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POSTURAL ASSESSMENT A general evaluation of posture and movement patterns offers initial clues as to areas that are either underactive or overactive in their ranges of motion or functionality. CROSSED SYNDROMES Patterns of imbalance, such as upper- and lower-crossed syndrome patterns, have classically been interpreted as demonstrating hypertonic extensor muscles overwhelming inhibited abdominal flexors. 5 P. E. Greenman explained this perspective as follows: "Muscle imbalance consists of shortening and tightening of muscle groups (usually the tonic 'postural' muscles), and weakness of other muscle groups (usually the phasic muscles), and consequent loss of control on integrated muscle function. The lower-crossed syndrome involves hypertonic, and therefore shortened, iliopsoas, rectus femoris, tensor fasciae latae, the short adductors of the thigh, and the erector spinae group with inhibited abdominal and gluteal muscles. This tilts the pelvis forward on the frontal plane, while flexing the hip joints and exaggerating lumbar lordosis." 6 In addition, it is not uncommon for the quadratus lumborum to shorten and tighten, while the gluteus maximus and medius weaken. The upper- crossed syndrome involves, among other muscles, hypertonic cervical extensors, upper trapezius, pectorals, and thoracic erector spinae, with inhibited deep-neck flexors and lower fixators of the shoulders. J. Key's research team noted that this pattern may involve "a posterior (pelvic) shift with increased anterior sagittal rotation or tilt," together with an anterior shunt/translation of the thorax and the head. 7 In such instances, diaphragmatic control and altered pelvic floor function might result. 66 m a s s a g e & b o d y w o r k m a y / j u n e 2 0 1 5 THE SOFT TISSUE PALPATION PUZZLE: PROBLEMS ARE NOT NECESSARILY WHERE THEY APPEAR TO BE! In the descriptions of crossed syndromes, individual muscles are named. However, it has become obvious in recent years that the concept of individual muscles is flawed. The multiple fascial connections between "named" muscles and other muscles means that their action is not independent. Force is transmitted in many directions, offering muscles additional leverage and functionality, as well as adding load to sometimes- distant muscles. Individually named muscles can no longer be considered to be discrete and separate, operating individually. P. Huijing has pointed out that agonists and antagonists are coupled structurally and mechanically via the fascia that connects them, so that when force is generated by a prime mover it can be measured in the tendons of antagonist muscles. 8 A. Franklyn-Miller and colleagues have shown that, for example, a hamstring stretch produces 240 percent of the resulting strain in the iliotibial tract and 145 percent in the ipsilateral lumbar fascia compared with the hamstrings. 9 Strain (load) transmission, during contraction or stretching, therefore affects many other tissues beyond the muscle being targeted, largely due to fascial connections. Importantly, this suggests that apparent muscular restrictions, such as "tight hamstrings," might not originate in the affected muscle but elsewhere. In the case of hamstring restriction, there may be fascial dysfunction in the tensor fascia lata, or the ipsilateral thoracolumbar, creating, encouraging, or maintaining hamstring symptoms. This sort of fascial interconnectedness exists throughout the body, so as knowledge accumulates as to what structures are linked to others via Information Gathering 1. A general evaluation of postural and movement patterns offers an overview of what is functional and which tissues, structures, and areas require further investigation (see Therapeutic Options, page 65). 2. Testing particular key muscles for relative shortness, as well as for functional efficiency, allows a more focused evaluation as to where restrictions exist. 3. Within identified areas, such as shortened muscles, local areas of dysfunction may be isolated by means of direct palpation (see notes on ARTT, page 69).