Do You Even Exhale, Bro? Part 2: On the Postural Restoration Institute and the 90-90 Hip Lift with Passive FA IR (aka a Tri-Planar Beast of an Exercise)

In the first installment of this series, I drew upon the insightful work of the Postural Restoration Institute (PRI) to describe a common postural and neurological pattern amongst athletes and gym-goers, the Posterior Exterior Chain (PEC). In that post I explained why this postural and neurological state might be beneficial in some situations, but potentially deleterious in others. The key takeaway is that, like seemingly many things in life, you want to have a balance and adaptability with your posture. Ideally, you want to be able to adopt the PEC postural and neurological pattern when it’s appropriate (e.g., during periods of high stress), but you also want to be able to get out of the PEC pattern when it’s inappropriate (e.g., during periods of calm and recovery). A (hopefully) useful analogy is to consider a manual car: you’d destroy your car if you could only drive in sixth gear. In the same way, being stuck in a PEC pattern might expedite wear-and-tear on your body in the form of overuse injuries, anxiety, and other stress-related issues.



Swiss Ball All Four Belly Lift

In part one of this series, I described an exercise from PRI that can help correct the PEC pattern, the Swiss Ball All Four Belly Lift. It’s an excellent exercise for strengthening the internal obliques, transverse abdominis and serratus anterior muscles, which tend to be “long” and “weak” in the PEC, and inhibiting the spinal erectors, which tend to be “short” and “strong.” In doing so, this exercise improves the position of the trunk and pelvis as well as diaphragmatic function (via improving the zone of apposition). Alas, the Swiss Ball All Four Belly Lift isn’t the panacea for the PEC, since there are other muscles that need to be targeted that the Swiss Ball All Four Belly Lift doesn’t address. Indeed, while the Swiss Ball All Four Belly Lift is a great exercise for many muscles above the pelvis, it doesn’t necessarily address some of the imbalances in the muscles below the pelvis.


Before I talk about a specific corrective exercise for people in a PEC pattern that better targets the muscles in the lower body, however, it may help to understand how those muscles are typically positioned. In a PEC pattern, both hip bones are chronically flexed, externally rotated and abducted. To see what this pattern looks like, watch Zac Cupples’ succinct and illustrative video below.



 A Visual Explanation of the PEC Pattern

As Zac described in the video, a PEC’s pattern is symmetrical. Both hip bones (i.e., innominates) are stuck in flexion, abduction and external rotation. To use the superficial pelvic muscles to describe the pattern (you can also use deep muscles, but I expect that’d confuse more people), both hip flexors are short and strong, both adductors are long and weak, and both hamstrings are long and weak. Assuming a PEC-patterned person doesn’t have any pathology in their hips then they’ll be bilaterally positive in the Thomas Test (which indicates that they can’t get full hip extension without compensation) and Adduction Drop Test (which indicates that their pelvis is anteriorly tipped). If a person with hip bones in this position has pathology at the hip that allows them to have negative Thomas Tests, then they’d still be bilaterally positive in the Adduction Drop Test. If so, then they’d be a Pathological PEC, which generally requires a slower progression through a similar (but not identical) program and is a topic whose discussion merits its own series of posts.


Given the above description of the muscular imbalances in the PEC pattern, the solution might seem obvious: strengthen the adductors and hamstrings, and inhibit the hip flexors in order to extend, adduct and internally rotate the pelvis, all while incorporating breathing. Thankfully, the folks at the Postural Restoration Institute have created exercises that accomplish these goals. One of my favorites for addressing the aforementioned tri-planar imbalances is the 90-90 Hip Lift with Passive FA IR.



90-90 Hip Lift with Passive FA IR

(Note: In the video, I mistakenly refer to the exercise as the “90-90 Hip Lift with Passive AF IR” instead of “90-90 Hip Lift with Passive FA IR”. In PRI terms it does make a rather important difference–you’ll learn this if you attend any of their classes, which we highly recommend–but for this article’s purposes I won’t go into those minute details. In my defense, the nomenclature error may have been due to the sleep deprivation/brain fog I experienced that day due to having my wisdom teeth removed, but I digress.)


