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ListofCommonCompensationPatternsandMovementDysfunctions
PostedonApril16,2016byMichaelRosengart,CPT,CES,CSCS

WithinHumanMovement,variouspatternsofcompensationandtheassociatedMovementDysfunctionlimitanindividualscapabilityinperformanceandalsodramaticallyincreasestherisk
of,ifnotguarantees,afutureinjury.Conversely,trainers,coaches,andathletesthatcanidentifycommonpatternsofcompensationinHumanMovementhaveanopportunitytocorrectthe
associativeMovementDysfunctions,restoreBiomechanicalIntegrity,improveMovementQuality,andlimittheriskofinjuryaswellascontributepositivelytobothtrainingandperformance.

FallfromGrace
PatternsofCompensationdevelopinHumanMovementformanyreasons.FrominjuriestoDailyLifeActivities,theHumanBodyisconstantlybeingshapedandremodeledthrough
mechanotransduction,whichistheprocessinwhichbiomechanicalforcesincombinationwithbiochemicalreactionsandenergyflowsliterallydeform(orchangetheformof)eachandevery
cell.Inaddition,mechanotransductionmanipulatesandmodifiescorrespondingstrandsofDNA.Inotherwords,HumanMovementcontinuouslyshapesandreshapestheHumanBody.

Whatsmostalarmingaboutthisrelationshipbetweenmovementandthebodyisthatmovementcanreshapethebodyfortheworst,andwillattimeslessenthebodyscapabilitytofunction
asitcouldorasitisdesignedtofunction.Thus,thescopeofHumanMovementcanhaveanegativeinfluenceontheevolutionoftheHumanBody.

ModernLiving
Asmanyprofessionalshavealreadylaidclaimtoinbooksandresearchpapers,thecollectivesummationofDailyLifeActivities(suchastextingorsitting)intheModernWorld(referringto
developsocietiesthatutilizeahighamountoftechnologyandautomationsystemsforsurvival)isundermining,ifnoterodinganindividualscapacitytomaintainBiomechanicalIntegrityand
correctjointandtissuefunctionwhenmoving.Inshort,modernlivingismakingindividualsmovepoorly.

Compensation
Apatternofcompensationisthebodysattempttomakeupforthelackofmovementinoneareabyaddinganewmovement.Morespecifically,acompensationpatternisaneuromuscular
strategyofincludinganewfiringsequence(MotorUnitsandMuscles)and/orutilizingstructuralreliance(bones,ligaments,tendons,fasciaandjointstructures)tosupplementoravoid
anotherfiringsequenceand/orstructuralreliance.

Essentially,acompensationpatternisanalternateneuromuscularstrategythatthebodyemployswhenthenaturallyprescribedneuromuscularstrategyisnolongeraviableoptiontousein
thecreationofagivenmovement.

Walkingonalimbafterananklesprainisanexampleofacompensationpattern.Thebodysimplyreplacesitsnormalgait(walking)mechanicswithanalternateversionorstrategythatlimits
theamountofweightplacedontheinjuredankle.

SubtleChanges
Manycompensationpatternsaresubtleorhardlynoticeableandgrowovertimetoalargerscaledcompensation.ThisdominoeffectisdetrimentaltoanindividualsBiomechanicalIntegrity
andMovementQuality.

Aperfectexampleofthecompensationdominoeffectiswitnessedinanindividualwhocontinuallywalksorstandsonhard,flatsurfaces,suchasaconcretefloorinanaverageworkshopor
asteelfloorinhighrisebuilding.Ineachofthoseenvironments,thehard,flatflooroffersnogive(malleabilityorflexibility)asgrass,dirt,sandorothernaturalsurfacesdo.

Consequentially,thePosteriorTibialis(CalfMuscle)becomesoverworkedinanefforttomaintainasupportarchinthefootfortheindividualwhoisconstantlystandingandwalkingonhard,
flatsurfaces.Thismuscleweakensovertimeduetotherepetitivehighvolumeofstress,i.e.attemptingtosupportallthebodyweightoverthearchofthefootwhilestandingorwalking.

Next,thefoothabituallypronatesinanexcessivemanner(allowsthearchofthefoottocollapsetowardsthefloor),aresultofthesequentialMovementDysfunctionassociatedwiththe
weakenPosteriorTibialismuscle.Theexcessivepronationofthefootaddsadditionalconsequencesovertime.

DominosFalling
Theactofhabituallywalkingonhard,flatsurfacesoverworksthePosteriorTibialisandallowsthearchofthefoottobecomecompromised,eventuallycollapsingtowardsthefloor.Thenext
dominotofallistheadductionorinwardmovementoftheTibia(Shinbone)thatcausesthePeroneals(LateralCalfMuscles)andBicepsFemoris(LateralHamstringMuscles)toeccentrically
(negatively)contractasacompensationstrategyforneutralalignmentandstabilityofthekneejoint.Inshort,oneformorstrategyofcompensationinHumanMovementeventuallyleadsto
anotherandanothernomatterhowsubtlethefirstformofcompensationisatthestart.

PatternsForm
Inthegamedominos,whenonetilefalls,anotherisquicktofollow,justlikecompensationsandMovementDysfunctions.Whenonemuscleformsacompensation,anothercompensationwill
follow,itsonlyamatterofwhereandwhen.Forexample,whenthefootcontinuouslypronates(allowsforacollapsedarch),thenthereisahighprobabilitythatthePeronealsandBiceps
FemoriswillbecomeoveractiveortightbecauseoneMovementDysfunctionleadsthewayforanotherMovementDysfunction.NomovementandnoMovementDysfunctioneveroccursin
thebodyinisolation.TheHumanBodyisasymbioticsystemofphysiologicalstructuresandHumanMovementisaninterdependentsystemofmovementsandMovementDysfunctions.
Thus,everystructureinthebody,i.e.joints,muscles,tendons,ligaments,etc.,isconnectedtoallotherstructureswithinthebody.

AllofHumanMovement,aswellasMovementDysfunctionsandCompensationStrategies,existinpatternswithinthebody.

ImportanttoRecognize
HavingtheabilitytorecognizepatternsofcompensationandMovementDysfunctionprovidestheindividualwiththeopportunitytocorrectandneutralizetherisksanddamageassociatedwith
patterns,aswellasallowstheindividualtodevelopmoreefficiencyandintegrityinregardtobiomechanicalfunctionsandMovementQuality.

Unfortunately,ifuncorrectedorundetected,thepatternsofcompensationandassociatedMovementDysfunctionscanandwilldisruptHumanMovement,increasingtheriskofinjuryand
damagetothebody,eveniftheindividualisunawareoftheserisks.

LearningtorecognizesomeofthecommonpatternsofcompensationisareliabletoolanindividualshoulduseintheefforttominimizeriskofinjuryanddamageassociatedwithMovement
Dysfunctions.

CommonPatternsofCompensation
Manypatternsofcompensationarecommon,orfoundinthemovementofmanyindividualsacrosstheworld,duetothehighrateofexposuretothecausesofthesecompensationpatterns.

Asmentionedbefore,walkingonhard,flatsurfacescreatesacollapsedarchinthefootandinitiatesacoordinatingpatternofcompensationinthebody.Mostofthemoderndevelopedworldis
equippedwithhard,flatsurfaces,onwhichmillions,perhapsbillions,ofpeoplewalkandstandeverysingleday.Therefore,theprobabilitythatalargenumberofpeopleexperiencethesame
patternofcompensationintheirmovementsishighlylikelyifnotalmostdefinite.

Aneffectivegoalforanindividual,especiallyfortrainers,coachesandathletes,istoidentifycommonpatternsofcompensationinHumanMovementtoaddressandcorrecttheassociated
MovementDysfunctions,limittheriskofinjury,andimproveMovementQuality.

ListofCommonPatternsofCompensationandMovementDysfunctions:

PronationDistortionSyndrome
ValgusKnee
PatellofemoralTrackingSyndrome
PatellofemoralPainSyndrome
QuadDominance
ITBandSyndrome
AsymmetricalWeightShift
GluteAmnesiaSyndrome
Buttwink
PosteriorPelvicTilt
AnteriorPelvicTilt
LowerCrossSyndrome
SwayBackExcessiveLordosis
UpperCrossSyndrome
RoundedShoulders
ExcessiveKyphosis
ForwardHeadPosture
ShoulderImpingement
WingedScapula
FlaredRibCage
ElevatedShoulders
UnevenShoulders
Hyperinflation

WhatfollowsisabriefsummationofeachoftheseCommonPatternsofCompensationthatmayhelpanindividualidentifyandaddresstheaboveMovementDysfunctions.

PronationDistortionSyndrome
WhenassessinganindividualsBiomechanicalIntegrityandMovementQuality,itisbesttostartatthebottomofthebodyasthefeetserveastheplatformuponwhichtherestofthebody
operates.Therefore,itisrecommendedtostartwithanalyzingforthePronationDistortionSyndrome.

