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Journal Win 2018 - Postural Asymmetries
Journal Win 2018 - Postural Asymmetries
A
s massage therapists or myotherapists working with human • Left brain dominance causes right hand and foot motor dominance
bodies over many years we begin to see familiar patterns in which through repetitive use is thought to cause the common
our clients. Right sided low back pain, neck pain, protracted compensatory pattern.
right scapula, overactive right SCM, overactive left • Left side vestibular dominance has been shown to relate to the
Piriformis, pain referral from myofascial triggers in QL and glut medius position of the foetus in utero in the third trimester. Delivery in
more often on the right are just some of the common presentation to my labour commonly occurs with the left side occiput anterior.
practice. • A study has shown that less than 12 per cent of infants’ heads are
For all our good work in treating muscle imbalances and painful symmetrical with a tilt of the occiput creating a tilt of the sacrum to
tissues, our clients invariably return at some future time with the same the same direction. Some of this distortion persists into adulthood
pain patterns or dysfunction. Understanding why these muscle
and will also produce an unequal distribution of weight between
imbalances persist and how they affect the way we function can give
lower extremities.
us the tools to treat our clients more effectively and give them some
• Zink2 postulates that adaptation during child development,
control over dysfunctional postural patterns.
resulting from minor traumas of the lumbar spine, creates a
The Postural Restoration Institute (PRI) was established in 1999 to
torsional bias.
explore and explain the science of postural adaptations and asymmetrical
patterns in the human body. Postural restoration is an innovative • Asymmetric leg growth has been shown to be common in children,
treatment approach developed by Ron Hruska. It involves treating the increasing with the age of the child.
whole body with muscle activation exercises, manual techniques and • Leg length discrepancy can be associated with dental malocclusion.
breathing to reverse compensatory patterns and inhibit overactive • Mandibular rest position and occlusion will affect head posture.
chains of muscle. The cervical spine will compensate for changes within the cranium
Asymmetry affecting whole body posture.
The human body is not symmetrical. We have a large liver on the • Correlation with asymmetrical position of heart, liver etc.
right and a heavy heart on the left. The right lung has three lobes while Reciprocal function needs to be balanced and integrated to keep these
the left has two lobes. The diaphragm, which has two domes, is larger imbalances under control. If normal imbalances are not regulated by
and more domed on the right, supported by the liver, whereas the left reciprocal function when walking, turning or breathing, weakness,
hemi-diaphragm is smaller and flatter. Asymmetries are commonly seen instability, breathing pattern dysfunction and painful conditions result.
in the face with one side smaller, higher eyebrow, ear etc. on one side. For example, most humans will keep the pelvis oriented to the right even
The neurological, respiratory, circulatory, muscular and vision when we are on the left foot. The torso will remain rotated to the left
systems are not the same on both sides of the body. The two hemispheres and we will see more posterior arm swing on the left than on the right
of the brain control opposite sides of the body, the left being more during gait.
dominant. The right vagus nerve is longer than the left. Breathing
Common compensatory pattern Leon Chaitow3 writes about the effects of Breathing Pattern Disorders
As humans we stand with our weight mainly on the right lower (BPDs) and the connection to chronic conditions of persistent pain and
extremity. This offsets the weight of the left upper chest and leads to a fatigue such as fibromyalgia, chronic fatigue syndrome, chronic pelvic
tendency for the left side of the pelvis to tilt forward, the right shoulder pain etc. BPD is described as overbreathing, upper chest breathing and
to move downward and abdominals on the left to be weaker than on the at extremes, hyperventilation. Breathing may be shallow, rapid with
right. gasps, sighs, and yawns or breath-holding. Dysfunctional breathing
These patterns of asymmetry can be seen in the way we stand, move patterns can be associated with fatigue, dyspnea, panic attacks, anxiety,
our extremities, walk, and breathe and the position of our jaw and teeth. and painful musculoskeletal conditions in the upper body.5 Paradoxical
The common compensatory pattern has been described by many breathing will be occurring when the abdomen is drawn in during
authors and several explanations have been postulated:1 inhalation and moves out during exhalation.4
28 w i n t e r 2 018 | M a s s a g e & M y o t h e r a p y A u s t r a l i a j o u r n a l
Modalities
Polyarticular Chains The AICs will influence respiration, trunk rotation, ribcage, spine and
In PRI teaching, Ron Hruska describes the common pattern seen in
7 lower extremity orientation. The BCs will influence cervical rotation,
humans as the Left Anterior Interior Chain Right Brachial Chain (LAIC RBC) shoulder dynamics and chest expansion during inspiration.
