The Practitioners Corner Archives

Treating The Deep Front Line

The Deep Front Line (DFL, from Thomas Meyers Anatomy Trains) is one of our most fundamental tracks of soft tissue. It is the soft tissue equivalent and partner of our skeleton (especially the axial) and is what most fundamentally holds the core of our structure together when it comes to musculature and soft tissue. To explain its role to my patients I tell them to think of a bridge. The concrete or steel of the bridge is your skeleton/spine (primarily axial) while the tissues of the deep front line are like the tension cables. Together their compression and tension hold together as the foundation of our structure with excellent integrity, if everything is doing its job. As long as there is no break or other structural problem with the skeleton (that concrete/steel part of the bridge) then we don’t have to worry about that. The majority of the problem comes in when there is problems in regulating tension in the soft tissues of the deep front line. All of you reading this know it’s not a matter of isolated or simple chronic tightness or ‘over use’ that causes tension disparities, nor is it because the muscles are ‘weak’ so we won’t even cover that aspect here (it seems half my articles are just explaining the premise of neuromuscular control theory).

Most of the 'Deep Front Line' which is commonly an instrumental element of TMJ dysfunctions.

Most of the ‘Deep Front Line.’



So what problems do happen with the DFL tension? Simply stated one length of the deep front line either gets too tight or too loose for the overall DFL to hold the tension it needs for dynamic structural integrity. When one length tightens too much…another has to slacken. When one slackens, another has to tighten. Any of you who do neuromuscular work and are familiar with anatomy trains can probably without hesitation tell me what 75% of someone’s deep front is up to (facilitation or inhibition) without even looking; and you probably have some notion for what’s causing what. This is because while individual circumstances and variables will change exactly what’s going on, the overall approach that the MCC takes to keep the structure safe is generally the same: compress and limit range of motion (there are some joints and injuries where this is not the case, such as ankle injuries). Anything that can compress is usually used for this function, and anything that will decompress is usually at least down-regulated if not inhibited.

The overall effect commonly looks like an undulation of facilitated, inhibited, facilitated, inhibited, etc. though not always. For example I most typically find the toe flexors and or post tib working for most if not all of the adductors. The pelvic floor is either facilitated for itself (commonly posterior to anterior but it can be all or nothing as well, especially after pregnancy/genital surgeries; episiotomies are common culprits) or for part of the core above. The iliacus is commonly facilitated for the psoas, though honestly I don’t tend to consider the psoas and iliacus as part of the deep line structure in this way, but I’ll leave that opinion for another article. The TVA, RA and multifidus is typically inhibited, with the TVA having the hardest job working (95% of the time or more it doesn’t; if you find one functioning, DON’T BELIEVE IT. Mess with things until it fails. If they’re on your table with a complaint, I don’t believe their TVA. An eccentrically loaded diaphragm is probably making it look like a pass.) followed by the RA and then the multifidi closely behind. The pelvic floor may be working for one of the aforementioned 3 primary core muscles, though the next step in the chain is the diaphragm which because it is attached to a balloon it’s an amazing central hub of facilitation. Commonly it will hold tension, even if only eccentrically (check my article on eccentric contractions causing false positives) to give the MCC enough sense of tension to allow things to function, including the TVA.

The deep front line continues up along the spine and throughout the thoracic cage including wrapping around the lungs and other organs. If your patient has pleurisy, see if clearing the deep front line helps as the condition is generally considered idiopathic but my money is on some form of severe deep front line dysfunction. As we go proximal we get into the deep neck flexors, which are commonly inhibited by a whole mess of things (extensors, especially suboccipitals, 1-2 of the scalenes, and or a levator), then into the floor of the mouth, the tongue, the masseter, and the temporalis. Unsurprisingly, this last group of structures tend to be highly facilitated. With the jaws wide range of motion and extreme strength, let alone common use, it is a shoe in for holding tension at the top of the chain so is very typically facilitated for large stretches of the core in the DFL as well as the neck, causing TMJ ‘syndrome’ frequently (even if they aren’t aware, see how evenly their jaw opens at the TMJ) and occasionally with attached tinnitus, let alone tension headaches around the temporalis.

So to recap and add a bit: we often see the deep posterior calve compartment working for the adductors, as well as the psoas, sometimes more (I’ve seen iliacus, TVA, RA, etc.). The pelvic floor, diaphragm and jaw commonly are facilitated for any of the three main core muscles; the TVA, RA, and multifidi/erectors (sometimes one to one, sometimes one to all). The neck flexors can be do the jaw or something else in the deep front line but usually I find that a local relationship to the neck/cervical vertebrae as part of a cervical compression strategy (more in my article on c2 displacement concerning cervical/axial compression strategies).

The thing to remember is that this is not a facilitation/inhibition relationship of ACTION, but one of tension. While one adductor may inhibit another via reciprocal inhibition as a functional antagonist, and a gastroc head may cause plantar flexon when there is no extension of the hip for ambulation, this set of relationships is most purely one of creating adequate structural tension around a strategy of compression. This means that while the pelvic floor, diaphragm and TMJ musculature are facilitated, releasing them does not necessarily fix the problem. Typically these structures tighten because something else fails and tension is required. As I tell my patients; if you take a week off sick and come back to find your co-worker has been doing your job, is that their fault? The work needed to be done, so they did it, don’t blame them. But if you can’t get your work done because of a mugger? Yeah, that’s the guy to take care of.

As always I urge people to find the actual culprit; releasing a facilitated diaphragm is no better than our previous paradigm of stretching a muscle because it’s tight. You must ask and find out why! I do not release these muscles very frequently because they are victims being forced to work too hard in most instances. Sometimes a local trauma will change the situation but most of the time it is simply a global stability strategy and you need to find the source. I may treat some symptomatically (but never the diaphragm) at these levels, but you aren’t treating the source unless you have reason to know it’s the source.