Whenthefootexcessivelypronatesandthearchofthefootcollapsesinwardtowardthefloor,thetibia(shinbone)alsocollapsesinwardlycausingaValgusKneemovement,placingan
inappropriateamountofstressontheknee,especiallytheACL.

Furthermore,thefemur(thighbone)adductsorcollapsestowardthemidlineofthebody,whichcreatestightnessintheVastusLateralis(LateralQuadricepsmuscle),theBicepsFemoris
(LateralHamstringmuscle),andthePeroneals(LateralCalfMuscles)asallthreemuscleseccentricallycontracttohelpstabilizethekneejoint.Thispatternofcompensationleadstothe
developmentofaValgusKneemovementinsquatting,lunging,jumping,running,andevenstanding.

Lastly,PronationDistortionSyndromecanevencauseLowBackPainastheHipFlexorcomplexbecomesoveractiveinthebodysattempttocontrolthemovementoftheFemur(thighbone)
andstabilizebothkneeandpelvis.Eventually,overactiveHipFlexorsanteriorlycompresstheLumbarSpineandcreateeitheranAnteriorTiltofthepelvisand/orexcessiveLordoticExtension
ofthespine,referredtoasSwayBack.

RX:Startpracticingacombinationofsofttissuetherapyandeffectivestretchingtechniquesonthefollowingoveractiveortightmuscles:Peroneals(LateralCalf),BicepsFemoris(Lateral
Hamstring),VastusLateralis(LateralQuadriceps),AdductorComplex(GroinMuscles),TensorFasciaeLatae(TFLHipFlexor)andPsoas(HipFlexors).Also,practicesofttissuetherapyon
thePosteriorTibialis(InteriorCalfMuscle)andtheGastrocnemius(CalfMuscle)toactivateandinducetheresponsivenessofsofttissueinthesemusclestoproperlyalignandsupinatethe
foot,i.e.strengthenthearchofthefoot.

Next,practiceActivationexercisestostrengthenandfacilitateproperfiringsequencesofthefollowingunderactivemuscles:GluteusMedias(LateralHipMuscle),PosteriorTibialis(Interior
CalfMuscle),Gastrocnemius(CalfMuscle)andtheIntrinsicFootMuscles.
Finally,practiceavarietyofexercisesintegratingtheseunderactivemuscleswithlargerMovementPatterns,includingsquatting,lunging,andrunning.Also,challengestability,coordination,
andbalancewithsinglelegand/orChangeofDirection(C.O.D.)exercises.

ValgusKnee
AValgusKneemovementisaninvoluntaryinwardmovementofthekneejoint,causedbyalackofStabilityintheAnkleand/orHip.Itisalsoinfluencedbythefollowingoveractivemuscle
groups:VastusLateralis(LateralQuadricepsmuscle),BicepsFemoris(LateralHamstringmuscle),andPeroneals(LateralCalfMuscles).

AValgusKneemovementwilldisrupttheproperpatellofemoraltracking(trackinginthekneejoint)andplaceaninappropriateamountofstressontheACL.

RX:Practiceacombinationofsofttissuetherapyandeffectivestretchingtechniquesonthefollowingoveractiveand/ortightmuscles:Peroneals(LateralCalfMuscles),BicepsFemoris
(LateralHamstring),VastusLateralis(LateralQuadriceps),theAdductorComplex(GroinMuscles),andPsoas(HipFlexors).

Next,practiceActivationexercisestostrengthenandfacilitateproperfiringsequencesofthefollowingunderactivemuscles:GluteusMedias(LateralHipMuscle),PosteriorTibialis(Interior
CalfMuscle),Gastrocnemius(CalfMuscle)andtheIntrinsicFootMuscles.

Finally,practiceavarietyofexercisesintegratingtheseunderactivemuscleswithlargerMovementPatterns,includingsquatting,lunging/stepups,andrunning.Also,challengestability,
coordination,andbalancewithsinglelegand/orChangeofDirection(C.O.D.)exercises.

PatellofemoralTrackingSyndrome
Thestructureofthekneeisdesignedwithtwocondyles(shallowgrooves)thatcradletheintercondylarfossa(twonotchesontheendofthefemur)andaslidingflatboneknownasthepatella
(kneecap)thatformsabracketandguidestherotationalmotionoftheknee.

WhenthetrackingormovementofthekneebecomesdistortedduetoValgusKneemovements,QuadDominance,andothercompensationpatternsormovementdysfunctions,themovement
dysfunctionisreferredtoasPatellofemoralTrackingSyndrome.

TherearetwomaintypesofPatellofemoralTrackingSyndrome.ThefirstincludesalateralshiftinthepositioningofthePatella(kneecap)asthekneeflexesorextends.Thistypeisusually
associatedwithaValgusKneeMovement.ThesecondtypeofPatellofemoralTrackingSyndromeoccurswhenthereistoomuchtensionorshorteningintheQuadriceps.Thiscontinuously
pullsthepatella(kneecap)intothedistal(bottom)endoftheFemur(thighbone)whilethekneeflexesorextends.ThistypeofPatellofemoralTrackingSyndromeisheavilyassociatedwith
QuadDominanceandleadstoPatellofemoralPainSyndromeorKneePain.

RX:Practiceacombinationofsofttissuetherapyandeffectivestretchingtechniquesonthefollowingoveractiveand/ortightmuscles:Quadriceps(AnteriorLegMuscles),Peroneals(Lateral
CalfMuscles),BicepsFemoris(LateralHamstring),andtheAdductorComplex(GroinMuscles).
Next,practiceActivationexercisestostrengthenandfacilitateproperfiringsequencesofthefollowingunderactivemuscles:VastusMedialOblique(VMOMedial/InsideQuadriceps),
Internal/ExternalHipRotators,GluteusMedias(LateralHipMuscle),PosteriorTibialis(InteriorCalfMuscle),Gastrocnemius(CalfMuscle),andtheIntrinsicFootMuscles.

Finally,practiceavarietyofexercisesintegratingtheseunderactivemuscleswithlargerMovementPatterns,includingsquatting,lunging/stepups,andrunning.Also,challengestability,
coordination,andbalancewithsinglelegand/orChangeofDirection(C.O.D.)exercises.

PatellofemoralPainSyndrome
PainthatoccursatthefrontofthekneeandregularlyjustbehindthekneecapisgenerallycategorizedasPatellofemoralPainSyndrome.Thiskneepainisfrequentlyaresultofatypeof
PatellofemoralTrackingSyndromewherethepatella(kneecap)iscontinuouslypressedorpulledintothebottomofthefemur,resultinginanincreasedamountoffrictionandwearandtearon
thestructuresoftheknee.

PatellofemoralPainSyndromeisgreatlyinfluencedbyrepetitivemovements,i.e.running,combinedwithlifestylefactors,i.e.sitting,thatcreateapatternofcompensationcalledQuad
Dominance.

RX:Practiceacombinationofsofttissuetherapyandeffectivestretchingtechniquesonthefollowingoveractiveand/ortightmuscles:Quadriceps(AnteriorLegMuscles),Peroneals(Lateral
CalfMuscles),BicepsFemoris(LateralHamstring),andtheAdductorComplex(GroinMuscles).

Next,practiceActivationexercisestostrengthenandfacilitateproperfiringsequencesofthefollowingunderactivemuscles:VastusMedialOblique(VMOMedial/InsideQuadriceps),
Internal/ExternalHipRotators,GluteusMedias(LateralHipMuscle),PosteriorTibialis(InteriorCalfMuscle),Gastrocnemius(CalfMuscle),andtheIntrinsicFootMuscles.

Finally,practiceavarietyofexercisesintegratingtheseunderactivemuscleswithlargerMovementPatterns,includingsquatting,lunging/stepups,andrunning.Also,challengestability,
coordinationandbalancewithsinglelegand/orChangeofDirection(C.O.D.)exercises.

QuadDominance
ThispatternofcompensationisatypeofSynergistDominancepatterninmovement,whereinoneofthesynergistorassistingmusclesbeginstooverlycompensatefortheprimemoveror
agonistmusclewithinaspecificmovementpattern.

QuadDominancereferstothepatterninwhichtheQuadriceps(thighmuscles)areoveractiveandcompensate/takeoverfortheGluteusandHamstringmusclesinmovementsthatinclude
squatting,lunging,jumping,runningandstanding.

QuadDominanceistiedtoanotherMovementDysfunctioncalledGluteAmnesiaSyndrometheGluteusmusclesareinhibitedorturnedoffduetoinactivity,alackofappropriateneuraldrive
andlifestylefactors,whichincludessitting.
RX:Practiceacombinationofsofttissuetherapyandeffectivestretchingtechniquesonthefollowingoveractiveand/ortightmuscles:Quadriceps(AnteriorLegMuscles),Psoas(DeepHip
Flexor),TensorFasciaeLatae(TFLSuperficialHipFlexor),andtheAdductorComplex(GroinMuscles).

Next,practiceActivationexercisestostrengthenandfacilitateproperfiringsequencesofthefollowingunderactivemuscles:GluteusComplex(PosteriorHipMuscle),HamstringComplex
(PosteriorLegMuscles),andTransverseAbdominis/Obliques(CoreMuscles).

