1. Posture Workshop Dr. Jeffrey Tucker 11600 Wilshire Blvd. #412
Los Angeles, CA 90025

2. The Basics: Evaluation of static posture
Hypertrophied sternocleidomastoid
Forward head posture
UE internal rotation/round shoulders
Gothic shoulders
Scapulae (winging, elevated)
Medial rotation of scapulae
Ribs
Hypertrophied thoracolumbar erector spinae
Pelvis (unleveling, tilt, distortion)
Protruding abdomen
Sway back or flat back
Anterior pelvic tilt
Flattened superolateral quadrant of the buttock
Prominence of the iliotibial band
Lateral deviation of the patellae
Foot (flattened heel, flat foot)

3. Points I always check Ankles – hypomobile/mobility
Knees – hypermobile/stability
Hips – hypomobile/mobility (ROM +)
Lumbar spine – hypermobile/stability
Thoracolumbar Junction – hypomobile (Thoracic 5 area– hypomobile)/mobility
Scapulo-thoracic – hypermoblie/stability
7th Cervical-T1 – hypomobile
Cervical spine - hypermobile
Upper cervical – hypomobile
One of the first lessons I teach you. The foot gets full of adhesions & you must be able to break them up.

4. ADVICE: MICROBREAK 1. Stand up
2.     Arms overhead – ‘push up the ceiling’
Brueggers
4.     Breath in deep
5. Seated decompression

5. Microbreak: Bruegger Band Exercises for Upper Body
Instructions: Begin with a long (2.5 meter) band wrapped on each hand with palm open: 1. Thumb and finger abduction and extension 2. Wrist Extension 3. Forearm Supination 4. Shoulder external rotation 5. Shoulder Abduction and Extension 6. Scapular retraction Slowly return in exactly the reverse order. Repeat 2 to 3 times. Maintain an upright posture with neutral neck and back.

6. Psoas
Psoas stretches

7. Self-Psoas Muscle Release
Execution: Place a small firm ball between about halfway between the belly button and hip bone.
Perform "cobra" while resting on the forearm/hands. Take several deep breaths.
Return to the floor and lay flat. Next, rise back up and rest on the forearms/elbows while slowly pulling yourself forward to deepen the pressure as tolerated. For the deepest pressure, you can elect to lift the leg up on the same side of the body.
Spend about two to four minutes on each side.
Application: Reduced breathing capacity; increased lumbar lordosis; APT.
I feel endurance athletes and those performing repetitive activities who suffer with hip tightness should learn to use a self-release technique routinely with a small trigger point ball to maximize mobility and reduce injury risk. Lying prone. Place a small firm ball between the abdomen and the floor (about halfway between the belly button and hip bone).
Slowly elevate your body into a "cobra" type position while resting the bodyweight on the hands. Hold the position while taking several deep breaths.
Return to the floor and lay flat. Next, rise back up and rest on the forearms/elbows while slowly pulling yourself forward to deepen the pressure as tolerated. For the deepest pressure, you can elect to lift the leg up on the same side of the body.
Spend about two to four minutes on each side. Once you finish, stand and lift the knee up to assess the elasticity of the hip flexor on each side.
Application: Reduced breathing capacity; increased lumbar lordosis; APT.

8. Glut max activation 2 leg bridge Cook hip lift bridge
Foot elevated hip lift (aerobic step, foam roller, med ball)
2 leg hip hinge – develops posterior chain
One-leg deadlift - improves balance, & decreases load & stress on the back
Slide board leg curls (start with toes up)
Stability Ball Leg Curl – develops torso stability while strengthening the hamstrings. Heels on ball + curl.
SLDL = with dumbbells in hand; DL the hips go back. SL Good Morning = bar across the shoulders.

9. Single-Leg Romanian Deadlift
Stand on your left foot with your right foot raised behind you, arms hanging down in front of you. Keeping a natural arch in your spine, push your hips back and lower your hands and upper body. Squeeze your glutes and press your heel into the floor to return to an upright position. Perform eight reps per leg.