This brings us to finding the original cause, which generally goes out of the scope of this article but we’ll give you a direction. 90%+ of what I treat is scars, concussions, broken bones and joint injuries, or they are being referred out to deal with limbic trauma (see my article on limbic/MCC function and their interplay in rehab work). There are of course other injuries, but these cover the main sources of ‘original causes’ which are driving the body to create a global compensation strategy in the first place, which again is marked by axial compression and is likely the cause of your deep front line dysfunction.

So let’s take an example: Patient A presents with chronic headaches, neck tightness, and low back pain. Upon initial testing you find the flexor hallucis longus working for the majority of the adductors and the psoas, the masseter working for the neck flexors and diaphragm working for the TVA. A pretty typical pattern, but when we get into the history we find that this patient had a vaginal tear (or episiotomy) during birthing and that she has also had urine urgency and poor sense of bladder fullness (when she has to go, she has to go immediately, and probably leaks very easily) as well as frequent constipation. This kind of injury is a severe insult to the deep front line and given its location on not just the deep front line, but the anterior core and on the genitals themselves the body frequently feels highly unstable and reacts globally.

Following the likely chain of compensations from her history and symptoms, we can see that her anterior pelvic floor is inhibited (she also reports not being able to feel a kegel, or if she does she can tell it is very weak and minimal; she may even feel pain during sex which may also be from a facilitated pelvic floor) and while it may be from another cause (non-neuromuscular) her posterior pelvic floor is likely to be facilitated for it to hold appropriate distal tension. By doing spot releases or an anti-kegel followed by a kegel you may or may not see improvements in neural connection to the anterior pelvic floor, but this isn’t the cause anyway so I am not concerned.

Moving on and up this instability leads to axial compression, likely including one hip, SI joint and an elevated shoulder on the same side (typically the side that is most unstable) which is capped (again commonly but not always) with an inhibited levator, resulting either in defensive tightness pulling the C2 and other vertebrae out of place or the other levator/scalenes which are facilitated are responsible for the subluxation. The C2 deviation or the SI jam ‘directly’ inhibit the TVA and cause even more dysfunction. A non-functioning TVA, faciliatory diaphragm, and cervical compressing secondary respirators all throw out the breathing patterns and seal the global compensation pattern.

The increased tension on the TMJ musculature and the compressing elements of the neck cause a lot of global tension to be routed through them, resulting in neck tightness and chronic headaches. A jammed SI and non-functioning TVA would be enough by itself to cause low back pain, but in all reality we would also have no psoas function and probably only one capable QL.

Going back to the likely original cause in this case, we instruct the patient to assist us in testing the pelvic floor scar and then releasing it. If this is the original cause we expect it to be, the SI should no longer be very causally involved, giving us a big jump in hip and lumbar spine stabilizer function (TVA, psoas, QL) and release the structurally mandated tension on the TMJ musculature. The pelvic floor itself may or may not immediately respond but I generally find unless there is a more severe injury at play, the patient should be able to feel a difference in her kegel (but again, not always right away!).

She may need symptomatic approaches for a time in addition, so other than the fundamental homework that would be scar release to kegels (yes, we on rare occasions assign kegels!), releasing the SI jam to a severely inhibited TVA via dying bug and release of one levator to another or suboccipitals to the deep neck flexors would be an appropriate approach to treatment.

Another worthy mention is that if someone has symptoms such as these; especially something like TMJ, there may be nothing you can do to permanently resolve it if they are a persistent gym chewer. Loading up extra pressure on the masseter will strongly reinforce the compensation despite your best homework releases in many cases, and part of the thing to realize is that it isn’t just additional time chewing. Because of the thickly ‘chewey’ nature of gum we tend to try to “smash the shit out of it,” as I put it to my patients (they laugh and then realize it’s really quite true). They really need to ditch the gum or their neck/head/jaw issues are likely there to stay forever.

Similarly, breathing patterns MUST be addressed to get the core (especially the TVA) working again and the diaphragm/secondary respirators regulated. Simple diaphragmatic breathing (having them hold their hands on, but don’t push, right below the belly button while supine and practice pushing their hands out with their low stomach during their inhale; starting and contributing the vast majority of their breathing volume with their abdomen, only having chest involvement near the end.

So there is a general approach and info to the role of the deep front line; the soft tissue foundation of our structure (just for more examples; the supporting rope for a mast, or the lines for a tent). Normalizing someone’s deep front line is one of the most profound things you can do for them and if you successfully clear it (not that you won’t have to venture out of the deep front line at times to treat it) their symptoms won’t likely stay gone for long. The next step would be making sure their rotational lines work as all real human movement is a mixture of rotation and counter rotation; when these don’t work properly then force must be transferred into other planes and inappropriate structures causing wear and a load of issues, but that’s for another day.

The Conscious/Unconscious Membrane And Resulting Movement Therapy Considerations

There is a semi-permeable membrane (in a metaphorical/functional fashion) between the conscious brain and the limbic/motor control center. When we learn a new skill we must pay more conscious attention to help our ‘employees’ that are the limbic/motor centers execute techniques properly and then memorize/pattern the movement. This is one example of conscious data going to more subconscious layers, but it flows both ways. When on the table a patient may feel certain angles or tests, or releases/directions of release are actually threatening and uncomfortable, while others (even just a minor change in direction) may be perceived as relaxing and therapeutic.

