If you are not focused on creating the ideal motor pattern (i.e., correct posture position) with your clients, you can be assured that sooner or later, immobility, pain or decreased performance will be the result.
Understanding the central nervous system (CNS) and the effect that any disruption of the CNS has on posture is part of being attentive to the needs of our clients. With the reverse also being true, it’s about time we shift our focus and truly help clients achieve overall health and function. To assist in this endeavor, let’s take a look at the importance of a muscle we take for granted and cannot live without: the diaphragm. We will take a look at where the diaphragm attaches and the ideal motor pattern for effective breathing.
The “ideal motor pattern” we are speaking of is one where the person can facilitate the diaphragm in a downward movement as a result of the body’s innate ability to stabilize the torso, spine, shoulder girdle, pelvis and lower extremities. This is achieved by re-patterning, through close interaction, of the CNS, the joints, their ligaments and the muscular system. This interaction is slowly ingrained from infancy and especially in the alignment of the joints. Because of the importance of it’s ligament information transferring qualities, they need to be aligned correctly throughout our continued developmental process as we age for optimal results.
Pulmonary oxygenation (i.e., breathing with efficient oxygen saturation) with full diaphragmatic involvement is a cornerstone of health and well being. On average, the human body takes a breath 12 to 15 times per minute. That gives us an average of almost 20,000 breaths per day. Knowing this, it makes great sense to assess whether your clients are breathing correctly or not. If you are not firing the correct sequence or stability system when breathing, you can be assured that every other movement throughout the day is compromised.
Whether it’s working on strengthening the shoulder or moderately intense abdominal training, the ideal motor pattern for breathing is crucial. Without it, the diaphragm cannot be the prime mover in the breathing process. The ideal motor pattern for breathing needs to be the focus of every client program you create. Because of the thoracic and lumbar spinal attachments of the diaphragm, stability and mobility in and around your client’s thoracic and lumbar spine is vital.
How about you? Let’s do a quick assessment to find out if you are breathing correctly, so you can experience the difference before taking this information to your clients. Stand in front of a mirror with no shirt or in a bathing suit and no shoes. Take a 30 percent larger than normal breath and focus on your chest and shoulder movement. In the ideal motor pattern for breathing, your chest and shoulder level should remain unchanged. The movement should not be elevation, but rather the chest should expand a bit as your lungs fill. If your shoulders rise up and hinge forward with your breath, you are using an incorrect motor pattern, and this will ultimately lead to inevitable tension throughout your body. The same holds true for the “tipping back” of your rib cage, seen from the sagittal view, causing the diaphragm to be tilted on an oblique angle. When this movement occurs, one can assume that the effects are being felt throughout all systems and joints in the body. For example, the lumbar, thoracic and cervical spine and their associated soft tissues, the rib cage and the temporomandibular joint develop tension as they inefficiently assist in breathing almost 20,000 times per day.
You already know that to achieve full diaphragmatic breathing. The diaphragm must have the ability to move downward into the abdomen during inhalation (breathing in), resulting in a pressing on the viscera (organs) and causing abdominal expansion. Notice that I said expansion and not inhibition. This downward movement kneads and facilitates all of the abdominal cavity organs of digestion, absorption and removal, much like pushing down on the end of a water balloon. Considering the thoracic cavity as a cylinder that works in all directions, the diaphragm draws down like a piston, increasing the size or volume of the lungs from below. As the volume of the thoracic cavity increases, the air pressure inside the lungs is lowered, and the air outside rushes into the lungs to restore the balance of inside and outside pressure.
With this drawing downward movement, the belly can distend because the contents of the abdominal cavity are displaced. For this reason, "belly out" breathing is widely viewed as the path of least resistance for movement. It is not the functional movement pattern that you should focus on, and it must be changed. The key to this is a functional, unconscious change in your client’s joint centration (maximum contact of the joint surfaces) and spinal alignment. An example of this is when the natural "S" curve of the spine is established or when the head of the humerus is “centrated” with the glenoid fossa.
