Introduction

A New Model of Upper-body Dysfunction (UBD)

Two Muscles that Keep Us Guessing

Arthrokinematic Dysfunction

Fascial Connections TLF

Upper Body Dysfunction

Pectoralis Minor, Coracobrachialis and Biceps Brachii

Levator Scapulae and Supraspinatus

Anterior Abdominal Fascia

How Does This Affect My Exercise Selection

Variations Between Individuals

Why We Need a Better Model

Signs of Upper Body Dysfunction

Postural/Movement Assessment

Using Chronic Conditions to Refine our Model

Serratus Anterior

Hyperkyphosis

What Can “Trigger Points” Tell Us

The Rotator Cuff

Upper Body Dysfunction (UBD)

NASM

ACSM

AFAA

NCBTMB

CanFitPro

PTAGlobal

ISSA

REPS

REPSI

PACE

YOGA

WITS

CIMSPA

AUSPHYSIO

TPTA

NYPT

AOTA

Predictive Model of Upper Body Dysfunction (UBD)

Upper Body Dysfunction (UBD) is an edit and update of previous <a id="posture" data-tip="1659" target="_blank" href="/glossary-term/posture" class="glossary">postural</a> dysfunction <a id="model" data-tip="1471" target="_blank" href="/glossary-term/model" class="glossary">models</a> (e.g. Upper-crossed Syndrome, Rounded Shoulder <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">Posture</a>, Protracted Shoulder Girdle, etc.). It is important to recognize that in these <a id="model" data-tip="1471" target="_blank" href="/glossary-term/model" class="glossary">models</a> the term &quot;posture&quot; is being used as an analogy for &quot;ideal alignment&quot;. Similarly, when movement professionals refer to upper body <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">Posture</a>, good <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">Posture</a>, poor <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">Posture</a>, better <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">Posture</a>, etc. they are referring to this analogy of ideal alignment; not the rigid positioning implied by the colloquial use of the term &quot;posture.&quot;&#xA0;
Postural dysfunction and <a id="movement-impairment" data-tip="1575" target="_blank" href="/glossary-term/movement-impairment" class="glossary">movement impairment</a> syndromes are likely the beginning of &quot;modeling&quot;. Modeling has significant potential to aid in refining clinical decision-making, intervention selection, program design, and improve the <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a> 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 <a href="https://brookbushinstitute.com/" target="_blank" rel="noopener">Brookbush Institute</a> recommends that all sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) consider these <a id="model" data-tip="1471" target="_blank" href="/glossary-term/model" class="glossary">models</a> to aid in refining decision-making in practice.&#xA0;
Additional Models:
<ul>
 <li><a href="https://brookbushinstitute.com/courses/lumbo-pelvic-hip-complex-dysfunction-lphcd" target="_blank" rel="noopener">Lumbo Pelvic Hip Complex Dysfunction (LPHCD)</a></li>
 <li><a href="https://brookbushinstitute.com/courses/lower-leg-dysfunction" target="_blank" rel="noopener">Lower Extremity Dysfunction (LED)</a></li>
</ul>


<h2>Definitions:</h2>
<ul>
 <li>Posture: Arthro- and osteo-kinematics alignment maintained by <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> myofascial activity and length, as a result of sensation, <a id="integration" data-tip="1472" target="_blank" href="/glossary-term/integration" class="glossary">integration</a>, and activation by the <a id="nervous-system" data-tip="1690" target="_blank" href="/glossary-term/nervous-system" class="glossary">nervous system</a> - both statically and dynamically. </li>
 <li>Postural Dysfunction: The absence of ideal <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">posture</a> as a result of maladaptation by one or multiple tissues within the human movement system. 
 <ul>
 <li>Brookbush Institute Modern Definition: Modeling patterns of <a id="movement-impairment" data-tip="1575" target="_blank" href="/glossary-term/movement-impairment" class="glossary">movement impairment</a> correlated with orthopedic dysfunction, based on all available evidence, with the intent of predicting best-practice <a id="assessment" data-tip="1480" target="_blank" href="/glossary-term/assessment" class="glossary">assessments</a> and techniques, to optimize measured outcomes.</li>
 </ul>
 </li>
</ul>
<h3></h3>
<h2>Summary:</h2>
<h3>Altered Mobility and Activity</h3>
Overactive (<a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> and Stretch):
<ul>
 <li><a href="https://brookbushinstitute.com/article/pectoralis-minor" target="_blank" rel="noopener">Pectoralis Minor</a></li>
 <li><a href="https://brookbushinstitute.com/article/levator-scapulae" target="_blank" rel="noopener">Levator Scapulae</a></li>
 <li><a href="https://brookbushinstitute.com/article/rhomboids" target="_blank" rel="noopener">Rhomboids</a></li>
 <li><a href="https://brookbushinstitute.com/article/latissimus-dorsi" target="_blank" rel="noopener">Latissimus Dorsi</a></li>
 <li><a href="https://brookbushinstitute.com/article/teres-major" target="_blank" rel="noopener">Teres Major</a></li>
 <li><a href="https://brookbushinstitute.com/article/subscapularis" target="_blank" rel="noopener">Subscapularis</a></li>
 <li><a href="https://brookbushinstitute.com/article/intro-to-deltoids" target="_blank" rel="noopener">Posterior Deltoid</a></li>
 <li><a href="https://brookbushinstitute.com/article/trapezius-muscle" target="_blank" rel="noopener">Upper Traps</a></li>
 <li><a href="https://brookbushinstitute.com/article/coracobrachialis" target="_blank" rel="noopener">Coracobrachialis</a></li>
 <li>Biceps Brachii</li>
 <li><a href="https://brookbushinstitute.com/article/anterior-oblique-subsystem-aos" target="_blank" rel="noopener">Anterior Oblique Subsystem</a></li>
</ul>
Underactive (Activate and <a id="integration" data-tip="1476" target="_blank" href="/glossary-term/integration" class="glossary">Integrate</a>):
<ul>
 <li><a href="https://brookbushinstitute.com/article/trapezius-muscle" target="_blank" rel="noopener">Lower Traps</a></li>
 <li><a href="https://brookbushinstitute.com/article/serratus-anterior" target="_blank" rel="noopener">Serratus Anterior</a></li>
 <li><a href="https://brookbushinstitute.com/article/infraspinatus-and-teres-minor" target="_blank" rel="noopener">Infraspinatus</a></li>
 <li><a href="https://brookbushinstitute.com/article/infraspinatus-and-teres-minor" target="_blank" rel="noopener">Teres Minor</a></li>
 <li>Long Head of Triceps</li>
 <li><a href="https://brookbushinstitute.com/article/intrinsic-stabilization-subsystem" target="_blank" rel="noopener">Intrinsic Stabilization Subsystem</a></li>
 <li><a href="https://brookbushinstitute.com/article/posterior-oblique-subsystem-pos" target="_blank" rel="noopener">Posterior Oblique Subsystem</a></li>
</ul>
Fascia (Reduction in <a id="extensibility-2" data-tip="1308" target="_blank" href="/glossary-term/extensibility-2" class="glossary">Extensibility</a>)
<ul>
 <li>Clavipectoral Fascia</li>
 <li>Cervicothoracic fascia</li>
 <li>Thoracolumbar fascia</li>
 <li>Abdominal fascia</li>
</ul>
Arthrokinematics
<ul>
 <li><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> Tipping: SC joint, AC Joint &amp; Scapula</li>
 <li>Excessive Kyphosis: Thoracic Spine and Costal Joints</li>
 <li>Hypo or Hypermobility: Glenohumeral Joint</li>
 <li>Forward Head Posture: Cervical Dysfunction</li>
 <li>Elevation and Stiffness: First and Second Rib</li>
</ul>

<h2>Signs of Dysfunction</h2>
<a href="//player.vimeo.com/external/82859920.hd.mp4?s=25c9409ab07a08414e3226731f60fc32" target="_blank" rel="noopener">Overhead Squat Assessment</a>:
<ul>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-10-arms-fall" target="_blank" rel="noopener">Arms Adduct (Arms Fall)</a></li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-10-arms-fall" target="_blank" rel="noopener">Arms Fall Forward (Arms Fall)</a></li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-11-shoulders-elevate" target="_blank" rel="noopener">Scapula Elevate</a></li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-9-anterior-pelvic-tilt-excessive-lordosis" target="_blank" rel="noopener">Anterior Pelvic Tilt (Excessive Lordosis)</a></li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-13-sign-clusters-upper-body-dysfunction" target="_blank" rel="noopener">Spine/Trunk Flexion during &quot;Overhead Squat with Modification: Arms Down&quot;</a></li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-15-sign-clusters-asymmetrical-weight-shift" target="_blank" rel="noopener">Asymmetrical Weight Shift</a> (<a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">Unilateral</a> 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, <a href="https://brookbushinstitute.com/article/sacroiliac-joint-motion-and-predictive-model-of-dysfunction" target="_blank" rel="noopener">Sacroiliac Joint Dysfunction</a>, or <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">Unilateral</a> <a href="https://brookbushinstitute.com/article/lower-leg-dysfunction" target="_blank" rel="noopener">Lower Leg Dysfunction</a>)</li>
</ul>
<a href="https://brookbushinstitute.com/courses/upper-body-goniometry" target="_blank" rel="noopener">Goniometric Assessment</a>
<ul>
 <li><a href="https://brookbushinstitute.com/videos/shoulder-flexion-goniometry" target="_blank" rel="noopener">Shoulder Flexion</a> &lt; 180-190&#xB0;</li>
 <li><a href="https://brookbushinstitute.com/videos/shoulder-extension-goniometry">Shoulder Extension</a> &lt; 20-25&#xB0;</li>
 <li><a href="https://brookbushinstitute.com/videos/shoulder-internal-rotation-goniometry" target="_blank" rel="noopener">Shoulder Internal Rotation</a> &lt; 70&#xB0;</li>
 <li><a href="https://brookbushinstitute.com/videos/shoulder-external-rotation-goniometry" target="_blank" rel="noopener">Shoulder External Rotation</a> &lt; 95-100&#xB0;</li>
 <li><a href="https://brookbushinstitute.com/videos/cervical-lateral-flexion-goniometry" target="_blank" rel="noopener">Cervical</a> &lt; 35-45&#xB0;</li>
</ul>
<a href="https://brookbushinstitute.com/courses/muscle-length-tests" target="_blank" rel="noopener">Muscle Length Tests</a>
<ul>
 <li><a href="https://brookbushinstitute.com/videos/latissimus-dorsi-length-test-muscle-length-test" target="_blank" rel="noopener">Lat Length Test</a>
 <ul>
 <li><a href="https://brookbushinstitute.com/videos/shoulder-external-rotation-goniometry" target="_blank" rel="noopener">External Rotation Goniometry</a>&#xA0;for Differentiation</li>
 </ul>
 </li>
</ul>
<a href="https://brookbushinstitute.com/courses/manual-muscle-testing-upper-body" target="_blank" rel="noopener">Manual </a><a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Tests
<ul>
 <li><a href="https://brookbushinstitute.com/videos/deep-cervical-flexor-endurance-test" target="_blank" rel="noopener">Deep Cervical Flexors</a></li>
 <li><a href="https://brookbushinstitute.com/videos/external-rotator-manual-muscle-testing-mmt-for-an-active-population" target="_blank" rel="noopener">Shoulder External Rotators</a></li>
 <li><a href="https://brookbushinstitute.com/videos/lower-trapezius-manual-muscle-testing-mmt-for-an-active-population" target="_blank" rel="noopener">Lower Trapezius</a></li>
 <li><a href="https://brookbushinstitute.com/videos/serratus-anterior-manual-muscle-testing-mmt-for-an-active-population" target="_blank" rel="noopener">Serratus Anterior</a></li>
</ul>


<h2>Correlated Injuries, Pathologies, and Pain</h2>
<ul>
 <li>Impingement Syndrome</li>
 <li>Thoracic Outlet Syndrome</li>
 <li>DDD in cervical and thoracic spine</li>
 <li>Facet joint dysfunction in cervical and thoracic spine</li>
 <li>Sternocostal dysfunction</li>
 <li>Radiculopathy</li>
 <li>Neuritis (median, ulnar, radial <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> distributions)</li>
 <li>Chronic Glenohumeral Instability</li>
 <li>Adhesive Capsulitis</li>
 <li>Glenohumeral Osteoarthritis</li>
 <li>Hyperkyphosis</li>
 <li>Scapular Winging</li>
 <li>Supraspinatus and biceps tendonitis</li>
 <li>Subacromial bursitis</li>
 <li>Suprascapular trigger point</li>
 <li>Mid thoracic trigger points</li>
 <li>Epicondylitis</li>
 <li>Pain:
 <ul>
 <li>Shoulder</li>
 <li>Neck</li>
 <li>Thoracic Spine</li>
 <li>Low Back</li>
 <li>Elbow</li>
 <li>SC or Sternocostal joint</li>
 </ul>
 </li>
</ul>

Course Description: Upper Body Dysfunction

For an introduction to <a id="posture" data-tip="1659" target="_blank" href="/glossary-term/posture" class="glossary">Postural</a> Dysfunction and <a id="movement-impairment" data-tip="1575" target="_blank" href="/glossary-term/movement-impairment" class="glossary">Movement Impairment</a> please refer to the article:
Introduction to <a id="posture" data-tip="1659" target="_blank" href="/glossary-term/posture" class="glossary">Postural</a> Dysfunction and Movement Impairment
Upper Body Dysfunction:
&#x201C;Upper-Body Dysfunction&#x201D; (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, <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity, or <a id="lengthtension-relationship" data-tip="1685" target="_blank" href="/glossary-term/lengthtension-relationship" class="glossary">length/tension</a> relationships that may prove to bias or limit the future advancement/evolution of this <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> 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 &#x201C;action&#x201D; noted at the scapula, and newer <a id="model" data-tip="1471" target="_blank" href="/glossary-term/model" class="glossary">models</a> of dysfunction describing <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity do not follow a &#x201C;cross&#x201D; pattern. Giving credit where it is due, the underlying precepts of Janda&#x2019;s work are the foundation of much of my work on <a id="posture" data-tip="1659" target="_blank" href="/glossary-term/posture" class="glossary">postural</a> dysfunction and <a id="movement-impairment" data-tip="1575" target="_blank" href="/glossary-term/movement-impairment" class="glossary">movement impairment</a>, and I am thankful for his inspiration. The <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> asserted in this article closely resembles the compensation patterns described by Shirley A. Sahrmann in Movement Impairment Syndromes with a few notable exceptions (7). The largest exception being the attempt of this <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> to illustrate a common thread between all upper-body impairments and present one primary <a id="compensation-pattern" data-tip="1696" target="_blank" href="/glossary-term/compensation-pattern" class="glossary">compensation pattern</a>. The corrective exercise strategies discussed later in this article are used by the <a href="https://brookbushinstitute.com/" target="_blank" rel="noopener">Brookbush Institute</a>, have their foundation in the corrective exercise <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> (CEx) developed by the National Academy of Sports Medicine (NASM), and described in the text &#x201C;NASM Essentials of Corrective Exercise Training&#x201D; by Dr. Mike Clark &amp; Scott Lucette (7).

