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Enhancing the Balance Between Upper and Lower Trapezius

Enhancing the Balance between Upper and Lower Trapezius

The latest webinar recording for Inner Circle members is now available below.

Enhancing the Balance Between Upper and Lower Trapezius

This month’s Inner Circle webinars discussed strategies to enhance the balance between the upper and lower trap, a common dysfunction I see.  We’ll cover:

  • The impact on posture and trapezius balance
  • The relationship between imbalances of the trapezius and shoulder and cervical pathology
  • The relationship between imbalances of the trapezius and performance
  • Strategies for exercise selection
  • Coaching cues and programming considerations

To access the webinar, please be sure you are logged in and are a member of the Inner Circle program.

 

3 Myths of Scapula Exercises

Scapula exercises are very common and usually a needed component to any rehabilitation or corrective exercise program.  Like anything else, there seems to be a few commonly accepted themes related to scapular exercises that many people take for hard fast rules.  No program is right everyone!  Here are 3 myths of scapular exercises that I thought would good to discuss.

 

Pinch Your Shoulder Blades Together

Pinch your shoulder blades.  Squeeze your scaps together.  Retract your shoulders back.  Pack your scapula.  These are all common coaching cues given during scapular exercises.  The goal of all of these concepts is essentially to get into better posture and “set” your scapula back, ultimately resulting in better posture and better movement patterns when performing exercises.  Given that as a society we have an abundance of people with posture.  The classic Upper Body Cross Syndrome of forward head, rounded shoulders.

Normal scapulohumeral rhythm requires a sequence of shoulder and scapular movement simultaneously.  Pinching your shoulder blades together is essentially contracting your middle trapezius to fully retract your scapula and then move your arm.  While this isn’t nearly as bad on shoulder mechanics as lifting your arm in a fully protracted position, I don’t think it is most advantageous to lift your arm in a fully retracted position.  By holding your scapula back, which is essentially performing and isometric trapezius contraction, you are likely limiting the normal protraction and upward rotation that occurs with arm elevation and movement.

Scapula Exercises

If the goal of this common coaching cue is to improve posture and improve mechanics while exercising the arm, maybe a better cue would be to instruct thoracic extension.  Perhaps even combine this thoracic extension with upper cervical extension such as when performing the chin nod with postural exercises like we talked about recently.  This truly improves your posture.  Realize that you can still have a very kyphotic and rounded thoracic spine and retract your scapulas.  Retracting the your scapulas isn’t a bad visual, but the goal is to really get your thoracic spine extended.

 

Work on Mobility and Strength to Improve Scapular Symmetry

Scapula StrengthWe’ve all been guilty of assessing someone’s posture, finding this forward head rounded shoulder posture, and then assuming we need to work on things like pec and upper cervical mobility while strengthening the lower trap and deep neck flexors.  These are all good things to work on, however this is likely a simplistic view.

First let’s take a step back and get something out of the way.  Your scapulas are not symmetrical.  The vast majority of people are not symmetrical and I would bet even people that are close have subtle differences.  The fact is, we are unilateral creatures.  We are typically one hand dominant and we typically function with predominant movement patterns that are related to this.  This tends to really become an issue when we start to talk about people that perform a repetitive unilateral activity all day.  I’m not just talking about athletes like baseball pitchers, you sitting there at your computer using your mouse in your right hand counts too.

This inherently creates asymmetries throughout the body, including the hips, spine, rib cage, and of course the scapula.

In my opinion, scapular position is more related to rib and thoracic position than anything else, including tight muscles and weak or inhibited muscles.  The scapula rests on the rib cage and thus moves with the rib cage.  Do you need to work on these muscle imbalances?  Absolutely.  However, proper alignment is needed as well and should be assessed first.