10. Perform glut activation prior to…
Straight leg mini-band or Superband x-walks are great for glut medius
Quaduped hip extension or Cook hip lift for Glut max
Perform glute activation prior to every workout

11. IDEAL cervical posture
Guideline to assess low cervical neutral:
Visualize a line across the upper neck, which follows the line of the jaw towards C2. Bisect this line.
Visualise a second line across the lower neck (B), which follows the line of the clavicle towards the C-T junction. Bisect this line.
A line that joins the bisectors ideally should be vertical or within 10 degrees of forward inclination.

12. IDEAL cervical posture
Guideline to assess upper cervical neutral:
Visualize a line in the plane of the face. This line ideally should be parallel to or within 10 degrees of the low cervical neutral line.

13. Plumb line from ear lobe
Should drop just posterior to clavicle (with scapula neutral)
Plumb line falling on or forward of the clavicle indicates a forward head posture.
Retracted chin posture (loss of normal lordosis) is often indicative of guarding or protective spasm.

14. Sit-to-stand test Have the patient sit on a stool or chair.
Observe them from the side and ask them to stand up.
Normal pattern is to lead with the posterosuperiour aspect of head.
If the SCM’s & subocciptal are dominating, they will lead with their chin. This is a faulty pattern.
This movement pattern is very closely related to the cervical flexion pattern.

15. Forward Head posture - FHP
Top 10 Detrimental Effects Of The Forward Head Posture Epidemic   1)  Increases Neck Pain Disability 2)  Contributes to Carpal Tunnel Syndrome 3)  Postural Cause of Cervicogenic Headaches 4)  Chronic Trigger Points in Suboccipital Muscles 5)  Causal Factor in TMJ Syndrome 6)  Higher Risk of Osteoporotic Fractures 7)  Associated With Dizziness & Vestibular Function 8)  Reduced Respiratory Function 9)  Often Found with Persistent Asthma 10) Higher Mortality Rate Among Elderly
Would you let any of your patients leave your office with a 20 lb bowling ball hanging around their neck without offering a solution? 
RESEARCH Rene Cailliet M.D.“Head in forward posture can add up to thirty pounds of abnormal leverage on the cervical spine. This can pull the entire spine out of alignment. FHP may result in the loss of 30% of vital lung capacity.“
A. I. Kapandji (Physiology of the Joints, Volume III), for every inch your head moves forwards it gains 10 pounds in weight. 

16. Observe Breathing
To practice relaxed breathing, have them lie on their back with both hands resting on the belly button. On the inhale, the hands should rise with the expanding abdomen and fall on the exhale. This should get them to realize what relaxed diaphragmatic breathing feels like.

17. Breathing interventions (things the patient will do at home)
Supine Prone – crocodile to cobra pose
On all 4’s
½ kneeling
Stand
Go for running, sprinting

18. Assess the scalenes
Stretching the Left Scalenes 1. Tip your head to the left to relax the muscle. Use your right hand: either the edge of your fingers or your thumb. Find the tight part of the muscle by sliding your hand up above and then behind the collar bone. Push down to tether or hold the muscle down. 2. Keep your chin tucked. Side-bend your head to the right. You can tip your head back a little if it helps. Try rotating your head toward or away from your hand, seeing which direction gets you a better stretch to the front of your neck and engages the tight fibers. Move only until you begin to feel the stretch in the front of your neck. You don't need to sidebend your neck very far. 3. Hold the stretch for seconds.

19. Scalene Cramp Test
Test: Used to reproduce suspected scalene pain or dysfunction. Use with caution: it may also distress a bulging disc or compromised facet joint on the side being tested. Discontinue test if cervical pain increases. Do not test through pain. Use with caution when patient has tender spinous processes in the cervical spine. 
Patient turns head to side and pulls chin firmly into clavicle area.
Hold for 60 seconds. No restriction: No change. Restriction: Pain or tingling may appear in scalene pain reference areas: chest, back, fingers. Follow immediately with Scalene Relief Test.
is essentially the same as playing the violin.

