Within my athletic performance practice, the framework and methodology of Dynamic Neuromuscular Assessment™ has become key in assessing my clients and leading them back to their desired performance levels.
DNA™ integrates with multiple treatment modalities including PDTR, NKT, NMR, etc. – which combine with soft tissue and movement practices to help restore client’s health, movement, and performance. The development of DNA™ has provided the framework and tools to find often hidden dysfunctions and causes of pain, even when the cause might be tied to old traumas. – Mark Kendall
Who would benefit from taking the DNA™ seminar?
Any professional who includes manual muscle testing in their therapeutic practice.
How is this seminar different than other modalities being offered?
DNA™ is the only manual muscle testing workshop that teaches a format I call Hybrid Movement Assessment. Hybrid Movement Assessment is the overarching skill you will learn in Dynamic Neuromuscular Assessment (DNA™). This Essential Skill informs the other four (The Five Essential Skills).
By learning to seamlessly transition between direct muscle testing strategies and indirect muscle testing, you will increase your ability to make change in the nervous system of your clients. You will find that in DNA we redefine manual muscle testing by changing the paradigm of testing muscles to assessing the response to movement. We will be asking ourselves, “Can the nervous system and the structure appropriately respond to the movement environment?”
Hybrid Movement Assessment strategies are essential for evaluating the players in respiration. For example, the Intrinsic Kinetic Chain has many players that cannot be evaluated with direct muscle testing strategies.
Hybrid movement assessment is exceptionally powerful because it is not testing muscles. Instead, it is about having a kinesthetic conversation and asking a foundational question whether the nervous system/structure can respond appropriately to movement stimulus.
DNA™ is a distillation of my 25 years’ experience using manual muscle testing as a diagnostic strategy. I developed this hybrid movement assessment nearly 20 years ago in my search to a short cut to find the quickest way possible to get the most results. I had many insights along the way that form the basis of DNA.
Insight highlights from 25 years of practice:
The bodies intelligence already contains the answers to what the body needs to be healthy, whole, and complete. It then becomes a communication strategy to ask the body the right question.
The body doesn’t know individual muscles; the body only knows functional movement to accomplish the movement goal at hand. The body’s solution for accomplishing the movement goal is based on what functional components are available to assemble into the global movement.
Concentric muscle testing is taking a mere snap shot of movement.
Eccentric muscle testing is a loading/cueing of the whole movie.
Eccentric movement assessment can only be fully evaluated with hybrid movement assessment.
The SAID principle, specific adaptation to imposed demand, is one of the most important principles to consider when employing corrective strategies.
What can I expect to learn during the DNA™ Seminar?
In addition to hybrid muscle testing, you’ll also learn an integration of The Five Essential Skills that will have a quantum effect on the outcome of your work with clients. You will learn nuances in manual muscle testing that will refine your assessment skills.
Dynamic Neuromuscular Assessment™ is informed by The Five Principal Actions. The Five Principal Actions have two primary attributes. One, developing the dynamic platform. And two, the storing & releasing elastic energy. Three elements are necessary to complete the dynamic platform: integration of the breathing apparatus, the ability to respond appropriately to gravity, and converting the absorption of load into ground force reaction. When the structure can respond appropriately to breath, shock absorption, and ground force reaction, then the generation of stored elastic energy and the translation of that stored elastic energy can be expressed optimally.
Is there support materials being provided for the workshop?
Absolutely! You will receive a printed DNA™ manual chocked full of information. You will also receive access to a private discussion group on Facebook for therapists employing the DNA™ modality in their practice. I am always happy to meet one-on-one to answer questions as well.
Do you have more questions?
DNA Seminar: Live Q&A next Wednesday, September 13th, 2017, 10am MT
Dynamic Neuromuscular AssessmentTM seminars take the skills you already possess and puts them into a context that will make those skills more effective.
When you employ what Joseph calls The Five Essential Skills with the corrective strategies you already use, the results of your work will have a quantum effect with your clients.
Essential Skill #1 – Hybrid Movement Assessment:
Learn to seamlessly transition between direct muscle testing strategies and indirect muscle testing – Manual Muscle Testing redefined
We will change the paradigm of testing muscles by assessing the response to movement. Can the nervous system and structure appropriately respond to the movement environment?
The Intrinsic Kinetic Chain has many players that cannot be evaluated with direct muscle testing strategies. Hybrid Movement Assessment strategies are essential for evaluating the players in respiration – a key element in assessing clients.
Essential Skill #2 – Completing the Feed-back Loop:
Afferent sensory neurons relay information about how movement is responding to the movement environment: this is feed-back motor control
Efferent motor neurons are the motor instructions to the periphery: this is feed-forward motor control
Using both feed-back and feed-forward movement completes the proprioceptive feed-back loop
Compensation is learned through the feed-back loop. Adaptation is need and response, two sides of the movement equation. Motor learning requires the integration of both feed-back and feed-forward communication to and from the brain. Feed-forward motor instructions allow the motor control center of the brain to capitalize on compensation patterns. DNA’s movement assessment strategies uncover hidden compensation.
