top of page
23659601_999860710152073_1397690620411853996_n
20664120_949941531810658_5006612002250258639_n
21761429_970035739801237_7334297301715121703_n
20257925_941417482663063_4738936754064667886_n
20106793_936822259789252_5033897353813634431_n
21317931_963615753776569_1546276555196863516_n
22008490_973284039476407_7446279369902673746_n
18920384_911092909028854_4555721020217591900_n
10430836_413427592128724_4999900465774528563_n
18194081_890657407739071_8075724334759484768_n
13164292_705438639594283_118538911446125776_n
18274866_890684221069723_6346910833661207128_n
18557312_899544083517070_2354976360421472177_n
18620354_903314326473379_5430082152329806607_n
19510585_923187257819419_2727884357163682846_n
19029740_915205631950915_217593412222556368_n
18198387_891375494333929_4026322297313286896_n
18447597_900172296787582_2072711910123019911_n
17862638_878552488949563_9109501673082199010_n
17861646_879221222216023_4755849282761436531_n
17626274_872091332929012_8269211074528783061_n
17021973_855421667929312_5623163240194108970_n
17308695_866733623464783_1673764234576834642_n
16939584_855421207929358_6395076236197910383_n
14370051_10208513917980520_766132139062934083_n
12961547_691181894353291_3180328181216505992_n
10419541_464622017009281_1509043394393740006_n
857634_222015861269899_488600969_o
13592436_727541030717377_2747774402982660851_n
13669551_730613753743438_424863794377906552_n
13700009_733613173443496_2264190926293452358_n
13882199_739842026153944_2829506856160370089_n
941339_686028568201957_3541043139625850057_n
IMG_3391
DSC_4318
DSC_4327
DSC_4288
DSC_4405 - Version 2
DSC_4341
DSC_4354
DSC_4296
Jack
IMG_3849 (1)
06-06-12 595
DSC_4218
DSC_4243
DSC_4270
punch_pull-0399
Casey
jackstep
IMG_2106
bbe59e9e-fe45-4752-8c61-d514448da963
matt+northeast+music+fest
What's it all mean

All patients have 2 things in common.

They live in gravity and they have to breathe. These 2 truths are at the heart of most postural compensations.

 

Gravity influences posture and movement as the brain will seek stability over mechanical correctness by shifting a patient's center of gravity away from an instability to maximize base of support.  Stability is gained but motion is lost as resting position is now shifted away from neutral. Nowhere is this more evident than in gait. As the center of gravity shifts to achieve stability, patients start to favor one of their legs and the entire body will shift in kind as seen in asymmetries. This leads to mechanical insult and with time, a pathology along the kinetic chain.

​

Respiration becomes compromised secondary to the systemic shift. A major part of favoring one leg for stability is the accompanying shift/rotation of the pelvis. In a rotated position at least half of the pelvic floor is compromised and therefore can not provide respiratory support for the diaphragm. With pelvic floor opposition lost respiration  becomes dependent on extension and auxiliary muscle of respiration including the neck and back.

​

Patients that present with this shift will have asymmetric objective findings in range of motion, morphology, and strength. 

​

The following treatment  progression overview is a  neuromechanical algorithm that we utilize to communicate to patients and their referring providers about initial deficits and progress.

​1. Is the patient Neutral?                                                           Sagittal Plane.​

 

Assessment: hip rotation symmetry, passive hip abduction symmetry, negative adduction drop test, lumbar rotation symmetry, infrasternal angle, shoulder rotation and horizontal abduction symmetry, cervical rotation, squat test, standing reach test

                                                               

Patients with asymmetric findings are stuck in a neurologic pattern of unilateral stance and inhalation. This changes the positioning of the pelvis, spine, trunk, diaphragm, and costal cage (as represented by the square).



Treatment Goal: Neutrality through Reposition/Inhibit/Exhale

 

​2. Is the patient Stable?                                                          Frontal Plane. 

​

Assessment: joint range of motion,  adductor lift frontal plane strength, abductor lift frontal plane strength, side plank integration,

 

Patients that exhibit too much joint range of motion are mechanically unstable.

Patients with frontal plane weakness are neurologically unstable. Both types of instability will result in compensation and postural shifting from C2 down (as represented by the arrow going from neck to the ground).

​

Treatment goal: Frontal plane integration. First on the table until adductor lift scores are >3/5, then in gravity with supported activities, and then integration with gait activities.

3. Can the patient reciprocate?                                        Transverse Plane

​

Assessment: AF stability test, single leg balance, retro gait, alternating reciprocal test,

ability to maintain neutrality and stability with tri-planer activities. 

 

Patients that have deficits in the transverse plane often present with poor balance. They are not able to hold positioning of the axis of rotation. Balance is triplaner strength. Patients need to be able to control pelvis on femurs to achieve alternating gait of right stance and  left stance.

​

Treatment goal: Transverse plane integration.

 

Integration of gait activities without compensation.

bottom of page