The Functional Role of Fascia in Posture and Movement: Part 2

Part 1 of this article discussed the role of the fascial system in developing optimal posture and movement. It also looked at how dysfunction or imbalance within the fascial systems directly contributes to the development of compensatory postural and movement strategies. Incorporating the concepts from the first installment, Part 2 of this article includes the strategy for training the specific functions of the deep and superficial myofascial systems. After completing the articles, the health and fitness professional will be able to design a rehabilitative or functional training program that integrates the role of the deep and superficial myofascial systems to restore and/or maintain optimal posture and movement.

Learning Objectives:

1. Incorporate the principles of alignment, breathing, and control to develop a more optimal postural and movement strategy
2. Develop a strategy for incorporating the deep and superficial myofascial systems into an integrative rehabilitation and/or functional training program
3. Execute the corrective and progressive exercise patterns that improve function of the deep and superficial myofascial systems in maintaining optimal posture and movement

Functional Integration of the Deep and Superficial Myofascial Systems

The first installment of this article highlighted the role of the fascial system in maintaining optimal posture and movement. It also discussed how an imbalance between the deep and superficial myofascial system contributes to common postural and movement dysfunction. Part II of this article as well as the accompanying video will focus on developing functional control of the thoracopelvic canister (core) utilizing specific strategies to target the integrative function of the deep and superficial myofascial systems. Improving functional control of the thoracopelvic canister is one of the most important strategies for developing optimal control of posture and movement (Osar 2013).

While they will be discussed independently, remember that the ultimate goal of any rehabilitative, corrective, and/or general conditioning program is to help the individual develop a strategy that integrates and supports optimal function of both systems. The following approach is adapted from the principle-based strategy utilized in the Integrative Movement System™ (Osar 2014). 

Training the Deep Myofascial System

Recall from the previous discussion that many individuals with non-optimal postural and movement strategies tend to over-recruit their superficial myofascial system (SMS) over their deep myofascial system (DMS). In other words, rather than holding their posture with ease or moving in a smooth, coordinated manner, they tend to ‘muscle’ movements or use excessive muscle activity especially when performing simple activities like holding their posture in standing or sitting, lifting their legs while walking, bending over, and/or squatting. As these individuals begin to add increasing levels of challenge, they compensate to an even greater degree further perpetuating the dysfunctional strategy. Adding more resistance or load upon these non-optimal strategies merely leads to further compensations and ultimately the development of chronic tightness and pain.

Therefore, it is imperative to develop a strategy that improves the individuals postural and movement control strategy. The goals for selectively training the DMS are as follows:

• activate the DMS to provide the specific joint alignment and functional control required to achieve optimal posture and movement without having to rely solely upon the SMS
• develop three-dimensional breathing which is instrumental in developing the intra-abdominal and thoracic pressure required to both stabilize as well as decompress the TPC
• develop the proper alignment and three-dimensional breathing strategy necessary to suspend and mobilize the viscera while releasing underlying fascial restrictions 
• provide a means of communication between the various regions of the TPC (For example, the proximal attachment of the psoas fascially blends with the diaphragm, transversus abdominus, and quadratus lumborum while the distal attachments fascially blends with the pelvic floor (Gibbons 2005). In this manner, the fascial attachments of the DMS function to connect adjoining regions within the TPC.)
• develop efficient TPC or core stabilization strategies that don’t over-rely upon compensatory ‘bracing’ or ‘gripping’ strategies to perform low level activities such as standing, sitting, bending, and walking

Three patterns will be used during the training of the DMS: the Happy Baby, Heel Drops, and the Supported Squat. 

Happy Baby

The Happy Baby position (image 1) refers to the position a child will adopt around three months into their development (Holubcova 2013). This position is especially important for postural and movement development because it helps create the internal pressure (intra-thoracic and intra-abdominal), which along with activation of the abdominal wall, is required to optimally stabilize the thoracopelvic canister (Holubcova 2013, Osar 2013). Additionally, as the child coordinates breathing with activation of the core musculature, she is learning how to lengthen her trunk and spine, which will promote proper alignment once she achieves the upright position.

                                                           
    Image 1: The Happy Baby position.

Because the diaphragm is intimately blended with the fascia of the deep muscular system, utilizing three-dimensional breathing in the Happy Baby position is a very effective position to begin training the DMS. An additional benefit of using this position is that it reduces many of the postural stresses that occur in the upright position while allowing better alignment of the three fascial diaphragms contained within the thoracopelvic canister – the fascial layer covering the thoracic inlet, the respiratory diaphragm, and the pelvic floor. This alignment is key to developing optimal pressure control within the TPC and is the way breathing becomes an effective method for activating the DMS while reducing hypertonicity within the SMS (Osar 2014).