20. Scalene Stretch - Supine
Use to improve lateral flexion of the head and neck.
Pt. Position: supine. Help him laterally flex his head and neck to the left as far as possible without pain. Prevent him from adding rotation to the motion by asking him to keep his nose pointed directly at the ceiling. He also pulls his right shoulder away from his head. This starting position lengthens the right scalenes to their pain-free end range.
Place your left hand on his head just above his right ear. Place your right hand against his right shoulder to anchor it in place. Direct the stretcher to begin slowly to push against your left hand, as if he is trying to bring his right ear directly to his right shoulder. Be sure he does not add rotation to his effort. He does not push up with his shoulder because we’re using the shoulder to anchor the ribs, which are the distal attachment of the scalenes. You provide matching resistance for this isometric contraction, being sure that the stretcher is breathing normally throughout.
After the isometric push, the stretcher relaxes and breathes in. As he relaxes, maintain the head in the starting position.
On the exhale, ask the stretcher to bring his left ear closer to his left shoulder, being sure to keep his nose pointed directly at the ceiling. This deepens the stretch of the right scalenes.
Repeat 2 to 3 times, then help the stretcher reposition his head to do the same stretch for the left scalenes.
For more specificity, you can isolate the anterior or posterior scalenes by rotating the head as follows:
Left anterior scalene—laterally flex the neck to the right, then rotate the head 45 degrees to the left. From this position, follow the stretching sequence

21. STERNO-CLEIDO - MASTOID STRETCH
START POSITION: Sit tall with the head and upper back supported and resting against a wall. Bend the elbow to hook the heel of the hand on top of the collarbone. The pressure should be directed downwards on the collarbone. Use your other hand to support this hand. ACTION: Keeping the back of the head on the wall, turn the head towards your hands until resistance to movement is felt. Keeping the head on the wall and turned towards your hands, tilt the head away from your hands until the chin starts to poke out. Only move as far as resistance allows or a stretch is felt. Do not lose the head rotated on the wall position. Maintain pressure on the collarbone then slide the back of the head up the wall to tilt the chin down towards the throat. Do not let the shoulders drop sideways to follow the head. There should be no neck or arm pain or headaches. Sustain this stretch ______ seconds. Repeat ______ times. L ____ R ____ 

22. Cervical Flexion-Rotation Test (CRF)
Supine pt. flexes the cervical spine fully in order to block rotational movement below the atlanto-axial articulation.
Dr. passively rotates the head left & right, determining ROM and end-feel. A firm end-feel with limited ROM presumes limited rotation of the atlas on the axis.
Using the CFR test
Patients with CGH average degree of A-A rotation to the side of the headache as compared to an average rotation of 44 degrees in asymptomatic patients.
Patients with migraine and other types of headaches may also be limited in CFR motion, averaging 42 & 35 respectively in either direction.
CGH cervicogenic headache

23. CRF Has an overall diagnostic accuracy of 85-91%.
Limited rotation to one side may be due to tightness of the contralateral subocciptal muscles, and not necessarily impaired C1-2 rotation.

