How do you walk? How do you run? Thanks to a subsystem of the body known as the posterior oblique subsystem, we are allowed to do the basic functions that are taken for granted. When these muscles are imbalanced, that’s when movement suffers. Treatment techniques, including laser therapy and soft-tissue mobilization, can bring movement back. Perry Nickelston, DC, FMS, SFMA, Dynamic Chiropractic, offers practical advice on how to reset the posterior oblique movement chain.
As human beings, we are 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.
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. It is the "linchpin" for effective force control—and without it, you don’t move. 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.
Dysfunction in one part of the subsystem leads to compensatory imbalance in the other, leading to a domino effect of movement impairment syndromes. As a result, a few things may 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.
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