Upper and Lower crossed syndrome

Gravitational Strain Pathophysiology (GSP)

S&S: - Changes/alterations in postural alignment (esp. w/ increased age) - Recurrent somatic dysfunctions - Lower back pain - Referred pain to extremities - Headache - Somatovisceral effects/presentations - Fatigue - Weakness THIS PROCESS CAN LEAD TO: Postural Decompensation —> "when an individual's functional homeostatic mechanisms are overwhelmed or when the degree of pathological change becomes structurally incapable of resisting gravitational force."

Type I vs. Type II muscles

Type I: Tonic, slow twitch muscles; long endurance work; postural muscles —-> THESE BECOME SHORTENED AND TIGHT Type II: Phasic; fast-twitch muscles —> TEND TO BECOME INHIBITED AND WEAK

Piriformis muscle/sciatic nerve variations

B, C, and D are pain-causing

Postural Diagnosis considerations for GSP

"The purpose of postural diagnosis therefore is to determine where in the continuum a given patient is and whether the osteopathic postural model could or should be integrated into that patient's healthcare regimen. To this end, the diagnostic process should answer at least four specific questions:" (1) "Does the patient's posture play a role in a patient's given complaint?" (2) "Does the patient's posture detract or limit the patient's ability for self-healing?" (3) "Does the patient's posture present a significant risk factor for pain, dysfunction, or pathology in the future?" (4) "Is the patient able to respond positively to a postural treatment regimen in a time- and cost-effective manner?"

General treatment strategies

(1) Postural Education and Compliance (2) OMT generally and to transition zones (3) Postural exercise (4) Static postural bracing (5) Functional postural orthotics (6) Other miscellaneous approaches

Psoas Syndrome

- "In patients with psoas syndrome, the psoas muscle has become significantly tight as demonstrated by restricted hip extension." - "The key in this situation is to treat the flexed upper lumbar component of the problem." (Foundations, 3rd Edition, p. 572-3). - "A chronic psoas spasm can create a persistent strain across the lumbosacral junction and impede resolution of lumbosacral somatic dysfunction in spite of OMT and exercises directed at the L-S region." (Foundations, 3rd Edition, p. 1014).

Piriformis syndrome

- "manifested as pain in the buttocks or hip with radiation into the calf or foot. It can be severe enough to result in the patient becoming bedridden." (DiGiovanna, p. 356-357) - "Even though the mechanism of sciatica or radicular type pain in piriformis syndrome is not completely understood, it is thought that the sciatic nerve may become impinged or compressed by the piriformis muscle."

Postural Compensation as an "Integrated Homeostatic Process"

- Begins in utero, continues throughout growth. - The CNS and peripheral nervous system together learn to balance the postural homeostatic mechanisms. —> "Each person will progressively compensate in a different way depending, in part, on his or her unique intrinsic and extrinsic risk factors" —> "Postural preferences and patterns will conform within the resultant connective tissue structure" —> "Neuromusculoskeletal structures will remodel to reflect the functional demands placed upon them" —> "Functional capability will be limited by less then ideal structure."

PRONATION of the subtalar joint and LOWER CROSSED SYNDROME

- Caused by: Mechanical stress at the knee (genu valgus/valgum), hip and lumbar spine - Muscle imbalance - tight/facilitated type I muscles vs weak/inhibited type II muscles - KEY muscle (often) - GLUTEUS medius weakness

Other Postural Considerations for crossed syndrome

- Coronal Plane: Groups Curves - Sagittal Plane: Kyphoses and Lordoses - Transverse Plane: Rotational preferences and Transitional Regions (OA, CT, TL, LS) - Correlate with : Somatic Dysfunction

Factors affecting GSP

- Intrinsic Factors - Extrinsic Factors - Tissue Responses: • Skeletal-Arthrodial (Wolff Law: "bone remodels over time in response to the stresses placed upon it." - Foundations, 3rd Ed. p. 446.) • Regional (Transition Zone) Fascial Response (J. Gordon Zink, D.O. and the Respiratory-Circulatory Model) • Muscular Response: - TriggerPoints (may be related to myotomal or sclerotomal pain patterns) - Tight vs. Weak muscle patterns, such as the *********** UPPER CROSSED and LOWER (Pelvic) CROSSED SYNDROMES********** • Ligamentous Response • Response of Related Neural, Vascular Lymphatic and Visceral Elements

Example of postural effect of psoas syndrome

1. Key non-neutral SD @ L1 or L2 side-bent left 2. Marked L psoas spasm 3. Rotation of sacrum on left oblique axis (often forward) 4. Right pelvic shift 5. Right piriformis spasm with tender point 6. Pain in right hip down back of thigh to knee

Tensegrity model and application to biological systems

Tension + Integrity = Tensegrity; this can also apply to biological systems, in addition to architecture. - "In this model, it is recognized that:" —> "Areas of hypomobile somatic dysfunction may cause compensatory hypermobility elsewhere" —> "Hypermobility in one or more regions may affect compensatory hypomobility elsewhere" —> "Fascial patterning and musculoligamentous tensions take on primary importance as the model's connecting elements"

What does postural diagnostic approach rely heavily upon?

The postural diagnostic approach to answering these questions relies heavily on observation and palpation. It attempts to correlate other findings from the patient's history and physical examination in order to determine if any pertinent signs or symptoms exist. It may also bring in radiological or biomechanical tests to help quantify the extent and type of postural change."

Compensatory or facilitative mechanisms may cause sx of

• Cervical, thoracic, lumbosacral pain • GI disorders, abdominal, pelvic and inguinal pain • Headache, neck pain —————————- ADDITIONAL STATEMENT: Overall, there are many approaches that "are used to assist the body's postural response to gravity. An individually designed conservative program includes a carefully selected combination of patient education, OMT, exercise, and functional orthotics. All of these are aimed at modifying the structure-function relationship and enhancing the body's ability to self-heal. Therefore, postural balancing requires an understanding of the biomechanical nature and functional anatomy of each patient and a full understanding of osteopathic philosophy.

FADIR test

• Flexion (to at least 60 degrees) • Adduction • Internal rotation ADD'L findings: • Positive result —> trochanteric & gluteal PAIN MORE: • Supine patient, however, can also be done in lateral recumbent position as/if needed.