<a href="https://brookbushinstitute.com/article/search-for-congruence" target="_blank" rel="noopener">The Search for Congruence</a> &#x2013; my revision of this <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> is nothing more than a search for congruence &#x2013; an explanation that can find congruence between theory, research, observation, practice, and chronic conditions. That is, a better <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> would be <a id="evidence-based-practice" data-tip="1538" target="_blank" href="/glossary-term/evidence-based-practice" class="glossary">evidence-based</a>, accurately describe what we see during an <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a>, predict exercise and techniques that will enhance performance, and contribute to our understanding of the <a id="etiology" data-tip="1489" target="_blank" href="/glossary-term/etiology" class="glossary">etiology</a> of common upper-body pathologies. For more on my views of evidence and the development of this <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> click here &#x2013; <a href="https://brookbushinstitute.com/article/search-for-congruence" target="_blank" rel="noopener">Search for Congruence</a>
Note: The <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> discussed and developed in this article may not describe the <a id="compensation-pattern" data-tip="1696" target="_blank" href="/glossary-term/compensation-pattern" class="glossary">compensation pattern</a> adopted immediately post-acute orthopedic injury (ex. impact injuries) or accurately describe neurologic dysfunction (ex. stroke); however, they may be useful in describing some of the compensation patterns adopted weeks, months and years post-injury.
Somewhat ironically, the common conditions that may be explained by UBD may also help to refine our <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> of <a id="movement-impairment" data-tip="1575" target="_blank" href="/glossary-term/movement-impairment" class="glossary">movement impairment</a>. We could view some of these syndromes as the &#x201C;extremes of UBD,&#x201D; or the outcome of a lifetime with LLD. It&#x2019;s as if the conditions are the &#x201C;answer&#x201D; to an &#x201C;equation&#x201D; we are trying to solve. This is analogous to how the brain may be studied by examining the effects of brain injury on cognition, sensation, and motion.

<a href="//player.vimeo.com/external/82859920.hd.mp4?s=25c9409ab07a08414e3226731f60fc32" target="_blank" rel="noopener">Overhead Squat Assessment</a>:
<ul>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-10-arms-fall" target="_blank" rel="noopener">Arms Adduct (Arms Fall)</a></li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-10-arms-fall" target="_blank" rel="noopener">Arms Fall Forward (Arms Fall)</a></li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-11-shoulders-elevate" target="_blank" rel="noopener">Scapula Elevate</a></li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-9-anterior-pelvic-tilt-excessive-lordosis" target="_blank" rel="noopener">Anterior Pelvic Tilt (Excessive Lordosis)</a></li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-13-sign-clusters-upper-body-dysfunction" target="_blank" rel="noopener">Spine/Trunk Flexion during &quot;Overhead Squat with Modification: Arms Down&quot;</a></li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-15-sign-clusters-asymmetrical-weight-shift" target="_blank" rel="noopener">Asymmetrical Weight Shift</a> (<a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">Unilateral</a> 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, <a href="https://brookbushinstitute.com/article/sacroiliac-joint-motion-and-predictive-model-of-dysfunction" target="_blank" rel="noopener">Sacroiliac Joint Dysfunction</a>, or <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">Unilateral</a> <a href="https://brookbushinstitute.com/article/lower-leg-dysfunction" target="_blank" rel="noopener">Lower Leg Dysfunction</a>)</li>
</ul>
<img src="https://www.datocms-assets.com/25800/1649258155-arms-fall-1.jpg" width="293" height="321">
<h4>Goniometric Assessment</h4>
<ul>
 <li>Shoulder Flexion &lt; 180-190&#xB0;</li>
 <li>Shoulder Internal Rotation: &lt; 70&#xB0;</li>
 <li>Shoulder External Rotation: &lt; 95-100&#xB0;</li>
 <li><a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> Flexion of the Cervical Spine: &gt; 35-45&#xB0;</li>
</ul>
<h4>Flexibility Assessments</h4>
<ul>
 <li><a href="https://brookbushinstitute.com/video/latissimus-dorsi-length-test-muscle-length-test" target="_blank" rel="noopener">Lat Length Test</a></li>
 <li><a href="https://brookbushinstitute.com/video/apleys-scratch-test" target="_blank" rel="noopener">Apley&apos;s Scratch Test</a></li>
</ul>
<h4>Arthrokinematic Dyskinesis (Joint Dysfunction)</h4>
<ul>
 <li><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> translation of humeral head in the glenoid fossa</li>
 <li><a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">Superior</a> translation of the humeral in the glenoid fossa</li>
 <li><a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">Superior</a> and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> translation with <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> rotation of clavicle at the acromioclavicular joint</li>
 <li><a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">Superior</a> translation and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> rotation of the clavicle in the sternoclavicular joint</li>
 <li>Cervical and thoracic spine stiffness (positive spring <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a>)</li>
 <li>Costovertebral and transversecostal joint stiffness</li>
 <li>Elevation of the first and second rib</li>
</ul>
<h4>SI Joint Dysfunction</h4>
<ul>
 <li>Innominate &quot;upslip&quot; on side of dysfunction</li>
 <li>Innominate <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> rotation on side of dysfunction</li>
</ul>
<h4>Associated injury, pathologies, and pain associated with UBD:</h4>
<ul>
 <li>Impingement Syndrome</li>
 <li>Thoracic Outlet Syndrome</li>
 <li>DDD in cervical and thoracic spine</li>
 <li>Facet joint dysfunction in cervical and thoracic spine</li>
 <li>Sternocostal dysfunction</li>
 <li>Radiculopathy</li>
 <li>Neuritis (median, ulnar, radial <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> distributions)</li>
 <li>Chronic Glenohumeral Instability</li>
 <li>Adhesive Capsulitis</li>
 <li>Glenohumeral Osteoarthritis</li>
 <li>Hyperkyphosis</li>
 <li>Scapular Winging</li>
 <li>Supraspinatus and biceps tendonitis</li>
 <li>Subacromial bursitis</li>
 <li>Suprascapular trigger point</li>
 <li>Mid thoracic trigger points</li>
 <li>Epicondylitis</li>
 <li>Pain:
 <ul>
 <li>Shoulder</li>
 <li>Neck</li>
 <li>Thoracic Spine</li>
 <li>Low Back</li>
 <li>Elbow</li>
 <li>SC or Sternocostal joint</li>
 </ul>
 </li>
</ul>

<a id="posture" data-tip="1659" target="_blank" href="/glossary-term/posture" class="glossary">Postural</a> dysfunction affects <a id="lengthtension-relationship" data-tip="1685" target="_blank" href="/glossary-term/lengthtension-relationship" class="glossary">length/tension</a> relationships, resting <a id="tone" data-tip="1639" target="_blank" href="/glossary-term/tone" class="glossary">tone</a>, afferentation, alters proprioception, joint <a id="dyskinesis" data-tip="1693" target="_blank" href="/glossary-term/dyskinesis" class="glossary">dyskinesis</a>, and maladaptive changes in <a id="connective-tissue-cell" data-tip="1368" target="_blank" href="/glossary-term/connective-tissue-cell" class="glossary">connective tissue</a> 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 <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> 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 &#x201C;general warm-up&#x201D; obsolete. You have 2 choices before you start training &#x2013; &#x201C;improve the quality of human movement and optimize mechanics, or spend 10 minutes on a treadmill reinforcing your compensation patterns.&#x201D;
Movement/postural impairment can be assessed either statically or dynamically. Conceptually postural/movement <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> is not complicated. We start by examining joint position and the effect that has on relative <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> length:
<ol>
 <li>Know what good <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">posture</a> looks like (ex. plumb line during static standing <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">posture</a>).</li>
 <li>Note each joint or joint system &#x201C;out of place.&#x201D;</li>
 <li>List the joint actions that have occurred to alter joint position.</li>
 <li>List the muscles that will contribute to these actions &#x2013; these are &#x201C;short&#x201D; muscles.</li>
 <li>List the opposite joint actions.</li>
 <li>List the opposing muscles to these joint actions &#x2013; these are &#x201C;long&#x201D; muscles.</li>
</ol>
<table>
 <tbody>
 <tr>
 <td width="152">Observed Joint Actions</td>
 <td width="176">Short Muscles</td>
 <td width="139">Opposing Joint Actions</td>
 <td width="172">Long Muscles</td>
 </tr>
 <tr>
 <td width="152"></td>
 <td width="176"></td>
 <td width="139"></td>
 <td width="172"></td>
 </tr>
 <tr>
 <td width="152"></td>
 <td width="176"></td>
 <td width="139"></td>
 <td width="172"></td>
 </tr>
 <tr>
 <td width="152"></td>
 <td width="176"></td>
 <td width="139"></td>
 <td width="172"></td>
 </tr>
 </tbody>
</table>
<h4>Traditional Model of Upper Body Dysfunction:</h4>
In the &#x201C;Traditional <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">Model</a> of Upper-Body Dysfunction&#x201D; (a.k.a. upper-cross syndrome or protracted shoulder girdle) the scapulae elevate and protract (shoulder girdle), and the shoulders (glenohumeral joint) internally rotates.
<table>
 <tbody>
 <tr>
 <td width="152">Observed Joint Action</td>
 <td width="176">Short Muscle</td>
 <td width="139">Opposing Joint Action</td>
 <td width="172">Long Muscles</td>
 </tr>
 <tr>
 <td width="152">Scapular Protraction</td>
 <td width="176"><a href="https://brookbushinstitute.com/article/serratus-anterior" style="color: #ff0000;" target="_blank" rel="noopener">Serratus Anterior</a>
 <a href="https://brookbushinstitute.com/article/pectoralis-minor" target="_blank" rel="noopener">Pectoralis Minor</a>
 </td>
 <td width="139">Retraction</td>
 <td width="172"><a href="https://brookbushinstitute.com/article/trapezius-muscle" target="_blank" rel="noopener">Mid Traps</a>
 <a href="https://brookbushinstitute.com/article/rhomboids" style="color: #ff0000;" target="_blank" rel="noopener">Rhomboids</a>
 </td>
 </tr>
 <tr>
 <td width="152">Scapular Elevation</td>
 <td width="176"><a href="https://brookbushinstitute.com/article/trapezius-muscle" target="_blank" rel="noopener">Upper Traps</a>
 <a href="https://brookbushinstitute.com/article/levator-scapulae" target="_blank" rel="noopener">Levator Scapulae</a>
 </td>
 <td width="139">Depression</td>
 <td width="172"><a href="https://brookbushinstitute.com/article/trapezius-muscle" target="_blank" style="color: #ff0000;" rel="noopener">Lower Traps</a>
 <a href="https://brookbushinstitute.com/article/pectoralis-minor" target="_blank" style="color: #ff0000;" rel="noopener">Pectoralis Minor</a>
 </td>
 </tr>
 <tr>
 <td width="152">Shoulder Internal Rotation</td>
 <td width="176"><a href="https://brookbushinstitute.com/article/pectoralis-major" target="_blank" rel="noopener">Pectoralis Major</a>
 <a href="https://brookbushinstitute.com/article/latissimus-dorsi" target="_blank" rel="noopener">Lats</a>
 <a href="https://brookbushinstitute.com/article/teres-major" target="_blank" rel="noopener">Teres Major</a>
 <a href="https://brookbushinstitute.com/article/subscapularis" target="_blank" rel="noopener">Subscapularis</a>
 <a href="https://brookbushinstitute.com/article/deltoids" target="_blank" rel="noopener">Anterior Deltoid</a>
 </td>
 <td width="139">External Rotation</td>
 <td width="172"><a href="https://brookbushinstitute.com/article/deltoids" target="_blank" rel="noopener">Posterior Deltoid</a>
 <a href="https://brookbushinstitute.com/article/infraspinatus-and-teres-minor" target="_blank" rel="noopener">Infraspinatus</a>
 <a href="https://brookbushinstitute.com/article/infraspinatus-and-teres-minor" target="_blank" rel="noopener">Teres Minor</a>
 </td>
 </tr>
 </tbody>
</table>
If we stay true to the graph above we would <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> and lengthen the short/overactive structures, and activate and <a id="integration" data-tip="1476" target="_blank" href="/glossary-term/integration" class="glossary">integrate</a> the long/under-active muscles. The first flaw with this <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> is the exclusion of several glenohumeral muscles.
HMS Rule #2: Every structure (<a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a>) that crosses a joint will affect joint motion.
How does UBD affect the relative length of the <a href="https://brookbushinstitute.com/article/supraspinatus" target="_blank" rel="noopener">supraspinatus</a>, <a href="https://brookbushinstitute.com/article/coracobrachialis" target="_blank" rel="noopener">coracobrachialis</a>, 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?
<h4>Consider the following muscles from the graph above.</h4>
<ul>
 <li><a href="https://brookbushinstitute.com/article/serratus-anterior" target="_blank" rel="noopener">Serratus Anterior</a> - Short/Overactive</li>
 <li><a href="https://brookbushinstitute.com/article/trapezius-muscle" target="_blank" rel="noopener">Upper Trapezius</a> - Short/Overactive</li>
 <li><a href="https://brookbushinstitute.com/article/rhomboids" target="_blank" rel="noopener">Rhomboids</a> - Long/Underactive</li>
 <li><a href="https://brookbushinstitute.com/article/pectoralis-minor" target="_blank" rel="noopener">Pectoralis Minor</a> - Long/Underactive</li>
 <li><a href="https://brookbushinstitute.com/article/intro-to-deltoids" target="_blank" rel="noopener">Posterior Deltoid</a> - Long/Underactive</li>
</ul>
Experienced DPTs, ATCs, DCs, and corrective exercise specialists may &#x201C;feel&#x201D; as though these muscles are on the &#x201C;wrong side&#x201D; of the graph. As an experienced clinician/trainer you may understand the concepts above, but &#x201C;feel&#x201D; the muscles do not &#x201C;behave&#x201D; that way. For example, the <a href="https://brookbushinstitute.com/article/pectoralis-minor" target="_blank" rel="noopener">pectoralis minor</a> is listed as long on this graph, but practice would dictate this <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> as short and overactive. These &#x201C;feelings&#x201D; do have a place in our refinement of this <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> &#x2013; they illustrate in-congruence between theory and practice.
<img src="https://www.datocms-assets.com/25800/1641826258-overhead-squat-assessment-17-sig-1-1.jpg">

Refining the Upper Body Dysfunction Model

Shoulder Impingement - It is theorized that impingement is caused by a <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> and <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the humeral head in the glenoid fossa (7). This causes the greater tubercle to approximate the acromion process and impinge the tissues between them (<a href="https://brookbushinstitute.com/article/supraspinatus" target="_blank" rel="noopener">supraspinatus</a> tendon, subacromial bursa, long head of the biceps tendon, <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> capsule) (5,8). For example, an individual with overactive deltoids (in particular the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> deltoid), <a href="https://brookbushinstitute.com/article/supraspinatus" target="_blank" rel="noopener">supraspinatus</a>, and <a href="https://brookbushinstitute.com/article/coracobrachialis" target="_blank" rel="noopener">coracobrachialis</a> will experience excessive <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> and <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> migration of the humerus during shoulder abduction and/or flexion. Our <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> should also consider scapular motion as it pertains to this impairment. In the traditional <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a>, the scapulae are elevated and protracted &#x2013; elevation increases subacromial joint space relative to the humerus, and protraction does a poor job describing an increase or decrease in subacromial space. This is obviously an incongruence. Considering what scapular motions would decrease joint space on a &#x201C;fixed humerus&#x201D; may aid in our refinement of the <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> of UBD. Considering which scapular joint actions will create the same relative position of the acromion, as is created by an <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> and superiorly migrated humerus will illustrate a more accurate account of the compensatory scapular position. A lack of <a id="extensibility-2" data-tip="1308" target="_blank" href="/glossary-term/extensibility-2" class="glossary">extensibility</a> in the downward rotators of the scapula would keep the acromion shelf depressed during movement. Further, <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> tipping of the scapula places the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> portion of the acromion in close approximation with the anterior/superior portion of the humeral head. Note, <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> tipping is defined as a sagittal plane motion around a &#x201C;y&#x201D; axis for the purposes of this article.
When our graph is modified to include these joint actions practitioners will note that the muscles in red, in the graph above, move to the &#x201C;correct&#x201D; side of the graph. Based on the practical observation of motor behavior in scapular musculature, these joint actions do a better job of creating congruence between theory and practice.