Everyone says “mobility before stability,” right?  Well, I’d like to add to that.  How about this:

[box type=”note” size=”large” icon=”none”][quote]Alignment before mobility before stability[/quote] [/box]

 

Perform Scapular Exercises Bilaterally

Ah, the old YTWL exercises.  I’ve discussed why I really don’t do a lot of the classic YTWL exercises either prone off the table or on a physioball.  I don’t love the upper trap activity needed to stabilize the head and just don’t feel like you get the proper movement pattern you are looking to achieve.  Perhaps it helps with posture.  I am sure there are pros and cons.

However, and probably more importantly, we don’t really tend to perform movement patterns that invovlve moving your arms like in this fashion.  When was the last time you retracted both arms such as during the T exercise?

If I am looking to strengthen a muscle, I am going to stick to my unilateral prone exercises and focus on strength and motor control.  That is my priority.

Then, when function and movement patterns becomes my next priority, I wonder if it is best to work on reciprocal scapular activities anyway?  Far more often we uses our arms in this fashion – one arms pulls while one arm pushes.  This can be seen in some of our most common activities like walking, jogging, and running as well as unilateral overhead sports like tennis, volleyball, softball, and baseball.  Here is a great example from Northeastern University:

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Are there times when you should work your scapulas bilaterally?  Sure.  Just off the top of my mind I would do this in swimmers (expecially for the breast and butterfly strokes) and people that have to push and pull large objects at work all day.  It goes back to specificity of training.

The take home message is that you don’t have to work your scapulas bilaterally, and there is some very clear reasons why you would actually want to do the opposite and work the reciprocal push-pull pattern instead.

 

I hope this at least stirred some thought and discussion.  There is a time and place for everything, however sometimes there seems to be an overwhelming approach in one direction.  Maybe these 3 myths of scapula exercises will make you stop and think next time your are working on improving scapular strength, what do you think?

 

 

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The One Thing We Need to Do With Everyone

I am often asked by students or people attending one of my seminars, “what is the one thing you do that you find works the best.”  What a loaded question!  I wish it were that simple that I could teach everyone just one magic technique.  I have been reflecting on this question for several months, planning on writing a post to provide an answer.  I took me sometime to figure out how I wanted to answer the question, but I think I might have an answer

 

The One Things I Do That Works the Best

The one thing that I would say that I do that works “the best” is probably something we should all be doing with everyone.  It’s not a stretch, it’s not an exercise, it’s not the latest fad in equipment, and it’s not the lastest manual technique.  It’s actually so simple, that it took me awhile to figure it out.  It is assessing and Reassessing.

A proper assessment and reassessement is by far the best thing we can do for every patient and client we encounter.  This is really the key to understanding each individual, what they need, and what works for them.   Everything should start with a proper assessment and then after treament or training, reassess!  Do it every time you work with that person and even multiple times a session.

[quote]Ask them, “what is your primary complaint?”  Assess it.  Quantify it.  Treat it.  Reassess it.[/quote]

This simple concept can have many meanings.  At the simplest level, imagine if you were working with a weight loss client and didn’t assess their body weight.  How would you know what was or wasn’t working?  How would you know how much improvement that client has made?

For the clinician, we have many evaluation and assessment tools – range of motion, joint mobility, strength, flexibility, and many many more.  But these measurements are irrelevant to the patient.  They don’t really care if they gained 10 degrees of motion.  They simply want to feel better and move better.

OK, your shoulder hurts.  When does it hurt?  What can you do to recreate that pain?  Great – you just established a baseline that you can reassess.  Don’t get me wrong, you still want to take objective measure, but you now have a real life baseline assessment that the patient can feel.

This is why tools like the FMS and SFMA are valuable – systematic methods of assessing movement.  This is especially true in the fitness fields, where assessments are even more limited.  Quantify the quality and feel of movement to assess changes.

FMS

Ultimately, this is going to always lead to better outcomes – instead of just applying treatment or exercise and hoping it works, assess what really works and adjust as needed.

