Brain Stem Activation for Upper Crossed Syndrome
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 seen above with Matthias Schlitte 3-time world arm wrestling champion. It’s obvious that Matthias’ arm muscles, ligaments, and bones have thickened in response to excessive demands from the one-sided sport. Simply put, the body gets better at doing whatever it does regularly.
So, how does the SAID principle apply to the suboptimal postural patterns we see in our practices? Bottom line: Sitting for hours in a flexion-dominant posture or performing exercises using poor form or less than perfect posture will cause the client’s body to 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 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, in this newsletter, 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 brainstem at the pontomedullary junction, where 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 cross syndrome pattern — forward jutted chin, 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 and rotational strain patterns that may indicate PMRF weakness. During the intake evaluation, I’m silently asking the client to prove to me that he or she does not have an upper cross, 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 side-to-side.
For example, the client in Image 2 is asked to perform a modified table angel test, and I see that some of his upper cross 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 rotational crossing patterns, I always check for vestibular imbalance side-to-side. Let’s look at an example of this dysfunctional pattern.
Bad balance, bad posture
Massage therapists are aware of the role good balance plays in enhancing performance and avoiding falls. However, many do not realize how activation of the inner ear’s vestibular system helps our clients stand tall and move with more precision. The inner ear transmits sensory information to the pons based on the client’s head position. Therefore, head-on-neck alignment is a critical factor in improving balance. Although I teach several vestibular tests and corrections in workshops and videos, the classic Romberg Test is the simplest way to determine the side of vestibular weakness.
Notice in Image 5 how the client’s head tilts right, which forces his body to sway in that direction. This may indicate right vestibular weakness due to occipitoatlantal (O-A) alignment problems. In Image 6,I show my favorite head-on-neck myoskeletal technique for leveling the eyes and activating the vestibular system. To enhance vestibular tone at home, I recommend 10 minutes a day of mini-trampoline bouncing or one-legged standing with eyes open and closed.
Understanding postural plasticity
With a healthy PMRF resisting flexion and a highly functioning vestibular system promoting extension, we’re better able to get our upper cross clients standing taller and moving better. Remember, your brain sets the tone for all your muscles. Like an overprotective mother, it decides how much activation to allow — and it always errs on the side of caution. The brain can activate or inhibit muscle tone and balance depending on what it determines to be the safest course for you. We are wired for survival. Your (Mom) brain is designed to protect you and, when functioning properly, knows when too much or too little of a good thing is just right for you.
5. To manually simulate vestibular tone to the walk right side, the therapist left sidebands the client’s head 20 degrees and asks him to chin tuck. The therapist’s hands follow the head flexion movement and then apply 2 seconds of overpressure to help release the tight suboccipitals, allowing the right occipital condyle to glide posteriorly on the atlas. The therapist repeats 3 – 5 times and resits with the Romberg Test for improved balance.