24. Evidence-based Approach to Forward Head Posture
Corrective Exercise Strategy:
Foam Roll (self myofascial release)
Overactive muscles
Stretch/Mobility
Shortened muscles
Activate
Weakened (lengthened) muscle
Integrate whole body
All muscle back into functional synergy

25. Forward Head Posture Workout
Inhibit & Lengthen: Levator scap, UT, SCM
Activate: Deep Cervical Flexors
Chin tucks
Integrate:
Ball prone cobra

26. Chronic Neck-Shoulder Pain-Rehab Plan of Action
Corrective Exercise Continuum
Inhibit
Activate
Integrate
Inhibitory Techniques
Self Myofascial Release
Activation Techniques
Positional Isometrics
Isolated Strengthening
Integration Techniques
Integrated Dynamic Movement
Lengthen
Lengthening Techniques
Static Stretching
Levator Scapula
Upper Trap
Pectoralis Minor/Major
Latissimus Dorsi
Foam roll: Hug arms across the front of the body, and hold for secs. Maintaining neutral spine, raise arms overhead as far as they will go and hold for secs

27. Forward Shoulders Program Design
Inhibit & Lengthen
SCM
Scalenes
Levator Scapula
Upper Trapezius
Pectoralis Minor/Major
Latissimus Dorsi
Activate
Mid/Lower Trapezius
Ball Combo 1
Teres Minor & Infraspinatus
Side Lying External Rotation
Integrate
Squat to Row
Push-up with Plus
Ball Combo 1:Movement 1. Squeeze butt muscles and lift chest off ball; do not arch back or jut neck forward. Extend arms in front of body. 2. Lift arms in front of body at 45-degree angle; thumbs up (scaption). Hold. 3. Move arms straight out to side - thumbs up. Hold. 4. Move arms to side of body - thumbs up (cobra). Do not shrug shoulders. Hold. 5. Return to start position.

28. Self Myofascial Release
Use of a Foam Roll, Thera-cane, The Stick, Knot-Out, etc.
Overactive muscles include:
Upper Trapezius
Levator Scapula
SCM
Pectoralis Minor (and major)
Latissimus Dorsi
Inhibit

29. STRETCH Use of Static or Neuromuscular Stretching
Shortened muscles include:
Upper Trapezius
Levator Scapula
SCM
Pectoralis Minor (and major)
Latissimus Dorsi

30. Activation Use of Positional Isometrics and/or Isolated Strengthening
Weakened muscles include:
Deep Cervical Flexors
Mid/Lower Trapezius
Rotator Cuff

31. Activation Static Back Pullover
While in Static Back (leg propped & knees bent 90 degrees), clasp hands tightly & keep elbows straight. Keeping both arms straight bring arms back behind your head, & back up to starting position. Abs are relaxed. Re-establishes proper scapula glide & promotes thoracic extension.
Creates horizontal load b/t shoulder & pelvis, which contributes to thoracic extension by engaging the stabilisers and hip flexors.

32. INTEGRATE: Dynamic Movement
Ball Wall Squat (w/overhead press)
Step-up (curl, overhead press)
Lunge (multiplanar)

33. Corrective exercise solution
Inhibit: Latz; Tsp foam roll
Lengthen: Latz; subscapularis
Activate:
Integrate:

34. Exercise Protocol for Chronic Neck Pain: Ylinen et al. 2006
Perform these exercise twice per week. For neck exercises, perform 3 sets of 15 repetitions in each direction.
Thera-Band Cervical Extension-Dynamic Isometric (sitting) Begin in sitting with a loop of band securely attached on one end, and the loop around your head. Keep your back and neck straight while you slightly lean forward from your hips, moving your head about 10cm forward. Hold and slowly return to the starting position. Keep your neck straight, moving with your shoulders.

35. Thera-Band Cervical Flexion-Dynamic Isometric (sitting)
Begin in sitting with a loop of band securely attached on one end, and the loop around your head. Keep your back and neck straight while you slightly lean forward from your hips, moving your head about 10cm forward. Hold and slowly return to the starting position. Keep your neck straight, moving with your shoulders.

36. Thera-Band Chest Flies
Secure the middle of the band to a stationary object at shoulder level.
Face away from the attachment. Use a staggered step with one leg slightly in front of the other.
Grasp the bands at shoulder height with your elbows straight. Keep your elbows straight and pull bands inward with palms facing each other. Slowly return.
VARIATION: Vary the height of the attachment of the band for an incline (lower attachment height) or decline (higher attachment height) fly.

