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Predictive Model of Upper Body Dysfunction (UBD): Signs of upper body postural dysfunction; muscle, joint, fascia, nervous system, neuromuscular recruitment, subsystems, and core muscle contribution. Exercise selection related to upper crossed syndrome, rounded shoulder posture, forward head, and neck pain.

Upper Body Dysfunction (UBD)

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 is an edit and update of previous postural dysfunction models (e.g. Upper-crossed Syndrome, Rounded Shoulder Posture, Protracted Shoulder Girdle, etc.). It is important to recognize that in these models the term "posture" is being used as an analogy for "ideal alignment". Similarly, when movement professionals refer to upper body posture, good posture, poor posture, better posture, etc. they are referring to this analogy of ideal alignment; not the rigid positioning implied by the colloquial use of the term "posture."

Postural dysfunction and movement impairment syndromes are likely the beginning of "modeling". Modeling has significant potential to aid in refining clinical decision-making, intervention selection, program design, and improve the reliability and effect size of outcomes. It is particularly helpful for aiding in the interpretation of multi-variant problems, which is how all clients and patients present. The 

 recommends that all sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) consider these models to aid in refining decision-making in practice.

Lumbo Pelvic Hip Complex Dysfunction (LPHCD)

 Arthro- and osteo-kinematics alignment maintained by optimal myofascial activity and length, as a result of sensation, integration, and activation by the nervous system - both statically and dynamically.

 The absence of ideal posture as a result of maladaptation by one or multiple tissues within the human movement system.

Modeling patterns of movement impairment correlated with orthopedic dysfunction, based on all available evidence, with the intent of predicting best-practice assessments and techniques, to optimize measured outcomes.

Anterior Tipping: SC joint, AC Joint & Scapula

Excessive Kyphosis: Thoracic Spine and Costal Joints

Hypo or Hypermobility: Glenohumeral Joint

Forward Head Posture: Cervical Dysfunction

Elevation and Stiffness: First and Second Rib

Anterior Pelvic Tilt (Excessive Lordosis)

Spine/Trunk Flexion during "Overhead Squat with Modification: Arms Down"

 (Unilateral Upper Body Dysfunction is rarely the cause of an asymmetrical weight shift, but it does occur. It is more likely that an asymmetrical weight shift is caused by LPHC Dysfunction, 

Correlated Injuries, Pathologies, and Pain

Facet joint dysfunction in cervical and thoracic spine

Neuritis (median, ulnar, radial nerve distributions)

Course Description: Upper Body Dysfunction

Introduction

For an introduction to Postural Dysfunction and Movement Impairment please refer to the article:

Introduction to Postural Dysfunction and Movement Impairment

“Upper-Body Dysfunction” (UBD) is a purposely chosen title for the impairment discussed in this article. This reduces the risk that the title itself will imply a certain set of joint actions, muscle activity, or length/tension relationships that may prove to bias or limit the future advancement/evolution of this model as more research becomes available. Common compensation patterns leading to upper-body impairment have been previously described as upper-cross syndrome and/or a protracted shoulder girdle (1,2,7). However, the titles themselves may be inaccurate in describing upper-body dysfunction. For example, protraction may not be the primary “action” noted at the scapula, and newer models of dysfunction describing muscle activity do not follow a “cross” pattern. Giving credit where it is due, the underlying precepts of Janda’s work are the foundation of much of my work on postural dysfunction and movement impairment, and I am thankful for his inspiration. The model asserted in this article closely resembles the compensation patterns described by Shirley A. Sahrmann in 

 with a few notable exceptions (7). The largest exception being the attempt of this model to illustrate a common thread between all upper-body impairments and present one primary compensation pattern. The corrective exercise strategies discussed later in this article are used by the 

, have their foundation in the corrective exercise model (CEx) developed by the National Academy of Sports Medicine (NASM), and described in the text “

NASM Essentials of Corrective Exercise Training

” by Dr. Mike Clark & Scott Lucette (7).

Why We Need a Better Model

Signs of Upper Body Dysfunction

Lateral Flexion of the Cervical Spine: > 35-45°

Arthrokinematic Dyskinesis (Joint Dysfunction)

Anterior translation of humeral head in the glenoid fossa

Superior translation of the humeral in the glenoid fossa

Superior and posterior translation with posterior rotation of clavicle at the acromioclavicular joint

Superior translation and posterior rotation of the clavicle in the sternoclavicular joint

Cervical and thoracic spine stiffness (positive spring test)

Costovertebral and transversecostal joint stiffness

Innominate "upslip" on side of dysfunction

Innominate anterior rotation on side of dysfunction

Associated injury, pathologies, and pain associated with UBD:

Postural/Movement Assessment

Postural dysfunction affects length/tension relationships, resting tone, afferentation, alters proprioception, joint dyskinesis, and maladaptive changes in connective tissue length (2,7,8). These neuromuscular and articular changes have an impact on force output, coordination, and endurance, leading to a decrease in performance. A model of UBD that implies a set of corrective exercises will be instrumental in refining movement prep/corrective exercise warm-ups for use in performance enhancement programs. In my opinion, the corrective warm-up renders the “general warm-up” obsolete. You have 2 choices before you start training – “improve the quality of human movement and optimize mechanics, or spend 10 minutes on a treadmill reinforcing your compensation patterns.”

