Getting Better...Better - Part 4 - Crossed Syndromes
To recap the last three posts, the discussion included:
Decreasing Pain and Improving Performance, and how this often time boils down to our ability to manage load.
Loads - which can be managed both Actively and Passively, or a combination thereof. When passive stabilization strategies become primary movement patterns, the resulting pain and dysfunction can often become seemingly insurmountable.
Chronic passive stabilization strategies which often can result in predictable Joint-by-Joint dysfunction. The upstream and downstream dysfunctions MUST be addressed when resolving regional dysfunction, or the body will tend to default to the old, faulty, familiar patterns.
Chronic Joint-by-Joint dysfunction is most often accompanied by muscular repercussions known as Janda's Crossed Syndromes.
As a joint relies on passive stabilizers as a primary load management strategy, it will often shut down or INHIBIT the muscles that would have acted as the active stabilizers. For example, a common passive stabilization strategy for core management is an Anterior Pelvic Tilt(APT). When a person carries themselves in an APT, the stabilization gained passively by approximated facets, spinous processes, and the anterior hip capsule, will often cue the brain the shut down the primary active stabilizers, namely the abdominal and glutes. These inhibitions allow antagonizers such as the hip flexor group and mid/low back extensors to become chronically facilitated or "tight."
While the Crossed syndromes are commonly recognized, often they are inappropriately prescribed with "stretching" and "strengthening" activities, in an effort to rectify the inhibited and facilitated groups. What often gets forgotten is that these syndromes are the RESULT of poor movement patterns, not the CAUSE.
If an athlete presents with lower crossed loading strategies, endless stretching and glute strengthening can create short-term solutions, but will often fail in the long-term, as the brain will continue to fault to passive patterns to manage load. This in turn negates all of the stretching and strengthening, as the passive joint strategies cause the active stabilizers to inhibit, which in turn allows the antagonizers to facilitate, creating an often frustrating and seemingly inescapable cycle of tight dysfunctional muscles and poor movement patterns.
While this is just one of several poor loading strategies that can result in Crossed Syndromes, providing the the appropriate treatment to just the muscles, without addressing the brain's stabilization strategies, will most often result in an incomplete and ineffective treatment strategy. Instead, using the apparent Crossed Syndromes as an identification tool and then teaching an individual how to find and maintain actively stable joint strategies, or what Janda refers to as "Joint Centration," will create long term solutions to pain and dysfunction, and in most cases resolve the Joint-by Joint dysfunction the resulting muscular repercussions.
As you know, it always depends on the context - different people have different goals, different anatomy, and different medical histories. Next time, we will begin addressing how centrated joints present segment by segment and strategies to maintaining these positions under load, in an effort to help you Get Better. Better.
If there is any specific topic you would like to see addressed or if you have any questions feel free to reach out to me(Jon) directly at firstname.lastname@example.org or contact our clinic at 816-554-6003.
Thanks for reading!!
Page, P., Frank, C., & Lardner, R. (2010). Pathomechanics of Musculoskelatal Pain and Muscle Imblance. In Assessment and Treatment of Muscle Imbalances: The Janda Approach(pp. 52-55). Champaign, IL: Human Kinetics.