Physical Therapy, Movement & Strength

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Here you’ll find my philosophy about movement and pain relief, and how that meshes with my philosophy about strength. I’ll also regularly update the site with answers to the most common questions I get asked from my patients, from personal trainers and coaches, and from my fellow physical therapists.

Lower Crossed Syndrome

When questions about lower-crossed syndrome and weak glutes, my first thoughts are to consider all four components to the lower-crossed. Weak glutes are just one quarter.

Tone through the hip flexors and lumbar spine may yield very dominant reciprocal inhibition of the glutes. Activating the glutes until the cows come home will only get you as far as the hips and low back let you.

Poor core stability and/or sequencing may also leave the potentially strong glutes unable to express their strength.

If the client or patient’s low back is dominant, minus manual therapy, here are some options for releasing tone in the lumbar spine.

  • Exercise-wise, take a look at their toe touch.
  • Can they touch their toes? No Lateral shift. Posterior Weight shift through the hip hinge? Can they reverse their curve into flexion as they drop down?

The last quality is one that might not see even if someone can actually touch their toes.

The fixes include……

Flexion Heel Sit
–Here is where flexion as a movement is a necessary evil. You use if it works, and then you are done with it. Proper Breathing at the end of this or Child’s Pose is almost mandatory for this to be the magic fix you see sometimes.

Cat/Camel or Upward/Downward Dog
–Same as with the heel sit, this is a great time to impose breathing. I think a trigger for the inner core is extreme mobility and extreme stability. This past weekend, we saw a lot of dysfunctional breaths cleared up once you get into a very challenging position.

Quad Squat
–This is the technique you’ve seen on Primitive Patterns where you are quadruped, and you sit back into a Swiss ball or soft contact that allows you some posterior movement until the slack of the ball is picked up.

If you do have manual therapy at your avail, trying to strip out the lumbar extensors in quad squat while breathing can basically restore a flexion curve in a few minutes.

Also, I choose to refrain from foam rolling through the lumbar spine, but I think you probably can do some things with the Akrowheels or tennis balls that don’t go right over the lumbar spine and provide a high and strong fulcrum into extension.

Or if the person has problems with all four parts, I would always start with the hip flexors and hip mobility first.

There is a role for the first suggestions, but like all corrective exercise, they are on an as-needed basis, and they are specific to one point of a lost toe touch.

They won’t hurt to do as they are challenging and a good place to practice proper breathing. I just want to put these ideas into the proper perspective.

As far as qualifying the value of glute activation, try this….

  • Put someone prone and stretch them into hip extension with a bent knee. Then let go. See if/where the leg drops. Did the low back curl into extension. This shows the glutes are always going to be fighting the tone of the lower-crossed. It can be both from the hip flexors and low back or one or the other.
  • Another option is the Janda Hip ABDuction test, or my version, which is putting in-line with the frontal plane of the trunk and letting go. If the hip glides forward, you know they are a mobility lower-crossed problem. If the person just rolls backwards or falls off the table, they are a stability lower-crossed problem.

I don’t think you can do too much glute activation. I am speaking more to the level of efficiency you might achieve if you go after the facilitated segments first or with more vigor.

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