Essential Skill #3 – The Functional Compass:
The functional compass provides a map for movement potential
Movement happens through non-linear spirals
Joints act in compression and distraction
Joint assessment using the functional compass evaluates the spectrum of movement potential
Shock Absorption of the Deep Longitudinal Kinetic Chain is interdependent with the ability of the joint capsule to translate compression to distraction over its range of motion. When the joint loses its ability to respond appropriately, compensation will show up as a symptom in ligaments, tendons, muscle and fascia. DNA’s joint by joint assessment strategies give laser focus attention on the root cause rather than the symptom.
This is analogous to non-painful dysfunctional movement
Movement functions can appear to be available with direct testing strategies
Hybrid Movement Assessment uncovers hidden layers of compensation
Movement functions can appear to be available with direct testing strategies. Challenging those movements with Hybrid Movement Assessment will uncover hidden layers of compensation: “just because you can doesn’t mean you should.”
Often, our clients are reinforcing compensation through their daily movement. DNA’s assessment strategies identify these patterns so they may be appropriately addressed.
Essential Skill #5 – Eccentric Movement Assessment:
Direct Concentric muscle testing is a mere snapshot of movement
Eccentric Movement Assessment challenges movement over a range rather than a snapshot
Eccentric Movement Assessment incorporates the SAID principle into assessment strategies
The rules of the SAID principle states that adaptation is specific to demand. If the motor program is not cued into the corrective strategy, it may not respond to the correction. Eccentric Movement Assessment cues the motor control center to a larger context of information. This brings up compensatory patterns that would not be revealed in standard concentric testing strategies.
DNA’s assessment strategies are unique as they incorporate both sides of the movement equation. Concentric activation must be balanced with Eccentric stabilization. This skill set can be explored through the core subsystems of The 5 Primary Kinetic Chains.
Muscles produce work in the body. They come in two distinct types, smooth and striated. Smooth muscles are governed by the autonomic nervous system. Their function is automatic. Smooth muscles perform the regulatory functions. The tissues that make up organs, the GI tract, and arteries utilize smooth muscles to perform their unique functions. Conversely, striated muscles are governed by the rules of conscious motor control. Striated muscles are often referred to as skeletal muscles. Their job is to act on the skeleton for posture and movement.
Skeletal muscles have a spectrum of roles. Highlights include: work production, multiple joint stabilization, and position sense. Muscles need to be available to do their job in the movement equation. If they can’t participate appropriately, the brain will come up with a coping strategy. This is a survival-based mechanism, and this is what we call compensation. Compensation has many flavors, and despite a bad rap, it is the intelligence of the body doing its best to keep you safe.
Muscles come in many configurations. Generally, the large powerhouse muscles are more superficial, while the intrinsic stabilizers are deeper. Some muscles are specific in fibril orientation and function while others are available for multiple roles. For example, the large powerhouse muscles of the posterior chain, the latissimus dorsi and gluteus maximus, have multiple fibril orientations that look like a fan. This gives these muscles mechanical advantage over the range-of-motion spectrum.
For simplicity, let’s categorize muscles into two sets: short and long-lever. Short-lever muscles are the dependable hardworking muscles. They have mechanical advantage on the joint. The brain likes to use them as the go-to muscle during work production. Long-lever muscles cross multiple joints and have multiple attachments. Long-lever muscles are best suited for stabilization during work production. Their role is key when movement deviates and unknown variables occur in the environment.
Compensation patterns have a common trait among short and long-lever muscles: short-lever muscles are the heroes. They come to rescue when the long-lever muscles are not responding appropriately in the movement environment.
Short-Lever Muscles:
– cross one joint
– mechanical advantage
– commonly up-regulated
Long-Lever Muscles:
– cross multiple joints
– stabilizer during work production
– commonly down-regulated
Common Relationships:
Short-Lever ~ Long-Lever
Tibia Rotation
popliteus ~ bíceps femoris
Knee Flexion
bíceps femoris short head ~ biceps femoris long head
Hip Flexion
iliacus ~ psoas
Spinal Extension
multifidus ~ erector spinea
Shoulder Abduction
subclavius ~ pectoralis major
Elbow Flexion
brachialis ~ biceps brachii
These examples are samples of utilizing short-lever ~ long-lever muscle relationships to assess movement compensation patterns. The kinetic chain charts in The 5 Primary Kinetic Chains provide a map for investigating synergistic dominance, regional interdependence, and functional opposite musculoskeletal relationships. Muscles are in constant response to joint position in the movement environment. Can the muscles in conjunction with motor control instructions respond appropriately to the environment?