Similarly, when a patient is trying to organize the movement strategy on the table they may come up with rolling eyes and conscious confusion where they have no idea how the hell to complete the task at hand. We give their brain a task, the MCC interprets it and comes back to the conscious brain like employees asking the manager for help…but the manager doesn’t know either. This shows that in the context of functioning tools, the MCC has no idea how to complete the task it has interpreted (I use this wording because what you’re asking their body to do may be interpreted as a different action by the MCC that may appear similar but is quite different, one they may be able to do, the other they can’t. One may be a compensation to achieve similar ends, or just a neurological misunderstanding of sorts).

Similar still is when you go to complete an action, which could be squatting down to pick something up, to walking on ice, to a complex gymnastics or martial arts technique and your limbic/motor control center sends you a conscious sense of danger. You actually don’t feel safe, like if you try to do whatever it is you were going to, you may be seriously injured. It may be because of perceived joint/global instability via the MCC or a memory of a past injury/trauma (emotional or physical) in a certain posture/motor pattern. Any of which, and all of the above examples, are ways the brain attempts to avoid potential threats. By learning effective and efficient motor skills, avoiding actions that your brain perceives as being clearly threatening or outside of your MCC’s repertoire of motor control, and making sure you pay attention when you are at the edge of these areas.

The clinical repercussions of this barrier should be in part pretty obvious. If a patient on the table is feeling threatened by a test you know that there is probably some pretty considerable instability there, which may even be caused by a limbic issue more than a direct physical instability (not to say that there isn’t an instability, but it may also be put in place by inhibitions caused by limbic trauma/perceived threat). Confusion is another obvious sign of significant inhibition, while you have to watch a little bit more closely to see the MCC select a different action than you asked for because it knows it can’t do what you’re asking but it is finding another way to ‘get the job done’ which may be an entirely different movement pattern.

A good history and honest discussion before/during this point can help you figure out if it’s instability from neuromuscular causes or if it may require the work of a specialist that can help with limbic issues, especially those which are directly connected with the physical body or specific motor patterns/body positions (I have another article written on this which I haven’t managed to post yet as of this writing).

The two aspects that I really wanted to briefly chat on in this article however looks more to a movement therapy perspective/practice. We all recognize that part of the cause or contributing factors to injuries, instability, and movement incompetence is due to the drastically limited nature of the majority of modern human movement. What little movement that does happen is repetitive and very limited in range of motion, so it surprises none of us that when our bodies are in essentially isolated incidents taken out of this normal range, both in actual range of motion as well as in more dynamic/unstable contexts, often result in injuries.

Even those who exercise, while in a better state in this capacity than those who do not, often execute their techniques in a very specific form, aka ‘ideal technique.’ I want my clients to know and execute their deadlift with proper technique, of course, but part of where the disconnect between ‘exercise’ and real life movement takes place is that the demands of natural movement do not always allow for that platonic ideal form. I want my clients to execute that normal form when they can, but when they are confronted with having to lift an awkward size/shape/weighted load (like their injured child which is no longer just a toddler) and find themselves having to go over/under something, their MCC better have the ability to take that deadlifting/carry/squat/step over skill and use it dynamically outside of normal form. If the MCC does not feel generally comfortable with the ranges of movement they are going through, it may inhibit and lock things down, shunting tension and forces through less supported routes (like an unstable knee which gets an ACL tear in a very minor movement deviation that likely would not have happened, had the knee stabilizers been working).

What I’m getting at is that all of the above calls for two specific types of intervention, which can be implemented as the same thing. Perceived threat is what runs our body, with the drive of movement/survival and reproduction behind it. That feeling uncomfortable on a sheet of ice, or not being able to do a lunge because you very powerfully feel like you WILL be injured is not nameless fear, but stimulus from the limbic and/or MCC telling your conscious brain to be very careful and be sure it really wants to do what it’s about to do. It’s trying to protect you, so don’t ignore it! We wouldn’t want to simply shut off our conscious/unconscious connection when it comes to warning us of perceived threat. While some people ignore it and end up doing some pretty stupid stuff, or their trainer makes them ignore it and do something that is sue-worthy, or at least cringe-worthy, it’s a valuable tool to help show us and let us work with our limits.

Just as using NKT we show the body that perceived instabilities and past injuries are no longer a threat to it, we can show it that it doesn’t have to keep acting like the damage is still there and be freer with its movements once more. Proper movement therapy/training can do very similar with movement based perceived-threat. By working in what the brain considers a safe range of motion and slowly expanding it (note…I really don’t mean stretching) we can simultaneously show it that there is no threat in this motion, which will grant us the semi-conscious confidence to actually do it, and expand the motor pattern of let’s say squatting, to let us go deeper while having just as high quality motor control as half the depth would.

So by slowly progressing in range (not just actual direct ROM like the depth of a squat but the more multi-planar dynamic range, which may include the coordination of multiple not fully related simultaneous actions) we remove perceived threat, we lay down permanent movement patterns that let us operate with higher degrees of motor control at these various ranges, And we improve the actual musculature that supports these ranges, especially the stabilizers, in the actual stability roles they have instead of just focusing on prime-movers shifting heavy weights.

So how would this look? Paul Mcllory, a renowned strength trainer and guest on Perry Nicklestons Stop Chasing Pain podcast series has a superb technique whereby if he has two identical athletes (let’s say clones/twins for the example) and one of them has been having repeated injuries, or pain from a long healed shoulder injury and they want to gain strength on bench he will start them both at 150 pounds, progressing to 300 pounds over 12 weeks. Obviously for the injured client we would have a lot we could do as various forms of NKTer’s but I still find a lot of value in his technique for removing the connected perceived threat/vulnerability from the injury, and better integrating our work anyway. For the injured client he puts six ½” boards on his chest, thereby limiting the end range of motion where most injuries of this nature occur in bench. Each week a board is removed, slowly increasing the range of motion and with this repetition in the ‘comfort zone’ of motor control, we expand the comfort zone and raise the perceived threat threshold of the movement and motor pattern. Halfway through the boards go back to 6 as the weight scales to the upper half and the athletes’ strength potential is increased. Starting from even an unloaded movement is a great way to help your patients begin this process as a way to take their homework and movement integration to the next step.