In the traditional <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> of upper-body dysfunction, the <a href="https://brookbushinstitute.com/article/serratus-anterior" target="_blank" rel="noopener">serratus anterior</a> is short and overactive; implying that the correct treatment would be <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> and stretching. However, in practice, activation of the <a href="//player.vimeo.com/external/82872750.hd.mp4?s=b2fdc17a9889c617483ee590167ba686" target="_blank" rel="noopener">serratus anterior</a> is used to treat various upper-body pathologies. It is particularly effective for improving scapulohumeral rhythm as an upward rotator of the scapula.
Scapular winging is a common impairment that gives us a clue to the compensatory pattern adopted by the scapula in UBD. Generally, scapular winging indicates poor shoulder girdle <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> and control and an underactive/long <a href="https://brookbushinstitute.com/article/serratus-anterior" target="_blank" rel="noopener">serratus anterior</a>. The joint actions of the <a href="https://brookbushinstitute.com/article/serratus-anterior" target="_blank" rel="noopener">serratus anterior</a> include protraction and upward rotation, but its functions include an approximation of the scapula and rib cage. In scapular winging the scapula is pulled away from the rib cage, rendering the <a href="https://brookbushinstitute.com/article/serratus-anterior" target="_blank" rel="noopener">serratus anterior</a> relatively long. Changing protraction to <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> tipping in our graph corrects this issue, and still does a fair job of explaining the relative forward position of the scapula noted during <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> in UBD.
<img src="https://www.datocms-assets.com/25800/1649258255-serratus-anterior-1.jpeg" alt="Serratus Anterior" title="Serratus Anterior">

The Serratus Anterior

Many professionals have undoubtedly recognized the relationship between upper-body dysfunction and thoracic hyperkyphosis. However, the traditional <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> does not go far enough to explain the intimate relationship between UBD and chronic hyperkyphosis. I doubt any movement professional would deny a relationship exists, but what is the mechanism that links the two impairments? What effect does UBD have on core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> synergies? Are we missing a joint system in the graph above? Should we include flexion of the spine in UBD?
During an overhead squat <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> UBD often causes compensations at the shoulder girdle including &#x201C;<a href="https://brookbushinstitute.com/video/overhead-squat-assessment-10-arms-fall" target="_blank" rel="noopener">arms fall forward or down</a>&#x201D; (extension and/or abduction), humeral internal rotation, and scapular elevation. However, to isolate this dysfunction to the upper body and ensure that the &#x201C;arms falling forward&#x201D; is not being caused by a hyperactive <a href="https://brookbushinstitute.com/article/latissimus-dorsi" target="_blank" rel="noopener">latissimus dorsi</a> related to an <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> pelvic tilt we should modify the <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> by performing a squat with the arms down &#x2013; hands on hip (effectively taking the <a href="https://brookbushinstitute.com/article/latissimus-dorsi" target="_blank" rel="noopener">latissimus dorsi</a> out of the <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a>). If the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> pelvic tilt persists then the origin of dysfunction is the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> pelvic tilt and short overactive lats, if the dysfunction results in a reduction or complete cessation of an <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> pelvic tilt then the dysfunction stems from the upper body.
However, putting the hands on the hips when an individual has upper-body dysfunction often results in the client perceiving the squat as more difficult and the individual will adopt a hyperkyphosis and/or a <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> pelvic tilt. This is a major clue. This sign links upper-body dysfunction and <a href="https://brookbushinstitute.com/article/anterior-oblique-subsystem-aos" target="_blank" rel="noopener">Anterior Oblique Subsystem (AOS)</a> dominance. This may be caused by a <a id="synergistic-dominance" data-tip="1649" target="_blank" href="/glossary-term/synergistic-dominance" class="glossary">synergistically dominant</a> latissimus dorsi firing before the <a href="https://brookbushinstitute.com/article/instrinsic-stabilization-subsystem" target="_blank" rel="noopener">Intrinsic Stabilization Subsystem (ISS)</a> (relative latent firing of core musculature) and reliance on global musculature for lumbar stabilization. This relationship also explains the client&apos;s difficulty when squatting with the hands on the hips. By eliminating the lats from the movement the client can no longer rely on this compensatory pattern. In order to improve motor recruitment of core musculature and optimize function of the shoulder girdle, exercises that increases the activity of the <a href="https://brookbushinstitute.com/article/anterior-oblique-subsystem-aos" target="_blank" rel="noopener">AOS</a> should be limited, the <a href="https://brookbushinstitute.com/article/intrinsic-stabilization-subsystem" target="_blank" rel="noopener">ISS</a> (Transverse abdominis and friends) should be activated, and <a href="https://brookbushinstitute.com/article/posterior-oblique-subsystem-pos" target="_blank" rel="noopener">Posterior Oblique Subsystem (POS)</a> <a id="integration" data-tip="1472" target="_blank" href="/glossary-term/integration" class="glossary">integration</a> exercises should be used during the integration/neuromuscular re-education portion of your routine.
A summary of the <a href="https://brookbushinstitute.com/courses" target="_blank" rel="noopener">Subsystem</a> involvement in Upperbody Dysfunction:
<table>
 <tbody>
 <tr>
 <td width="160"></td>
 <td width="160">Activate</td>
 <td width="160">Subsystem Integration</td>
 <td width="160">Limit/Inhibit</td>
 </tr>
 <tr>
 <td width="160">Upper Body Dysfunction</td>
 <td width="160"><a href="https://brookbushinstitute.com/article/intrinsic-stabilization-subsystem" target="_blank" rel="noopener">ISS</a> - <a href="https://brookbushinstitute.com/article/tva" target="_blank" rel="noopener">TVA Activation</a></td>
 <td width="160"><a href="https://brookbushinstitute.com/article/posterior-oblique-subsystem-pos" target="_blank" rel="noopener">POS</a> - <a href="https://brookbushinstitute.com/article/posterior-oblique-subsystem-integration" target="_blank" rel="noopener">Legs with Pull</a></td>
 <td width="160"><a href="https://brookbushinstitute.com/article/anterior-oblique-subsystem-aos" target="_blank" rel="noopener">AOS</a>
 <a href="https://brookbushinstitute.com/article/anterior-oblique-subsystem-aos" target="_blank" rel="noopener"></a>Avoid:
 <a href="https://brookbushinstitute.com/article/plank-progression" target="_blank" rel="noopener">Planks</a>, <a href="https://brookbushinstitute.com/article/bridge-progression" target="_blank" rel="noopener">Crunches</a>, <a href="https://brookbushinstitute.com/article/axe-chop-progression" target="_blank" rel="noopener">Chops</a> &amp; <a href="https://brookbushinstitute.com/article/anterior-oblique-subsystem-aos" target="_blank" rel="noopener">Legs with Push</a>
 </td>
 </tr>
 </tbody>
</table>

Although <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> may develop in long musculature, long musculature is generally inhibited (altered <a id="reciprocal-inhibition" data-tip="1655" target="_blank" href="/glossary-term/reciprocal-inhibition" class="glossary">reciprocal inhibition</a>) and less active decreasing the demand on these tissues. In the traditional <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> of upper-body dysfunction, we note <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> in several long muscles - <a href="https://brookbushinstitute.com/article/pectoralis-minor" target="_blank" rel="noopener">pectoralis minor</a>, <a href="https://brookbushinstitute.com/article/rhomboids" target="_blank" rel="noopener">rhomboids</a>, <a href="https://brookbushinstitute.com/article/supraspinatus" target="_blank" rel="noopener">supraspinatus</a>, and <a href="https://brookbushinstitute.com/article/deltoids" target="_blank" rel="noopener">posterior deltoid</a>. It would seem that a <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> that included these muscles as short and overactive would do a better job explaining <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> development. Downward rotation of the scapula, combined with the <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> and <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> migration of the humerus head in the glenoid fossa would place all of these structures in a shortened position.
<img title="Upper Body Trigger Points" src="https://www.datocms-assets.com/25800/1649258323-screen-shot-2016-10-23-at-5-00-07-pm-1.png" width="306" height="366" alt="Upper Body Trigger Points">
From top to bottom - Upper trapezius, levator scapulae, and rhomboid minor <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>, with a <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> deltoid <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> marked on the male.

To treat all rotator cuff muscles the same way is not congruent with the relationships between the scapula and humerus described above. It does not explain why the <a href="https://brookbushinstitute.com/article/supraspinatus" target="_blank" rel="noopener">supraspinatus</a> and <a href="https://brookbushinstitute.com/article/subscapularis" target="_blank" rel="noopener">subscapularis</a> are more <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">prone</a> to <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>, and it does not explain a reduction in both humeral internal and external rotation during <a id="goniometry" data-tip="1523" target="_blank" href="/glossary-term/goniometry" class="glossary">goniometry</a>. It also does not explain the propensity of external rotators to <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> weak relative to internal rotators. A more detailed <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> is needed.
If the humeral head shifts anteriorly and superiorly, the <a href="https://brookbushinstitute.com/article/supraspinatus" target="_blank" rel="noopener">supraspinatus</a> and <a href="https://brookbushinstitute.com/article/subscapularis" target="_blank" rel="noopener">subscapularis</a> are short/overactive. The shortened length of the <a href="https://brookbushinstitute.com/article/supraspinatus" target="_blank" rel="noopener">supraspinatus</a> can be further explained by the downward rotation of the scapula around a fixed humerus; this is synonymous with humeral abduction. It is not uncommon to note humeral internal rotation during <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> as well, reinforcing adaptive shortening of the <a href="https://brookbushinstitute.com/article/subscapularis" target="_blank" rel="noopener">subscapularis</a>. The <a href="https://brookbushinstitute.com/article/infraspinatus-and-teres-minor" target="_blank" rel="noopener">teres minor and infraspinatus</a> are put in lengthened position by the relative internally rotated and abducted position of the humerus. The over-activity of the <a href="https://brookbushinstitute.com/article/subscapularis" target="_blank" rel="noopener">subscapularis</a> and <a href="https://brookbushinstitute.com/article/supraspinatus" target="_blank" rel="noopener">supraspinatus</a> alter <a id="reciprocal-inhibition" data-tip="1655" target="_blank" href="/glossary-term/reciprocal-inhibition" class="glossary">reciprocal inhibition</a>, reducing neural drive to the <a href="https://brookbushinstitute.com/article/infraspinatus-and-teres-minor" target="_blank" rel="noopener">teres minor and infraspinatus</a>. This explains why the external rotators have a greater propensity toward weakness and deconditioning. The adaptive shortening of the <a href="https://brookbushinstitute.com/article/subscapularis" target="_blank" rel="noopener">subscapularis</a> explains the loss of external rotation; however, the loss of internal rotation is a little more complicated. This is likely due to the <a id="synergistic-dominance" data-tip="1643" target="_blank" href="/glossary-term/synergistic-dominance" class="glossary">synergistic dominance</a> of the <a href="https://brookbushinstitute.com/article/intro-to-deltoids" target="_blank" rel="noopener">posterior deltoid</a> and the development of <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> - as a result of inhibited external rotators. This is confirmed in practice as <a href="https://brookbushinstitute.com/article/intro-to-deltoids" target="_blank" rel="noopener">posterior deltoid</a> <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> is often effective in returning range of motion. If dominance of the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> deltoid is responsible for the shift in humeral position range of motion may increase for both internal and external rotation.
In consideration of the above&#x2026;
<img src="https://www.datocms-assets.com/25800/1646156803-figure-1-1b-rotator-cuff_side-view.jpeg" alt="Rotator Cuff - Side View" title="Rotator Cuff - Side View">

<table>
 <tbody>
 <tr>
 <td width="152">Observed Joint Action</td>
 <td width="176">Short Muscle</td>
 <td width="139">Opposing Joint Action</td>
 <td width="172">Long Muscles</td>
 </tr>
 <tr>
 <td width="152">Scapula Downward Rotation</td>
 <td width="176"><a href="https://brookbushinstitute.com/article/pectoralis-minor" target="_blank" rel="noopener">Pectoralis Minor</a>
 <a href="https://brookbushinstitute.com/article/levator-scapulae" target="_blank" rel="noopener">Levator Scapulae</a>
 <a href="https://brookbushinstitute.com/article/rhomboids" target="_blank" rel="noopener">Rhomboids</a>
 </td>
 <td width="139">Scapular Upward Rotation</td>
 <td width="172"><a href="https://brookbushinstitute.com/article/trapezius-muscle" target="_blank" rel="noopener">Upper Trapezius</a>
 <a href="https://brookbushinstitute.com/article/trapezius-muscle" target="_blank" rel="noopener">Lower Trapezius</a>
 <a href="https://brookbushinstitute.com/article/serratus-anterior" target="_blank" rel="noopener">Serratus Anterior</a>
 </td>
 </tr>
 <tr>
 <td width="152">Scapula Anterior Tipping</td>
 <td width="176"><a href="https://brookbushinstitute.com/article/levator-scapulae" target="_blank" rel="noopener">Levator Scapulae</a>
 <a href="https://brookbushinstitute.com/article/trapezius-muscle" target="_blank" rel="noopener">*Upper Traps</a>
 <a href="https://brookbushinstitute.com/article/pectoralis-minor" target="_blank" rel="noopener">Pectoralis Minor</a>
 <a href="https://brookbushinstitute.com/article/coracobrachialis" target="_blank" rel="noopener">Coracobrachialis</a>
 Biceps Brachii
 </td>
 <td width="139">Scapular Posterior Tipping</td>
 <td width="172"><a href="https://brookbushinstitute.com/article/trapezius-muscle" target="_blank" rel="noopener">Lower Traps</a>
 <a href="https://brookbushinstitute.com/article/serratus-anterior" target="_blank" rel="noopener">Serratus Anterior</a>
 Long Head of Triceps
 </td>
 </tr>
 <tr>
 <td width="152">Shoulder Internal Rotation</td>
 <td width="176"><a href="https://brookbushinstitute.com/article/pectoralis-major" target="_blank" rel="noopener">Pectoralis Major</a>
 <a href="https://brookbushinstitute.com/article/latissimus-dorsi" target="_blank" rel="noopener">Lats</a>
 <a href="https://brookbushinstitute.com/article/teres-major" target="_blank" rel="noopener">Teres Major</a>
 <a href="https://brookbushinstitute.com/article/subscapularis" target="_blank" rel="noopener">Subscapularis</a>
 <a href="https://brookbushinstitute.com/article/deltoids" target="_blank" rel="noopener">Anterior Deltoid</a>
 </td>
 <td width="139">External Rotation</td>
 <td width="172"><a href="https://brookbushinstitute.com/article/intro-to-deltoids" target="_blank" rel="noopener">*</a><a href="https://brookbushinstitute.com/article/deltoids" target="_blank" rel="noopener">Posterior Deltoid</a>
 <a href="https://brookbushinstitute.com/article/infraspinatus-and-teres-minor" target="_blank" rel="noopener">Infraspinatus and </a>
 <a href="https://brookbushinstitute.com/article/infraspinatus-and-teres-minor" target="_blank" rel="noopener">Teres Minor</a>
 </td>
 </tr>
 <tr>
 <td width="152">Humeral Anterior/Superior Migration</td>
 <td width="176"><a href="https://brookbushinstitute.com/article/supraspinatus" target="_blank" rel="noopener">Supraspinatus</a>
 <a href="https://brookbushinstitute.com/article/subscapularis" target="_blank" rel="noopener">Subscapularis</a>
 <a href="https://brookbushinstitute.com/article/deltoids" target="_blank" rel="noopener">Posterior Deltoid</a>
 </td>
 <td width="139">Humeral Depressors</td>
 <td width="172"><a href="https://brookbushinstitute.com/article/infraspinatus-and-teres-minor" target="_blank" rel="noopener">Infraspinatus and Teres Minor</a></td>
 </tr>
 <tr>
 <td width="152">Core Flexion</td>
 <td width="176"><a href="https://brookbushinstitute.com/article/anterior-oblique-subsystem-aos" target="_blank" rel="noopener">Anterior Oblique Subsystem</a></td>
 <td width="139">Core Extension</td>
 <td width="172"><a href="https://brookbushinstitute.com/article/intrinsic-stabilization-subsystem" target="_blank" rel="noopener">Intrinsic Stabilization Subsystem</a>
 <a href="https://brookbushinstitute.com/article/posterior-oblique-subsystem-pos" target="_blank" rel="noopener">Posterior Oblique Subsystem</a>
 </td>
 </tr>
 </tbody>
</table>
How does downward rotation of the scapula occur when I clearly see the scapula elevate during an assessment?
It&#x2019;s an optical illusion, kind of&#x2026; What you see is the <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> 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 &#x2013; glenoid fossa moving inferiorly, or as elevation of the <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> angle of the scapula around a fixed glenoid fossa.
The diagram below depicts a <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> view of the right scapula and humerus. The image on the left depicts downward rotation as it is &#x201C;traditionally&#x201D; 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 <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> deltoid.
<a href="https://brookbush.s3.us-east-2.amazonaws.com/wordpress/wp-content/uploads/2013/11/Scapula.png" target="_blank" rel="noopener"><img src="https://brookbush.s3.us-east-2.amazonaws.com/wordpress/wp-content/uploads/2013/11/Scapula.png" alt="&quot;Downward Rotation&quot; masquerading as &quot;Elevation&quot;"></a> On the left Downward Rotation (DR) as it is traditionally taught, on the right &quot;DR&quot; masquerading as &quot;Elevation&quot;.
Anterior Tipping versus Protraction:
<ul>
 <li>Based on the musculature involved, the incidence of scapular winging, and the position of the humerus - the forward motion noted during an <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> is likely an attempt by the body to adopt a position of <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> tipping. The picture below depicts <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> tipping (from left to right) from a <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> view of the scapula and torso.</li>
</ul>
<h4>Anterior Tippers:</h4>
<ul>
 <li>* <a href="https://brookbushinstitute.com/article/levator-scapulae" target="_blank" rel="noopener">Levator Scapulae</a>
 <ul>
 <li><a href="https://brookbushinstitute.com/article/pectoralis-minor" target="_blank" rel="noopener">Pectoralis Minor</a></li>
 <li><a href="https://brookbushinstitute.com/article/trapezius-muscle" target="_blank" rel="noopener">Upper Trapezius</a></li>
 </ul>
 </li>
</ul>
<h4>Relative to a fixed humerus:</h4>
<ul>
 <li>* <a href="https://brookbushinstitute.com/article/coracobrachialis" target="_blank" rel="noopener">Coracobrachialis</a>
 <ul>
 <li>Biceps Brachii</li>
 </ul>
 </li>
</ul>
<h4>Posterior Tippers:</h4>
<ul>
 <li>* <a href="https://brookbushinstitute.com/article/trapezius-muscle" target="_blank" rel="noopener">Lower Trapezius</a>
 <ul>
 <li><a href="https://brookbushinstitute.com/article/serratus-anterior" target="_blank" rel="noopener">Serratus Anterior</a></li>
 </ul>
 </li>
</ul>
<h4>Relative to a fixed humerus</h4>
<ul>
 <li>* Long head of Triceps</li>
</ul>