Because of its location and attachments, the diaphragm divides our torso into the thoracic cavity and the abdominal cavity. The very nature of the two cavities is quite different. The shape of the diaphragm is dictated by the shape of the organs and, more relevant to you, the position of the lumbar and thoracic spine and ribs. This is due to the attachment points. The functional movements of breathing with the diaphragm are two-fold. The first is to increase the size or volume of the lungs and the second is to create a point for all muscular movement to be focused. This relaxed, ideal breathing pattern automatically promotes a reduction of the excess muscle tone and, with little effort, can be maintained while participating in any movement. This is especially true when the CNS recognizes this movement as an ingrained pattern.
Following his studies under Vojta, Pavel Kolar, a Czech Pediatric Physical Therapist, has been spearheading a movement in the rehabilitation field to truly create stability in this system. His focus is on creating this ideal motor pattern by utilizing the information that Vojta developed in his developmental kinesiology work with infants. I had the pleasure of observing Kolar and his staff working at his hospital in Prague, Czech Republic last year. This all came about through Pete Egoscue’s relationship with Vladamir Janda. Knowing the effectiveness of Janda’s work, we had to check into Kolar’s work. His work is more hands on with remarkable results, and seeing him only re-confirmed why specialized exercises for posture correction and conditioning are so effective, in both the training or rehabilitation fields.
Here are some of the ideas utilized by Kolar and others as the basis of their work. Observed at around one month of age, an infant learns to use various points of support by beginning dynamic stabilization. Previous to this, the posture of the infant is unstable and unbalanced. His body relies solely on the tonic muscular system for support. After the third month of development, voluntary motor control begins. For example, in the prone position, the infant supports himself on the medial elbow and the pelvis bilaterally. When lying supine, the three support points are the lateral occiput, the inferior angle of the scapulae and the area of the PSIS/upper glute. For a more detailed description of this developmental process as it progresses to 12 months, please refer to Craig Liebenson’s book Rehabilitation of the Spine (see references), which contains chapters contributed by Janda, Lewitt and Kolar.
Keeping all this in mind, it is time to take another step in becoming a part of your clients' success, either in fitness training or in their goal to becoming and remaining pain free. So, let’s collectively move them toward function and allow them to enrich their system with an influx of oxygen and a much-improved posture... all this just by changing joint positions and breathing more efficiently.
Please do the following specialized exercises in the order listed below. Each of the following exercises builds on to the next, which is what makes the order important:
Unilateral Arm Circles/Pillow:
- Client stands barefoot with feet straight. Place a pillow between the knees.
- Bent Arm: Elbow, forearm and hand, palm down, onto a shelf or apparatus (90 degrees of ABDuction).
- Extended Arm: Bring the fingertips into the top of your palm to close-pack the wrist. Abduct the arm to shoulder level. The precise scapular movement is not Adduction/retraction, and interestingly enough, this downward, inward movement causes the rhomboid to act like an Abductor. This occurs because of the superior, medial border being moved toward the spinous processes of the thoracic spine.
- Hold this scapular position, press the bent arm and elbow down into the counter to cause a facilitation of the deep stabilizing chain including the serratus anterior, external oblique, internal oblique and transverse abdominus.
- Begin circling the straight, abducted arm (up and forward 40 times) and then turn the palm up and begin to circle (up and back 40 times).
- Do not tilt the sternum upward in substitution for the scapular rotation.
Unilateral Elbow Curls/Pillow:
- Client stands barefoot with feet straight. Place a pillow between the knees.
- Bent Arm: Elbow, forearm and hand, palm down, onto a shelf or apparatus (90 degrees of Abduction).
- Free Arm: Bring the fingertips into the top of your palm to close-pack the wrist. Place the knuckles against the temporal bone with the thumb facing the floor.
- Press the bent arm and elbow down into the counter to cause a facilitation of the deep stabilizing chain including the serratus anterior, external oblique, internal oblique and transverse abdominus.
