By: David Iannicca MSEd, ATC, CSCS | Kansas City Royals
Where It Started
“Flexion is the devil”……”everyone is weak in extension”…..this has been drilled in my head over and over for years. Traditional training and education in the past has constantly reinforced the idea that our athletes whether due to poor posture habits or through improper training in their athletic development need to heavily train the posterior chain to get these athletes in a more “upright” and “correct” postural alignment. As we’ve learned and evolved throughout the years the traditional training model has gone from large group training programs to more individualized programs guided by specialized athlete screening to address an individual’s strength and flexibility imbalances. Even with this new approach there has still been an over emphasis and heavy reliance on the posterior chain musculature in training. While I fully agree some athletes need this larger emphasis there is also a large population of athletes which do not but have been grouped into this training programming anyways. This leads me to think back to the mindset that developed for years that all athletes needed to work heavily on thoracic mobilization and extension patterns as it was believed all athletes needed to address this as well since thoracic extension was the new buzz. For the longest time we addressed all these individual issues in isolation to correct postural problems but as we have evolved over the years we have begun to take a more global model addressing the total kinetic chain when prescribing correctives and strength programs.
Over The Years
Over the years through my own personal observations as well as data collected during pre-participation screenings a growing observable pattern has been noticeable in our athlete population of an “overextended” body posture or as the Postural Restoration Institute refers to as a “hyperinflated”. As we know from the early work of Dr. Janda there is a postural pattern we can observe that he refers to as Lower Crossed Syndrome. As we perform postural screenings on athletes we can observe this syndrome as tightness of the thoracolumbar extensors on the dorsal side that crosses with tightness of the iliopsoas and rectus femoris. In addition there is measured weakness of the deep abdominal muscles ventrally crosses with weakness of the gluteus maximus and medius. Sometimes in isolation to or in combination with this pattern we can see what Dr. Janda refers to as Upper Cross Syndrome where tightness of the upper trapezius and levator scapula on the dorsal side crosses with tightness of the pectoralis major and minor. When looking at athletes history who fall into these postural patterns common injuries seen involve the hamstrings, low back, hip, and oblique injuries.
A New Discussion
What I would like to talk about is corrective and training considerations when dealing with this overextended population that has this observed and measured isolation or combination of upper and lower crossed syndrome or as I stated PRI refers to as “overinflated”. These athletes typically visually present when viewed laterally with a bilateral anteriorly rotated pelvis and bilateral rib flares. PRI discusses an Optimal Zone of Apposition (ZOA) which is the cylindrical aspect of the diaphragm that apposes the inner aspect of the lower mediastinal (Chest) wall. Athletes displaying this overextended posture have lost this ideal ZOA and this can happen unilaterally or bilaterally. What we are going to focus on here is when it is lost bilaterally. In order to reduce and correct this postural pattern we need to reposition and retrain the diaphragm and abdominal musculature (obliques and transverse abdominus) correctly. The goal is to decrease posterior chain tone, restore the diaphragms ability for proper respiration and decrease its use as a postural muscle, and provide control of the rib cage and pelvis thus decreasing this extended posture. We can accomplish this by incorporating more flexion patterns, teaching posterior tilt (“tuck the tail”), better cueing during exercises, and maximize the power of full exhalation to depress the rib cage prior to and during exercise which puts the body in better alignment to decrease the overreliance on posterior chain musculature and decrease muscular tone.
Looking at ways to modify common exercises to incorporate these points take for example exercises such as planks, chops, and paloff presses. Without full exhalation, rib depression, and some degree of posterior tilt prior to exercise repetitions the abdominal region will be trained in this extended body positioning thus decreasing maximal power potential, strength gains, and core control since the abdominal musculature is being trained in an elongated and disadvantaged state. Athletes with extended posture performing these exercises in this state will commonly report feeling their low back musculature and lats providing the bulk of the stabilization thus negating many of the reasons we are performing these exercises in the first place and reinforcing the extension pattern. These points can be carried over to many of the primary lifts that our athletes have been taught and performed for many years. Let’s take a look now at back squats and deadlifts. The primary cues many have used is “hips back”, “chest up”, “show the logo on your shirt” on the ascent or dead pull. As you can see many of the traditional cues have put our athletes into hip anterior tilt, lumbar lordosis, and an overreliance on the posterior chain (erectors, QL, lats), as well as quadriceps to help perform the lift and stabilization when our lower half (especially glutes) and abdominal musculature in proper positioning for stabilization should be performing the bulk of the work. Rep by rep without correction and proper positioning we continue to further reinforce the lower crossed pattern.
In review without going into a specific exercise by exercise breakdown whether you’re an athletic trainer, physical therapist, or strength and conditioning coach you should be able to incorporate and see the importance of posterior tilt, full exhalation to set the rib cage, and better cueing in this extended population to better maximize the benefits of your corrective and strength training exercise selection. We need to stay on top of monitoring our athletes while they perform their exercises and lifts so they obtain proper body alignment and muscle activation prior to and during their training and rehabilitation work to maximize the full benefits. We need to move past our old beliefs that flexion is evil and that heavy extension work is the gold standard for all athletes. Throw away that old textbook, maybe sometimes flexion isn’t the devil we believed after all.