A fellow trainer in my facility shared with me another technique, which I have used sense to good success and have detailed in my limbic/MCC article (again, haven’t posted this as yet at the time of this writing). He had a client that had been thrown from a car at a younger age (I can’t recall if he was an adult at the time or not) and hit the back of his head in the process. Since then he has been unable to back squat without his head trying to throw itself forward away from a potential impact. Front squatting is just fine, but anything that suggests to his brain a risk to his head has a very low (aka trigger-able) perceived threat threshold and his body acts accordingly. The moment a sense of stability is given he is able to squat neutrally instead of leaning forwards. By using a band to the squat wrack above/in front of him, or holding it in a chest loaded (front squat) position, or even with very light pressure from behind via his trainer or other implement, neutral form is created and maintained.

I have used similar on another car accident victim where stepping up onto a tire was well within her strength capability (despite known neuromuscular dysfunctions) but she couldn’t manage. With this technique we showed her a sense of safety and stability in this pattern and she accomplished it like it was nothing with full conscious comfort, instead of the sense of vulnerability and threat moments before. By training this and slowly removing layers of external stability, the comfort zone is expanded and the perceived threat threshold is raised, giving more developed motor control and muscular stability in the process.

Outside of injury/incident victims I instill this in my general clientele by teaching proper form first, such as proper squatting or deadlifting technique, while working on neuromuscular/patterning dysfunctions. Once good competency is acquired, we start expanding this ‘motor skill/pattern’ to a wider range/more dynamic nature, helping the body learn not only a different circumstance/environment where it might use that skill, but improve its running ability to adapt its current motor pattern skill set to novel demands. How this looks isn’t too surprising. With squatting as an example I will start with bodyweight box squats for form and move adding some weight in goblet form, then back squat, and move to bodyweight full squats (no box), then adding weight. Then we may do it on a plush 6” gym mat, eventually on a balance board, and progress in this kind of fashion until they can squat in non-standard form while under an abnormal load on an abnormal surface, possible while carrying out other simultaneous but disparate tasks.

Exercise systems which are based on ‘functional movements’ or ‘natural/primal movements’ have a lot of obvious crossover here. If you place the body in a biomechanically advantageous and natural (often both being the same thing for all intents and purposes) state then using/learning proper efficient and safe patterning while avoiding over use and injuries in general is a hell of a lot easier. They also drastically improve dynamic stability and the ability to adapt to novel situations given that we work on skills and movements in all manner of fashions that typical gym work simply does not offer. By supplementing with corrective work there is pretty much everything you could ask for, and working in long distance endurance training for runners, or heavy squats for strength based athletes no longer ends up being more of a risk than productive work.

This whole process not only gives the average client the strength, weight loss, general fitness and flexibility they likely came to me for, but also increases their movement confidence, and seriously decrease injury risk by improving their fine motor skills in a more dynamic nature, including their brains ability to adapt movement patterns to novel situations and demands outside of the normal range. This also obviously is a fantastic way to integrate corrective work (NKT homework) into re-patterning poor movement strategies for more profound and permanent results.

The Effects And Interplay Between The Limbic Center And The MCC

To have any ability to understand the body and how it functions, or how things go wrong, you need to have a basic understanding of the brain and how it relates to the particular system you’re looking into. As a Neurokinetic Therapist what I operate most directly and frequently with is the motor control center. This portion of the brain is the primary part of the brain that creates, stores, adapts and chooses motor patterns for the demands the conscious (and somewhat unconscious) will of the brain. This means if you decide to pick up a glass of water or hit a baseball going 90mph, your MCC is what decides exactly what selection and order of muscles and tissues will be used to accomplish it, making for a nearly indescribable orchestra of movement to accomplish even minor tasks.

The MCC does not simply work alone, however; it’s ‘orders’ come down from above in the form of “I’m thirsty,” to the volitional command “let’s get water.” It is more than the chain of command, though. The limbic center is like the roommate and partner of the MCC. They have very separate responsibilities in many ways but they are also inextricably connected. The limbic center is a collection of functionally related ‘parts’ in the brain (so too is the MCC) and is a very important part of our emotional brain but it also is vital for forming memories. More than just what we typically think of as memories, the limbic center also contributes to emotional memories and learning motor skills as well.

Most directly, when we enter an extreme fight or flight situation the limbic center functionally takes over the MCC and throws you into one kind of action or another. This alone makes them very closely bonded, but the part that I am really interested in for this discussion is the impact of emotions, injuries, the memories of both and their impact on the MCC and our physiology. First however, a thought towards some of our bodies ‘prime directives.’

Our job as living beings is to A: survive and B: reproduce. There are many particular aspects of this but it basically comes down to getting food, and avoiding dangers from starvation, exposure, and predators. All of these require quite a lot of movement. Without movement, as humans, we die. Movement is as such a complete requisite for life as humans, and so our brains primary roles are movement and threat assessment/avoidance. If your brain perceives a threat this becomes the biggest and most vital thing it can focus on. There may be multiple threats and it will have to approach them all as it’s able with an appropriate hierarchy of priority.

This is what drives the compensations of the MCC; a perceived threat to a joint or other body part which if allowed to continue could lead to a serious injury which could end mobility and by that result in death. Certain trade-offs result like an unstable knee in exchange for a more stable structure due that was compromised by a non-functioning core, etc. There are many things beyond the MCC that act powerfully and near singularly in focus to react to a perceived threat, pretty much all systems as able in their own way. For example the body perceives caloric restriction as a threat of starvation and has a considerably complex reaction which shuts down the metabolism to wait it out ‘until spring.’

