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The modified table angel test asks the client to tuck his chin, flatten his thoracic spine, and slowly begin raising his arms overhead, attempting to keep his wrists as close to the table as possible. In those with upper- crossed syndrome, the wrists will not be able to approximate the table above 90 degrees. Pontomedullary junction—the powerhouse of posture. 1 2 96 m a s s a g e & b o d y w o r k j u l y / a u g u s t 2 0 1 8 technique MYOSKELETAL ALIGNMENT TECHNIQUES faulty peripheral input, inaccurate cortical processing, flawed output, or a combination of these factors. Although there are seven primary brain areas responsible for the neurology governing posture, I'd like to focus on two: one that promotes forward- head postures and another that permits these postures. PONTOMEDULLARY RETICULAR FORMATION (PMRF) The PMRF is a dynamic sorting and switching station located in the brain stem at the pontomedullary junction, where the pons meets the medulla (Image 1). It is considered the epicenter for postural control and "the powerhouse of posture," according to the American Postural Institute. The PMRF houses eight cranial nerves that carry out vital motor and sensory functions, including eye-ear coordination to enhance head-righting reflexes and balanced gait. When functioning properly, the PMRF inhibits cervicothoracic flexion, which, in turn, effectively resists gravitational exposure. Clients with PMRF disorders commonly present with an upper-crossed syndrome pattern—forward-jutted chin, Postural Plasticity Brain Stem Activation for Upper-Crossed Syndrome By Erik Dalton, PhD The SAID principle (Specific Adaptation to Imposed Demands) is a classic sports medicine term that describes how physical adaptations develop when the body is placed under stress, thereby allowing the body to better handle future stressors. A common example is the tennis pro whose arm muscles, ligaments, and bones thicken in response to excessive demands from the one-sided sport. Simply put, the body gets better at doing whatever it does regularly. If that means sitting for hours in a flexion-dominant posture or performing exercises using poor form and less-than-perfect posture, the body will get better at adopting poor form and less-than-perfect posture. This is postural plasticity at work. Poor posture may start as a "tissue issue" due to tension, trauma, or overuse injuries. Eventually, however, it manifests as a sign of functional weakness in the brain's hardware. This weakness may stem from internally rotated arms, protracted shoulder girdle, and thoracic spine hyperkyphosis. In this population, the PMRF is unable to neurologically resist slumping, which causes connective tissue and joint adaptations in the myoskeletal framework. It's best to assess for PMRF weakness with the client unaware you're evaluating them. To accomplish this, I begin observing my client's posture as they enter the office, looking for front-to-back and side-to-side rotational strain patterns that may indicate PMRF weakness. During the intake evaluation, I'm silently asking the client to prove to me that they do not have an upper- crossed, right motor dominant, or cross- patterned gait problem. Weeding out these common compensatory patterns in early sessions gives me a good starting point for my bodywork intervention and also provides clues to possible PMRF weakness. For example, the client in Image 2 is asked to perform a modified table angel test, and I see that some of his upper-crossed pattern is coming from bilateral PMRF weakness. To help activate the pons and medulla, I apply a couple of graded exposure torso-extension stretches (Image 3). For those with unilateral PMRF problems, or

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