. DeLancey J. Structural Support of the Urethra as it Related to Stress Incontinence: The
Hammock Hypothesis. Am J Obstet Gynecol 1994; 170: 1713-23.
2. Lee LJ, Chang AT, Coppieters MW, Hodges PW. Changes in sitting posture induce multi-
planar changes in chest wall shape and motion with breathing. Respiratory Physiology &
Neurobiology 170 (2010) 236-245.
3. Netter FH: Atlas of Human Anatomy. New Jersey, CIBA-GEIGY Corporation, 1992.
4. Nygard I, Glowacki C, Sallzma C. Relationship Between Foot Flexibility and Urinary
Incontinence in Varsity Athletes. Obstet Gynecol. 1996 Jun;87(6):1049-51.
5. SmithM, Russell A, Hodges P, Do Incontinence, Breathing Difficulties, and Gastrointestinal
Symptoms Increase the Risk for Future Back Pain? The Journal of Pain, Vol 10, No 8
(August)2009: pp876-886.
Muscular Influence on Pelvic Floor Function

1. Boyle K. Managing a female patient with left low back pain and sacroiliac joint pain with
therapeutic exercise: a case report. Physiotherapy Canada, Volume 63, Number 2:154-163.
2. Deindl FM, Vodusek DB, Hesse U and Schusser B. Pelvic Floor Activity Patterns:
Comparison of Nulliparous Continent and Parous Urinary Stress Incontinent Women. A
kinesiological EMG study. British Journal of Urology (1994) 73, 413-417.
3. Hodges P, Smith M, Chang A, Sapsford R Breathing with the Pelvic Floor: Coordinated
Activity fo the Pelvic Floor Muscles During Inspiratory and Expiratory Efforts The
University of Queensland.
4. Hodges PW, Heijnen I, GAndevia S. Postural Activity of the Diaphragm is Reduced in
Humans when Respiratory Demand Increases. J Physiology (2001), 537.3, 999-1008.
5. Isbit J. Nature Knows Best. 2008.
6. Junginger B, Baessler K, Sapsford R. Effect of abdominal and pelvic floor tasks on muscle
activity, abdominal pressure and bladder neck. Int Urogynecol J (2010) 21:69-77.
7. Neumannn P, Gill V. Pelvic Floor and Abdominal Muscle Interaction: EMG Activity and
Intra – abdominal Pressure. Int Urogynecol J (2002) 13:125-132.
8. Smith M, Coppieters MW, Hodges PW. Postural Response of the Pelvic Floor and
Abdominal Muscles in Women With and Without Incontinence. Neurology and
Urodynamics 26:377-385 (2007).

Pelvic Floor Mid Zone

1. Neumann P. Pelvic floor and Abdominal Muscle Interaction: EMG Activity and IAP Int
Urogynecol J. 2002: 13: 125-132.
2. O’Sullivan PB, Beales DJ. Changes in Pelvic Floor and Diaphragm Kinematics and
Respiratory Patterns in Subjects with Sacroiliac Joint Pain Following a Motor Learning
Intervention: A Case Series. Manual Therapy 12 (2007) 209-218.
3. Thompson J, O’Sullivan P, Briffa N, Neumann. Difference in Muscle Activation Patterns
During Pelvic Floor Muscle Contraction and Valsalva Maneuver. Neurology and
Urodynamics 25: 148-155 (2006).
4. Urquhart DM., Hodges PW, Allen TJ, Story IH. Abdominal Muscle Recruitment A Range of
Voluntary Exercises. Manual Therapy 10 (2005) 144-153.

PRI Evaluation Form
Myokinematic Restoration Examination

Left Right
Adduction Drop Test + - + -
Extension Drop Test + - + -
Trunk Rotation _____inches _____inches
Straight Leg Raise _____degrees _____degrees
FA IR R.O.M. _____degrees _____degrees
FA ER R.O.M. _____degrees _____degrees
FA ER Strength 1 2 3 4 5 1 2 3 4 5
FA IR Strength 1 2 3 4 5 1 2 3 4 5
FA IR Muscle TFL / Glute Med TFL / Glute Med
Hruska Adduction Lift Test 1 2 3 4 5 1 2 3 4 5
Hruska Abduction Lift Test 1 2 3 4 5 1 2 3 4 5
Standing Reach Test _____inches ______inches
Pelvis Restoration Examination