My upcoming Dynamic Neuromuscular Assessment™ workshops (learn more here) will provide an integrated strategy for movement assessment in a changing environment. Some of the key skill-sets we will employ:
utilizing a hybrid that combines direct assessment with indicator testing to uncover functional dysfunctional movement
utilizing feed-forward motor control to assess structure that cannot be directly tested
completing the proprioceptive feedback loop to assess both motor instructions and structural response
investigating long series kinetic chains because muscles do not work in isolation, they work in synergistic sequences during movement
investigating dynamic stability as a two-part equation: concentric action balanced by eccentric action — eccentric movement evaluation uncovers hidden layers of compensation
There seems to be lot of “dysfunctional psoas causing back pain” articles. I’d like to offer another viewpoint.
Say a person does have an inhibition in their psoas. What effects would that have on posture?
The short answer is: a general facilitation along the anterior kinetic chain. The body doesn’t like to be in a position it cannot stabilize. If it is weak in an action such as flexion, the body will move more into flexion, which gives the illusion of being in a safe position.
This position then affects the ability of the hamstring to act on the ischial tuberosity. How do you think the lumbar is going to respond when it does not have the reciprocal muscles balancing extension?
The next question that we should be asking is why is the psoas inhibited in the first place? Is that the causation or a symptom of something else?
Lots of questions, and each person has their unique answer.
Looking deeper into causation instead of chasing symptoms is a good practice.
Don’t just treat what you find, look deeper. Peel away the layers.
Ask for next level factors. It could be structural. It could be physiological. It could be emotional/cognitive. There are environmental factors as well as habitual influences that could be in play. How we work and how we move are all considerations as well.
We are complex human beings, not just muscles and a nervous system.
The psoas is involved in posture, stability, and breath. Read more about the “Mighty Psoas” here.
The limbic system is the master regulatory system of the body. Information is gathered from both the outer environment and the inner environment. That information, or inputs, are then collated and prioritized so that the process of homeostasis occurs on structural, physiological, and emotional levels.
The sensory apparatus of the body is under a constant input from the outer and inner environment. We are familiar with the five traditional senses: sight, sound, smell, taste,and touch. There are also an array of non-traditional senses. Our kinesthetic sense is one of these. Our balance sense, relationship to gravity, and proprioception are components of our kinesthetic sense.
There is an array of sensory inputs to which we are registering and responding. They can be categorized as tangible and non-tangible. The tangible senses would be our response to the five traditional senses and the kinesthetic senses. What about electromagnetic fields, barometric pressure, spectrums of light, wave lengths of sound, or cosmic energy? These are measurable influences even if we cannot consciously quantify them in our experience. Our subconscious mind is sure to have the capacity to respond to these inputs. Many people are sensitive to these influences. I get headaches when I travel next to big overhead wires and I can sense the weather changing in my joints a week before the event occurs. When I wear special colored glasses my brain function integration improves, and so forth. These are just a few examples of tangible sensory inputs. There is a vast array of non-tangible as well.
If we look at the image of the iceberg, about 25% is above water and 75% is below. The 25% is the tangible realm, that which we can quantifiably create context. The other 75% is where it gets really interesting. This is the mystery. This is the realm to which some people have access. This information is often regarded as psychic senses or the paranormal; for most of us, it is our intuition. These inputs are unknowingly affecting us 24/7.
It is in the non-tangible that limbic resonance resides. Empathy comes to mind as I think of a non-tangible. There is a connection to the earth, the plant and mineral kingdom, another living being, a fellow human being, and so forth. Resonance is vibration. The harmonics are able to mesh and respond to each other. How many times have we heard “I had chemistry with that person.” This is limbic resonance.
In the therapeutic context, it’s a matching of vibration. The intention of the practitioner is clear, connected, and confident while remaining neutral, receptive, and present. It is a wonderful example of mindfulness. When we have limbic resonance with our clients, vistas of new possibilities can present themselves. We are out of the technical application of our craft and engaged in the inquisitive creative side of our consciousness. This does not take away from technical capacity. Limbic resonance is complementary.
We now have homework cards that complement The 5 Primary Kinetic Chain Posters. Each set has 5 cards – one corresponding card per each of the 5 kinetic chains.
The homework cards allow the practitioner to give specific homework based on their clients’ presentation. They serve as a reminder for the client to stay on track between sessions. They also provide a template for greater client education and understanding by emphasizing both manual release and integration exercises that work in tandem for success in recovery.
The cards are easy to use. The kinetic chain illustration is on the front of the card and there are four entries on the back of the card.
Down-Regulated (Underworked):
These are the player/s not engaged. This is the part of the movement equation that needs to get back in the game of keeping the structure safe.
Up-Regulated (Overworked):
These are the player/s that are overworked by trying to do the job for the down-regulated player/s. Often, these up-regulated player/s create secondary down system effects. Good detective work discovers the primary relationship between the up and down regulated players so that the application of the release and integration is effective at restoring balance back to the structure.