 

Assess and Reassess

How do you apply this?  The wrong way would be to just start working on someone that complains “my back hurts.”  “Well, hop up and let’s start throwing some massage techniques and exercises at it.”  In this example, there was no assessment, just treatment, so what do you reassess?  Pain?  That is not always the best assessment.

Maybe a better way would be to assess when and how the back hurts.  What movements bother you?  What can’t you do?  Now, provide care to that person and reassess what you just observed.  Simple, yet a powerful message when a person stands up and says, “wow, I can now touch my toes, that really worked!”

Here is an example of a recent patient I evaluated with complaints of left sided diffuse mid thoracic and rib pain.  I provided a comprehensive evaluation, but I will just cut to the chase and outline the important details.  His primary complaint was pain.  I could of just started trying to treat the area to reduce sympotms and essentially “chase the pain.”  However,  my primary focus was on his limited multisegmental rotation to the left.

Multisegmental rotation doesn’t tell us enough, so I dug deeper.  He had a moderate loss of thoracic rotation to the left.  I could of stopped here as the location of his symptoms were in this area, but I again dug deeper.  I was fine with his hip mobility.  However, I found that his pelvis was shifted with a left anterior tilt, causing his entire pelvis and SI joint to rotate to the right.  Subsequently, his lumbar spine was orientated slightly to the right, meaning his “neutral” was actually rotated to the right slightly, causing what looked like limited rotation to the left.

Thoracic Spine Mobility ExercisesWith my assessment in hand, I went to work.  First, I wanted to start at the thoracic spine to see what the precentage of invovlement may have been.  I worked on soft tissue, joint mobility, and few thoracic mobilization corrective exercises.  Reassessment at this point showed a fairly large improvement of thoracic rotation to the left.  I could of again stopped here, but I also wanted to check multisegmental rotation to the left, which only showed approzimately a 50% improvement in rotation to the left.

If I just stopped here, I would have restored half of his dysfunction, and I bet he would have slipped right back to where he started.

I next went to the pelvis and with a few exercises and manual techniques improved his pelvic alignment.  Reassessment of thoracic rotation and multisegmental rotation showed normal symmetrical movement, and naturally a reduction in his complaints of pain.

That is the power of assessing and reassessing.  Not just once, but multiple times in one session so that I can narrow down the effectiveness of each technique as best as possible.

 

The Power of Reassessment

That was a pretty good example of how I really narrowed down and enhanced by treatments by assessing and reassessing.  To summarize some of the key points:

  • Helps you individualize and find what works.  This is the no-brainer concept, to see if there was an immediate improvement that can be directly correlated to what you just did to the person.
  • Helps you find out what doesn’t work!  Don’t underestimate this one.  By properly assessing and reassessing you also find out what doesn’t work, which is just as valuable so you can shift gears and try another approach.
  • This is also diagnostic.  By assessing what does and doesn’t work you may also narrow down the exact dysfunction.  Perhaps their limited thoracic rotation is related to soft tissue changes rather than joint mobility.
  • Helps buy in.  Lastly, but probably most importantly, assessing and reassessing helps build buy in, confidence, and compliance from the person.  They will see immediate benefit in what you do.

 

That is probably what I would consider the one thing that we all need to do with every patient or client we see – assess and reassess, what do you think?

 

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Simple Thoracic Spine Mobility Exercises Everyone Can Perform

Thoracic spine mobility is an extremely important, and often times overlooked, component to a variety of dysfunctions.  Poor thoracic mobility can affect the shoulder, neck, low back, and hip very easily.  Unfortunately, our daily habits and posture make us all very prone to poor thoracic spine mobility.

I have talked about this before when discussing my reverse posturing theory and when discussing what may be the best posture stretch that I know.  A key component to reverse posturing is working on thoracic spine mobility.

There are many variations of thoracic spine mobility exercises and drills out there on the internet.  Many of them are great, but not for everyone.  Here is a collection of thoracic spine mobility exercises that you can try with your patients and clients.  These are all great example, but at the end I will discuss my preferred technique and a simple thoracic spine mobility exercises that is easy for everyone to perform.  I think it is a great place to start when trying to enhance thoracic spine mobility.