The upper trapezius is listed as both long and short in the <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> above. Practice and <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> have led me to believe that this <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> may become short/overactive, but this is generally not the case. Most often the upper trap is deconditioned as an upward rotator of the scapula (should be activated), and only short and overactive in the most extreme cases of UBD; in these cases, the upper trap should be <a id="release" data-tip="1253" target="_blank" href="/glossary-term/release" class="glossary">released</a>. The tightness and soreness most individuals attribute to upper trapezius over-activity can most often be explained by <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> in the <a href="https://brookbushinstitute.com/article/levator-scapulae" target="_blank" rel="noopener">levator scapulae</a>, <a href="https://brookbushinstitute.com/article/rhomboids" target="_blank" rel="noopener">rhomboids</a>, and <a href="https://brookbushinstitute.com/article/supraspinatus" target="_blank" rel="noopener">supraspinatus</a>. This may be confirmed via palpation.
The posterior deltoid is also listed as both short and long in this <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a>. Based on my experience this <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> may be one of the few long, but overactive muscles in the human body (similar to the way the biceps femoris acts in an <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> pelvic tilt). I have had the most success using <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> techniques alone, and I only administer stretching techniques when <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> does not return an individual&#x2019;s range of motion.
<img src="https://www.datocms-assets.com/25800/1647364757-trapezius.png" width="303" height="304" alt="Trapezius Muscles">

This <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> implies that UBD will result in cervical, thoracic, costovertebral, transverse costal, sternocostal, sternoclavicular, acromioclavicular, and glenohumeral joint <a id="dyskinesis" data-tip="1693" target="_blank" href="/glossary-term/dyskinesis" class="glossary">dyskinesis</a>. Joint manipulation is often necessary to optimize movement, especially when <a id="dyskinesis" data-tip="1693" target="_blank" href="/glossary-term/dyskinesis" class="glossary">dyskinesis</a> results in stiffness or &quot;functionally fixed&quot; joints. The number of effective self-administered mobilization techniques is limited, but a couple of techniques are easily administered and effective. If joint <a id="dyskinesis" data-tip="1693" target="_blank" href="/glossary-term/dyskinesis" class="glossary">dyskinesis</a> 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).
<h3>Common Presentation of Arthrokinematic Dysfunction:</h3>
<h4>SC joint, AC Joint &amp; Scapula:</h4>
<ul>
 <li><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> tipping of the scapula results in relative posterior/superior translation of the <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> clavicle and <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> translation of the <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> clavicle reducing the capacity of the clavicle to elevate and posteriorly rotate with scapular upward rotation.
 <ul>
 <li>Treatment: <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">Inferior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">Glide</a> of SC, PA <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">Glide</a> of AC, Physiologic Depression/UR/Posterior Tipping of Scapula</li>
 </ul>
 </li>
</ul>
<h4>Thoracic Spine and Costal Joints:</h4>
<ul>
 <li>Thoracic kyphosis (especially prominent at the CT junction) exacerbates dysfunction by limiting the thoracic spine&apos;s ability to extend and the ribs ability to move anteriorly (costovertebral, transversecostal, sternocostal motion), impeding the scapula&#x2019;s ability to posteriorly tilt. From a practical standpoint - &quot;the thoracic spine drives the ribs&quot;. Even if symptoms are related to rib dysfunction, techniques aimed at correcting thoracic <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> are usually more effective.
 <ul>
 <li>Treatment: Thoracic PA Mobilization/Manipulation, Rib Mobilization (<a id="contralateral" data-tip="1549" target="_blank" href="/glossary-term/contralateral" class="glossary">contralateral</a> rotation, <a id="contralateral" data-tip="1549" target="_blank" href="/glossary-term/contralateral" class="glossary">contralateral</a> flexion, and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> force), Sternocostal AP mobilization</li>
 </ul>
 </li>
</ul>
<h4>Glenohumeral Joint:</h4>
<ul>
 <li>Alterations in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> 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).
 <ul>
 <li>Inferior and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> mobilization of humeral head; static <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> of the <a href="https://brookbushinstitute.com/article/supraspinatus" target="_blank" rel="noopener">supraspinatus</a></li>
 </ul>
 </li>
</ul>
<h4>Cervical Dysfunction:</h4>
<ul>
 <li>Alterations in cervicoscapular <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity (<a id="synergistic-dominance" data-tip="1643" target="_blank" href="/glossary-term/synergistic-dominance" class="glossary">synergistic dominance</a>, decreased <a id="excitation-threshold" data-tip="1236" target="_blank" href="/glossary-term/excitation-threshold" class="glossary">excitation threshold</a>, and increased resting <a id="tone" data-tip="1639" target="_blank" href="/glossary-term/tone" class="glossary">tone</a>) will affect the facets of the cervical and thoracic spine via their <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> attachment. In essence, this is the bridge between UBD and cervical dysfunction. Cervical dysfunction deserves a <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> of its own, often presenting asymmetrically and requiring additional <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a>. 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 <a id="movement-impairment" data-tip="1579" target="_blank" href="/glossary-term/movement-impairment" class="glossary">dysfunctions</a> related to upper body dysfunction will be excessive flexion (limited extension) at the cervicothoracic junction and facet dysfunction related to <a href="https://brookbushinstitute.com/article/levator-scapulae" target="_blank" rel="noopener">levator scapulae</a> hypertonicity between cervical vertebrae 1-4
 <ul>
 <li>Treatment: <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> PA/transverse mobilization/manipulation of cervical facets.</li>
 </ul>
 </li>
</ul>
<h4>First and Second Rib:</h4>
<ul>
 <li>Although the first rib has no bony articulation with the shoulder girdle, the changes in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity mentioned above &#x2013; leading to cervical dysfunction, often results in hypertonicity of the scalenes and elevation of the first rib.
 <ul>
 <li>Treatment: Scalene <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a>, <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> mobilization of the first and second rib.</li>
 </ul>
 </li>
</ul>
<img src="https://www.datocms-assets.com/25800/1649258494-arthrokinematics-1.jpg" alt="Arthrokinematics" title="Arthrokinematics">

Fascial Connections

The <a id="fascial-system" data-tip="1689" target="_blank" href="/glossary-term/fascial-system" class="glossary">fascial system</a> needs more consideration in our corrective exercise strategies. The work of Tom Myers has brought this system to the forefront of human movement4, however, self-administered techniques for addressing fascial restriction are still fairly crude. There are many brilliant practitioners developing exercise strategies <a id="specificity" data-tip="1224" target="_blank" href="/glossary-term/specificity" class="glossary">specific</a> to fascia; we can expect to see rapid development in this area in the years to come. This <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> does reinforce some of Tom Myers&apos;s work and illustrates some important fascial connections. Adaptive shortening from supraspinatus to levator scapulae
<ul>
 <li>The Thoracolumbar Fascia: This fascial structure may be one of the most complex structures in the human movement system. Studies have verified a rich presence of Pacini corpuscles (quick adapting receptors that respond to pressure and vibration), paciniform corpuscles (like Pacini corpuscles but smaller), Golgi tendon organ (slower adapting receptors that respond to muscular contraction), and interstitial receptors (free <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> ending they may respond to <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a>, pressure, or noxious stimulation).</li>
</ul>
<img src="https://www.datocms-assets.com/25800/1647306269-1642021632-thoracolumbar-fascia.jpeg" title="Thoracolumbar Fascia" alt="Thoracolumbar Fascia">

Thoracolumbar Fascia

<ul>
 <li>Upper body dysfunction generally presents with inhibition of the <a href="https://brookbushinstitute.com/article/intrinsic-stabilization-subsystem" target="_blank" rel="noopener">Intrinsic Stabilization Subsystem</a> (<a href="https://brookbushinstitute.com/article/transverse-abdominis" target="_blank" rel="noopener">Transverse Abdominis</a> and Friends) and a reliance on global musculature for <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> (<a href="https://brookbushinstitute.com/article/latissimus-dorsi" target="_blank" rel="noopener">Latissimus Dorsi</a> and the <a href="https://brookbushinstitute.com/article/anterior-oblique-subsystem-aos" target="_blank" rel="noopener">Anterior Oblique Subsystem)</a>. As the thoracolumbar fascia is a complex structure invested by several muscles it is hard to determine a single sequence of inhibitions (under-activities) and facilitation (over-activities) that would result in the activity seen in this dysfunction, but it is worth considering how this <a id="compensation-pattern" data-tip="1696" target="_blank" href="/glossary-term/compensation-pattern" class="glossary">compensation pattern</a> alters or may be altered by the thoracolumbar fascia and embedded receptors. For example, is it over-activity of the latissimus dorsi that results in latent firing of the <a href="https://brookbushinstitute.com/article/transverse-abdominis" target="_blank" rel="noopener">transverse abdominis</a> and <a id="synergistic-dominance" data-tip="1643" target="_blank" href="/glossary-term/synergistic-dominance" class="glossary">synergistic dominance</a> of the <a href="https://brookbushinstitute.com/article/anterior-oblique-subsystem-aos" target="_blank" rel="noopener">anterior oblique subsystem</a>, or is it lengthening of the thoracolumbar fascia via thoracic flexion that results in stimulation of global musculature for added stability? I have had some success with <a href="https://brookbushinstitute.com/article/posterior-oblique-subsystem-pos" target="_blank" rel="noopener">Posterior Oblique Subsystem</a> taping (shown below, with external rotator taping) which would stimulate extension and reduce <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> on the thoracolumbar fascia, potentially reducing the dominance of the <a href="https://brookbushinstitute.com/article/trapezius-muscle" target="_blank" rel="noopener">anterior oblique subsystem</a> and improving the overall core recruitment strategy. In the image below I used this technique with a client/patient with <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> shoulder laxity and was pleasantly surprised by the carry-over between sessions.<a href="https://brookbush.s3.us-east-2.amazonaws.com/wordpress/wp-content/uploads/2014/03/Jeremy-POS-Taping.jpg" target="_blank" rel="noopener"><img src="https://brookbush.s3.us-east-2.amazonaws.com/wordpress/wp-content/uploads/2014/03/Jeremy-POS-Taping.jpg" alt="Jeremy POS Taping" title="Posterior Oblique Taping"></a></li>
</ul>

Myofascial (Core) Subsystems

<ul>
 <li>The pectoralis minor, coracobrachialis, and short head of the biceps brachii insert on the coracoid process with a fair amount of fascial congruity. A relationship noted by Tom Myers, in the popular text &quot;Anatomy Trains&quot;(6) as part of the &quot;Deep Front Arm Line.&quot; Although care must be taken to avoid the median, ulnar and musculocutaneous nerves; over-activity of the <a href="https://brookbushinstitute.com/article/pectoralis-minor" target="_blank" rel="noopener">pectoralis minor</a> may stimulate over-activity of the <a href="https://brookbushinstitute.com/article/coracobrachialis" target="_blank" rel="noopener">coracobrachialis</a> and biceps brachii implying that <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> techniques for these additional muscles may be appropriate additions to our <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> of upper body dysfunction. (Note: <a id="release" data-tip="1250" target="_blank" href="/glossary-term/release" class="glossary">releasing</a> the coracobrachialis is probably best left to the hands of an experienced manual therapist). Stretching of this <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a> myofascial synergy can be achieved with a modified <a href="https://brookbushinstitute.com/video/pectoralis-major-and-minor-sa-static-stretch" target="_blank" rel="noopener">Pec Stretch</a> in which the elbow is extended and the arm is positioned a little higher than demonstrated in the hyperlinked video - to roughly 135 degrees of abduction.</li>
</ul>
<img src="https://www.datocms-assets.com/25800/1649258549-pectoralis-minor-1.png" width="649" height="496" alt="Pectoralis Minor">

<ul>
 <li>There is a fascial congruity that exists between the levator scapulae and supraspinatus (and rectus capitis lateralis). This relationship is noted by Tom Myers as part of the &quot;Deep Back Arm Line&quot; (6). In fact, it is this relationship that made me reconsider the activity of the <a href="https://brookbushinstitute.com/article/supraspinatus" target="_blank" rel="noopener">supraspinatus</a> in shoulder/upper body dysfunction. I simply asked&#x2026; &quot;If the <a href="https://brookbushinstitute.com/article/levator-scapulae" target="_blank" rel="noopener">levator scapulae</a> is over-active, could the <a href="https://brookbushinstitute.com/article/supraspinatus" target="_blank" rel="noopener">supraspinatus</a> follow suit via this fascial integration?&quot; It is common practice to strengthen the rotator cuff to improve <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a>, including scaptions for <a href="https://brookbushinstitute.com/article/supraspinatus" target="_blank" rel="noopener">supraspinatus</a> strength, but I have found that more success may be had by treating this <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> as overactive and address it with <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> and lengthening techniques. Other manual techniques may be implied by this relationship and fascia line including instrument-assisted soft tissue mobilization (IASTM) and active <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a>. Further, this line is likely the best explanation for the relationship between Upper Body Dysfunction (UBD) and Cervical Dysfunction (the second-best explanation being the mechanical relationship between the thoracic and cervical spine). The link to rectus capitis lateralis reinforces this idea as the upper cervical spine is often the source of pain in those with cervical dysfunction.</li>
</ul>
<img src="https://www.datocms-assets.com/25800/1649258142-1642024498-levator-scapulae-1.png" alt="Levator Scapulae">