Manual Release:
This is the first step in repatterning. The release of the fixated segment or inappropriate tension allows for a new pattern to be learned. There are many appropriate interventions, as well there are ways of asking the body what it needs. This is up to the practitioner and their toolbox.
Movement Integration:
There is a window of opportunity for the nervous system to learn a new pattern, and to get the player/s that have been disengaged back in the game. The manual release acts as a hack. By temporarily removing the option for compensation, the nervous system must learn a new coping strategy. Activating the down-regulated player/s give the structure the support it needs to recover balanced action.
Note:
The order of cuing the motor control center is important so that effective change and reinforcement of the pattern becomes a learned behavior. If the compensated player is not temporarily taken out of the movement equation, then subsequent movement work often will reinforce a maladaptive pattern. The idea is to displace a maladaptive pattern with a more bio-mechanically efficient pattern. Displacing maladaptive compensation with appropriate movement integration keeps the container of coping mechanisms safe.
To summarize, the homework cards are the place where you:
Identify the underworked player/s ~
Identify the overworked player/s ~
Temporarily remove the overworked player from the movement equation ~
Integrate the underworked player back into the movement equation ~
Please note this particular series of blogs will describe each of the four muscles and their relationship to the five principal actions described in the charts of The 5 Primary Kinetic Chain Poster Set I’ve developed. This is Part Two of four. You can find Part One on the Piriformis here.
Introduction:
The sacrum, or sacred bone, is unique in the body. Mystics regard the sacrum as the focal point for kundalini, the spiraling energy that rises from the root through the crown. This triangular shaped bone provides the base of support for the spinal column.
The sacrum articulates with the pelvis through the sacral iliac joint, SIJ. The kinetic energy of ground force reaction moves from the feet engaging the earth, up through the legs, into the pelvis. The energy crosses through the pelvis into the sacrum and up through the axis of the spine. The manner by which this energy moves into and through the axis of the spine defines our ability to respond to ground force reaction.
There are four important muscles that act directly on the sacrum.
Posterior Surface:
multifidus/sacrospinalis
gluteus maximus
These four high level muscles often are not engaged with their task of stabilizing the sacrum through a spectrum of movement. When we look at the function of these four muscles, and the various movement they are involved in, there is a trend we see in most people’s presentation that are seeking therapeutic intervention.
The anterior surface muscles are often up-regulated. These muscles are over worked and do not respond appropriately. One of the flavors of synergistic dominance is when one group of fibers becomes up-regulated, those dominant fibers then down-regulate the function of that muscle over its spectrum of movement.
The posterior surface muscles are often down-regulated and are not available to respond appropriately to movement.
The relationship of how these four muscles work together in coordination changes over the spectrum of movement. The 5 Primary Kinetic Chains have unique Principal Actions that inform the sequence of movement. This series of essays will describe each of the four muscles and their relationship to the five principal actions.
Ilacus:
The iliacus is a large primary muscle of the pelvis that attaches to the bowl of the pelvis, the iliac fossa. This muscle has a large surface area as it fans across the inner bowl of the pelvis. The multiple direction of these fibers give them advantage over a range of functions.
As the fibers of the iliacus come off the pelvic bowl, they knit together multiple structures of the pelvis. Fibers attach to the anterior sacral ligaments, the sacrum, the psoas, and the lessor trochantor of the femur.
Looking at the web of connective tissue between the iliacus, the psoas, the anterior sacral ligaments, and the direct attachment on the body of the sacrum, it becomes clear that the iliacus has a profound effect on the sacrum.
The fibers of the iliacus are joined by the fibers of the psoas. Together they create a common tendon attachment on the lesser trochanter. This makes the iliacus and the psoas an important synergistic pair, yet they have some different roles in movement.
The psoas is a multi-segmented muscle. The psoas crosses multiple joints of the lumbar spine. Muscles that cross multiple joints have an important role as a stabilizer during the work production phase of movement. The shorter fibered muscles that cross one joint are the hard working prime mover. The important distinction here is that the psoas is acting on the lumbar spine while the iliacus is acting on the pelvis. When these two muscles are not playing well as individuals, or as a synergistic pair, the result is a destabilized lumbar-pelvis.
The iliacus is considered one of the more common up-regulated muscles. The bracing, or shortening action of an up-regulated iliacus, affects the sacroiliac joint, SIJ.
As the iliacus acts on the ilium, the relationship of a neutral SIJ becomes altered. The movement of the sacrum is self-limiting by the SIJ, while the ilium has more freedom to move around the sacrum creating a mobile/stable relationship. Hip rotation, hip hiking, and hip flare are relationships to sagittal, coronal, and transverse plane movement. The iliacus is involved in these movements even if it isn’t the driver.
Concentric Actions of The Iliacus:
Sagittal ~ hip flexion, ilium rotation, & sacral flexion
Transverse ~ hip external rotation, ilium flare & sacral downward/upward rotation on an oblique axis
The Iliacus and The 5 Primary Kinetic Chains:
Intrinsic ~ Breath
The iliacus is considered an extrinsic muscle of the pelvic floor. When you consider movement of the ilium, sacrum, and hip, the pelvic floor is involved.