Regardless of which thoracic mobility exercise you chose, there is one major goal that MUST be achieved during all of the different mobility drills:

[box type=”info” size=”large”]Mobility must come from the thoracic spine and NOT the lumbar spine[/box]

This is critical and the easiest way to turn a nice corrective exercise for the thoracic spine into a mobility drill for the lumbar spine that feeds into the person’s deficiencies.

 

Thoracic Spine Mobility Exercises for Extension

We should start with thoracic spine mobility exercises that work on increasing thoracic spine extension.  Here are a couple of nice examples.

 

Thoracic Spine Mobility Exercise for Extension Using Tennis Balls

Here is a nice example of a simple extension mobilization for the thoracic spine.  In this video, Michael Boyle shows us how he uses two tennis balls to act as a pivot to thoracic extension:

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Nice simple exercise that works on addressing the lack of thoracic spine exercise.  The tennis balls are positioned at various spine segments. A good place to start for many people.

 

Thoracic Spine Mobility Exercise for Extension Against a Wall

Another nice drill that emphasizes thoracic extension can be performed against a wall.  Bill Hartman demonstrates this well:

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This is another great option for many people, though may be challenging for someone with tight lats, shoulder issues, or really large restrictions in thoracic mobility.

 

Thoracic Spine Mobility Exercises for Rotation

After we work on thoracic spine extension, we can also focus on thoracic spine rotation mobility.  Here are a couple of examples of good thoracic spine mobility exercises to enhance rotation.

 

Thoracic Spine Mobility Exercises for Rotation in the Seated Position

A simple thoracic mobility drill for rotation can be performed in the seated position.  Here is a nice demonstration by Jeff Cubos:

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As you can see, the person is squeezing something between her knees in the seated position.  This is intended to help engage the core and limit the amount of lumbar stability.  This seems really simple but the majority of people with poor thoracic mobility will perform this poorly and rotate from the lumbar spine.  This one really needs to be coached and cued well to assure that technique is perfect, otherwise you will be working the wrong area!  You can see that she does a good job rotating at the thoracic spine with just a small movement, but as we all know, more is usually better in many people’s minds.  Be careful that they don’t go home and just torque their lumbar spine.

Here is another seated drill by Michael Boyle that incorporates rotation and extension:

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Thoracic Spine Mobility Exercises for Rotation in the Quadruped Position

A very common and popular thoracic spine mobility drill right now on the internet is in the quadruped position.  The quadruped position is used to put the hips in a degree if flexion to minimize the amount of lumbar spine movement.  Here is a great example from Eric Cressey:

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Eric does a good job showing his technique.  Lucky for us as the viewer you can see that Eric has some mobility issues that he is working on.  This is a good exercise but challenging for some people to get into the position due to lack of hip flexion mobility.  Realistically the quadruped position is unachievable by some people.  As you can see in Eric’s video, his hip flexion mobility isn’t great, so his hip flexion angle is not as much as it could be and subsequently he can get too much lumbar spine rotation.  This is a great exercise and Eric demonstrates it well.  This can be used in more advanced situations with people that have proper hip mobility and no concerns in the quadruped position.

 

A Simple Program to Work on Both Thoracic Spine Extension and Rotation

 My preferred technique for thoracic spine mobility exercises is actually pretty simple.  I use a foam roll to quickly combine three different drills into one quick program that is in an easily achievable position for many people:

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First, I start off with simple foam rolling of the thoracic spine.  I like to start with foam rolling to loosen up the soft tissue of the thoracic spine and reduce and potential spasm or muscle tightness that might limit my joint mobility.  My hands are positioned across my chest to protract and clear my scapulas to allow access to my paraspinals.  This video is a quick demonstration but I take my time with this and usually roll back and forth for about a minute, spending time on whatever area feels the tightest that day.