<ul>
 <li>The <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> Abdominal Fascia links many of the core muscles presumed to be dominant in upper body dysfunction. This is most eloquently explained by inhibition of the <a href="https://brookbushinstitute.com/article/posterior-oblique-subsystem-pos" target="_blank" rel="noopener">posterior oblique subsystem</a> and <a href="https://brookbushinstitute.com/article/intrinsic-stabilization-subsystem" target="_blank" rel="noopener">intrinsic stabilization subsystem</a> and <a id="synergistic-dominance" data-tip="1643" target="_blank" href="/glossary-term/synergistic-dominance" class="glossary">synergistic dominance</a> of the <a href="https://brookbushinstitute.com/article/anterior-oblique-subsystem-aos" target="_blank" rel="noopener">anterior oblique subsystem</a>. Considering anatomy, the <a href="https://brookbushinstitute.com/article/muscular-anatomy" target="_blank" rel="noopener">rectus abdominis</a> is enveloped by the rectus sheath and transverse abdominal fascia and is bisected by the linea alba. Further, the rectus abdominis tendons, linea alba, and superficial facia continue into the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">adductor</a> tendons. These fascial structures aid in the transmission of force and may influence the <a id="tone" data-tip="1642" target="_blank" href="/glossary-term/tone" class="glossary">tonicity</a> of the muscles invested including the <a href="https://brookbushinstitute.com/article/muscular-anatomy" target="_blank" rel="noopener">rectus abdominis</a>, <a href="https://brookbushinstitute.com/article/internal-obliques" target="_blank" rel="noopener">internal obliques</a>, <a href="https://brookbushinstitute.com/article/external-obliques" target="_blank" rel="noopener">external obliques</a>, and <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">adductors</a>. Any <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a>, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a>, or rotational force imparted on the trunk will result in an increase in activity (3). This ensures the <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> dissipation of forces and protection of non-contractile tissues and joints, but consider what may happen when one of these muscles becomes over-active. Will all the muscles invested in the superficial layers of this structure adopt the same relative activity?</li>
</ul>
<img src="https://www.datocms-assets.com/25800/1645299278-abdominal-fascia.png" title="Abdominal Fascia" alt="Abdominal Fascia">

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 &#x201C;tonic&#x201D;(short/hyperactive) and &#x201C;phasic&#x201D;(long/underactive). This predictable list of tonic and phasic musculature is useful when designing a corrective strategy.
<h4>Overactive (Release and Stretch):</h4>
<ul>
 <li><a href="https://brookbushinstitute.com/article/pectoralis-minor" target="_blank" rel="noopener">Pectoralis Minor</a></li>
 <li><a href="https://brookbushinstitute.com/article/levator-scapulae" target="_blank" rel="noopener">Levator Scapulae</a></li>
 <li><a href="https://brookbushinstitute.com/article/rhomboids" target="_blank" rel="noopener">Rhomboids</a></li>
 <li><a href="https://brookbushinstitute.com/article/latissimus-dorsi" target="_blank" rel="noopener">Latissimus Dorsi</a></li>
 <li><a href="https://brookbushinstitute.com/article/teres-major" target="_blank" rel="noopener">Teres Major</a></li>
 <li><a href="https://brookbushinstitute.com/article/subscapularis" target="_blank" rel="noopener">Subscapularis</a></li>
 <li><a href="https://brookbushinstitute.com/article/intro-to-deltoids" target="_blank" rel="noopener">Posterior Deltoid</a></li>
 <li><a href="https://brookbushinstitute.com/article/trapezius-muscle" target="_blank" rel="noopener">Upper Traps</a></li>
 <li><a href="https://brookbushinstitute.com/article/coracobrachialis" target="_blank" rel="noopener">Coracobrachialis</a></li>
 <li>Biceps Brachii</li>
 <li><a href="https://brookbushinstitute.com/article/anterior-oblique-subsystem-aos" target="_blank" rel="noopener">Anterior Oblique Subsystem</a></li>
</ul>
<h4>Underactive (Activate and Integrate):</h4>
<ul>
 <li><a href="https://brookbushinstitute.com/article/trapezius-muscle" target="_blank" rel="noopener">Lower Traps</a></li>
 <li><a href="https://brookbushinstitute.com/article/serratus-anterior" target="_blank" rel="noopener">Serratus Anterior</a></li>
 <li><a href="https://brookbushinstitute.com/article/infraspinatus-and-teres-minor" target="_blank" rel="noopener">Infraspinatus</a></li>
 <li><a href="https://brookbushinstitute.com/article/infraspinatus-and-teres-minor" target="_blank" rel="noopener">Teres Minor</a></li>
 <li>Long Head of Triceps</li>
 <li><a href="https://brookbushinstitute.com/article/intrinsic-stabilization-subsystem" target="_blank" rel="noopener">Intrinsic Stabilization Subsystem</a></li>
 <li><a href="https://brookbushinstitute.com/article/posterior-oblique-subsystem-pos" target="_blank" rel="noopener">Posterior Oblique Subsystem</a></li>
</ul>
<h4>Resistance Training and Relative Flexibility Progressions:</h4>
<a id="relative-flexibility" data-tip="1654" target="_blank" href="/glossary-term/relative-flexibility" class="glossary">Relative flexibility</a> <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a> are general guidelines for exercise selection while correcting <a id="posture" data-tip="1659" target="_blank" href="/glossary-term/posture" class="glossary">postural</a> dysfunction. In the case of <a href="https://brookbushinstitute.com/article/upper-body-dysfunction-ubd" target="_blank" rel="noopener">Upper Body Dysfunction</a> (UBD), upper body resistance training should be modified to reduce the chance that a <a id="compensation-pattern" data-tip="1696" target="_blank" href="/glossary-term/compensation-pattern" class="glossary">compensation pattern</a> 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 <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> tipping and downward rotation), resulting in over-activity of the <a href="https://brookbushinstitute.com/article/pectoralis-minor" target="_blank" rel="noopener">pectoralis minor</a>, <a href="https://brookbushinstitute.com/article/levator-scapulae" target="_blank" rel="noopener">levator scapulae</a>, and the <a href="https://brookbushinstitute.com/article/supraspinatus" target="_blank" rel="noopener">supraspinatus</a>. 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 <a id="extensibility-2" data-tip="1308" target="_blank" href="/glossary-term/extensibility-2" class="glossary">extensibility</a> 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 <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> mechanics even in the presence of restriction (Click on the hyperlinked titles below for expansive resistance training <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a> and videos of individual exercises).
<h4><a href="https://brookbushinstitute.com/article/chestpushing-movements" target="_blank" rel="noopener">Chest/Pushing</a> Relative Flexibility Progression:</h4>
<ol>
 <li>Sagittal plane press</li>
 <li>Horizontal plane press</li>
 <li>Incline Press</li>
</ol>
<h4><a href="https://brookbushinstitute.com/article/back-pulling-movement-patterns" target="_blank" rel="noopener">Back/Pulling</a> Relative Flexibility Progression</h4>
<ol>
 <li>Sagittal Plane (Below shoulder)</li>
 <li>Sagittal plane (Above shoulder)</li>
 <li>Frontal Plane</li>
 <li>Transverse Plane</li>
</ol>
<h4><a href="https://brookbushinstitute.com/article/shoulderoverhead-pressing-patterns" target="_blank" rel="noopener">Shoulder/Pressing</a> Relative Flexibility Progression</h4>
<ol>
 <li>Scaption</li>
 <li>PNF Carry Away</li>
 <li>Sagittal Plane Overhead Press</li>
 <li>Frontal Plane Overhead Press</li>
</ol>
<h3>For a repertoire of exercises and a sample routine check out the article:</h3>
<ul>
 <li><a href="https://brookbushinstitute.com/article/upper-body-dysfunction-sample-routine" target="_blank" rel="noopener">Upper Body Corrective Exercise and Sample Routine</a></li>
 <li>Case Study: <a href="https://brookbushinstitute.com/article/upper-body-dysfunction-hypertrophy" target="_blank" rel="noopener">Upper Body Dysfunction and the Beach Body</a></li>
</ul>

How does this affect my exercise selection?

Variations Between Individuals - Time Course of Dysfunction Hypothesis: I hypothesize that much of the variations between individuals with UBD can be explained by a time-course of dysfunction. That is, UBD is a progressive syndrome that slowly modifies structures over time. This may be due to the rate of adaptability in various tissues, mechanical restriction having a larger impact on movement than soft tissue, <a id="muscle-cell" data-tip="1377" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle fiber</a> type and resistance to fatigue, or motor the so-called &#x201C;hard-wired&#x201D; alternatives mentioned earlier. At this point, I seem to find the following trend (generally, it would appear that dysfunction moves <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> to <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a>)
<ul>
 <li><a href="https://brookbushinstitute.com/article/latissimus-dorsi" target="_blank" rel="noopener">Latissimus dorsi</a> and/or Thoracic Spine restriction</li>
 <li>Hyper-tonicity of scapular downward rotators</li>
 <li>Rotator-Cuff dysfunction (&#x201C;Short&#x201D; supraspinatus and subscapularis, &#x201C;Long&#x201D; infraspinatus and teres minor)</li>
 <li>Adaptive shortening of global shoulder musculature (pectoralis major, deltoid, etc.)</li>
 <li>Cervical spine dysfunction</li>
</ul>

<html><head></head><body><ol>
 <li>Phillip Page, <a href="http://www.amazon.com/s/ref=ntt_athr_dp_sr_2?_encoding=UTF8&amp;sort=relevancerank&amp;search-alias=books&amp;ie=UTF8&amp;field-author=Clare%20Frank" target="_blank">Clare Frank</a>, <a href="http://www.amazon.com/s/ref=ntt_athr_dp_sr_3?_encoding=UTF8&amp;sort=relevancerank&amp;search-alias=books&amp;ie=UTF8&amp;field-author=Robert%20Lardner" target="_blank">Robert Lardner</a>, Assessment and Treatment of Muscle Imbalance: The Janda Approach © 2010 Benchmark Physical Therapy, Inc., Clare C. Frank, and Robert Lardner</li>
 <li>Dr. Mike Clark &amp; Scott Lucette, “NASM Essentials of Corrective Exercise Training” © 2011 Lippincott Williams &amp; Wilkins</li>
 <li>Donald A. Neumann, “Kinesiology of the Musculoskeletal System: Foundations of Rehabilitation – 2nd Edition” © 2012 Mosby, Inc.</li>
 <li>Michael A. Clark, Scott C. Lucett, NASM Essentials of Personal Training: 4th Edition, © 2011 Lippincott Williams and Wilkins</li>
 <li>Leon Chaitow, Muscle Energy Techniques: Third Edition, © Pearson Professional Limited 2007</li>
 <li>Tom Myers, Anatomy Trains. © Elsevier Limited 2001</li>
 <li>Shirley A Sahrmann, Diagnoses and Treatment of Movement Impairment Syndromes, © 2002 Mosby Inc.</li>
 <li>David G. Simons, Janet Travell, Lois S. Simons, Travell &amp; Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition,© 1999 Williams and Wilkens</li>
 <li>Cynthia C. Norkin, D. Joyce White, Measurement of Joint Motion: A Guide to Goniometry - Third Edition. © 2003 by F.A. Davis Company</li>
</ol></body></html>

Bibliography

<html><head></head><body>(C) 2013 Brent Brookbush
Comments, questions, and critiques are welcome and encouraged.</body></html>

Copyright

A-Band - Refers to the part of the muscle cell that looks darker under a microscope.  This area of the cell is darker due to parallel arrangement of thicker filaments (myosin) and overlap with the thinner filaments (actin).
<ul>
 	<li>As a muscle contracts, the A-band is where actin and myosin interact.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Accuracy - the proportion of individuals correctly identified by the test results.
<ul>
 	<li>For example, a special test with perfect accuracy would imply a test has 100% specificity, 100% sensitivity, 100% positive predictive value and 100% negative predictive values.</li>
</ul>

Action Potential - A rapid change in voltage, resulting in a wave of excitation, that may result in stimulation of a nerve or muscle cell.
<ul>
 	<li>In order for an action potential to be initiated, the resting membrane voltage must exceed the excitation threshold, which then results in a cascade of depolarization and the "wave of excitation." Any stimulus below that threshold will not result in an action potential, and a stimulus greater than the threshold will not increase a single action potential, but may result in additional action potentials.  In this way, the action potential functions more like an on/off switch (all or none), and less like a dimmer switch.</li>
</ul>

A single-joint movement pattern (most often) designed to load a specific under-active muscle(s), while minimizing the contribution of over-active synergists via specific cues/joint motions.
<ul>
 	<li style="text-align: left;">Activation techniques/exercises are performed with the intent of addressing a muscle exhibiting a reduction in activity (tone) as a result of, or contributing to postural dysfunction.</li>
 	<li style="text-align: left;">Activation techniques/exercises cannot be multi-joint movement patterns due to relative flexibility, altered reciprocal inhibition, and synergistic dominance resulting in compensation patterns.</li>
</ul>
Example, <a href="https://brentbrookbush.com/articles/corrective-exercise-articles/activation/gluteus-medius-activation-progression/" target="_blank">gluteus medius activation</a> involves resisted hip abduction while minimizing the contribution of the TFL via hip extension.

Active stretching is a term used to describe a stretch that involves an active contraction of opposing musculature to lengthen a muscle to its end range. Generally these stretches are held for 2-5 seconds and repeated for 8-15 repetitions.

Adenosine triphosphatase (ATPase): is the enzyme responsible for catalyzing (initiating and accelerating) the decomposition of ATP to ADP.
<ul>
 	<li>This dephosphorylation (breakdown) reaction releases energy for processes like muscular contraction.</li>
</ul>

Adenosine triphosphate (ATP): The molecule that functions as a universal energy-transfer molecule, providing most of the energy associated with muscular contraction and human movement. ATP is composed of an adenine group, a ribose group, and three molecules of inorganic phosphates.
<ul>
 	<li>Energy is provided when hydrolysis results in the cleaving of a phophate group; resulting in adenosine diphosphate, an inorganigic phosphate group, and energy.</li>
</ul>

Algometry - measuring the amount of pressure to result in sensitivity or pain, using an algometer.
<ul>
 	<li>Generally, research uses algometry to establish a minimum pain pressure threshold (PPT), in which a lower PPT implies more sensitivity and pain, and a higher PPT implies less sensitivity and pain. PPT is a common outcome measure in trigger point research.</li>
</ul>
<a href="https://brentbrookbush.com/wp-content/uploads/2019/07/Algometer.jpg"><img class="aligncenter wp-image-140177" src="https://brentbrookbush.com/wp-content/uploads/2019/07/Algometer.jpg" alt="Image of an Algometer" width="500" height="333" /></a>

All-or-none principle - a nerve or muscle cell's response to a stimulus is independent of the strength of the stimulus. If that stimulus exceeds the threshold potential (threshold of an action potential), the nerve or muscle fiber will respond completely; otherwise, there is no response.

Example, when a motor unit in the biceps brachii is stimulated it contracts the same way whether a 10 lb or 50 lb dumbbell is lifted.  It is actually the number of muscle cells and the size of the motor unit that determines force output.