The extreme and direct perceived threat that triggers the limbic center to directly take over the MCC and its function is the perfect example of this, but it’s not the only way or degree that the limbic center intervenes on our physiology and MCC in general. Think now to the interplay between the limbic center and the MCC for perceived threats, as well as emotional and memory processing. We can see in NKT testing that with negative thoughts, especially of traumatic events that this alone can blow out a test. I don’t personally have the qualifications to work with this, but the effects are very real in their impact on MCC function due to perceived threat.

When your body gets injured it doesn’t just show up in the physical tissues, your brain remembers it. If it’s no big deal it may not matter, but some things you don’t think are a big deal your brain disagrees with because it creates a significant perceived threat, possibly from a perceived vulnerability due to the injury and the compensation strategies it had to use to cope with it. An injury by itself can create quite the memory, which I see quite often in injuries of the joint that must be resolved in regards of the brains threat assessment of it (you must show it that the vulnerability is no longer present by tapping into the memory directly with appropriate proprioception and intervention).

However where things get more complicated and are very much outside of my purview of practice is when an injury is not just physical but also a very emotional occurrence. Most severe injuries have an element of this simply because it would be emotional and thus the tissue injury memory and emotional memory are both created and have a related but not necessarily one entity. Meaning you can fix the fascial memory where that’s not an issue anymore but the emotional side is still active.

One of the clients I had been working with for some months with movement, before coming to NKT had been having some real mobility limitations and so we went more thoroughly into her history than I would have before NKT and she had had a traumatic hip break about 25 years ago. It was a side impact car accident at age 18 requiring a full cast. The first responding officer also tried to place the blame on her (he appeared to have something against the local youth she tells me). Given these factors and the severity of the injury it should surprise no one that there was emotional content. We could find issues that explained the specific dysfunctions but none of them would stick, even with the help of an advanced practitioner.

Another common example is when you work on someone who has been abused. As much as I wish it weren’t the case, the incredible emotional stress involved in being abused, even psychological/verbal abuse that has no physical element must be dealt with by an appropriate professional. Many times even if it has been addressed by a psychiatrist or other therapist it seems to continue in some way, but more often than not it has not been properly resolved and is repressed in some form or another from conscious thought but is still highly active as a perceived threat which is interfering with MCC function and proper structural and functional stability.

Because of the linked nature of the fascial and emotional memories many of us have had someone start crying on the table, often without the patient having any idea why. Or it may even be an incarnation of the permeable nature between the conscious-subconscious barrier of the limbic/MCC where they feel threatened or vulnerable in a testing position or during a test (kind of like you don’t feel safe doing certain exercise movements, or on some unstable surfaces). The former lets you know an emotional issue is lying under the surface and their crying may actually be realizing it, but unless you’re qualified to do so I would immediately send them to someone to can help them confront it. Some of the latter may also indicate the same course of action but can just be the MCC letting the conscious brain know that it doesn’t know how to safely complete the action requested and is basically ‘asking the manager for help.’

This is basically what it comes down to practicing in rehab, especially from the perspective of NKT, is that the limbic center is king. It doesn’t just forcibly take over in emergency situations but impacts our function in every aspect because of the effects of perceived threat which it funnels into motor operation. Simply having a more stressed life or outlook may impact things, causing generally increased ‘neurological noise’ which may make things not as clear in testing and make things just work a little bit less optimally, but its these traumatic injuries and abuse that we should be most aware of and screen for. If you find an issue but it won’t stick then you haven’t been working on the real cause, which may in this case be an emotional one.

Just before getting to this paragraph I had to go off and meet with a client for a session and a perfect example of this concept and working with it as a movement therapist came up and especially as she’s a mental therapist and found interest in a discussion of the topic we decided to try a technique that another trainer at my facility was using this week. I was having my client do some dexterity step-ups on a large tractor tire, where she was supposed to step up, into and to the other side and down. The tire was only 18” tall and she’s done step-ups higher than that before but she consciously knew she couldn’t do it and couldn’t get herself up onto the tire.

This client had been in a severe car accident at about age 18 if I recall (now in her 40’s), a side impact resulting in the fracture of her illium, this being the same client I mentioned above. I placed the tractor tire in the middle of a squat wrack and wrapped an elastic band from the top of the structure to wrapping under her arms. With this added sense of security and stability she was no longer above her perceived threat threshold. With her hips being in a ~90 degree flexion in the car crash and the use of the hip this may have been a limbic situation, or it may have just been the MCC letting her conscious brain know it didn’t feel stable enough to let her do that within a range of joint safety, but with the added support either way she stepped up like it was nothing, mentally and actually.

Come Monday we will be doing some checks on this issue but we will be slowly lowering the degree of added stability to this technique to increase the ‘range of comfort/safety’ and raise the perceived threat threshold regardless of the cause. This may not alleviate any limbic complications but it may lower the severity of their effects. I am referring her to my intuitive bodyworker, who specializes in this kind of ‘emotional healing.’

I have had the luck of experiencing his work myself and have sent numerous clients in his direction for dealing with acute traumas and abuse that have physiological symptoms (aka disrupted MCC). He does a light bodywork which I imagine is filled with energy work like intentions, while taking you verbally through the emotions and incidents that are related. By this method he works on the limbic center and MCC at the same time, and the memories there of so that limbic based dysfunctions can be removed from motor patterns. I personally have never felt such a profound change in my own body and felt some core activation I’d never had before right after my session. People who do tapping can get some similar results I imagine, but I believe this technique can actually interfere with some of the neural-memories of fascial injuries, especially in joints.

The discussion of neural injury-memories will wait for another day though. This interplay between the limbic center and the MCC, especially when it comes to memories of or current states of limbic perceived threat is vital to ensuring that your patients’ physiological dysfunctions can be concluded, by another practitioner if not yourself.