37. Thera-Band Shoulder Shrug
Stand on the middle of the band and grasp both ends by your side, taking up the slack.
Keep your elbows straight and lift your shoulders upward. Hold and slowly return. TIP: Avoid bending your elbows to complete the motion.

38. Thera-Band Shoulder Bench Press in Standing
Begin with middle of a long band or tubing securely attached behind you at shoulder level.
Begin in a stagger step position with your back & neck straight. Grasp both ends of bands with elbows bent and palms facing inward. Push band forward, extending your elbows to shoulder level.
Slowly return to starting position. TIP: Keep your back and neck straight. Don't shrug your shoulders. Don't hold your breath.

39. Thera-Band Shoulder Bent Over Row
Begin with one leg slightly in front of the other. Stand on the end of the band with the front foot.
Bend forward at the hips, keeping your back straight.
Grasp end of band with elbow straight. Pull band upward by bending elbows, bringing your hand to your waist.
Hold and slowly return.

40. Thera-Band Elbow Biceps Curl (standing)
Stand on the middle of the tubing. Grasp the ends of the tubing. Lift the tubing upward, bending your elbows and palms up. Keep your elbows by your side. Hold and slowly return. VARIATION: Perform with palms facing downward. TIP: Keep your back straight; avoid leaning backward or rounding your back.

41. …and not part of the original Ylinen workout but most valuable is
The work of Andersen called ___________!
Scaption

42. Exercises for deep cervical flexors
Hanney and Kolber (2007). Three step progression to increase strength and endurance of the deep cervical flexors. Step 1: Learn proper activation and isolation. The fist step involves sitting reclined on a bench set at 60 degrees incline. The subject tucks the chin and lifts the head 2-3 inches for a 10 second hold. Once this is mastered the bench can be reclined further by 10 degree increments. Step 2: Isolate deep neck flexors against gravity without compensation of superficial neck flexors. This is the same chin tuck exercise on a flat surface. Step 3: Increase strength and endurance. 1) prone cervical retraction. 2) seated cervical retraction with an elastic band. These exercises are isometric holds for 10 seconds and repeated up to 20 times. Perform frequently (3-5 days/wk) in addition to normal training. Reference: Hanney, W. & Kolber, M. (2007). Improving muscle performance of the deep neck flexors. Strength and Conditioning Journal, 29(3),
70% of the population suffers from cervical spine disorders and there is an association between cervical spine disorders and weak deep cervical flexors.

43. Chin-tuck-head-lift exercise

44. Chin retraction www.DrJeffreyTucker.com
(L) Cervical retraction exercise illustrates the chin-tuck position required to flex the upper cervical spine.
(R) Chin-tuck-head-lift exercise with improper form evident by the chin protruding forward.

45. Prone Retraction & Seated Retraction

46. Deep neck extensor function
Proprioception
Support – checkrein the weight of the head when it is held in partial flexion for prolonged periods
Dysfunction (Hallgren et al, McPartland et al) – atrophy of suboccipital muscles in patients with chronic pain

47. Deep neck flexors Longus colli, longus capitus, RCA & L
Segmental support
Counter bending of the cervical lordosis
Compression of the head
Longus colli flattens the C-curve; spasm vs inhibition (Vitti 1973, Winters & Peles 1990, Conley et al 1995, Mayhoux-Benhamou et al 1994, Panjabi et al 1998)

48. Active neck flexion test examination
Pt position: Supine & knees bent
Instruction: Pt asked to raise their head off the table as if to look at their toes.
Pass: The chin should tuck first, then their head should smoothly roll off the table while the neck is flexing.
Fail: If the SCM & suboccipitals are dominating & the DNF’s are inhibited, the chin will poke out at the beginning of the movement and will remain protruded throughout.

