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King and Queen

I am a huge Game of Thrones guy. The anticipation that grows over a year is near unbearable. Also unbearable, is when we as physical medicine and movement specialists overlook the king and queen of movement. (Yes, this is a PT blog not a GOT blog...unfortunately).

The King is your Thorax, the Queen is your pelvis. No, these bony structures are not gender defined, rather they are ranked by importance for producing clean, optimal movement patterns.

The Thorax

The Thorax is comprised of our ribcage and spine. It is absolutely necessary to understand the mechanics of these two structures if you hope to program and cue proper movement patterns in your clients/patients/athletes or self. The rib cage can flex, extend, internally rotate, externally rotate, and side bend. That might seem like a lot for a bony structure that we don't see move very often but picture this (see pictures below).

Flexed Rib Cage

Ribs are down in the front.

Extended Rib Cage

Side bent Rib Cage

Ribs are up in the front.

Ribs are side bent to right in this photo.

Internal and external rotation are a little trickier to understand. During daily life it is less common that we are flexing or extending both sides of our rib cage and more common that we are doing this on just one side. This is because our ribcage rotate back and forth as we walk and run. Imagine combining a small degree of the flexion and the side bend together and you would get internal rotation, the opposite side of the rib cage would be externally rotating.

Moving on...

If your body does all of these motions adequately then you likely don't have any issues. If you aren't able to do all of these than you may be experiencing tight shoulders or shoulder pain, a stiff neck or cervical spine pain, tight upper back and shoulders, a sore sternum or center of your chest where your pecs connect, low back pain (one of the million reasons why you might have LBP) or really poor cardio-respiratory function.

Let's think about that for a moment, if your rib cage (thorax) isn't able to move in all three planes of motion (flex/extend, side bend/side bend, internally/externally rotate) a bunch of different areas could affected? How do I know if my rib cage can do all these motions?

You examine your ribcage angle, your shoulder motion, your neck motion and your low back motion. Everything that hurts! Makes sense right? Physical therapy isn't that mysterious after all.

Well actually, it probably is. Because all PT's are not basing their examination and intervention off of the same knowledge base. Most PT's don't even recognize the rib cage as being a source of dysfunction. Which to me is kind of crazy. All extremity motion begins in the center and moves out. Therefore, your rehab strategy should as well.

The Thorax is king because the motions discussed above are produced and controlled by the abdominals and back musculature. Since the abdominals and back connect to the pelvis, a solid "core" needs to precede pelvic and lower extremity training.

The Pelvis

The pelvis is amazing because of how complex it is. However, you do not need to understand the complexity of the pelvis to train it appropriately in three planes of motion. What you really need to understand is that you will organize the muscles of your hip based off how your foot is planted on the ground. If your foot is flat, with your heel and toes in contact with the ground, you will get balanced activity from the anterior and posterior thigh. Depending on where your leg is in relation to the pelvis will determine the balance between inside and out side hip muscles.

A leg thats in front of us (all by itself, like in a lunge or split squat) is going to recruit the glutes and quads (hip extensors and flexors) to maintain balance. A leg that is beneath or behind us (in a single leg kneel position) is going to to recruit hip abductors and adductors to maintain balance. should always have hamstrings. Both positions (leg forward or back) require strong anti-gravitational demands and the hamstrings are key for that demand.

Assuming (and it may be grossly inappropriate to do so) that you have adequate foot placement and core control (the thorax is king after all) then performing split stance activity should exercise the tri-planar nature of the pelvis. Lateral split stance (skater's lunges, lateral stairs) will bias the frontal plane while forward and back split stance will bias the sagittal plane. The nature of split stance will always challenge transverse plane.

In situations involving pain it is not always wise to begin exercise up on your feet. Pain is a strong sensory input that can overrule our body's ability to organize properly. This can create compensatory patterns of movement that lead to further injury or limit our ability to exercise our variable movement strategies. .....What?

If your hurt, it is difficult to ignore pain and move properly. Moving properly will stop pain over time, but in the short term you need to identify activities that do not challenge your body so much that you need to compensate. These compensations will likely result in pain now, and pain later as well.

When things do not feel right, our back are tight, our necks are stiff, hips feel pinchy, shoulders clunk, or anything in the body that is not ideal, there is likely a cause. Living in pain is common, but not normal. If you feel you are not a victim to your pain, that it is just a side note that doesn't impact your overall well-being, ignore it. If it impedes on even one aspect of your life, get it addressed. My philosophy is not to make everyone a movement robot, instead I teach people how to express their range of motion and smooth out the kinks of their movement patterns that create and extend injury. Seems pretty simple but it is not the typical mindset of practitioners or patients. Many practitioners believe that something must be done to a patient to make them better. I believe your body has the answer, I just need to show you. Many patients believe that the practitioner needs to "fix" them, I believe you are fully capable of fixing yourself, you just need guidance. If every math teacher walked you through the equation rather than showing you the way and allowing you to learn, you would have never learned long division. You body is complex, but so is most everything in our world today.


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