Left Right
Pelvic Ascension Drop Test (PADT) + - + -
Passive Abduction Raise Test (PART) + - + -
Posterior Outlet Mediastinum Expansion Test + - + -
Functional Squat Test ______ ______
Postural Respiration Examination

Left Right
Apical Expansion with Contralateral Opposition Limited Limited
Horizontal Abduction _____degrees _____degrees
Shoulder Flexion _____degrees _____degrees
HG IR _____degrees _____degrees
Subclavius Flexibility Limited Limited
Elevated and Externally Rotated Ant. Ribs on: ______ ______
Cervical-Cranio-Mandibular Restoration Examination

Left Right
Cervical Axial Rotation _____degrees _____degrees
Horizontal Abduction _____degrees _____degrees
Mandibular Opening _____mm
Mandibular Lateral Trusion with Protrusion _____mm _____mm
(Bilateral temporal IR)
Mandibular Opening
with Non-Reducing Disc _____mm _____mm
Lateral Movement to: _____mm _____mm
Advanced integration Examination

Left Right
Hruska Alternating Reciprocal Rotation Test 1 2 3 4 5 1 2 3 4 5

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Pelvis Restoration – Home Study

An integrated approach to treatment of

10:00 – 10:15 Break 10:00 – 10:15 Break

3:00 – 3:15 Break

3:15 – 5:00 Respiratory Influences on the Pelvis

5241 ‘R’ STREET

The materials and information provided to you during this

Date of last revision: October 9, 2012

Copyright  2010-2013 Postural Restoration Institute® ii

SECTION TWO: APPENDIX

Copyright  2010-2013 Postural Restoration Institute® iii

Pelvis Restoration – An Integrated Approach to Treatment of Patterned Pubo-Sacral

Postural Respiration – An Integrated Approach to Treatment of

Cervical-Cranio-Mandibular Restoration – An Integrated Approach to Treatment of

Copyright  2010-2013 Postural Restoration Institute® iv

Myokinematic Restoration – An Integrated Approach to Treatment of

Pelvis Restoration – An Integrated Approach to Treatment of Patterned Pubo-Sacral

Postural Respiration – An Integrated Approach to Treatment of

Posterior Exterior Chain (PEC) L Internal Obliques/Transversus B Paravertebrals, R Quadratus Lumborum

Cervical-Cranio-Mandibular Restoration – An Integrated Approach to Treatment of

Copyright  2010-2013 Postural Restoration Institute® v

ANTERIOR INTERIOR CHAIN (AIC)

Copyright  2010-2013 Postural Restoration Institute® vi

Copyright  2010-2013 Postural Restoration Institute® vii

Copyright  2010-2013 Postural Restoration Institute® viii

Anterior abdominal wall: internal view

Pelvic Floor & Respiratory Influences on Gait

*Looking at the patient from the front

*Looking at the patient from the back

Left Anterior Interior Chain (AIC)

Copyright  2010-2013 Postural Restoration Institute® 2

Borders: ASIS, sacral base,

Borders: Ischial tuberosities,

Elsevier. Drake et al: Grays anatomy for students – www.studentconsult.com

Copyright  2010-2013 Postural Restoration Institute® 3

Anterior View of an Anterior &

*Left Anterior Inlet

*Left Anterior Inlet

Copyright  2010-2013 Postural Restoration Institute® 4

*Left Anterior Inlet

*Left Anterior Inlet

L IP ER = L AF ER (acetabular femoral external rotation)

Copyright  2010-2013 Postural Restoration Institute® 5

Posterior View of an Anterior &

*Left Posterior Inlet

*Left Posterior Outlet

Copyright  2010-2013 Postural Restoration Institute® 6

*Left Anterior Outlet

*Left Anterior Outlet

Copyright  2010-2013 Postural Restoration Institute® 7

*Left Anterior Outlet

*Left Anterior Outlet

L IsP IR of the outlet = L IP ER of the inlet

Copyright  2010-2013 Postural Restoration Institute® 8

Copyright  2010-2013 Postural Restoration Institute® 9

Left AIC Position Summary

Left Pelvic Inlet

Left Pelvic Outlet

Copyright  2010-2013 Postural Restoration Institute® 10

left AIC Pelvic Inlet

See Netter Plate 250

Illustrated by the Elizabeth Cunningham for the Postural Restoration Institute®

Copyright  2010-2013 Postural Restoration Institute® 11

骨盆底讲义

骨盆底讲义