Eccentric Loading False Positives

There is an element of functional anatomy that I feel often goes over looked in NKT practice simply because with everything else that is or can be going on, it is easy to miss. Being aware of it, however, really helps decrease the chances you will miss something. This is the eccentric activation of musculature that is seemingly unrelated to the movement portion of various actions. A month or two back I wrote an article about why soft tissue becomes inhibited, detailing several reasons and mechanisms by which inhibitions happen or are maintained. I certainly go over the topic in that article but I wanted to shortly highlight the role of eccentric loading in compensations and NKT testing.

One of the primary and unsurprising methods the MCC uses to inhibit muscles is to keep an antagonist eccentrically loaded so that via reciprocal inhibition the target muscle is quite thoroughly inhibited. But what about when a muscle that isn’t an antagonist or synergist? One of my current favorite reads is ‘Stability, Sport and Performance Movement’ by Joanne Elphinston and in this text she excellently describes the role of local and global stabilizing muscles which during a movement will help keep the body stably moving through and appropriate vector for the desired action (and at the same time helping appropriate transfers of force). This means traditional ‘core’ muscles may be activating while you are asking the body to complete a seemingly unrelated pattern with an NKT test, though ideally in a fairly minimal way because of how we test.

Where the problem comes in is in two ways. One, as Joanne details, is that stabilizer muscles can become movers instead, which in the end can impede optimal and even adequate stabilization, range of motion, and technique for a given task and then in normal daily demands. This obviously causes lots of problems, and it’s no real surprise to most of us I imagine. The second issue here is the reason for this piece today. Your MCC is nearly as concerned with stability as it is with mobility in as far as we need to move to survive but your MCC is happy cutting down a lot of ROM and inhibiting a hell of a lot of tissues for the sake of minimizing injury or risk while we get that life sustaining movement done, to the point where we may not actually be able to move at all.

Through a wide range of proprioceptive mechanisms the MCC has a pretty damn good idea of how stable it is on a global and local level around any particular joint, not that the way it reacts to what it finds is the way we’d like. The typical response is a series of compression strategies and over-facilitations to limit range of motion and keep certain parts of the body on lock down. Part of feeling stable is holding enough tension through the Deep Front Line and similar foundational soft tissue lines to support the axial skeleton and overall make up our central line. If there isn’t enough tension on this line, the axial skeleton has to compress beyond feasible levels for non-degenerative action (think tensegrity units).

So if one element of the deep front line is not working in as such as it can create tension when and in the amounts needed, another part of the line tightens. This is where we find (in my experience) most TMJ cases, many pelvic floor dysfunctions, and other issues along the DFL. Normalize the function and tension in the DFL and many of these go away (for example get the TVA working and much of the time TMJ goes away, assuming it’s not via a scar or neck dysfunction).

While the increased tension on this fascial line can cause symptomatic issues like TMJ, or pelvic floor issues (constipation or leakage with jolts like sneezing or jumping), it can also be asymptomatic, but regardless of how noticeable the tightening is, it gives the MCC a sense of security because there appears to be global stability, even though this may be from bilateral knee valgus, and eccentrically loaded TM muscles, the diaphragm, and the pelvic floor. While these are eccentrically loaded, your tests may appear to be locks, though usually the patient will feel that despite being able to hold the test, it was one hell of a battle, and likely was confusing (aka not well organized). Especially if you suspect a muscle isn’t working, don’t just accept a functional success result from a test, also ask the patient how easy and confident it did or didn’t feel.

So what do we do about these misleading positive results? How do we confirm what the issue is? A muscle is likely eccentrically loaded to give the DFL and the MCC enough sense of tensile stability that it allows other muscles to function, but come into the dynamic world where the patient is participating in sports, outdoor activities, or just a small slip on a wet day and there is a high probability they won’t have the real stability to prevent an acute injury.

So to deal with the issue you will have to figure out the direct causes for the inhibitions of the muscles in question, be it the psoas, TVA, or an opponens digiti minimi. Sometimes it’s the eccentric loader, but I find that almost always these muscles are giving the tension to make the MCC feel stable, but isn’t the original cause nor the direct cause of inhibition, they merely muck up your testing if you’re not aware of their role. However, you can do a light release to see the effect it was having. Really challenge the diaphragm and see the effect on the TVA test, and then do a light release or appropriate breathing exercise, then challenge and retest. It will let you know what kind of effect it may be having on the TVA or other target muscle and give you a better idea as to whether the TVA is actually functional, though it may not be the diaphragm that is eccentrically loading (but commonly is).

The Bottom Line:
• A test may be a functional success, but is not a lock because a stabilizer (usually global, and usually in the deep front line) is eccentrically loaded, giving the MCC a sense of stability it doesn’t really have. Compression works in the same way; remove the compression and suddenly it doesn’t actually work.
• While the eccentric facilitator may need to be released, it often (note, I’m not saying never!) doesn’t in the case of the TM musculature, diaphragm or pelvic floor, though compression should be released barring ligament damage or acute injuries.
• Along the same line, while it shows a functional success, the eccentric loader is very rarely the direct facilitator, let alone the top of the faciliatory hierarchy.
• Simply be aware that this may be giving false-positives to tests, though if desired you can sometimes clear the false-positive effects of the eccentric loader, at least temporarily (My diaphragm needed to be limbically released before it stopped showing false positives for my abdominals) which can help you move on and find the real problem(s) both direct and hierarchical.

Approaching C2 Displacement

While each of us should try to avoid cookbook rehab or confirmation/treatment bias, with a tool like NKT that lets us compare the power and impact of various dysfunctional elements and place them in an accurate order on a causal hierarchy, there are several patterns which I find with extreme frequency and regularity that are well worth being aware of and checking for with most or even every patient. The pattern we will be talking about today is C2 displacement and the causal and dysfunctional chain that springs to/from it.