Next, I will work on extension mobility.  When the thoracic spine is in a flexed position, it is going to be very difficult to achieve rotation, so I want to work on extension first so that my upcoming rotational drills are more effective.  In the video, I demonstrate a technique very similar to Michael Boyle above.  I roll up and down the thoracic spine and try to stop at each vertebral segment and perform a few extension mobilizations.  The foam roll acts as a fulcrum, my lower half (lumbar spine) is stable, and my upper half pivots at the foam roll.  This applies a very specific thoracic spine mobilization that you can focus on individual spine levels.  I will roll up and down about an inch at a time and then work on extension.  Again, the video is a quick demonstration, I will do about 10 extension movements at each segment, but will focus on specific levels as needed.

Lastly, now that we have loosened up the muscles and increased thoracic spine extension, we can work towards increasing rotation.  I again just simply use a foam roll in the same position on the ground.  This allows for a quick progression of drills that you can bang out in sequence with ease.  Similar to the extension mobility drill, I use the foam roll as a fulcrum.  Again, my lower half is stable and my upper half pivots into thoracic rotation at the point of contact of the foam roll, allowing for a specific mobilization at the level of your choice.  I prefer to extend my hands up in front of my face.  I feel that this helps my visualize the amount of rotation achieved.  I instruct people to just rotate your hands one hour on the clock to help them visualize the small amount of movement.  Otherwise, if you are rotating more than that, you are compensating somewhere, likely with lumbar rotation below the fulcrum of the foam roll.  As your mobility improves you can try to focus on rotating and adding a small extension component, similar to Michael Boyle’s drill above.

This series of thoracic spine mobility exercises are usually where I begin with people.  As mobility increases, I use many of the other exercises demonstrated above based on the person’s individual deficits and goals.  There are a lot of options when performing thoracic spine mobility exercises, what else have you found to be effective?

 

 

Thoracolumbar Fascia – An Area Rich with Activity

Today’s guest post is about the thoracolumbar fascia from Patrick Ward.  I have been reading Patrick’s website for a while now and have always been impressed his content, but he also has the ability to write and communicate in a fashion that fosters thought and learning.  I have been talking with him for months about sending me a guest post, so I am happy to finally have one, thanks Patrick!

Thoracolumbar fascia: An area rich with activity 

The thoracolumbar fascia can be thought of as a transitional area between the lower extremity and the upper extremity where forces are transferred in athletic and sporting movement.  For this reason, the thoracolumbar fascia plays an integral role in the movement system of the body as it connects many joint systems – hips, pelvis, lumbar spine, and thoracic spine.   Also, considering that the latissimus dorsi has attachments onto the thoracolumbar fascia and inserts onto the lesser tubercle of the humerus, the glenohumeral joint can also be thought of as ‘connected’ with the thoracolumbar fascia.  Additionally, the cervical fascia and the thoracolumbar fascia are continuous, so this fascial structures effect can be seen into the cervical and potentially even the cranial regions.

For this reason, the thoracolumbar fascia can be an important area for treatment both in instances of injury/pathology or when developing a recovery/regeneration treatment protocol for certain athletes.

 

Three layers of Thoracolumbar Fascia

Thoracolumbar FasciaThe thoracolumbar fascia can be thought of as having three layers which help to separate the muscles in this region into compartments:

  • Anterior layer – Attaching to the anterior aspect of the lumbar transverse processes and the anterior surface of the quadratus lumborum.
  • Middle layer – Attaching to the medial tip of the transverse processes and giving rise to the transverse abdominus
  • Posterior layer – Covering all of the muscles from the lumbosacral region through the thoracic region as far up as the splenii attachments.  Additionally, this posterior layer attaches to both the erector spinae and gluteus maximus aponeurosis.  It is in this posterior layer that the gluteus maximus and contralateral latissimus dorsi attach with each other and coordinate together to allow for pendulum like movements between the upper and lower extremity that make walking and running possible.