&nbsp;

The transition period between eccentric load and concentric contraction during a repetition of an exercise.  This term is most often used in reference to power/plyometric exercises, in which a shorter amortization phase is believed to be beneficial.  The shorter amortization phase may better use the stored energy from the elastic deformation of connective tissue and enhance synchronization of myotatic (stretch) reflex with maximum voluntary contraction.

Example, the athlete was cued to spend as little time as possible in the bottom of their squat stance (the amortization phase) during a set of box jumps.

Muscles that oppose the prime mover and synergists for a given joint action.

That is, all the muscles that can perform the opposing joint action.

Example: The triceps and anconeus are antagonists during elbow flexion.

An anatomical direction; toward the front

Example, the face is on the anterior aspect of the head

Appendicular Skeleton - referring to the bones the bones of the arms and legs, as well as the bones that support them. This includes the pelvis, clavicle and scapula. There are approximately 126 bones in the appendicular skeleton.
<ul>
 	<li>Etymology - Appendicular, as in appendage, "that which is appended to something as a proper part," 1640s, from <a class="crossreference" href="https://www.etymonline.com/word/append?ref=etymonline_crossreference">append</a> + <a class="crossreference" href="https://www.etymonline.com/word/-age?ref=etymonline_crossreference">-age</a>. - <a href="https://www.etymonline.com/word/appendage" target="_blank" rel="noopener">Etymology Online</a></li>
</ul>
"Appendicular skeleton" is a label referring to a set of bones whose function is distinct from the bones of the "<a href="https://brentbrookbush.com/glossary/axial-skeleton/" target="_blank" rel="noopener">axial skeleton</a>".

A reflexive decrease in muscle activity due to joint dyskinesis.
For example, a reduction in deep cervical flexor activity as a result of cervical spine dyskinesis.

Arthrokinematic Motion - Small amplitude motions between bone surfaces at a joint.  The arthrokinematic motions are roll, glide (slide or translation), spin, compression and distraction (traction). Arthrokinematic motions accompany osteokinematic motions to maintain joint congruence.
<ul>
 	<li>Example, arthrokinematic motion of the talus includes posterior glide on the tibia during ankle dorsiflexion.</li>
</ul>
Synonyms include: arthrokinematics, passive accessory motion, joint play and component motion

&nbsp;

Assessment - is the act of assessing, i.e. determining the importance, size, or value of -

In most cases, the results of an assessment are compared to normative data. If the individual exhibits values that are within normal parameters, it may be assumed that the aspect of health or motion assessed is not contributing to the patient's complaint, symptoms or movement impairment. If the results fall outside of normal parameters, it may indicate that the aspect of health or motion assessed is contributing to, or being affected by the patient/client's complaint, symptoms, or movement impairment. In some cases, the results of an assessment are compared to an "ideal model." In this case, deviations from the ideal are noted as potential issues. For example, deviations noted in the <a title="Introduction to the Overhead Squat Assessment" href="https://brentbrookbush.com/online-courses/articles/assessment/introduction-overhead-squat-assessment/" target="_blank">Overhead Squat Assessment</a> are compared to an "ideal model" of posture and motion.

Assessments used by human movement professionals can be divided into three broad categories:
<ul>
 	<li>"Clear" the Patient/Client for Intervention - These are tests, assessments and evaluations used to determine if a patient/client's issue may improve given the assessing professional's scope, skills, abilities and willingness to treat that individual.
<ul>
 	<li>For example, many of the special tests used in orthopedic medicine assist in determining the level of pathology or likelihood of a particular diagnosis. Certain issues and diagnoses are beyond the scope of the human movement professional, and are better treated by diagnostic professionals in the medical community (physicians, podiatrists, surgeons, etc.). A Calf Squeeze (Thompson) Test is one example, in which a positive sign may indicate a rupture of the Achilles tendon that may be better treated via surgical intervention.</li>
</ul>
</li>
 	<li>Highlight Contraindications - Tests, assessments and evaluations used to stratify risk or preclude a professional from addressing certain tissues, motions or using a particular technique.
<ul>
 	<li>For example, the Vertebral Artery Test (VBI) is often used to determine if high velocity thrust mobilizations (manipulations) are safe for a patient with cervical dysfunction.</li>
</ul>
</li>
 	<li>Refine Exercise/Intervention Selection: Tests, assessments and evaluations used to assist the professional in determining which techniques, modalities and exercises will best address a patient/client's complaints or desired goals.
<ul>
 	<li>Most movement assessments fall into this category. For example, a positive <a href="https://brentbrookbush.com/vimeo_videos/elys-test-rectus-femoris-flexibility-assessment/" target="_blank">Ely's Test</a> may indicate a need to release and/or lengthen the <a href="https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/rectus-femoris/" target="_blank">rectus femoris</a>.</li>
</ul>
</li>
</ul>
Note: An assessment, or assessment result, may fall into more than one category. For example, although goniometry is an assessment most often used to Refine Exercise/Intervention Selection, if a range of motion is significantly altered, with an abnormal end-feel, and/or causes the patient or client/pain, the individual may need to be referred to a physician for further testing and Clearance to resume rehab activities.  Further, that same patient may return to the human movement professional with a list of Contraindicated Activities from the physician. - "When in doubt, refer out!"

Axial Skeleton - referring to the bones of the head, neck, trunk and spinal column (does not include pelvis). There are approximately 80 bones in the axial skeleton.
<ul>
 	<li>Etymology - Axial, as in "axis", referring to "imaginary motionless straight line around which a body (such as the Earth) rotates," from Latin axis "axle, pivot, axis of the earth or sky" - <a href="https://www.etymonline.com/word/axis" target="_blank" rel="noopener">Etymology Online</a></li>
</ul>
"Axial skeleton" is a label referring to a set of bones whose function is distinct from the bones of the "<a href="https://brentbrookbush.com/glossary/appendicular-skeleton/" target="_blank" rel="noopener">appendicular skeleton</a>".

Balance - The ability to maintain a body’s center of mass over its base of support. Balance can be static or dynamic.
<ul>
 	<li>For example, maintaining balance is harder on one leg because the center of mass must stay over a much smaller base of support.</li>
</ul>

A ball and socket joint (also called a spheroid joint or spheroidal joint) is a synovial joint in which the rounded or spherical end of one bone fits into a cup-like depression of another bone. The distal bone is capable of motion around an indefinite number of axes, which have one common center. Examples include the hip and shoulder (glenohumeral joint)

Base of support (BoS) - refers to the area beneath an object or person, and the area within the perimeter created by every point of contact that the object or person makes with the supporting surface. This may include the <a href="https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/gluteus-maximus/" target="_blank" rel="noopener">glutes</a> of someone sitting on a chair, or the back of someone leaning against a wall.
<ul>
 	<li>For example, during a single leg balance the BoS is the area of the foot in contact with the surface; however, when a person is standing on two feet, the BoS is the area of both feet and the surface between them.</li>
</ul>

Pertaining to both sides

Example, bilateral rows are performed with both arms at the same time.

Case-control Study - a particular form of retrospective study that samples a matched group of people who have, and do not have the outcome being studied. A case-control study is a quasi-experimental design, often used in medicine to aid in determining potential contributing factors (cannot determine causality). In this study type exposure is the dependent variable and outcome is independent.
<ul>
 	<li>Example, in this retrospective case-control, medical records were investigated for trends correlated with cervical pain (1).
<ol>
 	<li>Mäkela, M., Heliövaara, M., Sievers, K., Impivaara, O., Knekt, P., &amp; Aromaa, A. (1991). Prevalence, determinants, and consequences of chronic neck pain in Finland. American journal of epidemiology, 134(11), 1356-1367.</li>
</ol>
</li>
</ul>

An anatomical direction; toward the tail, relative to humans this term is often used to refer to "in the direction of the tale (toward the feet)".

Example, to release the trapezius muscle the therapist used a force directed caudally.

Center of mass (CoM) - an object's mean position of mass; that is, a point that is perfectly surrounded by an equal amount mass in all directions.

Center of gravity (CoG) - point where gravity appears to act. Since the human body is so small compared to the earth, we can assume gravity acts uniformly on the body, and that CoG and CoM are the same.
<ul>
 	<li>Example, the CoM of the human body while lying down or standing straight up is close to our navel. However, it is possible that during a resistance exercise, the combination of the body's weight and the weight of the resistance will place the combined CoM outside the body. For example, during the mid-portion of a <a href="https://brentbrookbush.com/vimeo_videos/back-squat/" target="_blank" rel="noopener">back squat</a> the CoM would be several anterior to the naval.</li>
</ul>

An anatomical direction; toward the head (synonym: cranial)

Example, hip pain was felt with any force directed cephalad.

Cohort Study - a particular form of longitudinal study that samples a cohort (a group of people who share a defining characteristic), performing a cross-section at intervals through-out a period of time. A cohort study is a quasi-experimental design often used in medicine to aid in determining etiology or a cause-and-effect relationship. In this study type exposure is the independent variable and outcome is dependent.
<ul>
 	<li>Example, the study by Cholewicki et al. (1) investigated Yale Varsity Athletes (the cohort) with 2 and 3 year follow up (longitudinal design) and found that trunk muscle response time to off-loading was predictive of future low back injury.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/core/increased-trunk-muscle-latency-may-cause-rather-than-result-from-low-back-pain/" target="_blank" rel="noopener noreferrer">Cholewicki, J., Silfies, S., Shah, R., Greene, H., Reeves, N. Alvi, K., Goldberg, B. (2005). Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine. 30(23), 2614-2620</a></li>
</ol>

Comparable Sign: A combination of pain, stiffness and/or spasm during examination that is comparable to the patients symptoms.
<ul>
 	<li>One common error made during evaluation with special tests is attention given to any discomfort or pain, rather than attempting to identify the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable in every individual. Basing your assessment on positive tests that resulted in "concordant/comparable signs" will improve your chances of arriving at the correct diagnosis.</li>
</ul>

An alternative movement pattern that has been adopted to compensate for dysfunction/impairment in the human movement system.
Example: A lack of calf extensibility may limit dorsiflexion, leading to the knees bowing inward (functional valgus) and excessive forward lean of the torso during a squat.

An arthrokinematic motion - the approximation of joint surfaces; that is, a force that directs one bone surface into another resulting in a reduction in intra-articular volume. Although widely thought of as a "destructive force", it is likely best to consider compression as a naturally occurring, stabilizing force. Any arthrokinematic force in excess (spin, glide, roll, traction) may be viewed as potentially deleterious.

For example, during a squat the femoral head is compressed into the acetabulum by muscular forces, bodyweight and any additional external load.

Concave (Concavity) - Having an outline or surface curved like the interior surface of a bowl or sphere - to cave-in or curve inward.
<ul>
 	<li>Example, the internal surfaces of the pelvis is concave, holding some of the bodies viscera.</li>
</ul>

Concordant Sign - The patient's specific pain, symptom or complaint. 
<ul>
 	<li>One common error made during evaluation with special tests is attention given to any discomfort or pain, rather than attempting to identify the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable in every individual. Basing your assessment on positive tests that resulted in "concordant/comparable signs" will improve your chances of arriving at the correct diagnosis.</li>
</ul>

Conductivity: Stimulation results in more than a local effect (1).
<ul>
 	<li>For example, in a muscle cell the stimulation of a motor endplate results in a change in cell membrane polarity that rapidly propagates (is conducted) along the entire length of the muscle cell, stimulating all sacromere.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

A condyloid joint (also called condylar, bicondylar, ellipsoid, or ellipsoidal) is an ovoid articular surface, or condyle, that is received into an elliptical cavity.  These joints permit movement in two planes.  Examples include the knee, metacarpophalangeal joints and metatarsophalangeal joints.

Connective Tissue Cell - One of the four basic types of animal tissue, consisting mostly fibers and ground substance.  These cells are specialized to binds organs together, holds them in place, protect them from external forces, and may fill space in the body's cavities.

Example, the body's muscles are enclosed in durable connective tissue sheets known as the "epimysium", "perimysium", and "endomysium," which and in support and transmitting force.
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Contractility: The ability to shorten (1).
<ul>
 	<li>Contractility: Muscle cells are unique in the amount they can shorten when stimulated; this is this largerly due to the highly organized and unique arrangement of myofilaments (actin and myosin).</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Pertaining to the opposite side

Example, the external oblique muscle performs contralateral rotation; rotation to the opposite side.

Convex (Convexity) - Having an outline or surface curved like the exterior of a circle or sphere - to bulge or curve outward.
<ul>
 	<li>Example, the top of your head is shaped by the convex exterior surface of your skull.</li>
</ul>

Correlational Research - Non-experimental <a href="https://www.questionpro.com/blog/what-is-research/">research</a> method in which the statistical relationship between two variables is investigated.
<ul>
 	<li>In this research by Kwon et al., a correlation was noted between a decrease in extensibility during a hamstring length test (goniometry) and current knee pain (1).</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/correlation-patellofemoral-pain-syndrome-pfps-hamstring-activity/" target="_blank" rel="noopener">Kwon O, Yun M, and Lee W. (2014). Correlation between intrinsic patellofemoral pain syndrome in young adults and lower extremity biomechanics. J. Phys. Ther. Sci. 26: 961-964</a></li>
</ol>

Counter-nutation - posterior rotation of sacrum relative to ilium, and/or anterior rotation of ilium relative to sacrum.
<ul>
 	<li>The pelvic floor muscles are examples of muscle that may counter-nutate the sacrum.</li>
</ul>
[caption id="attachment_126335" align="aligncenter" width="400"]<a href="https://brentbrookbush.com/wp-content/uploads/2018/10/Nutation.png"><img class=" wp-image-126335" src="https://brentbrookbush.com/wp-content/uploads/2018/10/Nutation.png" alt="Nutation and Counter-nutation of the Sacroiliac Joint" width="400" height="967" /></a> Nutation and Counter-nutation of the Sacroiliac Joint[/caption]

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Crossover (Study) Design - A type of longitudinal, repeated measures quasi-experimental design in which each group receives both treatments, but at different times. It is named "crossover" due to the patients "crossing-over" to the other treatment or sham group after a specified period of time.
<ul>
 	<li>This type of study has the advantage of every individual serving as their own control, which may reduce the influence of confounding variables.</li>
 	<li>Unfortunately, the design itself introduces the chances that anyone receiving the experimental variable in the first period will continue to be effected in the second period.</li>
</ul>
In a study by Senna et al., a cross-over design was used to investigate the difference load made on inter-set rest intervals (1).
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/strength-training-research-corner/heavy-vs-light-load-single-joint-exercise-performance-with-different-rest-periods/" target="_blank" rel="noopener">Senna, G.W., Rodrigues, B.M., Sandy, Scudese, Bianco, A, &amp; Dantas, E.H.M. (2017). Heavy vs light load single-joint exercise performance with different intervals. Journal of Human Kinetics, 58, 197-206. </a></li>
</ol>

Cross-sectional Study - a research design that involves gathering data from a population or representative subset at a specific point in time.
<ul>
 	<li>Example, the study by Karimi-Mobarake et al.(1) investigated the prevalence of genu varum and genu valgum among school children 7-11 years old in Iran.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/low-prevalence-of-genu-varum-and-valgum-among-elementary-school-children/" target="_blank" rel="noopener noreferrer">Karimi-Mobarake, M., Kashefipour, A., Yousfnejad, Z. The prevalence of genu varum and genu valgum in primary school children in Iran 2003-2004. (2005) Journal of Medical Science 5(1). 52-54</a></li>
</ol>

Cytokine - A broad and loose category of small proteins that act through receptors, and are especially important to immune function (inflammation).
<ul>
 	<li>Cytokines include substances such as interferon, interleukin, and growth factors, which are secreted by certain cells of the immune system and have an effect on other cells. Their definite distinction from hormones is a topic of continued research.</li>
</ul>
&nbsp;

Dependent variable - in research, this is the variable that is changed by the independent variable, most often this is the "outcome" of the study.
<ul>
 	<li>Example, in the study by Cleland et al. (1), the independent variable is "thoracic manipulation," and the dependent variable is "lower trapezius muscle strength."</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/short-term-effects-lower-thoracic-manipulation-lower-trapezius-muscle-strength/" target="_blank" rel="noopener noreferrer">Cleland J, Selleck B, Stowell T, Brown L, Alberini S, St. Cyr H, Caron T. Short-term Effects of Thoracic Manipulation on Lower Trapezius Muscle Strength.  Journal of Manual &amp; Manipulative Therapy. 2004; 12(2): 82-90</a></li>
</ol>

An anatomical direction; further from the trunk or center of the body

Example, the foot is at the distal end of the leg.

