Discussing the role of lumbosacral control on scapular mechanics
February 26, 2013
In this video taken at a private FR® Release certification seminar in Scottsdale Arizona with the Arizona Diamondbacks (MLB) medical staff, Dr. Spina discusses the influence of the lumbosacral junction on scapular mechanics. More specifically, he demonstrates how the control of lower lumbar extension can dramatically improve scapular setting and spinal posture.
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As a therapy would you recommend lumbar extension first, then move on to the scapular mobility work or do them in a therapeutic sequence? Also, is passive spinal traction enough for the lumbar relief?
Hi Tom…thanks for the question
The lumbar segmental control is needed in order to correct for the scapular mechanics (a pre-requsite). I would immediately be working to improve L/S mobility and neurological control/awareness…while simultaneously improving scapular mobility (control of the scapula across progressively larger ROM’s). I would not prescribe ‘stabilization’ training however until these two goals were met. In addition to the immediate mobility work, postural cueing is another thing that I work on right away.
Dr. Spina,
Would the same theory apply if the patient has an anterolisthesis of L4 or L5? If this is the case, would the primary focus be producing sacral nutation?
Hi Joseph
This would depend on the cause of the anterolisthesis. Assuming that it is stable, our plan would change very little. The important point is not statically changing articular position, but ensuring the maximal amount of segmental control/mobility…and then training the nervous system to set proper posture through neural drive alteration.
how to help a gentleman such as the model in your video attain greater mobility and control over lumbar extension is a question that has plagued me for years as a yoga teacher/ bodyworker. do you achieve this with manual therapy alone?
Hi Lori…thank you for your question
I am commonly asked similar questions regarding the utilization of manual therapy for improving mobility. The answer I give is always as follows…our manual therapy applications do NOT fix anything! All they do is provide a ‘cellular environment’ which is responsive to training. The acquisition of mobility is far more complicated than is thought by most. It is not a matter of stretching this or strengthening that, nor of applying treatment x. It involves specific training application, coupled with time. This training method is what I teach in my Functional Range Conditioning (FRC) systems seminars. You can learn more at FunctionalRangeConditioning.com
regards
thanks for the reply. I suspected as much. FAP alone looks fantastic.
Hope to get there soon, or build enough interest in the san francisco bay area.
Dr. Spina, this is a highly informative and resonant post. I am a big fan of you, and your thoughtful approach to movement. Admittedly, a portion of it goes over my head, but I try to keep learning! A question, and a thought:
Could you elaborate a bit on the role, if any, of the thoracic spine in this scenario? Do you ever find that patients try to correct this type of scapular setting dysfunction with a lumbar hyperextension, as opposed to a lumbosacral correction and a concurrent thoracic extension? (In other words trying to get all of the movement from a few segments, rather than from the length of the spine?)
Seems to me that if the glutes and abs are appropriately strong and activated, and the two work in conjunction to properly set the pelvis, then the T-spine is in a better position to extend as well. Once the T-spine is properly set, then the scapular controllers seem to fall in line fairly quickly from there. It is entirely possible that I am either missing the point, or just wrong. Please set me straight if so!
Also, I love the way you are championing scapular mobility which in my view has been overlooked in the coaching world due to a tunnel vision preoccupation with scapular stability. It seems to me that the real stability at the shoulder starts further down the spine, and we have been asking the scapular controllers to do too much!
Highly interested in your thoughts! And thank you.
Hi Derrick….thank you for the kind words
The role of the Thoracic spine for scapular positioning cannot be over stated (you are correct). I do not find however that hyper extension of the lumbar spine can compensate for lost motion at the L/S junction. If this was the case, the spine would extend such that the base of support would translate posteriorly and would lead to the inability to maintain upright posture. What I do find is that with a decreased ability of the L/S junction to extend (or the sacrum to nutate…which ever way you want to think about it), compensation is made in the thoracic spine via an increased kyphosis. This position will greatly hinder the ability to achieve the needed scapular retraction. However you did make a key point in noting that often one tries “to get all the movement from a few segments rather than from the length of the spine.” I actually just tweeted on this very topic noting that “Spinal movement=the SUM of mvmnts across all of the regional motion segments. Thus 2improve spinal mvmt 1 must train the spine segmentally.”
I also agree with the point you made about the T-spine….I will only add that although good T-spine mobility/position is needed…the scapular retractors still must be taught to function in the appropriate position. Thus correction of the T-spine does not automatically lead to proper scapular function.
I will be posting further on scapular mobility in the coming months. I a happy to hear that you are enjoying the content.
Regards