49. Janda’s Active Neck Flexion Test
A-normal. B-abnormal movement pattern
Janda’s Upper Crossed Syndrome Posture: forward head, increased cervical lordosis, thoracic kyphosis, chin poke/hinge, elevated & protracted shoulders, rotation or abduction & winging of the scapulae.
Overactive mobilizers: scalenes, SCM, splenius, pec major/minor, lev. scap, upper trap, rhomboids, hyoids.
Inefficient stabilizers: DNF, semispinalis/MF, suboccipitals, rot cuff, upper/mid/lower trap

50. Cervical stabilization using a mini-ball with resisted scapular retraction

51. Thoracic Spine Section

52. Ideal scapular position
Superior angle of the scapula lie level with the T2 or T3 spinous process
The root of the spine of the scapula level with the T3 or T4 spinous process
Inferior angle level with the T7-9 spinous process
The scapula should sit approximately 30 degrees anterior to the frontal plane, in slight upward rotation and with the medial border and inferior angle flat against the chest wall

53. Assess: The Shoulder (FMS) Shoulder Mobility
Assesses bilateral shoulder range of motion, combining internal rotation with adduction and extension, and external rotation with abduction and flexion.
It requires normal scapular mobility and thoracic spine extension.
FMS method

54. Shoulder mobility corrective exercise
SMR
Shoulder traction partner stretch
Wall sit with shoulder flexion holding dowel
Side lying rotation
Arm lock out
KB arm lock out
Hip cross over progression
Dead lift progression
Chop/lift progression
Push up progression

56. Trapezius Exercises

57. Levator scapulae
Is an elevator and downward rotator of the scapula, and due to it’s attachment to the upper 4 cervical vertebra, also extends, ipsilaterally rotates and sidebends the cervical spine.
If overactive it may have the unwanted action of downward rotation of the scapula and, due to its cervical attachments, may place vertical compressive forces on the cervical spine.

58. Levator scapulae
PIR: Pt Position - patient supine A) raise the arm on the involved side over and behind the head (rotates the scapula externally to allow for max lengthening on the muscle). B) arm at side
Dr: Cradles the head with flexion, laterally flex away and rotate away from that side.

59. Pectoralis Minor
Has a protraction and downward rotation influence on the scapulae. It becomes a problem if overactive, hindering the action of the middle and lower traps.
Tightness interferes with upward rotation!
Normalized pectoralis minor muscle resting length has been associated with altered scapular kinematics, which, in turn, have been linked to pain and functional limitations due to impingement syndrome.
Borstad JD, Ludewig PM. The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals. J Orthop Sports Phys Ther –238

60. Thoracic mobility On foam roll: Supine with knees bent.
Arms raised overhead with palms facing feet.
Move both arms into horizontal abduction.

61. Thoracic mobility Prayer pose. Move right elbow to right knee.
Move scapula toward spine.

62. Tsp self mob
Sit cross legged – hands behind head >>>rot, then rot + lat bend
Childs pose with 1 hand behind head, rot elbow to opposite knee. It also gets lower traps
Plank on hands to downward dog + sink in the Tsp. Keep repeating, move heart center to the floor

63. Lats/Tsp stretch
Place the ball on the wall overhead, grasping either side of the ball with your hands. Lean your body forward, extending your shoulders. Keep your elbows straight. Rotate arms R – L.
Face away from wall and repeat above.

64. Thoracic Kyphosis Workout 1 (2-6 weeks)

65. Thoracic Kyphosis Workout 2: Pullup
Grab the bar with an overhand grip (palms forward) (change grips), your hands slightly more than shoulder-width apart. Hang with your arms fully extended. Pull yourself up over the bar, and then slowly lower yourself to the starting position. 
Pull yourself up until your chin is over the bar. 