pattern. Two Posterior Exterior Chains (PEC) also are present comprising
latissimus dorsi, quadratus lumborum, posterior intercostals, serratus
posterior, and erector spinae group of muscles.
PECs will influence lumbar lordosis, thoracic flatness, sacroiliac strain
and act as accessory muscles of respiration.
L:AIC and R:BC pattern
We commonly see a pattern of overactivity in the left AIC and Right
BC.
• The left side of the pelvis is anteriorly tilted (sagittal plane) and rotated
There are two Brachial chains (BC)
forward (transverse plane). Right side pelvis is posteriorly tilted.
attaching to ribs 4-7, xiphoid and
posterior inferior occipital bone, • Lower back and spine are orientated to the right.
anterior inferior mandible and the • The centre of gravity is shifted to the right.
corocoid process of the scapula. • Left hamstrings and ischiocondylar adductor magnus are long and
They are made up of triangularis weak
sterni, SCM, scalenes, pec minor,
• Left abdominals are long and weak.
intercostals and the muscles of the
pharynx and anterior neck. • Right side trunk is shortened.
• Left side anterior ribs are externally rotated (flared) compared with
right.
• Thoracic spine is rotated to the left above T8.
• Cervical spine is rotated and side bent to left.
• Shift of left scapular results in overactive, short pectorals on the left
and increased twist of levator scapula making it more powerfully
positioned.
There are two Anterior Interior • Shift of right scapula results in weaker right levator scapulae and
polyarticular muscle chains (AIC), appearance of medial border winging.
one on the left and one on the • Right SCM is overactive as cervical rotator and also as an accessory
right, attaching to ribs 7-12, lateral respiration muscle.
patella, head of fibula and lateral
Right sided dominance helps to keep us in this pattern. Compensatory
condyle of the tibia. They are made
up of the diaphragm, psoas, iliacus, movements in trunk, upper extremities and neck occur which affect rib
TFL, biceps femorus and vastus alignment and position and affect our ability to breathe. Breathing
lateralis. pattern dysfunction will often result.
Figure used with permission from the PEC Pattern
Postural Restoration Institute® © 2018,
www.posturalrestoration.com Another commonly seen pattern occurs when the pelvis tilts forward
bilaterally. The PEC patterned individual has compensated to increase
airflow into the chest by rotating the right innominate forward as well
as the left. The Posterior Exterior Chain is overactive bilaterally with
anterior ribcage elevated, increased lumbar lordosis and flattening of
the thoracic spine. Weak abdominals on both sides may lead to
paradoxical or belly breathing. Inefficient breathing will encourage rib
flares on both sides and deepening the lumbar lordosis. Rotation of the
pelvis and lumbar spine back to the left and right convexity scoliosis will
commonly occur. Left sided QL pain may present. Breathing pattern
disorders may also be involved.
m a s s a g e & m y o t h e r a p y a u s t r a l i a j o u r n a l | w i n t e r 2 018 29
Modalities
Figures used with permission from the Postural Restoration Institute® © 2018,
www.posturalrestoration.
30 w i n t e r 2 018 | M a s s a g e & M y o t h e r a p y A u s t r a l i a j o u r n a l
Modalities
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