To begin the Happy Baby exercise pattern, the client is supine with the legs supported over a physioball or chair so that the TPC is in the most aligned position. The goal is to achieve parallel alignment of the three diaphragms through proper positioning of the head, trunk and spine and pelvis (image 2). The client is instructed to breathe three-dimensionally so that they are fully recruiting the entire diaphragm. For a more thorough discussion on developing three-dimensional breathing, the reader is encouraged to refer to the following link: www.ptonthenet.com/articles/assessing-the-fundamentals-the-thoracic-connection-part-2-3302. 

Once the individual establishes three-dimensional breathing, they place their feet upon the floor in the hook lying position. Maintaining the visualization and connection to the DMS, the individual gently lifts their legs one at a time off the floor until the hips and knees are in the 90°-90° position (image 3). To improve connection of the DMS while in this position, an effective visualization is to imagine a deep wire connection from the front of the spine (proximal attachment of psoas to the spine and diaphragm) to the front of the hip region (distal attachment of psoas into the pelvic floor and onto the greater trochanter). For many individuals, co-activation of the pelvic floor has also been found to be effective at improving activation of the transversus abdominus (Lee and Lee 2013). Activation of the DMS is an important strategy for developing optimal control of the pelvic, spine, and hip positions.

Once in this position, they will perform three full diaphragmatic breathes and then return their legs one at a time to the starting position. They repeat this process for the appropriate number of sets and repetitions. The goal is to effortlessly use the combination of activation of the DMS and intra-abdominal pressure to lift and lower the legs rather than attempting to ‘muscle’ the legs up and down using primarily the superficial hip flexors and core muscles.

            Images 2-3: The supported and unsupported Happy Baby positions

Heel Drops

Heel Drops are used to add increased challenge to the DMS in controlling the position of the TPC (image 4). Using the Happy Baby position from above, the individual will incorporate the previous activation and visualization strategy to lift and lower their legs. They maintain this myofascial connection while attempting to use as little overall effort as possible to lower and then lift their leg up to the starting position. The client alternates lowering their legs for the appropriate number of repetitions.

   

            
Image 4: Heel Drops 

Again the goal remains to use as little effort as possible to move the legs without having to over rely on the SMS for stabilization of the TPC and/or movement of the legs. There should be absolutely no change in the position of the head, trunk, spine, and/or pelvis while lifting or lowering the legs. Movement within any of these regions indicates the individual has either lost control and/or the movement pattern is too great for their current level of control.

Supported Squat

The Supported Squat is essentially an upright version of the Happy Baby position. In addition to grooving upright control of the TPC, the Supported Squat pattern is an excellent pattern in which to train optimal alignment and control of the lower extremities and feet as well. The alignment and control established during the Supported Squat will be relatively the same mechanics that are required to properly execute unsupported and loaded squat progressions making this pattern an excellent movement preparation for higher level exercises. The goal is to be able to perform this pattern in a smooth and controlled manner to develop proper alignment and control while decreasing the need to excessively contract or grip throughout the SMS.

The client begins by lightly grasping a sturdy surface such as the squat rack in the gym bar or the knobs of an open door. The goal is not to have the individual hang or pull oneself up with the arms but rather to use the light support to help support optimal alignment of the TPC and extremities.

The client begins the pattern much like a traditional squat by flexing and sitting back into their hips while maintaining alignment of the TPC (image 5). The arms should remain straight through the pattern and should only be providing enough support to facilitate relaxation of the hips and other regions where the individual would otherwise be over-activating or ‘gripping’ for support. The client holds for 1-2 seconds in the bottom position and returns to the starting position for the appropriate number of repetitions.

     
 
Image 5: The Supported Squat

It is important to remember that the overall goal of utilizing this strategy is to improve the individual’s ability to activate the DMS and develop proper alignment, breathing, and control required to perform functional activities without compensation. Therefore it is imperative that all these patterns be performed with the least amount of effort that is required to optimally complete the appropriate number of sets and repetitions while not working to the point of fatigue or moving through pain.        

