Supine Sagittal Stability and the T-L Junction

Often in my training logs or through other discussions, I have referenced 3 1/2 month old breathing or Baby Breathing.
This is a developmental kinesiology progression that I have learned in the DNS methodology that usually begins the spinal stabilization process.  The methodology suggests similarly to others that stabilization in the sagittal plane should precede stability in other planes.

As Baby develops int the first few months, and the Joint by Joint begins to govern, the first fixed point of stability that Baby uses to establish purposeful movement is the Thoraco-Lumbar junction.  This is ideally T12-L1, but I would not be so presumptuous that there isn’t safe and successful variability among different folks’ anatomies.

This is actually at least 7 months biologically, but the movement of the arms and legs comes around stability at the T-L junction.

Skipping some steps here, the T-L junction’s stability is probably easier to understand via the uprighting and vertical positions.  Consider anti-extension positions.  These include quadruped and plank challenges, any kneeling position, anything with 1 or 2 arms overhead, among others.  These are all positions where if we give in to gravity, the lower back will drop into extension.  Successful motor control of the movement or exercise will prevent extension.
This Steve Smith article on Mike Reinold’s site has some other brilliant pictures and the DNS background on this topic.

That's a nice plank right there. No sag. No extension in the spine.

Sickening push-up without control of extension. And I believe that dude counting is some kind of US Army expert on fitness.

Keep in mind that stability is the control of a system in the presence of potential change.  The ideal is what we see in the stiff plank above, but one of the aberrant choices for stability is approximating lumbar vertebrae at key points.  This can lead to success at maintaining a position, but it can happen at a cost.  Decreasing joint space anywhere can lead to DJD, and in the lumbar spine, DDD as well.  Stability isn’t always a good thing if it is not gained from an efficient and active position.  “Hanging” on passive restraint can garner stability.  However, it is not ideal for maximal force production/transmission or durability.

Dude, this looks really hot, but that arch in her back is a disaster. This is a "choice" to stabilize in the anti-extension position.

What makes the T-L junction maybe a little more critical is that there is ribcage attachment at this level.  Rotation @ this level pulls the rib cage superiorly effectively changing the puntum fixum of the diaphragm.  I believe the PRI folks would call this some alteration of the Zone of Apposition.  Dysfunction @ T12-L1 in terms of hyperextension yields both hip and t-spine dysfunction as the pelvis runs into the “open scissors” posture.  The anterior tilt of the pelvis and posterior tilt of the rib cage creates a visual of an open scissors in the lateral view.  You will really fold into Upper- and Lower-Crossed with a hinging @ this T-L junction.

So when pain or dysfunction sets in, the suggestion is that one of the brain’s first options to set off compensations is destabilizing the T-L junction.  It is not a conscious choice.  It is rather one that is mediated below our volitional control.  It is similar to when you have knee pain, and you simply can not put weight through the knee and foot no matter how hard you try.  Think of when you sleep wrong, and your neck is wry, until it releases, moving your head diagonally backwards is not something you can push through.  Bad posture is protective, and it is not something that sets in by our own choice of motor programming.  When pain hits the system, we have some fair research that muscles become inhibited, others become unreliably facilitated, and the motor program inherits somewhat of a virus and begins to do its own thing.  The program has good intentions: to protect or compensate against a threat in the system.  Locomotion and primary movement may be preserved in the short-term, but there is an enormous cost, not just at the spine.  When it is inherent that you achieve a skill through movement at the T-L junction, there’s a good chance the whole thing is shot.

Now back to the beginning.

When Baby is in its first few months, supine is the preferred position.  And before the legs are able to kick around or arms reach up for something, there has to be a fixed point of stability for which Baby can move around.  That first point of stability in Baby’s development in the supine position is the T-L junction.  So through the different methods that espouse the Neuro-Developmental patterns, this supine position is an early option for both painful and non-painful individuals.  As you will see, it is almost a regression from the Leg Lowering 1 and 2 corrections for ASLR and MSF.  Given the reaching effects of the T-L junction, this supine stability position to establish intra-abdominal pressure can be be used to correct many postures and movements.  Using this segment as the link is far less efficient as using the 5-6 chains of the lumbar spine as the link.

The position is fairly simple to execute and is probably similar to some yoga positions that have names like Long Bird or Supine Flamingo.
Start supine with the neck packed.  The line from the crown of the head should be parallel to the floor that you are laying on.

That's Lee Burton. That's a 1 on the ASLR. And that's a packed neck on the bottom..........

.......just like every baby you see on their back.

At the initial position, the arms can be loose or at the sides or driven into the mat to deepen or establish the centration of the scapulae.  This may allow the t-spine and neck to lengthen further, which allows for a more appropriate breath.  Establishing the appropriate breathing pattern is the ultimate goal of these positions as the breath in these NDT positions can trigger a release of tone and restore centration and stability.

Hands can touch as far as……

the floor, random (holokinetic) reaching  @ 3.5 months,
the groin or private area @ 4 months,
the feet @ 6 months, and
the feet into the mouth @ 7 months.
The furthering of the reach pulls the shoulders out of centration which gives Baby a reason to reset them back over the posterior ribcage.  It is a brilliant of example of what we know as RNT in the FM System.  We stabilize and learn to move based on having a reason.  The reason in this case are the urge to explore the sensory-rich regions of the body.  The flexion moment is met with upper quarter stability, and the T-L junction reacting to the floor allows for this occur.

