News Letter

Wednesday, April 11, 2007

The A-Frame, the Peg Leg and the Teeter Totter

The A-Frame, the Peg Leg and the Teeter Totter
Description of posture patterns and what to expect for each type.
The A-Frame[anterior lumbar tilt]
Upper body anterior to hips but over feet; feet wide apart often turned out; knees may be locked (stable but damaging) or unlocked (Unstable and fatiguing); Head may be forward (degenerative)or upright (adaptive); arms and shoulders may be internally rotated (depressive) or held back (aggressive).
Probable cause:
Swollen lumbar joint capsules, torn ligaments or disc bulging which is being held away from nerve roots by pushing it posterior.
The A-Frame is formed by the femurs with the adductors forming a scissor truss to the ramus of the pubis. The femurs are stabilized by the tensor fascia, Quadratus femoris, piriformis, iliacus and various other muscles of the sacral-pelvic floor.
Any of the above may be hypertonic, eschemic, or have trigger points. The Psoas is often hypotonic due to disturbance of its enervation at the lumbar nerve roots. Depending on knees being locked or unlocked and degrading of tarsals and arches the tension chains will cross the knees and ankles in various patterns to be discussed later. The quadriceps and hamstrings will be under tremendous load and will tend to be hard and anaerobic. Also the erector spenai are under heavy load and will probably be hypertonic. Posture chains will continue to the skull but I will discuss them under lateral lean.
The Peg Leg [lateral lumbar tilt]
Upper body over one leg with weight predominantly on that heel and other leg with lesser weight carried or balanced on toe,otherwise similar to half the A-frame (in other words a lean-to [the pun makes it easier to remember]). Variations are left or right and with anterior or posterior component. Manifestation will be what is commonly referred to as an antalgic gait; in other words limping like they have a peg leg.
Probable cause:
Unilateral disc bulge or joint capsule inflammation, possible unilateral ligament tear or laxity. The proprioceptive response may tilt toward the disc damage to push the pulpus internal away from the nerve root, or the lean may be away from the disc damage and ether anterior or posterior to push the bulge away from the nerve root.
If the lean is over the leg with the affected nerve root, weight bearing will be more painful and shorter duration; lean away from the affected nerve root will probably allow for longer weight bearing but more severe cramping when not weight bearing.
Posture chains:
Due to the heel toe stance and the leg and arm opposite the lean being held abducted the posture tonicity has to be radically different on each side of the body. The righting reflex also will cause the thoracic and or the cervical spine to have hypertonicity opposite the lean. If the client has sufficient flexibility to compensate for the lumbar lean with a counter thoracic lean then the cervical hypertonicity will be on the same side as the lumbar contraction. Repetitive use trigger points then will be found in lateral aspects of the abducted leg, arm and compensated side of the neck, these can track slightly anterior or posterior depending on the additional lean component. The adductors of the femur and humerus on the opposite side will also be subject to repetitive use stress and the corcobreccei or terries may develop trigger points or it may extend out to pectorals and latisimus. Observation and palpation be your guide.
With a compensated scoliosis [thoracic correction for the lumbar lean with cervical correction to head level] the distortion of the ilium will be mirrored by the mastoids. [superior anterior ilium will be matched with inferior anterior mastoid, etc.] Therefore there will be a distortion of the cranio sacral rhythm.That is why Upledger teaches a ten step protocol to restore the CSR. My protocol is to estimate if the major trigger points and counter strains are anterior.If so to start with the client supine check the mastoids and ilium distortion and position the legs to start the unwinding. If the major complaint is upper body I work from the top down. If the distress is in the lower extremities I work from the feet up. If the major contractions are posterior I start with the client prone check the mastoid and hips and use a wedge bolster under the anterior ilium.
The Teeter Totter[posterior lean]
Shoulders posterior to hips, head anterior to shoulders, sacroiliac joints often locked, knees usually locked when standing with toes constantly wiggling to try to maintain balance and arms may also be held in balancing positions.
Probable causes:
Lumbar and or lower thoracic fixations, upper thoracic excessive kyphosis, anterior neck contractions or a combination.
If not extreme many will think this person has good posture but wonder why they are so nervous, fidgety or irritable.
My protocol is to start supine release the anterior cervical and illiosacral joints and possibly the abdominals then go to prone and try to balance or free the fixations of the spine.
This is by no means fully researched or documented but my observations over ten years with input from Chiropractic X-ray measurement, Paul StJohn's videotapes and lecture, Upledger's CranioSacral and STRAIN COUNTERSTRAIN by Lawrence H. Jones, DO.
I hope this contributes to the integration of postureology with various therapeutic modalities that assist in restoring homeostasis. HAQ
Hans A. Quistorff, LMP
Antalgic Posture Pain Specialist

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