Finally,practiceavarietyofexercisesintegratingtheseunderactivemuscleswithlargerMovementPatterns,includingsquatting,lunging/stepups,jumping,running,andevenstanding.Also
challengestability,coordination,andbalancewithsinglelegand/orChangeofDirection(C.O.D.)exercises.

GluteAmnesiaSyndrome
Asmentionedabove,GluteAmnesiaSyndromeisaMovementDysfunctionwheretheGluteusorPosteriorHipMusclesarenotusedenough,thereforeinhibiting,orturningoff,the
neuromuscularconnections.

Theneuromuscularconnectionsdonottrulyturnoffinstead,thebodyremodelsitsMotorBehavior(neuromuscularcoordination)touseanalternatepatternofMotorControltoperformcertain
tasks.Overtime,thispatternofcompensationissolidifiedasapatternofMotorBehaviororitbecomesaMovementHabitinwhichanindividualneglectstoactivateandusehisorher
Glutes(HipMuscles)toexecutespecificmovementsincludingsquatting,lunging,andrunning.

RX:Practiceacombinationofsofttissuetherapyandeffectivestretchingtechniquesonthefollowingoveractiveand/ortightmuscles:Quadriceps(AnteriorLegMuscles),Psoas(DeepHip
Flexor),TensorFasciaeLatae(TFLSuperficialHipFlexor),theAdductorComplex(GroinMuscles),Peroneals(LateralCalfMuscles),andBicepsFemoris(LateralHamstringMuscles).

Next,practiceActivationexercisestostrengthenandfacilitateproperfiringsequencesofthefollowingunderactivemuscles:GluteusComplex(PosteriorHipMuscle),Piriformis(PosteriorHip
Muscle),Semitendinosus(Medial/MiddleHamstringMuscles),Gastrocnemius(CalfMuscles),theIntrinsicFootMuscles,andTransverseAbdominis/Obliques(CoreMuscles).

Finally,practiceavarietyofexercisesintegratingtheseunderactivemuscleswithlargerMovementPatterns,includingsquatting,lunging/stepups,jumping,running,andevenstanding.Also,
challengestability,coordination,andbalancewithsinglelegand/orChangeofDirection(C.O.D.)exercises.

ITBandSyndrome
AnotherMovementDysfunctionandpatternofcompensationtiedtoGluteAmnesiaSyndromeandPronationDistortionSyndromeisITBandSyndrome.

ITBandSyndromeistheprocessinwhichtheIliotibialTendon(ITBand)thatconnectstheTensorFasciaeLatae(TFL)totheTibia(shinebone)becomesinflamedandsensitiveduetoan
inappropriateamountofstressbeingplacedonthesofttissuestructure.

ITBandSyndromeusuallyoccursinindividualswhodonotproperlyactivatetheirGluteusComplex,specificallytheGluteusMedius,and/ordonotproperlyactivatetheirintrinsicfootmuscles
andmedialGastrocnemius(CalfMuscles)toprovideadequateamountofcontrolandstabilityinthemovementsoftheknee.Consequentially,theTFLandITBandattempttoprovidestability
tothekneefromamechanicallydisadvantagedposition.TheendresultisprolongedinflammationandsensitivitytotheITBandfromthewearandtearandstressofthecompensationpattern.

RX:Practiceacombinationofsofttissuetherapyandeffectivestretchingtechniquesonthefollowingoveractiveand/ortightmuscles:TensorFasciaeLatae(TFLSuperficialHipFlexor),
GluteusMaximus(PosteriorHipMuscles),VastusLateralis(LateralQuadriceps),Peroneals(LateralCalfMuscles),andBicepsFemoris(LateralHamstringMuscles).

Next,practiceActivationexercisestostrengthenandfacilitateproperfiringsequencesofthefollowingunderactivemuscles:GluteusMedius(LateralHipMuscle),Piriformis(PosteriorHip
Muscle),Internal/ExternalHipRotators,Semitendinosus(Medial/MiddleHamstringMuscles),Gastrocnemius(CalfMuscles),theIntrinsicFootMuscles,andTransverseAbdominis/Obliques
(CoreMuscles).

Finally,practiceavarietyofexercisesintegratingtheseunderactivemuscleswithlargerMovementPatterns,includingsquatting,lunging/stepups,jumping,runningandevenstanding.Also,
challengestability,coordination,andbalancewithsinglelegand/orChangeofDirection(C.O.D.)exercises.

AnteriorPelvicTilt
Afterassessingthefeetandkneesforcompensations,thenextareaassessedisthepelvicregionorHips.TheHipsarethefoundationandplatformonwhichtheSpineandUpperBody
operates.AllpatternsofcompensationanddysfunctionsinthePelvicregionhaveaneffectonthemovementandalignmentoftheUpperBody.

OnecommonpatternofcompensationisanAnteriorTiltofthePelvis.AnAnteriorTiltmeansthetopofthePelvisrotatestothefrontofthebody,creatinganexaggeratedextensionofthe
LumbarSpineandpossiblytheThoracicand/orCervicalSpineaswell.AnAnteriorTiltiscommonlycausedbyacombinationofoveractivemuscles,namelytheHipFlexorsandthe
LatissimusDorsi.

ThetroublewithanAnteriorTiltisthatitplacesanunevenamountofstrainonthevertebraeanddiscsoftheLumbarSpine(LowerBack),andcanalsodisruptthealignmentoftheThoracic
Spine,RibCage,Shoulders,andHead.

AnAnteriorTiltcanbelinkedtoPronationDistortionSyndrome,GluteAmnesiaSyndrome,ITBandSyndrome,andQuadDominance.Furthermore,itcancreateevenmorepatternsof
compensationordysfunctionincludingForwardHead,UpperCrossSyndrome,Hyperinflation,andLowBackPain.

RX:Practiceacombinationofsofttissuetherapyandeffectivestretchingtechniquesonthefollowingoveractiveand/ortightmuscles:Psoas(DeepHipFlexors),TensorFasciaeLatae(TFL
SuperficialHipFlexor),LatissimusDorsi(BackMuscles),ThoracolumbarFascia(FasciaSheathoftheLowerBack),LowerErectorSpinae(LowBackMuscles),LowerMultifidus(LowBack
Muscles),IliocostalisLumborum(LowBackMuscles),QuadratusLumborum(LowBackMuscles),PosteriorPortionoftheExternalObliques(PosteriorCoreMuscles),Quadriceps(Anterior
LegMuscles),theAdductorComplex(GroinMuscles),Peroneals(LateralCalfMuscles),andBicepsFemoris(LateralHamstringMuscles).

Next,practiceActivationexercisestostrengthenandfacilitateproperfiringsequencesofthefollowingunderactivemuscles:GluteusComplex(PosteriorHipMuscle),Piriformis(PosteriorHip
Muscle),Internal/ExternalHipRotators,RectusAbdominis(AnteriorCoreMuscles),AnteriorPortionofInternal/ExternalObliques(Anterior/LateralCoreMuscles),Semitendinosus
(Medial/MiddleHamstringMuscles),Gastrocnemius(CalfMuscles),theIntrinsicFootMuscles,andTransverseAbdominis/Obliques(CoreMuscles).

Finally,practiceavarietyofexercisesintegratingtheseunderactivemuscleswithlargerMovementPatterns,includingsquatting,lunging/stepups,jumping,running,andevenstanding.Also,
challengestability,coordination,andbalancewithsinglelegand/orChangeofDirection(C.O.D.)exercises.

PosteriorPelvicTilt
CountertoanAnteriorPelvicTiltisthePosteriorPelvicTilt,inwhichthetopofthePelvisisrotatedtowardthebackofthebody.

APosteriorPelvicTiltplacesanunbalancedamountofstrainonthevertebraeanddiscsoftheLumbarSpine(LowBack),whichcanleadtootherpatternsofcompensation,suchasSway
Back,whilealsoeffectingthemovementandalignmentoftheUpperBody.

RX:Practiceacombinationofsofttissuetherapyandeffectivestretchingtechniquesonthefollowingoveractiveand/ortightmuscles:GluteusComplex(PosteriorHipMuscle),Piriformis
(PosteriorHipMuscle),Internal/ExternalHipRotators,RectusAbdominis(AnteriorCoreMuscles),AnteriorPortionofInternal/ExternalObliques(Anterior/LateralCoreMuscles),
Semitendinosus(Medial/MiddleHamstringMuscles),andGastrocnemius(CalfMuscles).

Next,practiceActivationexercisestostrengthenandfacilitateproperfiringsequencesofthefollowingunderactivemuscles:LowerErectorSpinae(LowBackMuscles),LowerMultifidus(Low
BackMuscles),IliocostalisLumborum(LowBackMuscles),QuadratusLumborum(LowBackMuscles),PosteriorPortionoftheExternalObliques(PosteriorCoreMuscles),Psoas(DeepHip
Flexors),TensorFasciaeLatae(TFLSuperficialHipFlexor),Quadriceps(AnteriorLegMuscles),andtheIntrinsicFootMuscles.