 

Together, the muscles that connect into the three layers of the thoracolumbar fascia help to provide both a stabilizing and biomechanical role for the body.  Additionally, the vast amount of mechanoreceptors in this region hint to the importance of the thoracolumbar fascia’s sensory role, making it a potentially rich target for hands on therapy.

Photo from Wikipedia

 

A Stabilizing Role 

The transverse abdominus, internal oblique, and quadratus lumborum all invest themselves into portions of the thoracolumbar fascia.  According to Neumann (2010), the transverse abdominus provides anticipatory/feed-forward stabilization of the lumbo-pelvic region via a tensioning of the thoracolumbar fascia and an increase in intrabdominal pressure.  The connection that the thoracolumbar fascia has with the posterior ligaments of the lumbar spine allows it to assist in supporting the vertebral column when it is flexed by developing fascial tension that helps control the abdominal wall (Gracovetsky, 1981) and it may also provide some sensory function to the body aid in both postural and protective reflex activity (Yahia, et al., 1992).

The biomechanical role of the thoracolumbar fascia is generally understood by individuals in the strength and conditioning and rehabilitation professions.  Exercise programs or “core training” programs are typically designed to elicit some sort of stabilization activity to the muscles in this region.  However, insight into the myofibroblasts and mechanoreceptors of the thoracolumbar fascia may require us to look a bit deeper if we wish to make larger changes to the function of the human body.

 

Myofibroblasts

Myofibroblasts are cells that have a sort of dual function, being part fibroblast and part smooth muscle.  It is because of these smooth muscle properties that the myofibroblasts can contract on their own – like other smooth muscles cells – placing them under the control of the autonomic nervous system and allowing the autonomic nervous system to potentially regulate fascial pre-tension independently of muscular tone.  Thus, the fascial system is an adapting organ which almost has a “life of its own.” 

Schleip and colleagues (2006) showed that the lumbar fascia, via its myofibroblasts, has the ability to contract in situations of either chronic tissue contractures, such as tissue remodeling, or during more smooth muscle-like contractions, which may help to influence low-back stability.  Furthermore, Yahia et al. (1993) showed that the thoracolumbar fascia had the ability to spontaneously contract when the tissue was stretched and held at a constant length repeatedly, causing the fascia to slowly begin to increase resistance.  This information could be potentially beneficial in understanding pathologies where increased myofascial stiffness is present.  However, influencing the system to make a change in this stiffness is a more difficult question.

 

Does it Come Back to Breathing?

Given the smooth muscle properties and the control that the autonomic nervous system may have over the fascial network, perhaps a potential window into effectively dealing with increased myofascial tone can circle around to breathing.

Respiratory function is on aspect of the autonomic nervous system that we actually have direct control over.  We can change our breathing and help to elicit a parasympathetic response to allow for greater relaxation and potentially less overall tissue tone/tension, hopefully leading to more of a comfortable state of being a decreased threat perception.  Additionally, the role of the diaphragm in stabilizing the lumbar region cannot be overlooked and the fact that it shares a fascial connection with the quadratus lumborum (as well as the psoas major) and the transverse abdominus fibers invest themselves into part of the diaphragm means that the diaphragm is in a potentially prime position to have an influence over the thoracolumbar fascia, since both of these muscles invest into layers of that fascial structure.

 

Manual Therapy of the Thoracolumbar Fascia

The thoracolumbar fascia is richly innervated with mechanoreceptors providing it with a strong sensory role and making it a target for manual therapy.

There are many ways to address the body with manual/touch therapy.  The idea of treating “fascia” has been a hot topic as of late and oftentimes therapists are doing similar things however explaining them in different ways, leading to large semantics debates.  With regard to treating fascia I believe that it is important to not leave out the nervous system, as the goal of any manual hands on treatment is to somehow effect the brain to create an environment that is ripe for healing – one which decreases overall threat perception, decreases fear avoidance, and opens a window for the individual to perform some sort of non-painful movement that increases confidence, and create relaxation (again, helping to achieve a parasympathetic response).