66. Thoracic Kyposis Workout 2: Rows
Dumbbell Single-Arm Row
Holding a dumbbell in your right hand, place your left hand and left knee on a bench. Hold the weight with your arm straight. Use your upper-back muscles to pull the dumbbell up and back toward your hip. Pause, then slowly lower the weight. 
Pull the weight up so your elbow passes your torso. 

67. Thoracic Kyphosis Workout 2: Barbell Bent-Over Row
Stand holding a barbell with an overhand grip, your hands slightly more than shoulder-width apart. Push your hips back and bend forward until your torso is almost parallel to the floor. Draw the bar toward your rib cage. Pause, then lower the bar.
Maintain a slight bend in your knees throughout the movement.

68. Thoracic Kyphosis Workout 2: Seated Wide-Grip Row
Sit on a bench or the floor and bend forward to grab the lat-pulldown bar from a low pulley cable. Using a wide overhand grip, pull the bar toward your midsection. Resist the weight as you extend your arms back out in front of you.
Keep your back straight as you pull the bar to your abs.

69. Thoracic Kyphosis Workout 2: Cable Scapular Retraction
Attach a bar to a low pulley cable. Sit on a bench or the floor and grab the bar with an overhand, shoulder-width grip. Without bending your elbows, pull your shoulder blades back as far as you can and squeeze them together. Return to the start position. 
This is a slight movement. The bar should move back only a few inches.

70. Thoracic Kyphosis Workout 2: Swiss-Ball Back Extension
Lie facedown on a Swiss ball and push your feet against a wall or hook them under a bench. Your chest should be off the ball. Cross your arms and bend forward at the waist until your midsection covers the ball. Then raise your torso up off the ball.
Your torso should be in line with your lower body at the top of the move.

71. Low Back Section

72. Ideal Posture: Pelvis
Ideal alignment of the pelvis: when the ASIS is in the same vertical plane as the pubic symphysis.
Ideally, a line from ASIS to the PSIS should deviate only 15 degrees from a horizontal line through PSIS.
Check height of the iliac crests, if unlevel, have the patient supinate both feet, if it levels out it’s coming from the feet.

73. Pelvic rotation (important for exercise prescription)
Rotation = the vertical plane through one ASIS is forward of the vertical plane through the other ASIS.
Clockwise rotation occurs when the left ASIS is forward of the right. A deformity that usually occurs in the direction of the external rotated leg. It is accompanied by tightness of the ipsilateral piriformis & contralateral TFL.
If the shoulder is rotated to the same side as the pelvis then compensation occurs in the upper cervical spine with possible accompanying symptoms.
If the shoulder does not rotate with the pelvis the spine is torqued & the patient often complains of fleeting pain along the torqued spine. This may be attributed to asymmetry of stride length during gait & ensuring dural torque.
Check ASIS & observe which one is closer to you

74. Pelvic obliquity
Often accompanied with a lateral shift of the pelvis to the opposite side in an attempt to functionally level the pelvis & the spine.
Usual causes are weakness of G. med/min, leg length discrepancy (LLD), weakness of QL.
Weakness of the proximal hip muscles may be due to a foot subluxation.
The pelvis shifts away from the short leg side. It attempts to level it out.

75. Anterior/posterior position of the pelvis
Is dependent on the relative tension & lengths of the stabilizing muscles (hamstrings, abdominals, gluteals, hip flexors).
Weakness of the G. max can lead to anterior torsion of the ipsilateral ilium.
All knee deviations serve to shorten the extremity.

76. Posture: Pelvic Motions
APT
PPT
Lateral pelvic tilt = one iliac crest is higher than the other with differences of less than ½” considered within normal range of variability.
Rotation = the vertical plane through one ASIS is forward of the vertical plane through the other ASIS. Clockwise rotation occurs when the left ASIS is forward of the right.
EX: Left rotation = the R TFL may be short & the R PGM may be long; on the L, the PGM or the hip lateral rotators muscles, the obturators, gemelli, & piriformis could be short or stiff.