The feet will contact……..

nothing @ 3 months,
big toes to each other @ 4 months,
medial edges to each other @ 5 months, and
via the soles to each other @ 6 months.
The feet progressions differ than the upper body in what the body is reacting to.  You can see that these progressions lead to a little more hip external rotation.  Slight hip external rotation is the centrated position of the hip.  With the appropriate muscle balance around the joint, the pelvis can set out of any anterior pelvic tilt and facilitate the breathing pattern.  You can grow mobility through the lower levels of breathing, or address the hips with manual therapy and come to these sagittal stability positions.

T-L Junction is where this all starts,..............

.........this is where it gets you.Interesting neck position too on the guy in front of the pack compared to the ones trying to find some extra gear they don't have.

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15 Responses to “Supine Sagittal Stability and the T-L Junction”

  1. Vincent says:

    Very fitting topic. Thanks for driving up…always great to see you, Charlie.

  2. Charlie says:

    Always, my friend. Always.

  3. Mark McGrath says:

    Great post Charlie. Loved the photographs you have chosen to illustrate teaching points. The mixed messages around what constitutes core stability are clarified through this overview.

    Congratulations,
    Mark

  4. Charlie says:

    Glad you’re on board, Mark. Thank you.

  5. Erik Lavesson says:

    Very interesting article. Thank you very much for providing this information.
    Erik

  6. Randy Macy says:

    Charlie,

    This article hits very close to home for me and some of the problems I have with my body.

    I had the pleasure of seeing you speak at Northeastern University in May of 2010 and have followed your work ever since. I was an Athletic Training student there at the time and I worked extensively with Art Horne, and helped him set up his conferences in 2009 and 2010. All of which were amazing experiences that I am extremely grateful for and humbled by. I’m certified now and working at an orthopedics clinic in the San Francisco Bay Area.

    Anyway, my question is do you know anybody in the San Francisco/San Jose, CA areas that does truly quality work as a rehabilitation professional? I’ve had more than my share of spine, hip, shoulder problems (some earned via snowboarding and mountain biking, and some more mysterious), and even though I’ve narrowed things down a lot on my own, I still need somebody who can comprehensively examine me pretty much from head to toe and treat me as well as teach me how to help myself recover.

    Thanks and keep up the great work!
    -Randy

  7. Charlie says:

    Randy, I was very impressed with Anthony Gilbert, who is a manual therapist in San Mateo I believe. He was one of my instructors for ART upper.
    I am sure he is an excellent choice for manual therapy.

  8. Brad Cole says:

    Charlie, that’s the most comprehensive yet concise explanation of respiratory stability I’ve seen. Glad you wrapped in the developmental principles and apply it to athletic performance. One more link cephalad and you have a entire discussion of T5, craniocervical and temporomandibular stability. I’d be interested to read your thoughts regarding athletic performance and stability of the masticatory system.
    Thanks for the efforts. Thanks for sharing.

  9. Cian Lanigan says:

    Great article. So concise I had to read it twice! Keep up the great work.

  10. dave says:

    So would it be a bad idea for chiros,pt’s,etc to manipulate/mobilize the TL spine in most people being that its designed more for stability?

  11. Charlie says:

    It would not be a bad idea as my belief is that reflexive stability is not ideal if the joint system does not have requisite mobility to begin with.
    Whether manipulation is the answer is certainly for debate.
    But the mobility should be determined from multi-segmental testing and breaking out the weakest link. Then address as fit.

  12. trayl says:

    Thanks for a great educational piece Charlie.
    Do you look for expansion at the TL junction at all in your assessments or just no extension.
    i know you encourage us to get fat and i do this with my clients but i do find some folk will take in huge belly breaths with no getting fat at the back at all.

    If they are supposed to demonstrate TL spine expansion what is actually happening there to cause this.I do have some yogis that know a bit about the diaphragm and they reason that if it shortens then because of its attatchments to the lumbar spine the pull would naturally take the TL spine into extension.
    When you have time could you explain this?
    Thanks for your good information.

    Trayl.

  13. Charlie says:

    1. Yes, the lateral expansion of the breath should extend posteriorly. Remember the parachute effect – posteriorly are the multifidus which are one set of strings from the harness to the chute.
    There are many, and I think a lot of them are yoga folks, that demonstrate the umbilicus protrusion and/or descent but are completely devoid of distal, lateral, or posterior expansion.

    2. There are far too many “reasons” to see a deviant spine, many with tiered causations. The reliable approach is to break out the movement, prioritize the faults and/or pains before suggesting anything.
    That being said, a dysfunctional diaphragam or an undesirable aysmmetrical pattern of the diaphragm can cause this. It is simply not the only cause.

  14. Karen says:

    Great post! I’d actually be interested in sharing this post on my website if you’re keen? My practice is all geared to central stability via the diaphragm and pelvic floor to gain peripheral stability to the upper and lower extremity.

    Awesome job!

  15. Drew WIlliams says:

    Very nice explanation Charlie. Using this position to re-establish T-L junction seems to have a wide range of potential benefits from allowing more efficient change of direction in field/court sports, to improving hip/trunk rotation for golf swing, to recovery. Keep up the great work!

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