- Keeping the wrist locked out, bring the elbow to a closed position in front of your face and then open it back up to the beginning position.
- Repeat this motion 35 times and then switch arms, all the while holding the constant downward pressure of the bent arm on the counter.
Upper Spinal Floor Twist:
- Client lies on her side in the fetal position (90 degrees at each joint). Place bottom hand on the IT band/lateral side of the top leg. Keep knees stacked.
- Open the top arm to the opposite side while applying some downward pressure against the knees with the other hand.
- Look in the direction of the opened arm while head remains in contact with the floor, allowing the body to segmentally open up the spine to rotation and extension.
- Breathe east to west by attempting to expand the kidney area of the low back as the lower ribs spread.
- Be careful: The distending abdominal area is the path of least resistance and not the ideal motor pattern you want.
- Hold for a minimum of one minute but anywhere from two to four minutes is acceptable, as long as the client is relatively comfortable.
- Client lies on back with knees bent and both feet pointed straight.
- Palms up.
- Use the abdominals to posteriorly tilt the pelvis.
- Using the low back musculature and the frontal hip flexors to tilt the pelvis anteriorly.
- Repeat motions 10 times per direction.
Elevated Child’s Pose w/Elbow Pressure:
- Client kneels down in the child’s pose with her elbows on the floor at head level. The pelvis is elevated six to eight inches from her heels and held throughout the entire exercise. As the femurs change position, the engagement of the iliopsoas functionally changes length and tension to stabilize the spine and pelvis.
- The placement of the elbows is crucial to achieve joint centration at the shoulder. Find the halfway point between 90 degrees of arm abduction and 180 degrees of complete shoulder flexion.
- Pronate both wrists to close-pack the entire upper extremity.
- Place downward pressure against the floor with the medial epicondyle of each elbow and hold. This movement causes a downward, inward movement of the scapulae to connect the deep stabilizing chain to assist in diaphragmatic facilitation.
- Continue the east to west breathing until it feels natural and there are no restrictions in the thoraco-lumbar fascia and lower ribs spread easily.
- The client stands on the edge of a stair, preferably holding onto both sides of the stair railing, with shoes on. Feet should be pointed straight.
- Client looks down at her shoelaces to align the hips above the lateral malleolus.
- The trick is to keep the pelvis in this position as you coach her to place her shoulders and head vertical again.
- Coach her to drop her heels off the stair to create a stretch on the calf musculature and hold for three to five minutes. Re-check the joints for stacking.
- As this is held, the body begins its micro adjustments, the global posture will improve and true thoracic extension will be the result.
- This extension happens because of the pull on the gastroc heads bilaterally, which rotates the femurs to a more efficient alignment. This improvement causes a hip and pelvic change and up the chain throughout the spine segmentally.
- Client lies on her back with both legs up over a block or chair.
- Arms at 45 degrees with the palms up.
- If the client can’t get her head onto the floor comfortably due to her thoracic kyphosis, place a lift under her head.
- Relax and let the lumbar spine react to the occiput, the area of the inferior angle of the scapulae and the PSIS/high glute area contact.
With these points activated, and the cumulative affect of the previous six exercises, your client’s ability to facilitate the ideal motor pattern will improve daily. Good luck.
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- Wirhed, R. Athletic Ability and the Anatomy of Motion, 3rd Edition. Elsevier, 2006.
- Egoscue, P. Pain Free: A Revolutionary Method For Stopping Chronic Pain. Bantam Publishing, 1998.
- Egoscue, P. Pain Free for Women. Bantam Publishing, 2002.
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- Liebenson C (ed.) Rehabilitation of the Spine: A Practitioner’s Manual. Baltimore: Williams and Wilkins, 1995.
- Hodges P, Richardson C. Contraction of trensversus abdominis invariably precedes movement of the upper and lower limb. (IFOMT). Norway. 1996.
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