Finally,practiceavarietyofexercisesintegratingtheseunderactivemuscleswithlargerMovementPatterns,includingsquatting,lunging/stepups,jumping,running,andevenstanding.Also,
challengestability,coordination,andbalancewithsinglelegand/orChangeofDirection(C.O.D.)exercises.

LowerCrossSyndrome
AnAnteriorPelvicTiltplaysacentralroleinLowerCrossSyndrome,acompensationpatterninvolvingstrengthormuscleimbalancesaroundthePelvis.

AStrengthorMuscleImbalanceoccursinthebodywhenonesetofmusclesgrowsdisproportionatelystrongerthanareciprocalsetofmusclesattachedtothesamejointcomplexorbone
structure.IntheLowerCrossSyndrome,twoconcurrentStrengthorMuscleImbalancesareevidenttheHipFlexorshavegrownmusclesstrongerand/ortighterthantheHamstringcomplex
andthePosteriorTrunk(LowBack)Extensorshavegrownmuchstrongerand/ortighterthantheAnteriorTrunk(Abdominals)Flexors.ThisstrengthdominanceoftheHipFlexorsandLow
BackExtensorsresultsintheshiftingofthePelvisintoanAnteriorTilt.

TheLowerCrossSyndromefurtherdisruptsanindividualsmovementasthecompensationpatternbecomesbothastaticpostureandahabitualdynamicalignment.Thishabitcausesthe
individualtolearnandinitiateallmovementwiththecompensation,resultinginarepetitiveMovementDysfunctionthatplacesaninappropriateamountofstressonthevertebraeanddiscsof
theLumbarSpine,ultimatelyleadingtoLowBackPainand/orinjury.

HabitualandprolongedperiodsofsittingincreaseanindividualsriskofdevelopingLowerCrossSyndrome.

RX:Practiceacombinationofsofttissuetherapyandeffectivestretchingtechniquesonthefollowingoveractiveand/ortightmuscles:Psoas(DeepHipFlexors),TensorFasciaeLatae(TFL
SuperficialHipFlexor),LatissimusDorsi(BackMuscles),ThoracolumbarFascia(FasciaSheathoftheLowerBack),LowerErectorSpinae(LowBackMuscles),LowerMultifidus(LowBack
Muscles),IliocostalisLumborum(LowBackMuscles),QuadratusLumborum(LowBackMuscles),PosteriorPortionoftheExternalObliques(PosteriorCoreMuscles),Quadriceps(Anterior
LegMuscles),theAdductorComplex(GroinMuscles),Peroneals(LateralCalfMuscles)andBicepsFemoris(LateralHamstringMuscles).

Next,practiceActivationexercisestostrengthenandfacilitateproperfiringsequencesofthefollowingunderactivemuscles:GluteusComplex(PosteriorHipMuscle),Piriformis(PosteriorHip
Muscle),Internal/ExternalHipRotators,RectusAbdominis(AnteriorCoreMuscles),AnteriorPortionofInternal/ExternalObliques(Anterior/LateralCoreMuscles),Semitendinosus
(Medial/MiddleHamstringMuscles),Gastrocnemius(CalfMuscles),theIntrinsicFootMuscles,andTransverseAbdominis/Obliques(CoreMuscles).

Finally,practiceavarietyofexercisesintegratingtheseunderactivemuscleswithlargerMovementPatterns,includingsquatting,lunging/stepups,jumping,running,andevenstanding.Also,
challengestability,coordination,andbalancewithsinglelegand/orChangeofDirection(C.O.D.)exercises.

Buttwink
TheButtwinkisacompensationpatterninvolvingadynamicPosteriorPelvisTiltduringHipFlexionthatoccursinasquattingorHipHingingmovement.Morespecifically,theButtwinkisa
compensationpatternthatattemptstoincreasetheRangeofMotionoftheHipand/orAnklebyrotatingthePelvisandflexingthroughtheLumbarSpine.

ThedangerofthiscompensationpatternistheinappropriateamountofstressplacedonanteriorportionsofthevertebraeanddiscsintheLumbarSpine(LowBack).Thiscancauseepisodes
ofacutemicrotrauma,eventuallyleadingtodischerniationand/orLowBackPain.

TheButtwinkrobsanindividualofbiomechanicalintegrityofthespineinregardtoalignmentandstabilitymanytimestheindividualmaynotbeawarethiscompensationpatternisoccurring.
RX:Practiceacombinationofsofttissuetherapyandeffectivestretchingtechniquesonthefollowingoveractiveand/ortightmuscles:GluteusComplex(PosteriorHipMuscle),Piriformis
(PosteriorHipMuscle),Internal/ExternalHipRotators,RectusAbdominis(AnteriorCoreMuscles),AnteriorPortionofInternal/ExternalObliques(Anterior/LateralCoreMuscles),
Semitendinosus(Medial/MiddleHamstringMuscles),andGastrocnemius(CalfMuscles).

Next,practiceActivationexercisestostrengthenandfacilitateproperfiringsequencesofthefollowingunderactivemuscles:LowerErectorSpinae(LowBackMuscles),LowerMultifidus(Low
BackMuscles),IliocostalisLumborum(LowBackMuscles),QuadratusLumborum(LowBackMuscles),PosteriorPortionoftheExternalObliques(PosteriorCoreMuscles),Psoas(DeepHip
Flexors),TensorFasciaeLatae(TFLSuperficialHipFlexor),Quadriceps(AnteriorLegMuscles),andtheIntrinsicFootMuscles.

Finally,practiceavarietyofexercisesintegratingtheseunderactivemuscleswithlargerMovementPatterns,includingsquatting,lunging/stepups,jumping,running,andevenstanding.Also,
challengestability,coordination,andbalancewithsinglelegand/orChangeofDirection(C.O.D.)exercises.

SwayBack
AnothercompensationpatterneffectingthealignmentoftheLumbarSpine(LowBack)isSwayBack.Inthiscompensationpattern,theLumbarSpine(LowBack)hasanexcessiveamountof
extension,placinganinappropriateandunbalancedamountofpressureonthevertebraeanddiscs.

SwayBackoccursduetomanydifferentreasonsandischaracterizedbyaposturewithprotruding(forward)HipsandanexcessivearchintheLowerBack.Manytimes,SwayBackis
causedbyacombinationoftightnessand/oroveractiveHamstringsandPosteriorTrunk(LowBack)Extensors.Sometimes,atightand/oroveractivePiriformismusclecontributestothe
protrudingHips.Regardlessofthecause,SwayBackisdangeroustothebiomechanicalintegrityandhealthoftheLumbarSpineandmayleadtoLowBackPain.

RX:Practiceacombinationofsofttissuetherapyandeffectivestretchingtechniquesonthefollowingoveractiveand/ortightmuscles:GluteusComplex(PosteriorHipMuscle),Piriformis
(PosteriorHipMuscle),Internal/ExternalHipRotators,Psoas(DeepHipFlexors),TensorFasciaeLatae(TFLSuperficialHipFlexor),Semitendinosus(Medial/MiddleHamstringMuscles),
LowerErectorSpinae(LowBackMuscles),LowerMultifidus(LowBackMuscles),IliocostalisLumborum(LowBackMuscles),andQuadratusLumborum(LowBackMuscles).

Next,practiceActivationexercisestostrengthenandfacilitateproperfiringsequencesofthefollowingunderactivemuscles:RectusAbdominis(AnteriorCoreMuslces),Internal/External
Obliques(LateralCoreMuscles),TransverseAbdominis(InteriorCoreMuscles),Quadriceps(AnteriorLegMuscles),andtheIntrinsicFootMuscles.

Finally,practiceavarietyofexercisesintegratingtheseunderactivemuscleswithlargerMovementPatterns,includingsquatting,lunging/stepups,jumping,running,andevenstanding.Also,
challengestability,coordination,andbalancewithsinglelegand/orChangeofDirection(C.O.D.)exercises.

LowBackPain
TheNationalAcademyofSportsMedicinereportsthat80%ofadultswillexperienceLowBackPainatsomepointintheirlives.Thisishighlylikelyconsideringtheanatomicaldesignofthe
HumanSkeleton.Thereisalackofstructuralsupportconnectingtheupperbodytothelowerbody,andtheLumbarSpineistheonlyboneystructurebridgingthetwohalvesofthebody
together.
Allthecompensationpatternspreviouslymentioned,aswellastheonesstilltocome,negativelyimpactthebiomechanicalintegrityoftheLumbarSpine(LowBack),especiallyinregardsto
alignmentandstability.

Toreduce,eliminate,orpreventLowBackPain,anindividualsalignmentandstabilityoftheLumbarSpinemustbeaddressedandintegratedintoatrainingprogram.

