POS: Reduce Pain and Increase Performance

SwingDysfunction of one movement system can lead to a multitude of injuries. Treatment and care for one movement system can prevent our most common ailments. Most potential clients I interview complain of one or more of the following: sacroiliac joint (SIJ) pain and instability, non-specific low back pain (LBP), chronic hamstring strains or tightness, and peri-scapular and thoracic tightness or pain. Whether these complaints are isolated to one body part or involve many, the pain can typically be resolved by treating dysfunction of the Posterior Oblique Subsystem.

 

What is the Posterior Oblique Subsystem (POS):

As described by Neumann, (2002), Aaberg (2007) and NASM (2011), the POS is one of the 4 major global  movement systems of the body. The system is composed of the latissimus dorsi, thoracolumbar fascia, and the gluteus maximus. Using the thoracolumbar fascia as a bridge, POSthe upper extremity is connected to the contralateral lower extremity. Although not described in literature as being part of this system, I consider the gluteus medius, biceps femoris, sacrotuberous ligament, erector spinae, serratus anterior and teres major to also be part of this system. This is based on my clinical observations and knowledge of the underlying functional anatomy, muscle synergies and predictive movement impairment. The POS is strongly correlated to the Back Functional Line and loosely associated to the Superficial Back Lines as described by Tom Meyers’ Anatomy Trains (2001, 2009, 2014).

Function and Dysfunction of the POS:
ThrowThe diagonal pattern and line of pull of these structures makes the POS system powerful in the propulsion in gait and sprinting. It is also responsible for the eccentric loading during the swing phase of gait. Rotational activities such as swinging a baseball bat or throwing a football are also heavily reliant on the strength and integrity of the POS system. Tension across the POS helps stabilize the sacroiliac joint and lumbar spine.

If the POS system is not functioning optimally, it can lead to the injuries I mentioned in the opening paragraph: SIJ dysfunction, LBP, mid-back tightness, shoulder pain, and chronic hamstring strains.  Lack of integrity and ability to stabilize the pelvis can also lead to chronic knee pain. A dysfunctional POS also reduces metabolic efficiency during sport-specific movement, like running and cutting, making an athlete less powerful and more susceptible to fatigue.

Treatment options:

Manual therapy to reduce hypertonicity along the POS system is beneficial. Muscle energy works well for the lat, teres major, and biceps femoris. Attack the local, stabilizing muscles of the peri-scapular region and gluteus medius with positional release technique (strain-counterstrain). Use the fascial release technique as described in Meyers (2014) to release the thoracolumbar fascia. Follow manual therapy with static stretching.

Exercise to improve POS dysfunction:

The exercises below are designed to work on multiple levels. First, strengthen the muscles of the POS system. Second, put the muscles of the POS through a full range of motion to improve dynamic flexibility, and third, improve mobility of joints impacted by the POS dysfunction.

  1. Cross-leg RDL w/ Med Ball Reach:
    • Begin by standing tall while holding a medicine ball.
    • Cross left leg over the right.
    • Keeping the right knee straight, bend at the waist to perform an RDL.
    • At the end range reach the medicine ball to the floor about 1 ft. to the right.
    • Squeeze the glute to return to the standing position.
    • Perform 8-12 repetitions then switch to the other side.
  2. S/L RDL withPNF:
    • Begin standing tall on the right leg, while holding a weight in the left hand.
    • Keeping the right knee straight, bend at the waist to perform a single leg RDL.
    • As you bend reach the weight toward the floor, directly under the left shoulder.
    • Squeeze the glute to return to the standing position.
    • While returning to the standing position, bring the weight to the left shoulder and reach over head.
    • Perform 8-12 repetitions then switch to the other side.
  3. Single arm standing tubing row with rotation:
    • Begin wrapping moderate resistance tubing around a stationary object.
    • Standing feet shoulder width apart, knees slightly flexed, hold arms straight out front of you while holding the tubing.
    • Squeeze and depress the scapula.
    • Perform a row with the right arm, and at the end range of motion, rotate the spine to the right.
    • Slowly return to the starting position.
    • Perform 8-12 repetitions and then switch to the other side.
  4. Squat with unilateral row and rotation
    • This exercise is just a progression of the standing row with rotation and will incorporate the glutes into the routine.
    • Begin wrapping moderate resistance tubing around a stationary object.
    • Standing feet shoulder width apart, hold arms straight out front of you while holding the tubing.
    • Drop in to a squat while holding arms straight out in front of you.
    • Squeeze the glutes and press through the heels as you return to the standing position.
    • While returning to the standing position, simultaneously, perform a row with the right arm and the end range of motion rotate the spine to the right.
    • Slowly return to the starting position.
    • Perform 8-12 repetitions and then switch to the other side.

Another exercise I really love is an exercise that was adapted from Gray Cook’s SMFA, but is best explained by Brent Brookbush of the BrookbushInstitute.com. If you have never ventured to Brent’s site, do it. Also check out his YouTube channel. It is fantastic. Brent modified Gray Cook’s assessment to create a Thoracic Spine Mobility and Strengthening exercise. Take a look at the video below. I use it and have great success with it.

Summary:

Many musculoskeletal complaints of pain and injury can lead back to suboptimal efficiency or dysfunction of the POS system. By targeting the tissue through manual therapy, flexibility and strengthening, we can resolve many common injuries such as SIJ dysfunction, LBP, shoulder pain, chronic hamstring strains and chronic knee pain.

If you or someone you know is suffering from chronic pain and recurrent injuries, please feel free to contact me.

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