Training the Superficial Myofascial System

Once the optimal alignment, breathing, and control are developed through training of the DMS, the individual is progressed to increasing levels of challenge to incorporate the SMS. Most high-level patterns such as squatting, lunging, bending, rotating, pushing, and pulling incorporate the superficial myofascial chains for both stabilization and force production. For purposes of this article, the cable push and pull pattern will be utilized to specifically target the anterior and posterior oblique chains. Remember that all high-level patterns require the integrated function of the DMS to control joint alignment and maintain internal pressures while the SMS provides the force production and higher level stability required for the increased demands.

*Cable pushes

In the split stance position, the individual faces away from the cable machine and aligns their TPC (image 6). Grasping the cable in one hand with the opposite arm held straight, the individual pushes the cable away from their body while reciprocally pulling their unloaded arm in to their side. They then control the eccentric phase of the pattern to return to the starting position. The trunk and spine should rotate upon an imaginary axis that runs from the top of the head through the tailbone during both the concentric and eccentric phases of the pattern.  After performing the appropriate number of repetitions, reverse the arm and leg positions to train the contralateral anterior oblique chain.

*Cable pulls

To target the posterior oblique chain, the individual will face the cable machine and align their TPC while in the split stance position. They will grasp the cable handle while holding one arm straight in front of their body. On the loaded side, they will pull the arm towards the side while reciprocally pushing the opposite arm away from the body (image 7). As with the pushing patterns, the trunk and spine should rotate upon an imaginary axis that runs from the top of the head through the tailbone during both the concentric and eccentric phases of the pattern.  They then control the eccentric phase of the pattern to return to the starting position. After performing the appropriate number of repetitions, reverse the arm and leg positions to train the contralateral posterior oblique chain.

*Bands or elastic tubing can be substituted for cable machines.

            
 
  Images 6 and 7: cable push pattern (left); cable pull pattern (right)

Click on the video below to see optimal performance of these patterns.

Conclusion

This article series has discussed the contribution of the fascial system to developing and maintaining optimal control of posture and movement. By understanding and integrating the functional roles of the DMS and SMS, an appropriate rehabilitation and/or exercise program can be designed that selectively targets each system’s unique contribution to maintaining alignment, breathing, and control. This approach helps to restore tensegrity within the myofascial and osseous systems and is the strategy for developing and maintaining optimal posture and movement regardless of an individual’s functional goals.

While there are many patterns that can be utilized, the Happy Baby, Heel Drop, and Supported Squat patterns were used to specifically target the function of the DMS while the Cable Push and Pull patterns integrated the SMS. The important take home concept is that the ultimate goal of achieving optimal balance of the myofascial systems is to create the most efficient strategy that enables the individual to successfully accomplish their health, fitness, and/or functional goals. By designing a rehabilitation, corrective, and/or progressive training program that seamlessly marries the functional roles of these two distinct yet interrelated systems, the health and fitness professional can be instrumental in helping their clients perform at their most optimal level while minimizing the risk for developing the compensatory strategies that lead to decreases in performance and/or injury.

References

Chaitow L, Findley TW, Schleip R. 2012. Fascia Research III. Kiener: Munich. 

Jacobs JV, Henry SM, Jones SL, Hitt JR, Bunn JY. 2011. A history of low back pain associates with altered electromyographic activation patterns in response to perturbations of standing balance. Journal of Neurophysiology: 106(5): 2506-2514. 

Gibbons S. 2005. Assessment & Rehabilitation of the Stability Function of the Psoas Major & the Deep Sacral Gluteus Maximus Muscles. Kinetic Control: Ludlow, UK. 

Holubcova Z. 2013. Dynamic Neuromuscular Stabilization: Exercise Strategies. Course handouts: Chicago, IL.

Myers TW. 2011. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. 2^nd ed. Elsevier: Edinburgh.  

Lee D. 2011. The Pelvic Girdle. Fourth ed. Churchill Livingstone: Edinburgh. 

Lee D and Lee LJ. 2013. Treating the Whole Person with The Integrated Systems Model. Discover Physio Course handouts: Vancouver, CA.

Osar E. 2013. Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction. Lotus Publishing: Chinchester, UK. 

Osar E. 2014. The Integrative Movement System™. The Integrative Movement Specialist Certification™ Course handouts: Chicago, IL. 

Paoletti S. 2002. The Fascia. Eastland Press Inc.: Seattle, WA. 

Richardson C, Hides J, Hodges PW. 2004. Therapeutic Exercise for Lumbopelvic Stabilization: a Motor Control Approach for the Treatment and Prevention of Low Back Pain. 2^nd ed. Churchill Livingstone: Edinburgh.

Wetzler G. 2014. The Listening Connection – Another Step to “Wow”. Discover Physio Course handouts: Vancouver, CA