The following two scenarios are common presentations:
Spinal Wave:
The iliacus is a participant in the spinal wave during the breath cycle.
An up-regulated iliacus is the action of the exhalation phase thereby affecting the inhalation phase of the breath. This is a relationship of reciprocal inhibition.
Pelvic Floor:
The iliacus attaches on the bowl of the pelvis creating an extrinsic boundary. An up-regulated iliacus partners with the pelvic floor. During the inhalation phase of the breath, the pelvic floor’s action is eccentric lengthening. An up-regulated pelvic floor loses this ability.
Deep Longitudinal ~ Shock Absorption
An up-regulated iliacus interferes with the kinetic wave of shock absorption. The up-regulated iliacus is a bracing strategy for the SIJ. Compression in the SIJ functionally acts as an abutment to the kinetic wave of ground force reaction.
The body’s appropriate response to the kinetic wave of shock absorption is to counter with the push reflex. Imagine stepping off the curb. The hip must descend so that the foot can meet the ground. This is an eccentric action of the quadrates lumborum, the QL. An up-regulated iliacus down-regulates the push reflex.
Lateral ~ Axial Stability
The adductor magnus, a lateral kinetic chain subsystem muscle, needs to play well with the iliacus. The adductor magnus is a synergist with the adductor longus. The iliacus is synergist with the adductor longus.
During the transition phases of the gait, mid stance, late stance, propulsion, and shift, this synergistic pair action is eccentric lengthening. This lengthening is storing elastic energy that will be released in the swing phase of the gait.
The lateral kinetic chain is in contralateral relationship with the anterior spiral kinetic chain: stance/swing. This movement requires stability across the anterior surface of the sacrum. The iliacus and contralateral piriformis become functional synergists during the swing phase of the gait. Looking at these kinds of contralateral relationships is an important aspect in movement assessment.
The iliacus and piriformis pictured here are in ipsilateral relationship. When the iliacus and piriformis are in contralateral relationship they create a functional X across the anterior surface of the sacrum.
Posterior Spiral ~ Generation of Stored Elastic Energy
The coiling of the thoracolumbar fascia acts on the sacrum and the SIJ. The hip is extending and externally rotating. The iliacus is actively engaged in eccentric lengthening, or is a functional opposite.
An up-regulated iliacus is going to down-regulate the coiling action of the posterior spiral kinetic chain. This is important when looking at the posterior surface muscles that act on the sacrum. Often, multifidus/sacrospinalis and gluteus maximus are down-regulated and need to get back into the equation for sacral stability.
Anterior Spiral ~ Translation of Stored Elastic energy
The iliacus is a powerful hip flexor. An up-regulated iliacus will look for recruits to assist in hip flexion during the swing phase of the gait. The common players the body looks to recruit are the psoas, tensor fasciae latea, rectus femoris, sartorius, and all the adductors.
The anterior spiral pairs with the contralateral lateral kinetic chain. At the moment when hip extension translates into hip flexion, the iliacus and the contralateral piriformis are in functional synergist relationship. This creates stability across the anterior sacrum during shock absorption.
Remote Relationships:
The body starts to look for recruitments to assist an up-regulated and fatigued muscle/s. One common recruitment pattern are muscles in contralateral pairs. The pectoralis minor and the iliacus are common up-regulated muscles, they work together in the contralateral shoulder to hip relationship of the anterior spiral.
Manual Therapy Application:
One important aspect of any manual intervention is to ask the body directly if the modality is appropriate. This can be verified by doing a little bit of release. Go back to the relationship and take notice. Did the response change in a favorable way? If it did, then the release technique was appropriate. If it did not, then the nervous system needs something else to restore the coordination.
Here are a few strategies I regularly employ when working with an up-regulated iliacus.
Strain Counter Strain:
This is a one of my favorite go to techniques. It is gentle and effective. There is little risk to further irritation of an up-regulated iliacus. The lessor trochanter, the common tendon junction and the bowl of the pelvis are good entry points for this gentle technique.
Belted Pelvis:
This active bilateral release can have a dramatic positive effect in the SIJ. The belt puts the SIJ in compression while the bilateral activation of internal/external rotation resets the receptors. The therapist can approach the release in two ways. One is to use feedback pressure to activate the balance between internal and external rotation. The other is to use bilateral pressure on both piriformi to reset the muscle spindles.
Active Muscle Spindle:
This is a technique that resets the muscle spindles interpretation of muscle length. Support clients leg with thigh vertical, leg horizontal. Have the client hold their leg in place to accurately access the common tendon junction near the bowl of the pelvis. The placement of the practitioners fingers should be such that there is zero visceral impingement. Once appropriate contact is made, the clientslowly extends the leg and draws back to the starting position.
