PT on the Net Research

Lower Cross Syndrome


I have a client who has had rotator cuff problems and his feet turn out. I have tried to help my client's shoulders with PNF stretching. Is there something tight that may be causing these things?


Thank you for this question. You mentioned you helped your client's shoulders through PNF stretching. How much background do you have in the PNF protocols? The reason I ask is that PNF has six stages or protocols to go through. The contract-relax or stretch stage is fifth. Yet, many of us in this profession go straight to number five. I think we should revisit our techniques to start with the first phase and work our way to phase five. I want to add that anecdotal evidence always outweighs science. If your client feels better and his shoulder is better, no one can argue with your outcomes. I commend your abilities and applaud your efforts. The next issue I would like to address is that his rotator cuff problems are more than likely not the real issue. It is very intuitive on your part to think that something may be tight and something may be weak. The technical term for this phenomenon is called reciprocal inhibition (RI). RI means that if the agonist or mover of a joint is tight, the opposite muscle must loosen to some degree to allow motion at the joint to occur. Quite often, rotator cuff problems are due to faulty postures. When your client stands in his normal position, try to look at his hands. I am guessing his palms may be facing behind him, and his humerus may be rotated internally and slightly anterior or in front of his body. The proper positioning is that his palms are facing his body and are directly lateral or along his sides. Vladimir Janda has coined this type of posture as upper crossed pattern or syndrome. It is very common in people who sit for most of the day and/or do many pressing exercises in the gym. With this posture, you will find that his lats are very tight. It almost doesn't make sense that a muscle that is largely in the back can cause issues in the front. What we must remember is that the latissmus dorsi are internal rotators of the humerus, thus adding the rounded shoulder or upper crossed pattern.

We have not addressed the meat of the question in which you asked. The reason his feet turn out is quite possibly another postural issue. This pattern is called lower crossed pattern or syndrome. I am guessing that his Ilio-tibial band (ITB) is very tight. He may also mention that his hamstrings are tight. He will also probably have an anteriorly rotated pelvis or his butt may stick out. Does he have lower back pain?  People who exhibit these characteristics commonly have low back pain. What can you do? The first thing you may want to try is to buy a foam roller. Have your client lie on his side and place the foam roller under his upper leg between his knee and hip. Do not allow him to roll on his knee joint or his hip joint at this time. I caution you that he may feel quite extreme discomfort. We call this technique a self-myofascial release. Self means they have the ability to stop at any time and adjust the amount of load to be placed on roller. The trick is to stay on the spot that feels discomfort for about 30 seconds or more. There is an immense amount of science that goes with the reasoning why we suggest this type of technique. Unfortunately, it does take more than this article to discuss this thoroughly. (Please see "related articles" at right for more on self-myofascial release.)

The best way to help prevent and to try to help postural distortion patterns is to not allow the client to make compensations in the intended movement. A compensation, for example, is to allow your client to turn his feet out while squatting, or to put blocks under his heels to stop his heels from popping up. Instead of allowing the compensation to occur try to focus in on why the heels are popping up in the first place. My guess is that the client has tight calves and cannot dorsi-flex the needed amount. What I am saying is that the human body has a particular way in which it is meant to move. When you allow the body to compensate or move in another pattern of motion, you will create changes in the lengths of those muscles and through reciprocal inhibition will cause changes in their opposing muscles, and so the serial distortion patterns begin.

These types of postures trigger predictable patterns of dysfunction throughout the body. This dysfunction is commonly called kinetic chain dysfunction. The postural problems are commonly called serial distortion patterns. It is my personal mission to have all trainers use some form of kinetic chain assessment before they design a program for any client. A trainer possessing the tools to do a thorough kinetic chain assessment and who has the ability to train his/her clients with correct programming based on the proper kinetic chain assessment is a trainer who can truly help his/her clients beyond putting muscle on and getting them more esthetically pleasing.