Movement/postural impairment can be assessed either statically or dynamically. Conceptually postural/movement assessment is not complicated. We start by examining joint position and the effect that has on relative muscle length:

Know what good posture looks like (ex. plumb line during static standing posture).

Note each joint or joint system “out of place.”

List the joint actions that have occurred to alter joint position.

List the muscles that will contribute to these actions – these are “short” muscles.

List the opposing muscles to these joint actions – these are “long” muscles.

Traditional Model of Upper Body Dysfunction:

In the “Traditional Model of Upper-Body Dysfunction” (a.k.a. upper-cross syndrome or protracted shoulder girdle) the scapulae elevate and protract (shoulder girdle), and the shoulders (glenohumeral joint) internally rotates.

If we stay true to the graph above we would release and lengthen the short/overactive structures, and activate and integrate the long/under-active muscles. The first flaw with this model is the exclusion of several glenohumeral muscles.

HMS Rule #2: Every structure (muscle) that crosses a joint will affect joint motion.

How does UBD affect the relative length of the 

, biceps brachii, and long head of the triceps? For example, the relatively common occurrence of biceps tendonitis may be an indication of a relative change in length and/or activity of the biceps brachii. Could it be short and overactive?

Consider the following muscles from the graph above.

Experienced DPTs, ATCs, DCs, and corrective exercise specialists may “feel” as though these muscles are on the “wrong side” of the graph. As an experienced clinician/trainer you may understand the concepts above, but “feel” the muscles do not “behave” that way. For example, the 

 is listed as long on this graph, but practice would dictate this muscle as short and overactive. These “feelings” do have a place in our refinement of this model – they illustrate in-congruence between theory and practice.

Using Chronic Conditions to Refine our Model

Serratus Anterior

The Serratus Anterior

Hyperkyphosis

What Can “Trigger Points” Tell Us

Upper Body Trigger Points

The Rotator Cuff

Rotator Cuff - Side View

Refining the Upper Body Dysfunction Model

A New Model of Upper-body Dysfunction (UBD)

How does downward rotation of the scapula occur when I clearly see the scapula elevate during an assessment?

It’s an optical illusion, kind of… What you see is the superior angle (superior/medial corner) of the scapula elevate, but the glenoid fossa remains fixed. That is to say, downward rotation of the scapula can occur as it is traditionally taught – glenoid fossa moving inferiorly, or as elevation of the superior angle of the scapula around a fixed glenoid fossa.

The diagram below depicts a posterior view of the right scapula and humerus. The image on the left depicts downward rotation as it is “traditionally” taught, while the diagram on the right depicts relative downward rotation around a fixed glenoid fossa (downward rotation masquerading as elevation).

Note: scapular downward rotation around a fixed humerus is relative humeral abduction indicating a decrease in length of the supraspinatus and posterior deltoid.

On the left Downward Rotation (DR) as it is traditionally taught, on the right "DR" masquerading as "Elevation".

Based on the musculature involved, the incidence of scapular winging, and the position of the humerus - the forward motion noted during an assessment is likely an attempt by the body to adopt a position of anterior tipping. The picture below depicts anterior tipping (from left to right) from a lateral view of the scapula and torso.

Two Muscles that Keep Us Guessing

Arthrokinematic Dysfunction

This model implies that UBD will result in cervical, thoracic, costovertebral, transverse costal, sternocostal, sternoclavicular, acromioclavicular, and glenohumeral joint dyskinesis. Joint manipulation is often necessary to optimize movement, especially when dyskinesis results in stiffness or "functionally fixed" joints. The number of effective self-administered mobilization techniques is limited, but a couple of techniques are easily administered and effective. If joint dyskinesis is expected an attempt should be made to improve arthrokinematics; assuming that the techniques themselves do not result in or exacerbate pain. Luckily, a corrective strategy that addresses all musculature involved will often result in spontaneous improved joint motion. Note: be careful not to breach laws dictating the scope of practice in your state. When necessary refer out to a licensed manual therapist (DPT, ATC, DC, DO).

Common Presentation of Arthrokinematic Dysfunction:

Anterior tipping of the scapula results in relative posterior/superior translation of the distal clavicle and superior translation of the proximal clavicle reducing the capacity of the clavicle to elevate and posteriorly rotate with scapular upward rotation.

Treatment: Inferior Glide of SC, PA Glide of AC, Physiologic Depression/UR/Posterior Tipping of Scapula

Thoracic kyphosis (especially prominent at the CT junction) exacerbates dysfunction by limiting the thoracic spine's ability to extend and the ribs ability to move anteriorly (costovertebral, transversecostal, sternocostal motion), impeding the scapula’s ability to posteriorly tilt. From a practical standpoint - "the thoracic spine drives the ribs". Even if symptoms are related to rib dysfunction, techniques aimed at correcting thoracic mobility are usually more effective.