77. Evaluation of static posture Pelvis
Lateral shift
Most often caused by poor body mechanics when sitting or standing unevenly.  
Visual signs: one hip is higher than the other.  
Palpatory signs: Hypertonic quadratus lumborum muscle, which is the primary lateral flexor of the low back.  
Pain is felt on the side where the pelvis is higher, in the muscle belly and attachment sites.
Underactive glute med

78. Evaluation of static posture Pelvis
Anterior pelvic tilt
Tight hip flexors/erector spinae
Weak/inhibited glute max/abdominals

79. Evaluation of static posture ANTERIOR PELVIC TILT
Often coincides with forward head posture. Some of the contributors include poor body mechanics, pregnancy, and weight gain.  
Visual signs: increased curvature of low back (lumbar)  
Palpatory signs: Hypertonic (tight) postural musculature including the iliopsoas, erector spinae, quadratus lumborum and rectus femoris  
Pain is often felt in the low back, pelvis, hips and thighs.  

80. Compensations for anterior tilt pelvis
One knee flexed – to offset the anterior tilted pelvis
One foot abducted or set forward – attempt to decrease the anterior tilted side
One shoulder depressed – on anterior tilted side (length tension of paraspnals, T/L fascia & lat)
Torso can laterally flex – away from anterior tilted side to take pressure away from lumbar region.

81. A-P Tilt: Corrective Exercise Strategies
Foam Roll: Calf, hamstrings, rectus femoris, lats
Stretch: the overactive muscles – hip flexors, Er Sp, Lats
Activate: isolated muscles – low load bodyweight exercises (Tube walking, Ball bridges)
Whole body: strength exercises – Squats, Single leg squats

82. Evaluation of static posture *Pelvis
Torsion (PI/AS in combination)
SIJ dysfunction
Blocked side of SIJ = spasm of psoas, piriformis, inhibition of G. max.
Opposite side = inhibition of G. med/min (lateral shift & rotation of pelvis)
Shearing of pubic symphysis = spasm of lower abdominal quadrant
Sacrotuberous lgmt & piriformis – functional unit long head of biceps fem

83. Evaluation of static posture Pelvis
Hip hiking
QL tightness

84. Quadratus Lumborum stretch
Is one of the most commonly overlooked muscular sources of low back pain. It functions as a stabilizer of the lumbar spine and can act as a hip hiker and as a lateral flexor of the lumbar spine.
1. Perform Lying Self-Stretch.
Hold for 30 seconds each side.

85. Quadratus Lumborum strength
Perform Hip-Hike Exercise. Alternate sides, holding for 10 seconds each.
Repeat twice

86. Quadratus Lumborum (Wall) Modified Triangle Pose
Stretch & strenghens

87. Assess: Hip extension
Substituting lumbar extension for hip extension is the major culprit in many of the problems that we see. This is one of the primary problems in lower back pain.
Proper strengthening of the glutes will be the best cure. In fact we may not even be strengthening but just reeducating the neuromuscular system.

88. Substituting lumbar extension for hip extension

89. Treatment approach for altered hip extension
Adjust/mobilize T/L junx, hip & L-sp
Relax & if necessary stretch hip flexors, hamstrings & erector spinae
Train motor control of glut max during lifting, walking & lunging
Bridges, squats, rocker/wobble/balance shoes
Train torque production ability in hip extension (squatting, lunging)

90. PRIMAL PICTURES Complete Detailed Accurate
To purchase any Primal Pictures software title with a 20% discount please go to select your products and use discount code JTUCKER before you check out. If you have any questions, please contact Dan McGarry

91. *Free Shipping on Orders of $250 or more
Valid Through April 20th, 2013 For One Time Use
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SPEAKER ID:
TUCKER234
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92. Thank you!
I appreciate you allowing me to share with you and taking the time away from your personal life. Always feel free to call me or me. I like to hear how it is going for you.
Sincerely,
Jeff