Several types of receptors have been found in connective tissue (not just the thoracolumbar fascia) such as pacini and paciniform corpuscles, ruffini organs, interstitial receptors, and golgi receptors.  Different receptors are responsive to different sorts of techniques and forms of therapy.  For example, pacini receptors are responsive to pressure changes and vibrations, while ruffini receptors are responsive to sustained pressure and tangential forces such as a lateral stretch.

 

Practical Applications

The thoracolumbar fascia plays an important role in human movement as it not only serves as an attachment site for numerous muscles in the lumbar, thoracic, and sacral regions, but also is an important area of transition between the upper and lower extremities where forces are transferred to allow for coordinated function.

Understanding the implications that the thoracolumbar fascia has over the body will help therapists to develop both exercise programs and manual therapy/hands on treatment programs for either rehabilitation or recovery (to help increase relaxation in this area between competitions and prevent overuse or excessive strain which is common in sport).

The smooth muscle properties of the thoracolumbar fascia (and all fascia of the body) indicate a potential role of the autonomic nervous system in regulating fascial tone.  For this reason, understanding the individual athlete and levels of stress as well as their individual stress resistance can be helpful in managing overall fascial tension.  The pH of the body plays an important role in fascial tension, as greater levels of alkalinity create vasoconstriction and increased muscle tone.  The pH of the body can be influenced by increased levels of threat and changes in breathing, which cause alterations in expired CO2.  Thus, breathing, relaxation, and/or meditation, may be potential ways in which the fascial system can be influenced in a training or therapy session.  Managing stress using a variety of recovery modalities in between competitions can be help to keep athletes healthy and performing well.

Finally, the high number of mechanoreceptors found in the thoracolumbar fascia (and in all fascia) indicate that the fascial system provides an important sensory role for the body.  Various manual/hands on therapies can be utilized to influence the sensory system (and the brain) to help decrease tone/tension, improve proprioception and awareness to the area being treated, decrease threat perception, increase relaxation, and provide a window into the parasympathetic nervous system which can potentially create an optimal environment for healing.

Taking all of this into consideration, when assessing an athlete it is important to look at the entire body and keep in mind that the thoracolumbar fascia shares a connection with many structures and its influence can be seen as far up as the cervical region and into the extremities.  With that in mind the thoracolumbar fascia may be a potential area for therapy when attempting to influence other parts of the body.

 

About the Author

Patrick WardPatrick Ward, MS, CSCS, LMT is a certified strength and conditioning specialist and licensed massage therapist.  He owns Optimum Sports Performance (www.optimumsportsperformance.com), a sports conditioning and soft tissue therapy company which provides training, treatment, and consulting to professional, amateur, and high school athletes.  He writes excellent articles on his website OptimumSportsPerformance.com.

 

References

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  • Schleip R, Klinger W, Lehmann-Horn F. Fascia is able to contract in a smooth muscle-like manner and therby influence musculoskeletal mechanics. Proceedings of the 5th World Congress of Biomechanics, Munich, Germany. 2006. 51-54.
  • Hammer WI. Functional Soft-Tissue Examination and Treatment by Manual Methods. Jones and Bartlett Publishers. Sudbury, MA.  2007.
  • Schleip R. Fascial Plasticity: A new neurobiological explanation part 1. Journal of Bodywork and Movement Therapies 2003; 7(1): 11-19.
  • Schleip R. Fascial Plasticity: A new neurobiological explanation part 2. Journal of Bodywork and Movement Therapies 2003; 7(2): 104-116.
  • Yahia L, et al. Sensory  innervation of human thoracolumbar fascia: An immunohistochemical study. Acta Orthop Scand 1992; 63(2): 195-197.
  • Hoheisel U, et al. Nociceptive input from the rat thoracolumbar fascia to lumbar dorsal horn neurones. Euro J Pain 2011; 15: 810-815.