Treatment: Thoracic PA Mobilization/Manipulation, Rib Mobilization (contralateral rotation, contralateral flexion, and lateral force), Sternocostal AP mobilization

Alterations in muscle activity and scapula position result in adaptive shortening of soft tissues and relative superior/anterior migration and abduction of the humeral head in the glenoid fossa (relative to the downward rotation of the scapula).

Inferior and posterior mobilization of humeral head; static release of the 

Alterations in cervicoscapular muscle activity (synergistic dominance, decreased excitation threshold, and increased resting tone) will affect the facets of the cervical and thoracic spine via their proximal attachment. In essence, this is the bridge between UBD and cervical dysfunction. Cervical dysfunction deserves a model of its own, often presenting asymmetrically and requiring additional assessment. That is not to say that the cervical spine should be ignored in individuals with upper body dysfunction, only that it is beyond the scope of this article to address the numerous potential patterns of dysfunction. The most notable cervical dysfunctions related to upper body dysfunction will be excessive flexion (limited extension) at the cervicothoracic junction and facet dysfunction related to 

 hypertonicity between cervical vertebrae 1-4

Treatment: unilateral PA/transverse mobilization/manipulation of cervical facets.

Although the first rib has no bony articulation with the shoulder girdle, the changes in muscle activity mentioned above – leading to cervical dysfunction, often results in hypertonicity of the scalenes and elevation of the first rib.

Treatment: Scalene release, inferior mobilization of the first and second rib.

Arthrokinematics

Fascial Connections TLF

Thoracolumbar Fascia

Upper Body Dysfunction

Myofascial (Core) Subsystems

Pectoralis Minor, Coracobrachialis and Biceps Brachii

Levator Scapulae and Supraspinatus

Anterior Abdominal Fascia

Abdominal Fascia

Fascial Connections

How Does This Affect My Exercise Selection

Certain muscles have a tendency towards hyperactivity and tightness, while other muscles have a tendency toward under-activity and elongation. Various texts have discussed this tendency1-5, most commonly referring to these groups of muscles as “tonic”(short/hyperactive) and “phasic”(long/underactive). This predictable list of tonic and phasic musculature is useful when designing a corrective strategy.

Resistance Training and Relative Flexibility Progressions:

Relative flexibility progressions are general guidelines for exercise selection while correcting postural dysfunction. In the case of 

 (UBD), upper body resistance training should be modified to reduce the chance that a compensation pattern is adopted during any exercise in the routine. For example, a standing incline cable chest press will likely be performed with compensation as limitations in glenohumeral abduction will result in compensation at the scapula (generally anterior tipping and downward rotation), resulting in over-activity of the 

. This reinforces compensation patterns, reversing the gains attained from your corrective programming, and may contribute to inflammation of soft tissues (impingement). Whereas, by starting with a sagittal plane pushing pattern, which requires less extensibility of commonly short/over-active structure, less neuromuscular control, and maintains more of the subacromial space throughout the ROM, we may be able to reinforce optimal mechanics even in the presence of restriction (Click on the hyperlinked titles below for expansive resistance training progressions and videos of individual exercises).

For a repertoire of exercises and a sample routine check out the article:

Upper Body Corrective Exercise and Sample Routine

Upper Body Dysfunction and the Beach Body

Variations Between Individuals

How does this affect my exercise selection?

Assessment and Treatment of Muscle Imbalance: The Janda Approach

NASM Essentials of Personal Training: 4th Edition

Diagnoses and Treatment of Movement Impairment Syndromes,

David G. Simons, Janet Travell, Lois S. Simons, 

Travell & Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition

Bibliography

Comments, questions, and critiques are welcome and encouraged.

Upper Body Dysfunction (UBD)

Related Courses:

Course Description: Upper Body Dysfunction

Introduction
1 Sub Section

Signs of Upper Body Dysfunction

Postural/Movement Assessment

Refining the Upper Body Dysfunction Model
5 Sub Sections

A New Model of Upper-body Dysfunction (UBD)
1 Sub Section

Arthrokinematic Dysfunction

Fascial Connections
5 Sub Sections

How does this affect my exercise selection?
1 Sub Section

Bibliography

Related Courses:

Comments

Guest

Upper Body Dysfunction (UBD)

Related Courses:

Course Description: Upper Body Dysfunction

Introduction1 Sub Section

Signs of Upper Body Dysfunction

Postural/Movement Assessment

Refining the Upper Body Dysfunction Model5 Sub Sections

A New Model of Upper-body Dysfunction (UBD)1 Sub Section

Arthrokinematic Dysfunction

Fascial Connections5 Sub Sections

How does this affect my exercise selection?1 Sub Section

Bibliography

Related Courses:

Comments

Guest

Introduction
1 Sub Section

Refining the Upper Body Dysfunction Model
5 Sub Sections

A New Model of Upper-body Dysfunction (UBD)
1 Sub Section

Fascial Connections
5 Sub Sections

How does this affect my exercise selection?
1 Sub Section