An arthrokinematic motion - a force applied to a body part that may result in the separation of joint surfaces, a reduction in intra-articular pressure, and/or an increase in intra-articlar space.

For example, to hang from one's hands (i.g. in preparation for a pull-up) results in a traction force on the glenohumeral joint (shoulder).

An anatomical term of location; back or upper surface

Example, shoe laces may compress tissues on the dorsal surface of the foot

The "drawing-in" maneuver is a common cue used during exercise and rehabilitation programs. A light contraction of the <a href="https://brentbrookbush.com/articles/muscular-anatomy/transverse-abdominis/" target="_blank" rel="noopener">transverse abominis</a> (and potentially the entire <a href="https://brentbrookbush.com/articles/corrective-exercise-articles/core-subsystems/intrinsic-stabilization-subsystem/" target="_blank" rel="noopener">intrinsic stabilization subsystem</a>) achieved by gently pulling the lower abdominal region away from one's waist band. This should have minimal effect on breathing, and should not be confused with a maximal contraction of the <a href="https://brentbrookbush.com/articles/muscular-anatomy/transverse-abdominis/" target="_blank" rel="noopener">transverse abdominis</a> resulting in a "vacuum pose".
<ul>
 	<li>Research often refers to this maneuver as the "abdominal drawing-in maneuver"; abbreviated ADIM.</li>
</ul>
Development and introduction of this cue into practice is based on the pivotal research and resulting text:
<ol>
 	<li>Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization – A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004</li>
</ol>

Faulty or abnormal movement; an alteration of normal kinematics.

For example, joint stiffness or a reduction in arthrokinematics motion that results in limited osteokinematic range of motion - inadequate inferior glide of the femoral head resulting in limited abduction of the hip.

The seeping into, or abnormal collection of fluid in a body cavity.

For example, knee effusion describes swelling within the knee joint.

Note: the word "effusion" is used differently in medicine than it is used in reference to the movement (seeping out) of liquids and gases, for example in chemistry.

&nbsp;

A trait of body tissues that allows a tissue to return to its resting length or state after deformation or stretch.
Example:  Muscle is elastic tissue; many muscles will return to their resting length after being stretched to 150% of that length without any appreciable change in tissue quality.

Elasticity: Elasticity refers to the ability of a cell to return to its resting length after being stretched/lengthened.
<ul>
 	<li>Note: this term is often confused with extensibility. Elasticity is not the ability to stretch; it is the ability to return to normal length after being stretched. Muscle tissue, connective tissue and even nerve tissue have varying levels of elasticity.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Epithelial cell - One of the four basic cell types, found lining the body's cavities, blood vessels, organs and constitutes most gland tissue.  These cells are specialized to aid with absorption, secretion, or act as a barrier from foreign objects.
<ol>
 	<li>Saladin, K. S., &amp; Miller, L. (1998). Anatomy &amp; physiology. New York (NY): WCB/McGraw-Hill.</li>
</ol>

Equilibrium - a state in which opposing forces or influences are balanced.
<ul>
 	<li>For example, to maintain a neutral trunk while pushing or pulling a weight in one hand, your core musculature must balance the force by creating an equal amount of force in the opposite direction.</li>
</ul>

The study of causation, or origination. The word is commonly used in the medical professions, where it may refer to the study of why things occur, or the reason behind why things act a certain way.

For example, the etiology of low back pain is a complex subject, with multiple contributing factors and various structures implicated.

<div class="gs_citr" tabindex="0">Evidence-based medicine (practice) is the integration of best research evidence with clinical expertise and patient(client) values (2)."</div>
<ul>
 	<li class="gs_citr" tabindex="0">...the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients (clients).  It involves the integration of at least (a) clinical expertise/expert opinion, (b) external scientific evidence, and (c) client/patient/caregiver perspectives to provide high-quality services reflecting the interests, values, needs, and choices of the individuals we serve (1).</li>
</ul>
&nbsp;
<ol>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Sackett, D. L., Rosenberg, W. M., Gray, J. M., Haynes, R. B., &amp; Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn't. Bmj, 312(7023), 71-72.</li>
 	<li class="gs_citr" tabindex="0">Sackett D et al. Evidence-Based Medicine: How to Practice and Teach EBM, 2nd edition. Churchill Livingstone, Edinburgh, 2000, p.1</li>
</ol>

Excitability: The ability of a cell to change in membrane conductance as a response to stimulation.

<ul>
 	<li>For example, muscle cells are specialized to react to a change in membrane potential with contraction, where as nerve cells are specialized to propagate a change in membrane potential along there axons and communicate that message to other tissues via neurotransmitters.
</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Excitation threshold: The level that a depolarization must reach for an action potential to occur.
<ul>
 	<li>The excitation threshold is a contributing factor to the "all-or-none" response of muscle and nerves cells to a stimulus.</li>
</ul>

Exercise Progression - Modification of an exercise with the intent of promoting adaptation by increasing demand. This can be accomplished by increasing reps, load, tempo, range of motion, complexity, and/or challenge to an individual's stability.
<ul>
 	<li>Because load, reps, tempo and complexity are often explicitly noted, the term "exercise progression" is most often used throughout Brookbush Institute (BI) content to refer to an exercise, or series of exercises that make it harder to maintain stability with good form.
<ul>
 	<li>Sample Exercise Progression: <a href="https://brentbrookbush.com/vimeo_videos/kneeling-chop-pattern/" target="_blank" rel="noopener">Kneeling Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/static-standing-chop-pattern/" target="_blank" rel="noopener">Standing Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/single-leg-chop-pattern/" target="_blank" rel="noopener">Single-leg Chop</a></li>
</ul>
</li>
</ul>

Exercise regression - The opposite of progression; that is, modification of an exercise with the intent of reducing demand. This can be accomplished by decreasing reps, load, tempo, range of motion, complexity, and/or challenge to an individual's stability. Generally, regressions are used to modify an exercise to the client's current level of ability, with the intent of improving form, motor learning and retention.
<ul>
 	<li>Because load, reps, tempo and complexity are often explicitly noted, the term "exercise regression" is most often used throughout Brookbush Institute (BI) content to refer to an exercise or series of exercises that make it easier to maintain stability with good form.
<ul>
 	<li>Sample Exercise Regression: <a href="https://brentbrookbush.com/vimeo_videos/single-leg-chop-pattern/" target="_blank" rel="noopener">Single-leg Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/static-standing-chop-pattern/" target="_blank" rel="noopener">Standing Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/kneeling-chop-pattern/" target="_blank" rel="noopener">Kneeling Chop</a></li>
</ul>
</li>
</ul>

Experimental Research - Studies in which the researchers introduce the variable to be studied, with the intent of observing the outcome. This is different than observational research which observes the effect of a variable already present. Many texts also assert that experimental research should include randomization and ideally a control group, as is seen in Randomized Control Trials. Studies in which the variable is introduced by the researchers, but participants are not randomized may be considered Quasi-experimental research.
<ul>
 	<li>In this study by Esformes, the experimental variable was squat depth and the outcome measures observed were various performance measures related to power (1).</li>
</ul>
<ol>
 	<li><a href="https://brookbushinstitute.com/article/back-squat-depth-lower-body-post-activation-potentiation/" target="_blank" rel="noopener">Esformes, J., &amp; Bampouras, T. (2013). Effect of back squat depth on lower-body postactivation potentiation. Journal of Strength and Conditioning Research, 27(11), 2997-3000.</a></li>
</ol>
&nbsp;

Extensibility: The ability of a cell to be stretched or lengthened without damage (1).
<ul>
 	<li>For example, most cells would rupture with even a modest stretch, but muscles can stretch up to 3 times their contracted length.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

False Negative - the proportion of negatives in a group that were assessed incorrectly (assessed as negative when the patient was actually positive)
<ul>
 	<li>Test Results: Although most tests/assessments result in either a positive or negative, the accuracy of a test is dependent on the number  of positives and negatives that are correct. Therefore, when the accuracy of a test is determined, their are 4 possible results, because a positive or negative result could be right (true) or wrong (false).</li>
</ul>

False Positive - the proportion of positives in a group that were assessed incorrectly (assessed as positive when the patient was actually negative)
<ul>
 	<li>Test Results: Although most tests/assessments result in either a positive or negative, the accuracy of a test is dependent on the number  of positives and negatives that are correct. Therefore, when the accuracy of a test is determined, their are 4 possible results, because a positive or negative result could be right (true) or wrong (false).</li>
</ul>

The function of fascia is to transmit force, provide support, and protect tissues. Fascia can effect motion by:
Transmitting force from one or more muscles (example: the thoracolumbar fascia)
Restricting motion in cases of adaptive shortening and/or adhesion to proximal structures (example: iliotibial band in cases of lower-leg dysfunction)
Elastic recoil after stretching can contribute to force production (example: plyometric exercise)

Note: There is evidence that fascia may house more receptors related to human movement than other tissues. In this way fascia may act as a motherboard for the nervous system

The fascial system does not contract or develop trigger points, and its capacity to adapt to stretching and or strengthening exercise is limited, especially when compared to the adaptive capacity of muscle tissue.

Fibromyalgia - A loosely defined diagnosis that is associated with a combination of widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. Consideration may also be given to the presence of psychosocial stressors and inflammatory disease in the patients history. Newer research suggests that fibromyalgia may be at least in part due to central sensitization of myofascial pain, often associated with trigger points (1 - 4).
<ol>
 	<li>Wolfe, F. (2018). Fibromyalgia Syndrome and Fibromyalgia Syndrome Criteria: Problems in Definition and Validity. Fibromyalgia Syndrome and Widespread Pain: From Construction to Relevant Recognition.</li>
 	<li>Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. L., ... &amp; Fam, A. G. (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis &amp; Rheumatism: Official Journal of the American College of Rheumatology, 33(2), 160-172.</li>
 	<li>Alonso-Blanco, C., Fernandez-de-las-Penas, C., Morales-Cabezas, M., Zarco-Moreno, P., Ge, H. Y., &amp; Florez-García, M. (2011). Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. The Clinical journal of pain, 27(5), 405-413.</li>
 	<li>Staud, R., Nagel, S., Robinson, M. E., &amp; Price, D. D. (2009). Enhanced central pain processing of fibromyalgia patients is maintained by muscle afferent input: a randomized, double-blind, placebo-controlled study. PAIN®, 145(1-2), 96-104.</li>
</ol>
&nbsp;

Muscles that act to reduce or prevent movement at proximal joints to improve force transmission.
Example: The muscles of the core are important fixators; reducing motion of the spine/trunk to enhance force transmission between the extremities and environment.

An increase in joint stability via compressive forces resulting from muscular contraction and increased tension in fascial structures (1,2).
<ul>
 	<li>This term is most often used in reference to core intrinsic stabilizers, the thoracolumbar fascia and the sacroiliac joint; however, force closure and form closure have been mentioned in the literature referring to other joints.</li>
 	<li>Related term: Form closure</li>
</ul>
<ol>
 	<li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: <a class="glossaryLink " title="Glossary: Integration" href="https://brentbrookbush.com/glossary/integration/" target="_blank" rel="noopener noreferrer" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Integration&lt;/div&gt;&lt;div class=glossaryItemBody&gt;Making a whole of parts.&lt;br /&gt;&lt;br /&gt;Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.&lt;/div&gt;">Integration</a> of Research and Therapy. (c) 2007 Elsevier Limited</li>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Vleeming, A., Pool-Goudzwaard, A. L., Stoeckart, R., van Wingerden, J. P., &amp; Snijders, C. J. (1995). The Posterior Layer of the Thoracolumbar Fascia| Its Function in Load Transfer From Spine to Legs. Spine, 20(7), 753-758.</li>
</ol>

The relative contribution of joint shape and structure to the stability of a joint (1,2).
<ul>
 	<li>This term is most often used in reference to the "rough" articulating surfaces of the sacroiliac joint and the wedge shape of the sacrum; however, force closure and form closure have been mentioned in the literature referring to other joints.</li>
 	<li>Related term: Force closure</li>
</ul>
<ol>
 	<li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: <a class="glossaryLink " title="Glossary: Integration" href="https://brentbrookbush.com/glossary/integration/" target="_blank" rel="noopener noreferrer" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Integration&lt;/div&gt;&lt;div class=glossaryItemBody&gt;Making a whole of parts.&lt;br /&gt;&lt;br /&gt;Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.&lt;/div&gt;">Integration</a> of Research and Therapy. (c) 2007 Elsevier Limited</li>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Vleeming, A., Pool-Goudzwaard, A. L., Stoeckart, R., van Wingerden, J. P., &amp; Snijders, C. J. (1995). The Posterior Layer of the Thoracolumbar Fascia| Its Function in Load Transfer From Spine to Legs. Spine, 20(7), 753-758.</li>
</ol>

An arthrokinematic motion - linear motion across a joint surface parallel to the plane of the adjacent joint surface, just as your posterior moves relative to a "slide" in a park.

For example, the glide of facet joint in the spine during spinal flexion and extension, or the posterior glide of the humeral head that must accompany anterior roll to maintain congruence with glenoid fossa during shoulder horizontal adduction.

A plane joint (also called an arthrodial joint, gliding joint or plane articulation) is a synovial joint which allows only gliding movement in the plane of the articular surfaces. The opposed surfaces of the bones are flat or almost flat, with movement generally limited by tight capsules and ligaments. Plane joints are numerous, are most often small, and allow very little motion.  Examples include the carpal joints of the wrist, the tarsal joints of the ankle, and the facet joints of the spine.

"...refers to the measurement of angles, in particular the measurement of angles created at human joints by the bones of the body (1).

&nbsp;
<ol>
 	<li>Cynthia C. Norkin, D. Joyce White. Measurement of Joint Motion: A Guide to Goniometry 3rd Edition. Copyright (C) 2003 by F.A. Davis Company</li>
</ol>

Ground reaction force (GRF) - The force exerted by the ground on the body in contact with it.

For example, when a runner's foot strikes the ground with a force equal to the mass of the individual times their acceleration due to gravity, momentum and muscular exertion, the ground exerts an equal and opposite force on the runner's foot.
<ul>
 	<li>GRF is often measured in research studies using force plates as a means of quantitatively measuring the force generated by an individual.</li>
</ul>

H-Band - Refers to the central zone of a sarcomere that looks lighter under a microscope.  This area of the sarcomere is a lighter portion of the A-band where there is no overlap between the thinner filaments (actin), and the thicker filaments (myosin).
<ul>
 	<li>Example, when a muscle contracts, actin and myosin cross-bridging occurs in the region of the A-band until the H-band is reached where no overlap occurs.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

A hinge joint (also called a ginglymus) is a synovial joint in which the articular surfaces fit one another in a way that only permits motion in one plane. Examples include the elbow, the knee (unless considered a condyloid joint) and the interphalangeal joints.

Holism (holistic) (biological holism) - (from Greek holos "all, whole, entire") is the idea that systems and their properties should be viewed as wholes, not just as a collection of parts.
<ul>
 	<li>Summarized by Aristotle in his "Metaphysics": "The whole is more than the sum of its parts". However, the term "holism" was introduced into language by the South African statesman Jan Smuts as recently as 1926. (Smuts J. C. 1987 [1926]. Holism and evolution. Cape Town: N &amp; S Press.)</li>
</ul>
Example: The Brookbush Institute promotes a holistic approach to human movement science, in which the muscular, fascial, articular and neural systems are not viewed as separable and all proximal segments are considered.