RX:PracticeacombinationofsofttissuetherapyandeffectivestretchingtechniquesonallofthemusclesthatconnecttoboththeSpineandthePelvis,aswellasforthemusclesthat
operatewithintheFoot/AnkleandShoulder/NeckComplexes.Thisultimatelymeanstheentirebodyneedstobetreatedwithsofttissuetherapyandeffectivestretchingtechniques.

Next,practiceActivationexercisestostrengthenandfacilitateproperfiringsequencestoasmanymusclegroupsaspossibleintheentirebody,especiallythemusclegroupsthatconnectto
theSpineandPelvisaswellasmusclesthatrunthroughtheFootandAnklecomplex.

Finally,practiceavarietyofexercisesthatusethemajorjointstructures(i.e.Foot/Ankle,Hip,SpineandShoulders)insmoothandcontrolledmovements.Smoothmovementsmustbe
accomplishedbeforepracticinglargerMovementPatterns,suchassquatting,lunging/stepups,jumping,andrunning.Oncemovementiscompletedinacontrolledandstablefashion,then
challengestability,coordination,andbalancewithsinglelegand/orChangeofDirection(C.O.D.)exercises.

AsymmetricalWeightShift
AnothercommonpatternofcompensationisanAsymmetricalWeightShift,orthehabitualprocessofshiftingonesweightovertoonespecificlegwhilesquattingand/orstanding,aswellas
inpushingandpullingmovements.

AnAsymmetricalWeightShiftisanindicationthataStrengthImbalanceexistssomewhereinbody.OnelimboronesideofthePelvisand/orTorsoiscompensatingfortheweaknessand/or
dysfunctionoftheoppositelimborsideofthePelvisand/orTorso.

ThecausesofanAsymmetricalWeightShiftareasvastasthenumberofStrengthImbalancecombinationspossibleinthebodyverylarge.However,assessingthemovementefficiency
andRangeofMotionofvariousjointsinvolvedincreatingagivenMovementPatternareaneffectiveguidetouncoveringandevaluatingthespecificdetailsofanypossibleStrength
Imbalance.

RX:WhenanAsymmetricalWeightShiftisobserved,assesstheBiomechanicalIntegrityofeachjointinvolvedinthegivenMovementPatterntouncoverthepossibleStrengthorMuscle
Imbalanceaffectingtheindividualsmovement.

StartwithacombinationofsofttissuetherapyandeffectivestretchingtechniquesonallmusclesthatconnecttoboththeSpineandthePelvisinadditiontothemusclesthatoperatewithin
theFoot/AnkleandShoulder/NeckComplexes.Thisultimatelymeanstheentirebodyneedstobetreatedwithsofttissuetherapyandeffectivestretchingtechniques.

Next,practiceActivationexercisestostrengthenandfacilitateproperfiringsequencestoasmanymusclegroupsaspossibleintheentirebody,especiallythemusclegroupsthatconnectto
theSpineandPelvisaswellasthemusclesthatrunthroughtheFootandAnklecomplex.

Finally,practiceavarietyofexercisesthatusethemajorjointstructures(i.e.Foot/Ankle,Hip,SpineandShoulders)insmoothandcontrolledmovements.Smoothmovementsmustbe
accomplishedbeforepracticinglargerMovementPatterns,suchassquatting,lunging/stepups,jumping,andrunning.Oncemovementiscompletedinacontrolledandstablefashion,then
challengestability,coordination,andbalancewithsinglelegand/orChangeofDirection(C.O.D.)exercises.

FlaredRibCage
Whenthelowerribsprotrudeforwardandstickout,thisisasignthattheCoremusculatureisexperiencingaStrengthorMuscleImbalancethealignmentandstabilityoftheLumbarSpineis
beingcompromised.

AFlaredRibCagepointstooveractiveand/ortightPosteriorTrunkmusclesthatareattemptingtomanageandstabilizetheSpinewithoutadequateamountofassistancefromtheAnterior
Trunkmuscles,includingtheInternal/ExternalObliquesandAbdominals.ThisStrengthorMuscleImbalanceplacesadisproportionateamountofstrainonthevertebraeanddiscsofthe
LumbarSpine(LowBack)andmayleadtoLowBackPainaswellasotherMovementDysfunctionsandcompensationpatterns.

RX:PracticeacombinationofsofttissuetherapyandeffectivestretchingtechniquesonmusclesthatconnectaroundthetopoftheRibCage,especiallytheFirstRib,whichincludesthe
UpperTrapezius(NeckandShoulderMuscle),Scalenes(NeckMuscles),PectoralComplex(ChestMuscles),andtheLatissimusDorsi(BackMuscles).

Next,practiceActivationexercisestostrengthenandfacilitateproperfiringsequencesofthefollowingmuscles:Diaphragm(DeepCoreMuscle),Internal/ExternalObilques(LateralCore
Muscles),Multifidus(PosteriorCoreMuscles),andtheTransverseAbdominis(CoreMuscle).

Finally,practiceavarietyofbreathingexercisesthatemphasizeexhalation.AlsopracticeexercisesthatintegratethefiringsequencespracticedinCoreActivationexerciseswithlarger
MovementPatterns,suchassquatting,lunging,running,etc.OnceintegrationisachievedandRibFlareiseliminated,continuetointegratetheCoreFiringsequenceintoexercisesthat
challengestability,coordination,andbalance,i.e.singlelegand/orChangeofDirection(C.O.D.)exercises.

ExcessiveKyphosis
AhunchbackisanexaggeratedexampleofexcessiveKyphosis,whichistheforwardflexionorroundingoftheThoracicSpine(vertebraethatrunthroughtheRibCage).TheThoracicSpine
hasanaturalKyphoticorforwardcurvetoitsalignment.However,thisforwardcurvaturecanincreaseresultinginaMovementDysfunctionthataffectstheShoulders,Head,LumbarSpine
(LowBack)andHips.

AnExcessiveKyphoticSpinecanbeobservedinastandingstaticpostureassessmentaswellasinaforwardbendingassessment,suchasthesitandreachtest.Thenatural(neutral)
alignmentofthespineisaskinnySwhenobservedfromthesideinastaticpostureassessment.Thenaturalalignmentofthespineinaforwardbendisglobalflexionofthespine,oran
evenlyproportionedarch.ExcessiveKyphosiswillstandoutineachassessment.

Inastaticpostureassessment,theskinnySballoonsinthetopcurveandbecomesafatterS.Meanwhile,theevenlyarchedspineintheforwardbendalsoballoonsthroughtheribcage,
assimilatingahunchbacklikecurvature.

ExcessiveKyphosisdoesnotexistinisolationitisaccompaniedbyothertypesofcompensationpatternsandMovementDysfunctions.This,alongwithanexcessivelyKyphoticalignmentof
thespine,areothercompensationpatternsanindividualmaynotrealizehe/shepossesses.

RX:PracticeacombinationofsofttissuetherapyandeffectivestretchingtechniquesonmusclesthatconnecttoandaroundtheRibCageandThoracicSpine.Thesemusclesinclude:the
UpperTrapezius(NeckandShoulderMuscle),PectoralComplex(ChestMuscles),LatissimusDorsi(BackMuscles),Psoas(DeepHipFlexors),TensorFasciaeLatae(TFLSuperficialHip
Flexor),LowerErectorSpinae(LowBackMuscles),LowerMultifidus(LowBackMuscles),IliocostalisLumborum(LowBackMuscles),andQuadratusLumborum(LowBackMuscles).

Next,practiceActivationexercisestostrengthenandfacilitateproperfiringsequencesofthefollowingunderactivemuscles:Rhomboids(UpperBackMuscle),MidandLowerTrapezius
(UpperBackMuscles),SerratusAnterior(ShoulderGirdleMuscle),RectusAbdominis(AnteriorCoreMuscles),Internal/ExternalObliques(LateralCoreMuscles),andTransverseAbdominis
(InteriorCoreMuscles).

Finally,practiceavarietyofexercisesintegratingtheseunderactivemuscleswithlargerMovementPatterns,includingOverheadandHorizontalPresses,VerticalandHorizontalPulls,
Diagonal1&2Movements(ChopsandLifts),andSwings.Alsochallengestability,coordination,andbalancewithsinglearm(unilateral)and/orlocomotive(crawling/climbing)exercises.

ForwardHeadPosture
TheForwardHeadPostureorForwardHeadAlignmentisacompensationpatternprevalentindevelopedsocietiesduetothecombinationofhighlevelsofphysicalinactivityandhighover
usageratesofelectronicdevices.

Inthiscompensationpattern,thecervical(neck)andsuboccipital(head)musclesbecomeoveractiveandtightduetothedemandtopositiontheheadtooptimallyviewanelectronicdevice,
screen,orpointofinterest.Atthesametime,themusclesofthetorso,hips,andlegsarebiomechanicallydesignedtosupportthepositioningofthehead.However,theselattermuscles
becomeinhibitedand/orweakenedincomparisontoheadandneckmusclesduetotheimbalancebetweenphysicalactivity(movementofthebody)andmental/communicationactivity
(stimulationofthemindandheadsensoryorgans).Theendresultisheadandneckmusclescompensatingforthelackofsynergisticsupportfromtherestofthebody,leadingtotightened
musclesandtransformedhead/neckalignment.

