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108 m a s s a g e & b o d y w o r k m a r c h / a p r i l 2 0 1 4 Strength without the ability to move freely is pointless. Any compound movement requiring precision and communication between connective tissue, joints, and the brain will be more difficult, and the risk of injury—or reinjury—that much higher. Power, output, and speed are all compromised by reduced joint mobility. BREATHING AS A MOBILIZER It's virtually impossible to overstate the influence of breathing on t-spine mobility and postural stability. The diaphragm, abdominals, and accessory respiratory muscles produce upward of 21,000 breaths a day. 2 With a strong, freely moving diaphragm serving as the primary muscle for respiration, auxiliary muscles are able to remain soft and relaxed. However, many clients with upper t-spine restrictions (such as a dowager's hump) breathe primarily with the scalenes and upper scapular fixators. A weakened diaphragm causes increased resting tone in upper rib cage muscles such as the scalenes, upper trapezius, levator scapula, and pectorals. This common muscle imbalance pattern creates shoulder girdle protraction, forward head carriage, decreased lumbar lordosis, and possible rotator cuff impingement due to glenohumeral joint decentration. 3 Forward head posture may result in significant suboccipital and cervicothoracic pain, as these areas are now asked to bear excessive loads to compensate for the hyperkyphotic t-spine (Image 2, page 107). An often overlooked way of relieving nagging neck, shoulder, or low-back pain is to improve mid-back mobility. In Image 3, I demonstrate a rib-lifting release for the intercostal muscles and thoracolumbar fascia. This soft-tissue stretch helps create space between the rib cage and pelvic girdle. To activate an inhibited diaphragm, a webbing technique combined with client-assisted respiration helps open the costal arch myofascia, while mobilizing the rib cage (Image 4). MYOSKELE TAL ALIGNMENT TECHNIQUES 3 4 To create space between rib cage and pelvic girdle, the client's right hand isometrically pulls on the table while the therapist mobilizes thoracolumbar fascia and intercostals. ©erikdalton.com To lift a kyphotic t-spine and activate an inhibited diaphragm, the client forcefully exhales as the therapist's webbed hands work all tissues binding the diaphragm. To enhance the release, the client performs slow pelvic tilts. ©erikdalton.com The body does what is easy, not always what is best. As we age and the thoracic spine stiffens, we compensate by over-rotating the neck and low back, sending shock waves throughout the kinetic chain. Bodywork historians have recognized one of the keys to relieving low-back, neck, and shoulder pain resides in improved t-spine mobility and kinetic chain awareness. It is exciting to witness this missing link return to the forefront of discussion. Hopefully, the epidemic of musculoskeletal problems among baby boomers will spawn additional research into kinetic chain compensations. Our clients will reap the benefits as these modern movement assessments are integrated into daily practice. Notes 1. Philip E. Greenman, Principles of Manual Medicine (Baltimore, Maryland: Lippincott Williams & Wilkins, 2003): 229–307. 2. Lauralee Sherwood, Fundamentals of Physiology: A Human Perspective (Independence, Kentucky: Thomson Brooks/Cole, 2006). 3. Craig Liebenson, ed., Rehabilitation of the Spine: A Practitioner's Manual, 2nd ed. (Baltimore, Maryland: Lippincott Williams & Wilkins, 2007). Erik Dalton is the executive director of the Freedom from Pain Institute. Educated in massage, osteopathy, and Rolfing, Dalton has maintained a practice in Oklahoma City, Oklahoma, for more than three decades. For more information, visit www.erikdalton.com. T-spine homework should emphasize extension and rotation, such as this door stretch: the left hand stabilizes the pelvic girdle and lumbar spine, while bodyweight slowly shifts into extended arm and right foot. Repeat on opposite side. Pilates, yoga, Fascial Fitness, and functional training are but a few modalities that complement good t-spine bodywork. Select a teacher who is respectful of your limits. Additionally, I encourage clients to stand and perform this proprioceptive thoracic extension exercise several times a day: • Place thumbs under the armpits with fingertips pointing toward the ceiling. • Lift the thumbs as high as possible keeping the chin tucked. • Extend the thorax while lifting the sternum. ©erikdalton.com Exercise Advice