Pin and Stretch:
This flossing technique is a mixed bag. It can either be highly effective or over stimulates the nervous system. Ask the body if it is appropriate to the client’s presentation.
Conclusion:
When assessing the players involved with sacral stability, ask if the identified players can cooperate with each other. Getting all the players back on the same team make for a happy sacrum.
Glossary:
Concentric activation ~ The muscle fibers are shortening; the muscle attachments are moving toward one another.
Eccentric activation ~ The muscle fibers are lengthening; the muscle attachments are moving away from one another.
Synergist ~ Muscles that work together during movement.
Functional Opposite ~ Muscles that work opposite to one another. One muscle is lengthening while the other is shortening.
Up-Regulated ~ An overstimulated muscle that is compensating for other muscle/s that are not participating. Often the muscle will become overworked and fatigued and unable to respond appropriately.
Down-Regulated ~ An under stimulated muscle. The function is impaired and unable to respond appropriately.
Reciprocal Inhibition ~ When a muscle/s is contracting, the opposite muscle/s must be lengthening. If the opposite muscle/s are unable to lengthen, being up-regulated for example, then that will functionally inhibit the muscle that is contracting.
*Please note this particular series of blogs will describe each of the four muscles and their relationship to the five principal actions described in the charts of The 5 Primary Kinetic Chain Poster Set I’ve developed. This is the first in a series of four posts. You can find the second post on the Iliacus here.
Introduction to the Sacrum:
The sacrum, or sacred bone, is unique in the body. Mystics regard the sacrum as the focal point for kundalini, the spiraling energy that rises from the root through the crown. This triangular shaped bone provides the base of support for the spinal column.
The sacrum articulates with the pelvis through the sacral iliac joint, SIJ. The kinetic energy of ground force reaction moves from the feet engaging the earth, up through the legs, into the pelvis. The energy crosses through the pelvis into the sacrum and up through the axis of the spine. The manner by which the energy moves into and through the axis of the spine defines our ability to respond to ground force reaction.
There are four important muscles that act directly on the sacrum.
Posterior Surface: multifidus/sacrospinalis & gluteus maximus
These four high level muscles often are not engaged with their task of stabilizing the sacrum through a spectrum of movement. When we look at the function of these four muscles, and the various movement they are involved in, there is a trend we see in most people’s presentation that are seeking therapeutic intervention.
The anterior surface muscles are often up-regulated. These muscles are over worked and do not respond appropriately. One of the flavors of synergistic dominance is when one group of fibers becomes up-regulated, those dominant fibers then down-regulate the function of that muscle over its spectrum of movement.
The posterior surface muscles are often down-regulated and are not available to respond appropriately to movement.
The relationship of how these four muscles work together in coordination changes over the spectrum of movement. The 5 Primary Kinetic Chains have unique principal actions that inform the sequence of movement. This series of essays will describe each of the four muscles and their relationship to the five Principal Actions I’ve described in the 5 Primary Kinetic Chains poster set.
Piriformis:
The piriformis is a flat, pyramidal shaped muscle that runs from the anterior surface of the sacrum to the greater trochanter of the femur. The manner by which the muscle fans across the broad surface of the sacrum is somewhat similar to the subscapularis attaching to the scapula. The piriformis is an external rotator of the femur; the subscapularis is an internal rotator of the humerus, thereby making them functional opposites.
Many people have challenges due to the structure and function of their piriformis. Approximately one in 5 of us have piriformis anomalies (Read more here). Those that have this are often grouped into a category of “piriformis syndrome,” a pattern of up-regulated piriformis that irritates and compresses the nerve bundles, the sciatica nerve, that pass through the muscle.
People that have this presentation are often challenged by common movement triggers. Prolonged sitting, driving, and — for some — simply walking, is enough to exacerbate the pressure of the muscle acting on the nerve.
Concentric Actions of The Piriformis:
Sagittal ~ hip extension & sacral flexion
Coronal ~ hip abduction & sacral downward/upward rotation (limited by SIJ gap)
Transverse ~ hip external rotation & sacral downward/upward rotation on an oblique axis
The Piriformis and The 5 Primary Kinetic Chains:
Intrinsic ~ Breath
The relationship between the piriformis and the pelvic floor is often a good starting point for evaluation. The following two scenarios are common presentations:
Spinal Wave:
The piriformis is a participant in the spinal wave during the breath cycle.
An up-regulated piriformis is the action of the exhalation phase thereby affecting the inhalation phase of the breath.
Pelvic Floor:
The sacral tuberous ligament, and the obturator internus help make up the extrinsic boundaries of the pelvic floor. The piriformis is a synergist to the obturator internus making it an easily recruitable option for an up-regulated pelvic floor.
Deep Longitudinal ~ Shock Absorption
An up-regulated piriformis interferes with the kinetic wave of shock absorption. The up-regulated piriformis is a bracing strategy for the SIJ. Compression in the SIJ functionally acts as an abutment to the kinetic wave of ground force reaction.