Worseofall,ForwardHeadPostureisadrasticallyinefficientbiomechanicalalignmentandposition.TheHeadweighs(onaverage)12lbsforeveryinchtheHeadismovedaheadofnatural
alignment,themechanicalweightoftheheaddoubles.Thus,anindividualwhoseheadprotrudesaninchoutofalignmentessentiallyisholdingandmovinga24lbHeadduetothemechanical
disadvantageofthisposture.Additionally,ForwardHeadPosturedisruptsthenaturalflowofkineticenergythroughtheSpineaswellastherestofthebody.Thisdisruptioninkineticenergy
causestheindividualtoalterhisMovementPatternstherebycreatingpatternsofcompensation.

Manytimes,ForwardHeadPostureexistsincombinationwithExcessiveKyphosis,RoundedShoulders,UpperCrossSyndromeandShoulderImpingement.

RX:PracticeacombinationofsofttissuetherapyandeffectivestretchingtechniquesonmusclesthatconnecttotheHead,Neck(CervicalSpine),andRibCage(ThoracicSpine).These
musclesinclude:theSuboccipitalTriangle(PosteriorHead/NeckMuscles),theUpperTrapezius(NeckandShoulderMuscle),Scalenes(NeckMuscles)andthePectoralComplex(Chest
Muscles).

Next,practiceActivationexercisestostrengthenandfacilitateproperfiringsequencesofthefollowingunderactivemuscles:Rhomboids(UpperBackMuscle),MidandLowerTrapezius
(UpperBackMuscles),SerratusAnterior(ShoulderGirdleMuscle),andtheCervicalFlexors(AnteriorNeckMuscles).

Finally,practiceavarietyofexercisesintegratingthecorrectedNeckAlignmentwithallotherMovementPatterns.

RoundedShoulders
Customarily,InternallyRotatedandProtractedShoulderalignmentisthebiomechanicaldescriptionofroundedshoulders.

RoundedShouldersisacompensationpatternthatusuallydevelopsfromtheoveruseofpushingorpressingexercisesthatcausethePectoralisComplex(ChestMuscles)tobeoveractive
and/ortightinrelationtothePosteriorMuscles,specificallytheRhomboids,LowerandMidTrapezius,andtheexternalrotatorsoftheShoulders(InfraspinatusandTeresMinor).

TheStrengthImbalanceassociatedwithRoundedShouldersreducesthestabilityandmobilityoftheshoulder,whichcanleadtoacuteinjuryorprolongedinappropriatewearandtearofthe
shoulder.Musclesactivatedinthecompensationincludesomephysiological(softtissueandjoint)structuresthatwhenoverusedcanleadtoshoulderimpingementorinjuryinthefuture.

RoundedShouldersalsoinfluencesthedevelopmentofForwardHeadPostureandExcessiveKyphosis,nottomentionanintegralpartofUpperCrossSyndrome.

RX:PracticeacombinationofsofttissuetherapyandeffectivestretchingtechniquesonmusclesthatconnecttoandaroundtheRibCageandThoracicSpine.Thesemusclesinclude:the
UpperTrapezius(NeckandShoulderMuscle),PectoralComplex(ChestMuscles),andLatissimusDorsi(BackMuscles).

Next,practiceActivationexercisestostrengthenandfacilitateproperfiringsequencesofthefollowingunderactivemuscles:Rhomboids(UpperBackMuscle),MidandLowerTrapezius
(UpperBackMuscles),SerratusAnterior(ShoulderGirdleMuscle),andTeresMinorandSupraspinatus(ExternalRotatorsintheShoulder).

Finally,practiceavarietyofexercisesintegratingtheseunderactivemuscleswithlargerMovementPatterns,includingOverheadandHorizontalPresses,VerticalandHorizontalPulls,
Diagonal1&2Movements(ChopsandLifts),andSwings.Also,challengestability,coordination,andbalancewithsinglearm(unilateral)and/orlocomotive(crawling/climbing)exercises.

UpperCrossSyndrome
TheUpperCrossSyndromehasasimilarschematicframeworkasLowerCrossSyndrome,bothofwhicharecompensationpatternsdiscoveredandstudiedbyVladimirJanda,arenowned
physicaltherapist.

TheUpperCrossSyndromeischaracterizedbyacombinationofStrength(Muscle)ImbalancesaroundtheShoulderGirdleandThoracicSpine.Inthiscompensationpattern,theshoulder
girdleisheldinaprotractedpositionwhiletheThoracicSpineexperiencesexcessiveflexioninitsalignmentduetooveractiveand/ortightPectoralis(Chest)Musclesandoveractiveand/or
tightUpperTrapezius(ShoulderandNeck)muscles.Theseareincombinationwithunderactiveand/orweakMidtoLowerTrapeziusandRhomboid(Back)Musclesaswellasunderactive
and/orweakCervicalSpineFlexors(AnteriorNeckMuscles).

Inshort,themusclesofthechestanduppershoulders/neckarearemainincontractedorshortenedstates.Thereciprocalpairingoftheanteriorneckandupperbackmusclesareheldina
lengthenedstatethataltogetheroffersagreatmechanicaldisadvantagetothemobilityandstabilityoftheshoulders.Additionally,UpperCrossSyndromecanbeviewedasthecombinationof
twocompensationpatterns:ExcessiveKyphosisandRoundedShoulders.
UpperCrossSyndromepresentsbarriersinefficiencyandlowerstheMovementQualityofallupperbodycentricmovementsaswellasinfluencesthealignmentandmovementoftheLumbar
Spine,Pelvis,andFeet.Essentially,UpperCrossSyndromecanleadtoinjury(includingRotatorCufftears)andMovementDysfunctions(suchasLowBackPain)inanypartofthebody.

Manytimes,anindividualdevelopstheUpperCrossSyndromethroughacombinationofLifestyleFactorsincludingcomputerwork,wearingabackpack,prolongedperiodsofsittingandeven
texting.Itisalsoheavilyinfluencedbythehighvolumeoftrainingorexercisingmirrormuscles,or,themusclespredominantlyvisibleinthemirror,i.e.thechest,abdominals,biceps,and
anteriorshoulders.

RX:Theultimategoalistoreeducatethebodyshabitofholding(continuouslyusing)thispatternofcompensation.

StartwithacombinationofsofttissuetherapyandeffectivestretchingtechniquesonmusclesthatconnecttoandaroundtheHead,Neck(CervicalSpine),andRibCage(ThoracicSpine).
Thesemusclesinclude:theSuboccipitalTriangle(PosteriorHeadandNeckMuscles),Scalenes(NeckMuscles),UpperTrapezius(NeckandShoulderMuscle),PectoralComplex(Chest
Muscles),andLatissimusDorsi(BackMuscles).

Next,practiceActivationexercisestostrengthenandfacilitateproperfiringsequencesofthefollowingunderactivemuscles:theCervicalFlexors(AnteriorNeckMuscles),Rhomboids(Upper
BackMuscle),MidandLowerTrapezius(UpperBackMuscles),SerratusAnterior(ShoulderGirdleMuscle),TeresMinorandSupraspinatus(ExternalRotatorsintheShoulder).

Finally,practiceavarietyofexercisesintegratingtheseunderactivemuscleswithlargerMovementPatterns,includingOverheadandHorizontalPresses,VerticalandHorizontalPulls,
Diagonal1&2Movements(ChopsandLifts),Swings.Also,challengestability,coordination,andbalancewithsinglearm(unilateral)and/orlocomotive(crawling/climbing)exercises.

WingedScapula
Manytimes,anindividualwithUpperCrossSyndromewillalsoexhibitawingedscapulaatthesametime.ThiscompensationpatternoccurswhenthereisaStrengthorMuscleImbalance
aroundtheScapula,whichforcestheflat,triangularbonetorepositionandholdinaninternallyrotatedand/oranteriortiltedalignment.

AwingedscapulaoccurswhenthePectorals(Chest)andUpperTrapezius(Shoulder/Neck)Musclesareoveractiveand/ortightincomparisontotheLower/MidTrapezius(Back)andthe
SerratusAnterior(RibCage)Muscles.ThisStrength/MuscleImbalanceshiftsandholdstheScapulainaforwardtiltedpositionsotheMedial(Inside)Ridgeofthebonesticksout,awayfrom
theRibCage,likeawing.

AWingedScapulacompromisestheBiomechanicalIntegrityoftheShoulderandcausesothermuscles,suchasthePectoralsandUpperTrapeziusmuscles,toovercompensatetheir
contractilepullontheScapulatocreateenoughstabilityforanymovementutilizingtheArmsand/orUpperBody.

RX:PracticeacombinationofsofttissuetherapyandeffectivestretchingtechniquesonmusclesthatconnecttoandaroundtheRibCage(ThoracicSpine),Scapula,andShoulder.These
musclesinclude:theUpperTrapezius(NeckandShoulderMuscle),PectoralComplex(ChestMuscles),andLatissimusDorsi(BackMuscles).