Hormone: Chemical messengers produced by the endocrine system, transported via tissue fluids such as blood, to stimulate cells to "act."
<ul>
 	<li>Example: Growth hormone is secreted by the pituitary gland in the brain; stimulating growth, cell reproduction and cell regeneration in certain types of cells</li>
</ul>
The English physician E. H. Starling discovered in collaboration with the physiologist W. M. Bayliss secretin, the first hormone, in 1902. (1).
<ol>
 	<li>Henriksen, J. H., &amp; de Muckadell, O. S. (2000). Secretin, its discovery, and the introduction of the hormone concept. Scandinavian journal of clinical and laboratory investigation, 60(6), 463-472.</li>
</ol>

A range of motion achieved by the patient/client that is more than normal.
<ul>
 	<li>Note: Both hyper-mobility and hypo-mobility may adversely affect motion and may lead to deleterious effects on joints and soft tissue over time. There is no evidence to suggest that more or less flexibility than normal is beneficial.</li>
</ul>
Example: If an individual can place their forehead on their knees they are likely hypermobile at one, if not several joints

Example 2: 110° of shoulder external rotation would be considered hyper-mobile.

Hyperplasia is an increase in organic tissue size due to an adaptive increase in the number of cells per organ.
<ul>
 	<li>Although muscle hyperplasia has been noted in some animals, human muscle tissue does not seem to have this adaptive ability.</li>
</ul>

A condition of excessive tone of the skeletal muscles; increased resistance of muscle to passive stretching.  May be related to increased neural drive, synergistic dominance, trigger points, reflexive over-activity, and/or muscle length.
Example:  Individuals who exhibit ankle eversion and abduction during an overhead squat assessment likely have hypertonic fibularis (peroneal) muscles.

Muscular hypertrophy is an increase in muscle mass/size due to increase in the volume and cross-sectional area (CSA) of individual muscle cells. The increase in cross-sectional area can be attributed to an an increase in contractile proteins and structural elements (myofibrillar hypertophy), as well as an increase in glycogen storage and elements related to metabolism (sarcoplasmic hypertophy). Hypertrophy is an adaptation of both cardiac and skeletal muscle fibers in response to progressive increases in workload.
<ul>
 	<li>Note: Hypertrophy is not hyperplasia. Hyperplasia is an increase in muscle size due to an adaptive increase in the number of muscle fibers/cells per muscle. This type of adaptation does not occur in human muscle tissue.</li>
</ul>

A range of motion achieved by a patient/client that is less than normal.
<ul>
 	<li>Note: Both hyper-mobility and hypo-mobility may adversely affect motion and may lead to deleterious effects on joints and soft tissue over time. There is no evidence to suggest that more or less flexibility than normal is beneficial.</li>
</ul>
Example: If the end range of shoulder external rotation is reached and measured as 75° during goniometric assessment, the client/patient is exhibiting hypomobility of the glenohumeral joint (shoulder).

Hypothesis - a proposed explanation for a phenomenon; "scientific hypotheses" are generally constructed in a way that is testable or falsifiable.
<ul>
 	<li>Example: The hypothesis, "excessive knee valgus may be correlated with future knee pain and injury," has been the subject of several studies published over the last decade.</li>
</ul>

Diminished tone of skeletal muscles; diminished resistance of muscles to passive stretching.   May be related to inhibition, reciprocal inhibition, arthrokinematics inhibition and/or  increased resting length of muscle.
Example:  If your knees cave (hip adduction) during a squat or leg-press it is likely that your gluteus medius is hypotonic.

I-Band - Refers to the part of the muscle cell that looks lighter under a microscope.  This area of the cell is lighter due to parallel arrangement of thinner filaments (actin), and no overlap with the thicker filaments (myosin).
<ul>
 	<li>As a muscle contracts, the I-bands will decrease in width and move closer to one another.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Independent variable - in research, this is the variable or phenomenon being manipulated in the study.
<ul>
 	<li>Example, in the study by Ghanbari et al. (1), the independent variable is "knee joint mobilization", the dependent variable is "quadriceps muscle strength."</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/effect-knee-joint-mobilization-quadriceps-muscle-strength/" target="_blank" rel="noopener noreferrer">Ghanbari A. and Kamalgharibi S. (2013). Effect of knee joint mobilization on quadriceps muscle strength. International Journal of Health and Rehabilitation Sciences. 2(4): 186-191</a></li>
</ol>

An anatomical direction; toward the bottom (below)

Example, the mouth is inferior to the eyes

A reduction in neural drive, muscular activity, and or force output due to altered neuromuscular reflex.  Alterations in neuromuscular reflex may occur due to increases in muscle length (hypothesis: increased excitation threshold), altered reciprocal inhibition in response to increased antagonist tone, and or alterations in joint motion (arthrokinematics inhibition).

Making a whole of parts.

Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.

Intermuscular Coordination - Optimal timing and motor unit recruitment of agonists, antagonists, synergists, neutralizers, stabilizers and fixators.

Example: Role of Muscles during Hip Extension
<ul>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Prime Mover" href="https://brentbrookbush.com/glossary/prime-mover/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Prime Mover&lt;/div&gt;The muscle most responsible for a joint action under load -&lt;br /&gt;&lt;br /&gt;That is, the muscle that can produce the most force for a given joint action. Often this term is used synonymously with the term agonist. The prime mover as defined above, may or may not be the most active muscle for a joint action during activities of daily living.&lt;br /&gt;&lt;br /&gt;Example: the gluteus maximus is the most powerful hip extensor and therefore the prime mover; however, the hamstrings are likely the most active hip extensors during low level activities like walking or standing.">Prime Mover</a>:  <a href="https://player.vimeo.com/external/82855344.hd.mp4?s=54c3e7d98fb9d4e0af8d282c85ba9b3e">Gluteus maximus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Synergists" href="https://brentbrookbush.com/glossary/synergists/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Synergists&lt;/div&gt;Muscles that assist the prime mover in performing a joint action.&lt;br /&gt;&lt;br /&gt;That is, all muscles that can perform a joint action that are not the prime mover, are termed synergists.&lt;br /&gt;Example: The rectus abdominis is the prime mover of spinal flexion. All other muscles that can perform spinal flexion are synergists including – external obliques, internal obliques and psoas.">Synergists</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/biceps-femoris/">Biceps femoris (long head)</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/semitendinosus-and-semimembranosus/">semitendinosus, semimembranosus</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/adductors/">posterior head of adductor magnus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Antagonist" href="https://brentbrookbush.com/glossary/antagonists/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Antagonist&lt;/div&gt;Muscles that oppose the prime mover and synergists for a given joint action.&lt;br /&gt;&lt;br /&gt;That is, all the muscles that can perform the opposing joint action.&lt;br /&gt;&lt;br /&gt;Example: The triceps and anconeus are antagonists during elbow flexion.">Antagonists</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/psoas/">Psoas</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/iliacus/">iliacus</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/tensor-fascia-latae-tfl/">tensor fascia latae</a> (TFL),<a href="https://brentbrookbush.com/articles/muscular-anatomy/rectus-femoris/"> rectus femoris</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/adductors/">anterior adductors (especially pectineus)</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/sartorius/">sartorius</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Neutralizer" href="https://brentbrookbush.com/glossary/neutralizers/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Neutralizer&lt;/div&gt;Muscles that oppose unwanted joint motions created by the prime mover and/or synergists, and/or muscles that prevent unwanted ancillary motion.&lt;br /&gt;Example: The teres minor and infraspinatus neutralize the internal rotation force created by the pectoralis major during horizontal adduction of the shoulder.">Neutralizers</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-minimus/">Gluteus minimus</a> and <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-medius/">anterior fibers of gluteus medius</a> neutralize external rotation force of <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-maximus/">gluteus maximus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Stabilizer" href="https://brentbrookbush.com/glossary/stabilizers/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Stabilizer&lt;/div&gt;Muscles whose primary role is to improve arthrokinematics by maintaining optimal alignment of joint surfaces.&lt;br /&gt;&lt;br /&gt;Most often these muscles are the most intrinsic muscles of a joint, have a larger percentage of Type I muscle fibers and are rich in proprioceptors.&lt;br /&gt;Example: The muscles of the rotator cuff act as stabilizers for most shoulder motions.">Stabilizers</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/deep-rotators-of-the-hip/">Deep rotators of hip</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Fixator" href="https://brentbrookbush.com/glossary/fixators/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Fixator&lt;/div&gt;Muscles that act to reduce or prevent movement at proximal joints to improve force transmission.&lt;br /&gt;Example: The muscles of the core are important fixators; reducing motion of the spine/trunk to enhance force transmission between the extremities and environment.">Fixators</a>: <a href="https://brentbrookbush.com/articles/core-subsystems/intrinsic-stabilization-subsystem/">Intrinsic stabilization subsystem</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/rectus-abdominis/">rectus abdominis</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/internal-obliques/">internal</a> and <a href="https://brentbrookbush.com/articles/muscular-anatomy/external-obliques/">external obliques</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/quadratus-lumborum/">quadratus lumborum</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/erector-spinae/">erector spinae</a></li>
</ul>
&nbsp;

Example from: <a href="https://brentbrookbush.com/articles/anatomy-articles/introduction-to-functional-anatomy/kinesiology-of-the-hip/" target="_blank" rel="noopener">Introduction to Functional Anatomy: Kinesiology of the Hip</a>

Intramuscular coordination refers to the coordinated recruitment of motor units within a single muscle. This concept is used to explain increases in maximal strength and power; however, the coordinated and sequential recruitment of motor units is also essential to strength endurance and smooth coordinated motion.  Related terminology may include; motor unit recruitment, preferential recruitment, rate coding, sequence, etc..

Example: It is hypothesized that the "shaking" noted during a novice exercisers attempt at an activity like the <a href="https://brentbrookbush.com/vimeo_videos/ball-crunch-and-progressions/" target="_blank">stability ball crunch</a> may be due to relatively poor intramuscular coordination. Rather than smooth, sequential firing of rectus abdominis motor units, groups of motor units turn on and off in an uncoordinated manner.

Pertaining to the same side

Example, the quadratus lumborum performs ipsilateral flexion; lateral flexion toward the same side as the muscle.

An isoform, or variant, is a member of a set of similar proteins, that originate from the same gene, or gene family.
<ul>
 	<li>Example, the variations in myosin heavy chain proteins (MHC I, MHC IIA, MHC IIB/X) that contribute to the characteristic differences between muscle fiber types.</li>
</ul>

“The Prime Assumption”
Everything crossing a joint will influence joint motion during every joint action.

A concept that has expanded over the past several decades to describe the integration of 4 body systems (muscle, joints, fascia and nerves), as well as, the coordinated function of various body segments (e.g. hip, knee and ankle) to produce motion. Kinetic referring to motion, and chain being an analogy for the interdependent link between systems.

Example, the posterior kinetic chain, refers to the integrated function of nerves, muscles, fascia and joints on the posterior side of the body.

The concept of the kinetic chain was originally adapted from the work of a mechanical engineer named Franz Reuleaux (Kinematics of Machinery (1875)) by Dr. Arthur Steindler in 1955 (Steindler A: Kinesiology of the Human Body. Springfield, IL, Charles C. Thomas Co.. 1955).

Latent Trigger Point - A myofascial trigger point that is not painful at rest, only painful when palpated, and may or may not exhibit a characteristic referral pain pattern when palpated.  Latent trigger points do result in an acute point of sensitivity, in a taut band of muscle, and may restrict range of motion (1).

Note: Based on the clinical experience, the Brookbush Institute suggests that latent trigger points (sometimes refereed to as Tender Points) are more common than active trigger points. Further, they are likely addressed more often than trigger points; being the intended target of many soft-tissue mobility techniques.
<ol>
 	<li>David G. Simons, Janet Travell, Lois S. Simons, Travell &amp; Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition,© 1999 Williams and Wilkens</li>
</ol>

An anatomical direction; further from the midline

Example, the anterior deltoid is lateral to the pectoralis major

Length/Tension Relationship - The amount of force generated by a muscle is dependent on sarcomere length.
<ul>
 	<li>The ability of sarcomere to maximally produce force occurs when sarcomere length results in optimal overlap between actin and myosin. Stretching a sarcomere decreases overlap between actin and myosin filaments and reduces force production (1-3). When length is less than optimal, actin from opposite ends overlap and interfere with cross-bridging, and myosin filament are compressed as they contact the the Z-disk also reducing force (4)</li>
</ul>
<ol>
 	<li>Gordon, A. M., Huxley, A. F., &amp; Julian, F. J. (1966). The variation in isometric tension with sarcomere length in vertebrate muscle fibres. The Journal of physiology, 184(1), 170-192.</li>
 	<li>Edman, K. A. P. (1966). The relation between sarcomere length and active tension in isolated semitendinosus fibres of the frog. The Journal of Physiology, 183(2), 407-417.</li>
 	<li>Lieber, R. L., Loren, G. J., &amp; Friden, J. (1994). In vivo measurement of human wrist extensor muscle sarcomere length changes. Journal of neurophysiology, 71(3), 874-881.</li>
 	<li>Lieber, R. L. (2002). Skeletal muscle structure, function, and plasticity. Lippincott Williams &amp; Wilkins.</li>
</ol>
&nbsp;

Levels of Evidence - Relative to evidence-based practice, levels of evidence are an attempt to describe the strength of the results measured in a clinical trial or research study.  Note: levels of evidence do not supersede the critical evaluation of an experienced professional, and should be viewed as guidelines - a meta-analysis may be poorly constructed (Level IA), and a comparative study (Level III) may employ new technologies and a strong methodology.


The Levels of Evidence used by the Brookbush Institute, as described by Shekelle et al.(1):
<ul>
 	<li class="p1">IA - Evidence from meta-analysis of randomized controlled trials</li>
 	<li class="p1">IB - Evidence from at least one randomized controlled trial</li>
 	<li class="p1">IIA - Evidence from at least one controlled study without randomization</li>
 	<li class="p1">IIB - Evidence from at least one other type of quasi-experimental study</li>
 	<li class="p1">III - Evidence from non-experimental descriptive studies, such as comparative studies, correlation studies, and case-control studies</li>
 	<li class="p1">IV - Evidence from expert committee reports or opinions or clinical experience of respected authorities, or both</li>
</ul>
<ol>
 	<li>Shekelle, P. G., Woolf, S. H., Eccles, M., &amp; Grimshaw, J. (1999). Developing clinical guidelines. Western Journal of Medicine, 170(6), 348.</li>
</ol>

Likelihood Ratios - Likilihood ratios are used for assessing the value of performing a diagnostic test. They use sensitivity and specificity to determine whether a test result usefully changes the practitioner's chance (probability) of reaching the correct assessment. Calculation of likelihood ratios is based on Baye's theorem.
<ul>
 	<li>Positive Likelihood Ratio (LR+) - The ratio of a positive test result in people with the pathology to a positive test result in people without the pathology.</li>
 	<li>Negative Likelihood Ratio (LR-) - The ratio of a negative test result in people with the pathology to a negative test result in people without the pathology.</li>
</ul>

Longitudinal Study - a research design that involves observing the same variables, several times over a period of time.
<ul>
 	<li>Example, the study by Hewett et al. (1) is a type of longitudinal study called a "cohort study." This study investigated whether excessive knee valgus during landing was a predictor of knee injury risk in adolescent females over the course of a season.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/research-review-increased-valgus-during-landing-predicts-acl-injury-in-adolescent-female-athletes/" target="_blank" rel="noopener noreferrer">Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., &amp; Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes A prospective study. The American journal of sports medicine, 33(4), 492-501</a></li>
</ol>

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