Human beings were designed to move! We evolved into a bipedal position of locomotion using cross-body "X" patterns for optimal efficiency in stability and mobility. Cross-body patterning harnesses the elastic power of muscles and soft-tissue fascia for efficient body-movement flow.
Every motion demands that we create force and control force. How well you can control force will determine durability, technical proficiency and overall resistance to injury. The posterior oblique sling (POS) is a movement subsystem of the body comprised of the gluteus maximus, thoracolumbar fascia and contralateral latissimus dorsi muscle, connecting the opposite hip and shoulder for locomotion. Without it you don't move.
Safe to say it's an important pattern to learn and optimize. Dysfunction in this system puts the brakes on stability and mobility in the recovery continuum. How do you know if the POS is dysfunctional and how can you restore function? That's what you are about to discover.
Functional Force Management and the Dysfunctional POS
Joanne Elphinston states that there are four key elements to functional force management:
- How effectively force is generated and directed (Can you control where it goes?)
- How effectively forces are transmitted through the body
- How effectively forces are dispersed or shared across the structures of the body
- How effectively force is dispersed or released from the body
The POS is the "linchpin" for effective force control. Think of the POS as a full-body slingshot with elastic bands. How far back you can pull the bands (arms and legs) and how stable the slingshot base (core) is determines how far what you are shooting (your body) travels and at what speed. Without proximal stability, you cannot have optimal distal mobility. This lack of central zone core stability may cause an increase in joint compression as a compensation mechanism for stability.
The nervous system feeds forward a protective pattern of decreased mobility for increased stability. Not the desired way to accomplish stabilization. The most common dysfunction of this system is neural sequencing inhibition of the gluteus maximus (glute amnesia) and inhibition of the latissimus dorsi, with facilitation (upregulation) of the thoracolumbar fascia.
In essence, you have only one part of the subsystem working effectively – the thoracolumbar fascia. The glutes and lats are very often slow to activate when needed for optimal function because of their inhibition; therefore, the TLF gets overworked and tired. Force closure of the pelvis is intimately associated with coordinated function of the posterior oblique and anterior oblique slings of the body.
The anterior oblique movement chain consists of the contralateral hip adductors, abdominal oblique complex, rectus abdominis and the transversus abdominis. Think of them as being in a "yin and yang" balanced relationship for central zone core stabilization. Dysfunction in one leads to compensatory imbalance in the other, and a Domino effect of movement impairment syndromes begin. As a result, a few things may now occur:
- Decreased stamina from muscle imbalance
- Decreased recovery from central nervous system desensitization
- Decreased strength from muscle inhibition and facilitation
- Increased tightness in fascial structures and kinetic chains
- Increased fatigue factors
- Increased risk of injury from poor coordinated movement patterns and reaction times
Common signs of a dysfunction in this system include:
- Rounded shoulders and flexion posture (Janda's upper-crossed syndrome)
- Internally rotated hips and decreased hip extension
- Shoulder pain
- Knee pain and instability
- Sacroiliac pain and sacral jamming
- Lower back pain and lumbopelvic hip destabilization
- Decreased ability for acceleration and deceleration in gait patterning
How to Reset and Engage the System
- Mobilization to subluxated segments of the thoracic spine, pelvis and hips.
- Soft-tissue release of the thoracolumbar fascia (instrument-assisted soft-tissue release, laser therapy, ultrasound, muscle stimulation, manual therapy, etc.).
- Corrective exercise activation of the latissimus dorsi and gluteus maximus. Several options are listed below, depending on the stabilization capability of the individual you are working with on a case by case basis. It is critical not to challenge a patient beyond his/her stabilization capacity. If a movement pattern is too difficult for a patient to perform with good, pain-free quality, the nervous system will be unable to adapt to the proper sequencing. A fight-or-flight response will overload the neural system of adaptation. More is not better in the category of corrective exercise. Better is better.
Possible Exercise Options
- Quadruped alternating arm and leg extensions (the classic bird dog)
- Legs with pull using exercise bands, beginning with a stable base: double-leg stance rowing, squat to row and squat to unilateral row
- Proceed to single-leg versions: static lunge to row and static lunge to unilateral row
Cross-body pulling and stabilization is an essential component to human movement. No matter where your patient is on the rehabilitation timeline, they can benefit from POS program integration. When patients move better, they feel better. Enhanced timing and coordination will be evident in all basic pattern movements, from walking to pushing/pulling, stepping, lunging and rotating.
Take the brakes off mobility and allow the natural forces of stabilization to work. You may find your chiropractic adjustments are quicker to lock in and maintain mobility patterns. Give the body a stable base of support and mobility will thrive.
- Calais-Germain, Blandine, and Stephen Anderson. Anatomy of Movement. Seattle: Eastland, 1993.
- Cook G. Movement: Functional Movement Systems: Screening, Assessment, and Corrective Strategies. Aptos, CA: On Target Publications, 2010.
- Elphinston J. Stability, Sport and Performance Movement: Practical Biomechanics and Systematic Training for Movement Efficacy and Injury Prevention. Lotus Publishing, 2013.
- Brookbush B. Fitness or Fiction: The Truth About Diet and Exercise. Self-published, 2011.
- Weinstock D. NeuroKinetic Therapy: An Innovative Approach to Manual Muscle Testing. Berkeley, CA: North Atlantic, 2010.
Click here for more information about Perry Nickelston, DC, FMS, SFMA.