PT on the Net Research

Infant Development and Adult Dysfunction


Question:

I have an incredibly athletic client who is 49 years old and easily maintains around 18 percent body fat. She can do clapping push ups for sets of 10 or more reps, quick 24 inch box jumps with ease, has around a 14 second hexagon test and has great posture and symmetry in single leg and split stance. But she cannot squat deep. Once she breaks parallel, she falls backwards. Her knees are aligned, her heels are flat, but her torso just falls backwards. Now, if I put her heels onto one inch pieces of wood, she squats perfectly. Of course, if it's on the toes, she falls. I've put her through what RNT I know with the core board, etc, but I'm missing something.

Also, she complains to me that her golf swing is horrible and that she cannot serve or hit well in tennis. I have been confused as to why for months because I see such amazing things in the gym. Her half and tall kneeling chops, lifts, etc are symmetrical. I do spit stance curl to press and alternating chest presses with herm, and they're all right on. So I find myself asking, “WHY can't she swing a club or hit a tennis ball!?” I recently found out that as an infant, she never learned to crawl. She went straight to walking. After finding this out, I looked closely at her gait and her arms do NOT swing opposite arm and leg. They're distorted (i.e., left arm moves with left leg). If she really concentrates, she can do it right, but then she sometimes confuses her breathing pattern. Could this explain why she has trouble with her golf swing and tennis serve?

Answer:

As for the first part of your answer, the first thing you need to do is assess your client. If you are not assessing (length tension, dynamic movement patterns, neurological testing, SIJ, breathing, shoulder, spine, atlas, TMJ, pelvic, etc), you are guessing. Typically, when trainers or practitioners refer clients to me, the missing link is that they did very little to no assessments. If this is out of your league, refer out.

If I was to guess, it sounds like a couple of things. She may have and most likely has a flexion-extension imbalance. This can be and most likely is inner unit to outer unit dysfunction (most likely within her anterior and posterior oblique systems). If she is doing a back squat, you may be using too much weight and it is throwing her backwards. It does not matter if she can lift it. It matters if she can do it with quality of movement. Another thing you might want to try is front squats. This front loads a person, decreasing the amount of pressure on the discs and facet joints as well as creates firing of the short/long thoracic extensors and most of the anterior flexors of the body. It is a great leg exercise but an even better back exercise. The goal here in your training sounds like it needs to be taken out of the strength phase and regressed to the stabilization phase. This does not mean mat exercises only. It just means you have to alter the variables (sets, tempo, rest, sets, etc.) to match her physiological load. I would do some of the same exercises, but slow the tempos up a bit to get more slow twitch recruitment. This will eliminate outer unit compensations.

The second part of your question is quite intuitive on your part. As a CHEK Level 4 Practitioner, this is part of our assessment process. We do an infant development assessment to see where a person stops developing and at what age. It is quite an in depth assessment, but I will give you the gist of what is going on.

As we develop in the womb and as a child, we go through many phases of development. Linda Hartley in Wisdom of the Body Moving explains these as the star fish (naval radiation, primitive reflexes developed in the womb), the tunicate or sea squirt (mouthing pattern, developed when we breast feed, pushing and pulling stimulating the cerebral spinal pump), the lancelet (prespinal patterns), the inch worm (spinal patterns), the fish (spinal reach to pull pattern), the frog (homologous patterns = UE/LE), the salamander (homolateral patterns = R to L), the cat (homolateral pull to reach), the ape (brachiation) and the human. These are essentially the patterns we go through as humans. We assess these to see where a client stopped developing. This typically gives us answers on why someone is not “coordinated” and has trouble with contralateral or homologous movement patterns, with movements in life or sport.

We assess these all on a mat using different movement patterns (i.e., crawling, pulling, pushing, reaching and then standing) with more primal movement patterns (squat, push, pull, bend, lunge, walk and rotate). Also, we are assessing and looking at all the different development patterns. This helps to dictate the exercise program and whether we do things sitting, standing, single arm, ipsilateral or contralateral movements, etc.

When we walk, it is more of a contralateral movement pattern. Your client is doing it more like an ipsilateral pattern, which would tell me that she stopped developing around age three to five months and is stuck in the homologous stage of development. Here is what I would do:

  1. Homologous: Integrate movement patterns into her program for about six weeks that incorporate synergistic teamwork between pushing and pulling of the UEs and LEs. Examples are the forward ball roll, neutral stance squat to bilateral row, supine lateral ball roll, bilateral cable push, etc.
  2. Homolateral: After six weeks, start using more ipsilateral movement patterns. This would entail more pushing and pulling, same leg to same arm movements. This would entail patterns such as SA pull, SA push, etc.
  3. Contralateral: After that, you can start incorporating more primal patterns into her program. Also, you can use other patterns such as the crawl, horsestance, etc.

The other two important areas you should focus on are breathing patterns and naval radiation (inner unit work and proper recruitment). I find that most people’s developmental compensations and pain patterns highly correlate to breathing dysfunctions (inverted, hypo or hyper mobile ribs, decreased first rib angle, forward head posture, trigger points in diaphragm, etc) and lack of inner unit recruitment. This is where all life and movement begins and ends. If we can’t breathe properly, we die. So the body will compensate anything and everything in order for us to live!

This is quite a complex thing that takes a lot of time to learn, assess and incorporate into a client’s program. Do your research, and I am sure you will help her. Good luck!