Next,practiceActivationexercisestostrengthenandfacilitateproperfiringsequencesofthefollowingunderactivemuscles:Rhomboids(UpperBackMuscle),MidandLowerTrapezius
(UpperBackMuscles),SerratusAnterior(ShoulderGirdleMuscle),andTeresMinorandSupraspinatus(ExternalRotatorsintheShoulder).

Finally,practiceavarietyofexercisesintegratingtheseunderactivemuscleswithlargerMovementPatterns,includingOverheadandHorizontalPresses,VerticalandHorizontalPulls,
Diagonal1&2Movements(ChopsandLifts),Swings.Also,challengestability,coordination,andbalancewithsinglearm(unilateral)and/orlocomotive(crawling/climbing)exercises.

ShoulderImpingement
TheNationalAcademyofSportsMedicinereportsthat40%ofshoulderpainisaresultofshoulderimpingement.Approximatelyhalfofthoseindividualsexperiencearecurrenceofpainwithin
thenexttwoyears,evenafterbeingassessedandtreated.Thesenumberssuggestthatanytrainerorcoachhasahighprobabilityoftraininganathlete/clientwhohasorhadashoulder
impingement.Therefore,understandinghowtodetectandaddressashoulderimpingementisverybeneficial.

Manytimes,ShoulderImpingementoccurssimultaneouslywithothercompensationpatternsincludingUpperCrossSyndrome,RoundedShoulders,ExcessiveKyphosis,andForwardHead
Posture.

MechanicsofaShoulderImpingement
AShoulderImpingementusuallyoccursfromrepetitivemovementsinananterior(forward)andsuperior(upward)direction,suchasahighvolumeofpushingorpressingexercises(likethe
benchpress)and/oranoveruseofcertainDailyLifeActivitiesincludingcomputerworkanddriving.

Repetitivemovementsandoveruseinananterior(forward)andsuperior(upwards)directioncreatesoveractivemusclesandaleveloftightnessinthePectorals(Chest),AnteriorDeltoid
(Shoulder),andUpperTrapezius(Neck/Shoulder)Muscles.TheresultingtightnessofthesemusclescompressesorsequencestheShoulderComplexuntiltheAcromianProcess(frontportion
oftheScapulathatconnectswiththeCollarBone)pressesdownontothesofttissuebelowitcausinganabnormalamountoffrictionwhentheShoulderisinmotion.Essentially,thefriction
causedbythecompressionfromtheShoulderComplexacceleratesthewearandtearofthesofttissuebelowtheAcromianProcess,causingpaininadditiontopossiblyleadingtoarupture
ortearofthesetissues.

RX:OneofthemainobjectivesofthetreatmentofaShoulderImpingementistocreatemorespaceundertheAcromianProcessbyusingacombinationofstifftissuetherapyandstretching
tolengthentheshort,tight,andoveractivemuscles,specificallythePectorals(Chest),Deltoid(Shoulder),andUpperTrapezius(Neck/Shoulder)musclesthatconnecttotheShoulder
Complex.Oncethetightnessinthesetissuesisaddressed,thenextstepistoincreasetheRangeofMotionandstabilityoftheentireShoulderComplexasawaytopreventaShoulder
Impingementfromreoccurring.

StartwithacombinationofsofttissuetherapyandeffectivestretchingtechniquesonmusclesthatconnecttoandaroundtheRibCage(ThoracicSpine),ScapulaandShoulder.These
musclesinclude:theUpperTrapezius(NeckandShoulderMuscle),PectoralComplex(ChestMuscles),AnteriorDeltoids(Shoulders),andLatissimusDorsi(BackMuscles).

Next,practiceActivationexercisestostrengthenandfacilitateproperfiringsequencesofthefollowingunderactivemuscles:Rhomboids(UpperBackMuscle),MidandLowerTrapezius
(UpperBackMuscles),SerratusAnterior(ShoulderGirdleMuscle),andTeresMinorandSupraspinatus(ExternalRotatorsintheShoulder).

Finally,practiceavarietyofexercisesintegratingtheseunderactivemuscleswithlargerMovementPatterns,includingOverheadandHorizontalPresses,VerticalandHorizontalPulls,
Diagonal1&2Movements(ChopsandLifts),Swings.Also,challengestability,coordination,andbalancewithsinglearm(unilateral)and/orlocomotive(crawling/climbing)exercises.

ElevatedShoulders
ManypeopleexperiencetheCompensationPatternofElevatedShouldersduetotheDailyLifeActivitiesofdriving,workingonacomputer,workingatadesk,andcarryingbagsontheir
shoulders.Formanyindividuals,thispatternofcompensationoccurssimultaneouslywiththeUpperCrossSyndromeandForwardHeadPosture.

ElevatedShouldersisessentiallyacompensationpatternbasedonaStrengthorMuscleImbalancearoundtheShoulder.Inthispattern,theshouldersareraisedorelevatedbytheUpper
TrapeziusandScalenes(Neck/Shoulder)MusclesinanattempttostabilizeandcontroltheScapulaandArmbecausetheinferior(below)synergisticmusclesoftheSerratusAnterior(Rib
Cage),Rhomboids(Back),andLower/MidTrapezius(Back)musclesarenotadequatelyfiringandprovidingstabilitytotheShoulderComplex.

SincetheScapulaactsasaplatformfortheShoulderandArmtomoveupon,thelackofsynergisticsupportfromtheSerratusAnterior,Rhomboids,andMid/LowerTrapeziusmusclesonly
compromisesthepositioningoftheScapula,thuscompromisingthemovementoftheArmandShoulder.Thiscompensationpatterninadvertentlyplacesaninappropriateamountofstrainonto
theCervicalSpine(Neck),weakeningtheforceoutputoftheArmsandShoulders.

RX:Thefirststepistousesofttissuetherapyandstretchingtolengthenandreleasetensioninthetightandoveractivemusclesthatelevatetheshoulders.Thenextstepistofocuson
activating/strengtheningmusclesthatcandepressoranchortheShoulderGirdleontotheRibCagewithsupportoftheTrunk(Core)Muscles.

StartwithacombinationofsofttissuetherapyandeffectivestretchingtechniquesonmusclesthatconnecttoandaroundtheRibCageandThoracicSpine.Thesemusclesinclude:theUpper
Trapezius(NeckandShoulderMuscle),Scalenes(NeckMuscles),PectoralComplex(ChestMuscles),andLatissimusDorsi(BackMuscles).

Next,practiceActivationexercisestostrengthenandfacilitateproperfiringsequencesofthefollowingunderactivemuscles:Rhomboids(UpperBackMuscle),MidandLowerTrapezius
(UpperBackMuscles),SerratusAnterior(ShoulderGirdleMuscle),RectusAbdominis(AnteriorCoreMuscles),Internal/ExternalObliques(LateralCoreMuscles),andTransverseAbdominis
(InteriorCoreMuscles).

Finally,practiceavarietyofexercisesintegratingtheseunderactivemuscleswithlargerMovementPatterns,includingOverheadandHorizontalPresses,VerticalandHorizontalPulls,
Diagonal1&2Movements(ChopsandLifts),Swings.Also,challengestability,coordination,andbalancewithsinglearm(unilateral)and/orlocomotive(crawling/climbing)exercises.

UnevenShoulders
Oneofthemostdifficultpatternsofcompensationtoassess,UnevenShouldersisacomplicatedStrengthorMuscleImbalanceoccurringinmanypeoplewithouttheirknowledge.This
patternofcompensationusuallydevelopsinanindividualduetoapreviousinjuryand/orlifestylefactors,includingsimplehabitssuchascarryingabagononlyoneshoulder.

Unevenshouldersareeasilyobservedinastaticpostureassessment.However,thecausesorthenatureoftheStrength/MuscleImbalanceinvolvedinthiscompensationpatternisnotas
easilynoticeableduetothecomplexnatureofthemovementoftheHips,Torso/Core,andShoulders.Insomeindividuals,theUpperTrapezius(Neck/Shoulder)Musclemaybetightand
overactive,whileinothersitmaybetheLatissimusDorsi(Back)orPectoralis(Chest)oreventheQuadratusLumborum(LowBack)Musclesthataretightandoveractive.

RX:Usesofttissuetherapyandstretchingtechniquestosystematicallyaddressallmusclesinthebody.PracticemovementintrainingwiththelargestRangeofMotionpossibleforthe
individual.Additionally,attempttochangesimpleDailyLifeActivities,suchaswearingabagontheoppositeshoulderandopeningdoorswiththeopposite(nondominant)hand.The
combinationofmobilitytrainingwiththechangeofDailyLifeActivitieswillhelpeliminatetherepetitivemovementsthatcreateUnevenShouldersandhaveanegativeeffectonposture.

Hyperinflation
Mostpeopletaketheactofbreathingforgranted.Nottoomanypeoplepaymuchattentiontobreathing,letalonethemechanicsinvolved.However,themechanicsofbreathinghaveahuge
influenceoveranindividualspostureandmovement.