The body’s appropriate response to the kinetic wave of shock absorption is to counter with the push reflex. Imagine stepping off the curb. The hip must descend so that the foot can meet the ground. This is an eccentric action of the quadrates lumborum, the QL. An up-regulated piriformis down-regulates the push reflex.
The peroneal nerve, a division of the sciatic nerve, innervates the subsystem muscles of the deep longitudinal kinetic chain. An up-regulated piriformis that compresses the peroneal nerve will affect the peroneus muscles and the short head of the bicep femoris. When these subsystem muscles are unable to respond appropriately, the compensation is joint compression strategies that will move up the kinetic chain.
Lateral ~ Axial Stability
The gluteus medius, a lateral kinetic chain subsystem muscle, needs to play well with the piriformis. The piriformis is both a synergist and functional opposite to actions of the gluteus medius.
The gluteus medius attaches to the pelvis with a broad fan-like orientation of fibers. The action includes abduction of the hip, and internal and external rotation of the femur. This is significant because some fibers act as synergists and others act as functional opposites. Often, select fibers of an up-regulated gluteus medius will functionally down-regulate the other fibers. This contributes to an up-regulated piriformis.
The lateral kinetic chain is in contralateral relationship with the anterior spiral kinetic chain: stance / swing. This movement requires stability across the anterior surface of the sacrum. The contralateral iliacus and the piriformis become functional synergists during the swing phase of the gait.
The iliacus and piriformis pictured here are in ipsilateral relationship. When the iliacus and piriformis are in contralateral relationship they create a functional X across the anterior surface of the sacrum.
Posterior Spiral ~ Generation of Stored Elastic Energy
The coiling of the thoracolumbar fascia acts on the sacrum and the SIJ. The hip is extending and externally rotating. The piriformis is a synergist to the gluteus maximus, a posterior spiral subsystem muscle and sacral stabilizer.
Potentially any muscles in the posterior spiral kinetic chain could be in a synergistic dominance relationship.
Posterior spiral kinetic chain is paired with the contralateral deep longitudinal kinetic chain. The push leads the strike; the piriformi are in an alternating activation.
Anterior Spiral ~ Translation of Stored Elastic energy
The anterior spiral pairs with the contralateral lateral kinetic chain. At the moment when hip extension translates into hip flexion, the ipsilateral iliacus and the piriformis are in functional synergist relationship.
Remote Relationships:
The body starts to look for recruitments to assist an up-regulated and fatigued muscle. One common recruitment pattern is muscles that have similar fibril orientation. The lateral pterigoid is a common jaw remote relationship.
Manual Therapy Application:
One important aspect of any manual intervention is to ask the body directly if the modality is appropriate. This can be verified by doing a little bit of release. Go back to the relationship and take notice. Did the response change in a favorable way? If it did, then the release technique was appropriate. If it did not, then the nervous system needs something else to restore the coordination.
There are few strategies I regularly employ when working with an up-regulated piriformis.
Strain Counter Strain:
This is a one of my favorite go to techniques. It is gentle and effective. There is little risk to further irritation of an up-regulated piriformis.
Belted Pelvis:
This active bilateral release can have a dramatic positive effect in the SIJ. The belt puts the SIJ in compression while the bilateral activation of internal/external rotation resets the receptors. The therapist can approach the release in two ways. One is to use feedback pressure to activate the balance between internal and external rotation. The other is to use bilateral pressure on both piriformi to reset the muscle spindles.
Pin and Stretch:
This flossing technique is a mixed bag. It can either be highly effective or over stimulate the nervous system. Ask the body if it is appropriate to the client’s presentation.
Conclusion:
When assessing the players involved with sacral stability, ask if the players can cooperate with each other. Getting all the players back on the same team make for a happy sacrum.
Glossary:
Concentric activation ~ The muscle fibers are shortening; the muscle attachments are moving toward one another.
Eccentric activation ~ The muscle fibers are lengthening; the muscle attachments are moving away from one another.
Synergist ~ Muscles that work together during movement.
Functional Opposite ~ Muscles that work opposite to one another. One muscle is lengthening while the other is shortening.
Up-Regulated ~ An overstimulated muscle that is compensating for other muscle/s that are not participating. Often the muscle will become overworked and fatigued and unable to respond appropriately.
Down-Regulated ~ An under stimulated muscle. The function is impaired and unable to respond appropriately.
The Intrinsic Kinetic Chain is the first of Five Primary Kinetic Chains. If I may, I will use an analogy from the epic series by JRR Tolkien, it is: “one ring to bind them all.” This sums up the intrinsic kinetic chain. Breath is essential for survival. Breath is the barometer for vitality. Breath is intrinsically connected to the central nervous system.
The thoracic diaphragm is a striated muscle that is directly connected to the autonomic nervous system. As such, we are incapable of holding our breath to the point of oxygen deprivation. Survival reflexes will override and the body will issue instructions to contract the thoracic diaphragm.