GW520H600 We are told, rightfully so, to start local and then go global. The local area is important to find the direct thing causing the symptoms that we notice, in part to give symptomatic relief and in part to track down the causal hierarchy. Much, if not the majority of the time, however, the issue will be of a global/core nature when a recent or concurrent known acute injury is not present (and even then). The axial skeleton and deep front line, the soft tissue equivalent to the spine and the tension element of the intrinsic tensegrity unit, is usually this ‘core’ we need to look to. The cervical spine is the saddle of our head on top of this structure and has an enormously profound effect on balance and ‘steering’ the body.

Since this particular dysfunction was pointed out to me by one of our NKT colleagues a month or two ago, literally EVERY single patient since has had their issues tracked back to C2 displacement and related issues up or down the chain (what caused it directly or originally), except one patient who had had a fractured C4. No surprise that the C4 was her top of the totem pole. Again, because of our ability with NKT to place this dysfunction on a hierarchical order without any doubt, we can show whether or not the C2 is an issue, or the issue, if it is dysfunctional. If you don’t know what I mean, check out my hierarchy placement protocol article Here.

So how do we know if the C2 is an issue and why are we looking there in the first place? The easiest way to tell is to look at head tilt and angle. Have them close their eyes and move their head around a bit, returning it to what they feel to be neutral. If their neutral is tilted one way and rotated, you have an upper cervical rotation. If they have just a head tilt, it may be lower down the cervicals, or simply a muscular tension issue not related to cervical displacement (though the muscular tension can result in the cervical displacement anyway). If they have SI dysfunctions or seem to have one side of the body trying to launch into space (hip compression, SI compression, hip height and shoulder height, can be some or all), that’s a good clue as well, and we’ll speak about them a bit more shortly. Sometimes you can also palpate the C2 and feel it shifted considerably out of place (usually to the left, anecdotally, which I imagine is a left/right handed thing but I am just not getting any lefty’s these days). Obviously imaging wouldn’t hurt either, but isn’t a necessity for our purposes here.

head tilt rotation dysfunction (Note that it does not need to be this severe. It is best viewed from supine.

Origins:

One of the most important processes in NKT and rehab overall is tracing back symptoms to the direct and the original cause. If you don’t try to walk the line back then have you really cleared the whole problem? Maybe, but probably not. If you haven’t, there’s a good chance it’s going to come back. Sometimes you get things dealt with without tracing something back and you can definitely get much symptom relief otherwise, but we’re here to fix the cause. With the C2, it’s definitely important. Have it adjusted and don’t fix the soft tissue or the original issue driving in the need for the soft tissue dysfunction and it will just come back eventually or cause a dysfunction elsewhere, usually pretty damn quick due to the high priority of the dysfunction.

Every time so far I find an fairly early age (birth to puberty, but sometimes teen years and I would somewhat expect it at any age, it just increases the impact when it’s during formative years) injury to the head from a fall off a tree, running into furniture, etc. which causes a sense of vulnerability or instability leading to some kind of protective compression strategy. Either the scalenes or the levators (or both) often end up being an element of this strategy and it’s usually the left side being facilitated and pulling the C2 to the left (that whole potentially right handed thing I mentioned). It’s not always the facilitated muscle, however, as sometimes the inhibited muscle (usually the levator/scalene on the other side) is defensively tight and needs to be turned on, not released. Lastly, sometimes there is this defensive relationship pulling the C2 one way causing dysfunction, but once that’s cleared the C2 is still being pulled from the other side. Either way, normalizing tension between the scalenes and levators is vital to getting it to stay centrated and obviously the rest of the neck needs to be cleared and general hand-shoulder-neck, core-neck stability established for lasting results.

Signs and Symptoms:

As mentioned elsewhere in this article, there is quite a bit of dysfunctions that can be found directly and through a hierarchical causal chain due to the C2’s importance as a saddle for the head on the axial skeleton. Severe inhibitions around the neck resulting in headaches of all kinds, shoulder, elbow, hand and core issues are common. It can also directly cause a jam to the SI (especially it seems via scalene facilitation) and is often then related to a shortened leg via hip compression, hip raise, and shoulder raise all on one side (in part or all of the above). Anytime I see an SI jam I check out what it’s doing locally and then fix it around the C2 in the scalenes. It hasn’t been a long time but I’ve had 100% success in this so far.

With facilitated or inhibited scalenes there is a high chance of inflammation at a certain point which can put pressure on the brachial plexus, so especially if your patient has ipsilateral tingling, numbness, or other nerve based issues in the fingers, hand and arm, this is a good place to start. That said I’ve seen bilateral neuropathies stemming from a cervical displacement/compression but also from one scalene being over facilitated, and the other defensively tight from inhibition, thereby resulting in interdependent bilateral brachial plexus pressure.

The list goes on quite a bit, and I’ve found symptomatic inhibitions with the C2 displacement being the top of the discovered hierarchy going as far as inhibited toe flexors. Spasms, especially in the neck, but sometimes elsewhere due to severe facilitation/inhibition is also an occasional related finding. I’ll end the list here but because of its importance and core role/placement, I keep it in mind for pretty much everything.

Before we get started on fixing the issue, I am a big fan of the SFMA or a decent equivalent that lets us see how the neck is functioning before and after our treatment. Especially if there is a one sided imbalance in cervical rotation (though because of the respective facilitation and defensive inhibited relationship it is probably more often bilateral) I want to see this cleared up after some good work on the C2, related structures and the causal elements. If you think you’ve cleared the C2 issue and related dysfunctions but they can’t pass an SFMA cervical assessment, it’s time to keep looking.