Hyperinflationreferstothehabitualprocessofinhalingand/orholdingontotheinhalationofabreathcycletothepointthattheRibCageandmusclessurroundingtheThoracicCavity(Upper
Torso)areheldinanexpandedorsemiexpandedposition.Inotherwords,Hyperinflationisthecontinualactofnotbreathingoutdeeplyenoughtofullyclearthelungsofairandcontractthe
RibCage.

DoesHyperinflationreallymatter?Yes.Hyperinflationcandisruptanindividualsmovementbothmechanicallyandphysiologically.

Inmechanicalterms,HyperinflationkeepstheRibCageexpanded,divertingtheflowofkineticenergythroughthebody,forcingcertainmusclestocompensatefortheabnormalflowof
energy.Additionally,Hyperinflationcreatestightnessinthemusclesassociatedwiththeinhalationcycleofthebreath,namelytheUpperTrapezius(Neck/Shoulder)Muscles.

Inphysiologicalterms,HyperinflationreducesstimulationoftheParasympatheticNervousSystem,whichnormallyletsthemusclesreleaseheldcontractions,restorestheirnaturallengths,
andregeneratessofttissuecellsthataidinanindividualsfullrecoveryfromboutsoftrainingaswellasfromDailyLifeActivities.

Itisnearlyimpossibletocorrectanypatternofcompensationifitisundetected.Therefore,itsimportanttohavesomekeysorguidelinestousewhenassessingforhyperinflation.So,what
doesHyperinflationlooklike?

First,observethemovementoftheRibCageandThorax(Torso)whilebreathing.NoticeiftheChestandShouldersriseandfallorifthebellyandThorax(Torso)asawholeriseandfall.The
latteristhemoreappropriatemechanicforbreathing.Also,observetheindividualforthepatternofFlaredRibswherethelowerribsstickout,adysfunctionthatcommonlyoccurs
simultaneouslywithHyperinflation.

Next,timethedurationofaninhale(breathin)comparedtothelengthofanexhalation(breathout).Aretheyeven?Cantheindividualmaintainanevencycleofinhale/exhalefortenfull
cycles?TheseareeasyobservationstointegratewhileobservingthemechanicsoftheThorax(Torso)andRibCagetogetinsightinanindividualshabitofbreathing.Somepeoplemaybe
abletoestablishanevenbreathcycleforafewbreaths,buthabituallybecomehyperinflatedwhenleftunchallenged.

Lastly,watchtheindividualbreathewhilemoving,especiallywhenperformingstretchesand/orexercises.Observinganindividualsbreathingmechanicswhilemovingrevealsbreathinghabits.
Dotheyholdtheirbreathwhentheymove?Dotheybreatheeasyandevenly?Whathappenswhentheyarecuedtoexhale?Howlongcantheindividualsbreatheeasilyandevenlyafter
cuing?Theseareallquestionstoasktogetinsightinindividualsbreathinghabits.

RX:Oneveryeffectiveexercisetoteachanindividualproperbreathingtechniqueissimplylyingonthefloorwhileblowingupballoons.

JasonMasek,MA,PT,ATC,CSCS,PRusesballoonsasanexerciseattheUniversityofNebraskatoteachproperbreathingmechanicsthatfocusonstrongexhalation,alsoinducingthe
ParasympatheticNervousSystemtocalmthestudentathletesbeforetrainingorcompetition.

Blowingupballoonsisaveryeffectiveexercisethatcanbepracticedanywhere,evenwithoutballoons.Simplyimaginingtheactofblowingupaballoontrainsproperbreathingmechanics
andrestoresmobilityandfunctiontotheentireThorax(Torso)andRibCage.

Recap:CommonPatternsofCompensation
TheHumanBodyiscontinuouslybeingshapedandremodeledbyHumanMovementinmachotransduction,aprocessinwhichtheforcesexperiencedbythecellsofthebodyinanyandall
movementphysiologicallychangethecellindirectcorrelationtothedirectionandmagnitudeofthoseforces.Sometimes,asinpatternsofcompensation,thisprocessofremodelingthebody
increasesinefficienciesandcanevenleadtoinjury.However,anindividualcanmarginalize,ifnoteliminate,theriskofinefficiencyandinjurybyobservingpatternsofcompensationandthen
activelyworkingtocorrecttheassociatedMovementDysfunctions.

Common
DuetosimilaritiesinLifestyleandDailyLifeActivitiesinthemoderndevelopedworld,acollectionofcommonorreadilyrecurringcompensationpatternsandMovementDysfunctionshas
beendeveloped.Thislistcanbeusedbytrainers,coaches,andindividualstoguidetheirownobservationsandassessmentofmovementtoproactivelyreduceand/oreliminateriskofinjury
andinefficiency.

Resources

AssessmentandTreatmentofMuscleImbalance:TheJandaApproach.
PPage,CFrank,RLardner,editors.HumanKinetics:Windsor,Ontario,Canada

ClarkMA,LucettSL.NASMEssentialsofCorrectiveExerciseTraining,Baltimore,MD:LippincottWilliams&Wilkins2011.

ClarkMA,LucettSL.NASMEssentialsofPersonalFitnessTraining4thed.Baltimore,MD:LippincottWilliams&Wilkins2012.

Baechle,Earle.EssentialsofStrengthTrainingandConditioningThirdEditionNationalStrength&ConditioningAssociationHongKong,HumanKinetics2008

BronC,DommerholtJ.EtiologyofMyofascialTriggerPoints,CurrentPainHeadacheReport,2012Oct16(5):439444

JointStructureandFunctionFifthEditionAComprehensiveAnalysisbyPamelaLevangieandCynthiaNorkin,F.A.DavisCompanyPhiladelphia2011

TheWhartonsStretchBookFeaturingtheBreakthroughMethodofActiveIsolatedStretchingbyJimandPhilWharton,ThreeRiversPress,NewYork1996

BiomechanicsAQualitativeApproachforStudyingHumanMovementbyEllenKreighbaumandKatharineBarthelsAllynandBaconBoston1996

BiomechanicsintheMusculoskeletalSystembyManoharPanjabiandAugustusWhiteChurchillLivingstoneNewYork2001

AppliedKinesiologyRevisedEditionATrainingManualandReferenceBookofBasicPrinciplesandPracticesRobertFrostNorthAtlanticBooksBerkley2013

BowmanK,MoveYourDNA,USA,FirstPrinting,2014

StarrettK,CordozaG,BecomingaSuppleLeopard,USA,VictoryBeltPublishing,2013
MyersT,AnatomyTrains,USA,ChurchillLivingstoneElsevier,2014

RestrictedHipMobility:ClinicalSuggestionsforSelfMobilizationandMuscleReEducationMichaelReimanandJWMathesonIntJSportsPhysTher.2013Oct8(5):729740.PMCID:
PMC3811738
 BruceKelly,MS,CSCS,NSCACPT,NASMPES,TheImportanceofMobility
http://www.fitnessnutritionweightloss.com/theimportanceofmobility.html

JamesHoffman,MS,BS,ADifferentApproachtoMobility
http://www.jtsstrength.com/articles/2014/10/13/differentapproachmobility/

diZerega,GereCampeau,Joseph(2001).Peritonealrepairandpostsurgicaladhesionformation(PDF).HumanReproductionUpdate7(6):547555.doi:10.1093/humupd/7.6.547.Retrieved
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Liakakos,T.,Thomakos,N.,Fine,P.,Dervenis,C.,&Young,R.(2001).Peritonealadhesions:etiology,pathophysiology,andclinicalsignificance.Recentadvancesinpreventionand
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Junker,DanielH.Stggl,ThomasL.,TheFoamRollasaTooltoImproveHamstringFlexibility,JournalofStrengthandConditioningResearch,December2015,Vol.29Issue12:p3480
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ScandJMedSciSports.2010Aug20(4):5807.Iliotibialbandsyndrome:anexaminationoftheevidencebehindanumberoftreatmentoptions

ScottLawrance,DHS,LAT,ATC,MSPT,CSCS,UnlocktheHip:UsingJointMobilizationtoImproveMobilityGreatLakesAthleticTrainersAssociation45thAnnualWinterMeeting
Wheeling,IL,March16,2013

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ThisentrywaspostedinAlignment,Athlete'sToolbox,Biomechanics,FunctionalMovement,Mobility,MovementEvaluation,PerformanceEnhancement,PreHab,Training
ProgramsandtaggedAlignment,Biomechanics,Buttwink,compensationpatterns,correctiveexercises,HumanMovment,injuryprevention,LowBackPain,LowerCross
Syndrome,malalignments,movementdysfunctions,movementefficiency,movementpatterns,movementquality,posture,PreHab,prehabexercises,PronationDistortion
Syndrome,repetitivemovementpatterns,repetitivestresssyndrome,UpperCrossSyndromebyMichaelRosengart,CPT,CES,CSCS.Bookmarkthepermalink
[http://www.prehabexercises.com/compensationpatterns/].

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