The thoracic diaphragm acts like a bellows for the lungs. The rib cage, provides the support structure so that when the thoracic diaphragm contracts, intra-abdominal pressure changes. The pressure drops, and negative intra-abdominal pressure creates a void. That void is then filled with positive atmospheric pressure, filling our lungs with precious life giving oxygen.
The thoracic diaphragm works in partnership with the pelvic diaphragm. The thoracic diaphragm is a dome that faces upward. Contraction pulls the dome downward. The opposite is true for the pelvic diaphragm. The pelvic floor is a dome facing downward. Contraction pulls the dome upward.
When we breathe, the domes of the thoracic & pelvic diaphragms move in sync. They move in the same direction, though one is in concentric action while the other is in eccentric. During the inhalation phase, the thoracic diaphragm is in concentric activation while the pelvic diaphragm is in eccentric. Both domes are moving downward. While the thoracic diaphragm is pushing the visceral contents of the abdomen downward, the pelvic floor provides the hammock that supports the viscera.
Restoring the proper sequence in breathing is often the foundation of the therapeutic process. As the mechanics of the breathing apparatus are restored, balance can return to the structural, physiological, and emotional components.
Today I’m sharing a recent conversation between a colleague and I regarding limbic versus cognitive behavior that I hope brings you some food for thought:
Some people find the holidays a stressful time of the year. Stress correlates to an up-regulated sympathetic nervous system. We often hear “take a deep breath” as an easy way to regulate.
Let’s reframe this slightly. To take a deep breath requires being in action. With an up-regulated sympathetic nervous system, we are already doing too much. Instead, let’s be the observer.
Imagine that that the breath is like a glass of water. When you fill a glass with water, the water fills from the bottom to the top. Conversely, when you empty the glass, the water empties from the top to the bottom. As you observe your breath, feel the inhalation expanding the belly, the lower ribs, then the upper ribs and clavicle. And as the exhalation happens, watch the breath descend in the reverse order.
Being the observer allows you to tune into the sensation rather than focus on accomplishing something. This subtle reframe has a profound effect on your experience in that moment. We can’t think our way out of a sympathetic nervous system response, however we can feel our way through as we navigate sensations.
Amy Maynard Buckles: “Being the observer allows you to tune into the sensation rather than focus on accomplishing something.” Love that! Why can’t we think our way out of a sympathetic nervous system response?
There is a long version and a short version to that question.
The short version is related to the mechanism of information gathered by the Autonomic Nervous System (ANS). The limbic inputs, the sensory apparatus of the body, the five-traditional and the non-traditional senses communicate with the ANS. That information is collated and prioritized based on past experiences: our associations and hard-wired reflexives. The most relevant way that we can affect our ANS is through the sensory input of the limbic channels. This points to why breath work, aromatherapy, and the five tastes are such powerful tools that we can utilize to make change in the response to our environment.
Personally, I am most interested in the non-traditional senses. The information we take in from our environment, such as electromagnetic fields, barometric pressure, bioelectric energy, and so forth. There are unknown realms of information that we are experiencing and collating at an unconscious level. This spectrum of perception I find fascinating.
The tip of the iceberg analogy also works well here. Twenty-five percent of information is perceived consciously, while 75% of information largely goes unperceived by our consciousness. That is huge.
Buckles: Great explanation and info to share! I am curious as to your thoughts on how much of our conscious thoughts, with practice, could change the ANS response. Like in a panic attack for example. I understand that while focusing on breath, we are out of our heads and more into our body awareness. Which, would activate the PNS. To me, that’s not thinking. However, if we gain information about our environment, our safety, and other sources of input and responses…then we can consciously choose to think differently. Hopefully not only to prevent ANS distress, but also reverse or stop it.
“consciously choose to think differently”
That is a key to cognitive thought process.
Here is the big challenge to overcome: thought is chemistry. The Law of Adaptation says that the body adapts to its environment regardless of outcome.
Emotions are a specific cocktail of chemistry. We get better, more efficient at making the “cocktails” of our predisposition. Those chemicals require receptor sites to plug into. Over time we end up making more of that unique composition of chemistry to fill the receptor sites. Through adaptation, we become addicted to thought. Overcoming that requires conscious effort.
If our predisposition is to respond to a situation in a familiar way, reproducing those feelings becomes easier each time we have them. You can see this in people that have “knee jerk reactions” — these folks are quick to produce the chemical signature they are familiar with.
Some people have the disposition to do that kind of work on a cognitive level; change your thoughts and change your behavior. Others need stimulus from the other part of the brain, the limbic center. These are the people that do better at maintaining attention on sensation.
There is a loop in the brain and how we process our environment:
Limbic—>Association—>Cognitive
Sensory—>past or projection of future—>Ego or survival
Our ability to interpret the information of our sensory apparatus, and reframe from a place of being hijacked by associations that are interpreted by the ego, define our ability to cope.