Does this exercise promote bilateral posterior pelvic tilt? Yes. Does this exercise promote bilateral hip adduction? Indeed. Does this exercise promote bilateral femoral internal rotation? Si. As such, you should “feel” the exercise in your hamstrings (i.e., the back of your thighs) and anterior core, adductors (i.e., inside of your thighs), and hip internal rotators (i.e., the outside of your hips). What distinguishes this exercise from many of the other 90-90 exercises is that both femurs are being passively internally rotated, which facilitates these oft-underused muscles. The typical set and rep scheme for this exercise is similar to that of other 90-90 exercises (e.g., three sets of five breaths), though I will discuss the implementation of this exercise within a workout and program in more detail later in this article.


As with many of these exercises, it’s important to consider not only which muscles you’re facilitating, but also which muscles you’re inhibiting. In the case of the 90-90 Hip Lift with Passive FA IR, you’re inhibiting the hip flexors, hip abductors, hip external rotators, and the spinal erectors (although perhaps to a lesser extent because the spine isn’t flexing much), all of which are short and strong in the PEC pattern.


One detail I didn’t mention in the video is that some people may benefit from having a pillow beneath their head and/or tailbone. Putting a pillow beneath the head might help someone who feels that their neck muscles are especially active during inhalation. Putting a pillow that’s a few inches thick beneath the tailbone passively posteriorly tilts the hips, which might be necessary for a Pathological PEC. If someone does need to put a pillow beneath their hips, then the goal is to gradually progress them to not using the pillow so that they are actively posteriorly tilting their pelvis.


Like our programming for the Swiss Ball All Four Belly Lift (which I discussed in part one of this series), we like to program the 90-90 Hip Lift with Passive FA IR in both the warm-up and cool-down, throughout the day, and sometimes paired with traditional strength and power exercises during the workout. During the warm-up, the exercise can reposition the person so that they perform the subsequent workout with better form and better use the appropriate muscles (e.g., being better able to use hip extensors, such as the hamstrings and glutes, instead of relying on spinal extensors). During the cool-down and throughout the day, the exercise promotes a neurological state that expedites recovery from the workout.


We plan to discuss the rationale for pairing the exercise with traditional strength and power exercises in a future post, but the short explanation is that the goal is to promote neurological and postural variability. Thus, the exercise improves both biomechanics for the subsequent lift and trains the client to readily and efficiently vary their neurological state.


As is (hopefully) evident, this exercise is better for some people than others–it isn’t a one-size-fits-all exercise. To know whether this exercise is appropriate for you or your client, you therefore need to do some assessments. You will learn these assessments at a PRI course, specifically Pelvis Restoration, which, again, we highly recommend taking. Furthermore, while the exercise might be appropriate for someone when they first start the program (i.e., they are a PEC in their initial assessment), they might benefit more from different exercises if their assessment changes in the following weeks. Thus, it’s important to assess and re-assess to make sure that you’re prescribing the appropriate exercises. That being said, the PEC presentation is, based on our experience, common amongst athletes and gym-goers, so you might use it a lot of with your clients (or with yourself).


In the next post in this series, I plan to discuss one of my favorite exercises in the PRI arsenal, the Supine Hemi Extension with Respiratory Rectus Femoris and Sartorius—it might be as awesome as its name is long and confusing. So stay tuned for the next installment. As always, don’t hesitate to share your thoughts, ask questions, or make suggestions. Also, special thanks to Zac Cupples for letting us use his video in this post. If you haven’t already visited his web site (link here), then please do yourself a favor and start reading his excellent blog posts pronto–they’re remarkably thorough, accessible, and funny.


Until next time, all the best.

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