Treating The Issue:

Firstly, testing issues against the C2 is where we want to start to get an impression of what’s going on. If you can feel the C2 being actually displaced, then it’s all the easier. Hold light pressure on the C2 from the left or right side of the spinous process as a TL and then test part of the neck, core, hips, nearly anything and seeing what it does. One direction should make it substantially better or lock, while the other will usually knock it out pretty substantially (it’s been fun to use as almost a ‘party trick’ in initial consultations when appropriate to have someone sit up straight with ease with the C2 held and then pull it away and watch them instantly slump). If it doesn’t, it isn’t likely the direct issue or the muscle(s) causing the displacement or the injury in the first place is the more important element in the equation for what you’re testing it against. Refer to my article on hierarchical placement to figure out what needs to be dealt with. Sometimes, however, there is enough compensatory ‘noise’ that you may need to lightly clear some of this stuff to get a clearer idea of where to go and how to progress.

As I am not a chiropractor I don’t do adjustments on my patients, but from my experience in this particular cervical displacement simply getting the tension regulated around the neck and the C2 in particular takes care of the issue and I have not found the C2 having to be directly adjusted to stick. I have however seen adjusted C2’s that did not stick due to a continuing soft tissue issue that was causing the displacement from some kind of head trauma, as I imagine all of you have.

As stated above, clearing the neck as far as ensuring it is stable, and the same with the shoulders, hands, and then the core will be crucial. Most issues in any of these areas are likely to be directly connected to the others anyway. To make defensive muscles feel less threatened I have found it very useful to go down that anatomy train(s), especially for the scalenes, but the levators as well (check the subclavius on the inhibited side). A personal favorite for the scalenes, which can blow out a lot of SFL/DFL and some LL, as well as cause dysfunction in the neck and arms, is the point on the antero-distal ribs near where the RA and EO fascia meet at the most protruding area (and in the surrounding fascia) circled in the image below. This area is most over-active when the abdominal musculature is dysfunctional so it appears that the abdominal fascia tries to step into this role in the same way the IT band does for the TFL in lateral ankle stability. I’ve found it standing in for the glute medius, TFL, pretty much anything in the core, the QL’s and parts of the neck with fair frequency.

oblique I am hoping to find a subject to do a short video on clearing the neck and the C2 dysfunction in particular in the near future. As with all things, do not simply release something because it is tight or painful. Making sure that the levator or scalene (or whatever else you’re looking at) is truly facilitated and not just defensively tight is crucial, or the problem will simply worsen.

So how do we find and treat the origin? Usually it’s a head trauma or scar (including oral surgery) that happened in a formative age but can be much later. To get an idea of whether they are the issue or not you can TL them, and go through the hierarchy placement protocol to confirm. I know some of you have non-NKT scar techniques that work, and in either level 2 or 3 (no idea which) scars are addressed and will give you the necessary tools to conclude C2 displacements sprouting from them. Until then if you can find that one of these issues is the hierarchy, then send them to an appropriately qualified practitioner as until that top issue is dealt with, the dysfunction likely won’t clear, it will just send the symptom elsewhere at best a little bit further down the line (time wise).

When it comes to concussive head trauma it may have caused a past sense of instability and injury which resulted in the protective compression chain to the displaced C2 and directly fixing it may be all you need to do. I imagine some cranial fascial work may be in order, and cranio-sacral work may be of great benefit (I don’t do this myself yet so my experience is limited with it. I’d love input from any of you who do). I’ve been told otherwise that when it comes to inter-cranial injuries really the best, if not only, decent option is a class four laser. I will likely be experiencing this myself in the near future for a 10 year old severe concussion which appears to be the root of my many dysfunctions.

I would love more input from any of you concerning head traumas and your treatment methods, especially on the side affecting neuromuscular and joint function.

So using the hierarchical placement protocol, or another method achieving the same ends, you will know which thing needs the most treatment. Sometimes it is a head trauma, sometimes the C2, sometimes the muscle causing the displacement, regardless of the chronological order. Clear the top issue and usually the others will clear automatically (sometimes chronologically but sometimes just the one causing the most issues). To ease things along better and faster I don’t mind hitting a few levels at once especially during the session but in the patients’ homework as well. Sometimes also it will be the head injury and compression to say, the extensors, while it is the over-facilitated levator to the TVA, over-facilitated scalene to an SI jam, etc instead of just one top facilitator against all the inhibited tissues. Check the issues you find against a few crucial issues to make sure you aren’t missing something crucial. TVA, multifidi, general hip stabilizers (illiacus, psoas, QL), and general neck function is obviously high on the list.


Wrapping Up:

The other proximal cervical vertebrae can have similar effects and so should be checked out, especially if you are having a head tilt with rotation and any of the above discussed symptoms but are not finding success with treating the C2 or possibly causative head traumas/scars (Don’t forget oral surgery and oral scars, they aren’t usually the issue, but sometimes they are). I decided to discuss the C2 because it is what I find causing the issue with the vast majority of these cases. Part of my intake assessment is to run the entire spine looking for tender or displaced vertebrae and those which are tender or displaced are often the source of dysfunction to anything attaching to them. That said, however, while I do find some T2 or T4 and sometimes the surrounding thoracic vertebrae often give me locks on the local area and core, I have typically found them to be lower on the causal chain to the cervical dysfunction. Good to keep in mind though and to check during your follow up after the patient has done cervical normalizing homework to see if it has fixed itself or not. If not, this may be the next most important step to pursue.

For this article in particular because of its trek through the chiropractic realm, I would love input from the chiropractors, osteopaths, and other most relevantly related professionals, not to mention anyone else that has some experience with this or good insight!

 Page 1 of 3  1  2  3 »