The sagittal plane comes first.
There's no intro for this concept because wasting time, giving the run around instruction/treatment, and delaying the truth is exactly my impetus for writing this piece in the first place. When trainers, coaches, fitness professionals, therapists, and all manner of movement specialists coach movement many seem to forget that our bodies are tri-planar beings.
1) Sagittal = front to back, forward and backward (think of the motion for first down)
2) Frontal = side to side, the way the lines run on a football field
3) Transverse = circular motion
Too often I hear complaints of "My hip pinches when I squat," "My shoulders pop, click and grind when I raise them overhead," "The front of my knees always hurt after squatting," and the reaction from their instructor is to push the knees out or squeeze your shoulder blades together. This is conceptually completely backwards. Here's why...
This picture depicts the common compensations in postural alignment that are the result of an excessive anterior pelvic tilt, a sagittal plane deficiency. When the pelvis rotates forward in the sagittal plane, the muscles on each side of the pelvis alter their resting length.
Flexibility is the ability to tolerate stretch on your muscles, but their theoretically is a limit to how far muscles can go. For this reason, an anterior pelvic tilt makes your hamstrings and quads feel tight. Hamstrings because they are long and taut (see this awkward video for more on this) and your quads feel tight because they are resting at a shorter length and are recruited constantly in a force couple with your low back to hold you up right.
Voila, angry front of the knee, pinching of the hips during squatting. An awesome cue used appropriately during an exercise might mitigate this, but it might not. You might need to train control over your sagittal plane before engaging in challenging tri-planar movements like squatting, running, lunging, cleans etc.
Another example of when poor sagittal plane control results in poor performance and induces pain is during overhead pressing.
If the hips are in an anterior pelvic tilt, the abs are lengthened at the front of the rib cage, the lats and lower back muscles are shortened in the back of the rib cage, then the entire rib cage tilts back. The front ribs flare and the shoulders appear rounded forward.
If you are having pain or issues with overhead shoulder motion sure, your pecs might be tight, but your lack of sagittal plane control at the rib cage and shoulder blades is what's causing that tightness.
Having made is this far into the rant I believe it's important to point out that as a health care practitioner we have two options during a treatment session. Do we treat the symptoms, or do we treat the cause. As a consumer you might not know the difference, and the words your practitioner uses might mislead you into thinking you are doing one versus the other. So here it is.
Ice, E-stim, ultrasound, dry needling, cupping, laser (lol), hot packs, manual therapy, foam rolling, massage, myofascial release, stretching, IASTYM (the metal or plastic thing they rub you with) and mobilizations are all treating symptoms. Something is tight, sore, restricted, straight up painful, make it feel better with one of these symptom modification techniques.
Education and exercise. These are the only treatments that address the cause of your pain. If you are able to understand why you are feeling pain and dysfunctions, you can do something about it. Therefore, education treats the cause. If you have a postural dysfunction that is altering the flexibility of muscles, fascia, joint capsules or is causing weakness then carefully chosen exercises can reverse the dysfunction, therefore exercise treats the cause. If inappropriate technique or poor tolerance for movements without biomechanical implications is causing your pain exercise can mediate this as well, treating the cause.
The good thing about this is that you have the power to decide what is best for you. Unlike systemic disease where a foreign body (or your own defense system) has come to destroy you and you are at the mercy of our current medical knowledge, your physical health is all up to you. Sure, someone can make you feel better, but only you can make yourself actually better. You may need guidance, and if you do seek it from someone you trust, but don't expect your physical health to be in the hands of another. If you do commit the responsibility of your physical health to another, you will most certainly be disappointed eventually.
If you do not know where to start, begin in the sagittal plane. Can you roll your hips back and perform a posterior pelvic tilt (youtube it if you don't know), can you exhale and bring your ribs down, tucking them right into your belly? Good, now go the opposite and see how it feels. Does it feel under control? Is curling yourself up into that posterior pelvic tilt and exhaled rib position harder? Is extending painful? GOOD. Your like most everyone else. Get better at your weaknesses, understand your whole body is connected, and train with a brain.
For those of you who want more information of Tri-planar exercises, programming, integration into complex exercise and treatment principles, sign up for my newsletter at