In class this past weekend, there was some confusion around what students were seeing, and what then needed to be addressed. So, here are some general guidelines.
When we see a shoulder that is medially rotated on the thorax, we can assume adhesions of: the pectoralis major at the humeral head; the pectoral fascia layers to the chest; the pectoralis minor to the first, second and third ribs; the latissimus dorsi to the side of the thorax; and adhesion of the subscapularis and serratus anterior layers to the thorax.
These adhesions will limit the mobility of those muscles and lock the shoulder in medial rotation. Which, of course, will limit the shoulder’s ability to extend with the breath, and limit the mobility of the clavicle when the client breathes.
When we see one shoulder lower than the other, we can assume compression between the shoulder girdle and upper thorax, as well as adhesion of the pectoralis minor and serratus anterior layers to the rib, and adhesion between the intercostal of the first, second and third ribs. These then limit the ability of the ribs and shoulder to extend with the breath, and the shoulders’ ability to move separately from the thorax. The end result is that both the shoulder girdle and thorax are forced to rotate when the client moves.
If the client’s head and neck are rotated to one side, we can assume adhesion between the trapezius, levator scapulae, and scalenes, which will lock the shoulder in elevation. Adhesion between the SCM and scalenes – and between the posterior, medial and anterior scalenes – will lock rotation in the neck, create torsion between the shoulder and neck, and limit the ability of the first and second ribs and the plural dome to move with the breath.
If the shoulder girdle is shifted forward on the thorax and the thoracic spine is locked in flexion, it’s safe to assume adhesion between the pectoral fascia and the rectus abdominis, as well as between the upper portion of the trapezius, levator scapulae, SCM, and scalenes. This combination will collapse the chest and limit the mobility of the thoracic and lumbar spine, and your client’s ability to stand upright and breath fully.
If we encounter lateral flexion of the thorax, we can assume adhesion between the QL and psoas layers, which force rotation and abduction of the leg when walking. This also creates torsion between the thorax and pelvic girdle and limits the mobility of the respiratory diaphragm and pelvic floor.
A flattened or posterior lumbar curve indicates adhesion of the rectus abdominis at the costal margin of the thorax and pubic bone, the imbalance between the rectus abdominis and psoas layers (core and sleeve), side-to-side imbalance between the psoas layers and, of course, limited mobility in the thorax, pelvis and spine.
When the is pelvis tipped forward (anterior) and rotation is evident in the lumbar spine, we can assume adhesion between the QL and psoas layers, imbalance between the rectus abdominis and psoas layers, and imbalance between the psoas and lateral hip rotators. These result in limited mobility in both the respiratory diaphragm and the pelvic floor.
Assessing our client’s posture in this way – and interpreting what we have assessed – can be helpful. But it should not limit our ability to see the bigger picture. As SI practitioners, we seek to assess and understand the alignment and mobility of all the body’s bony segments, and the interrelationships among them.
We also seek to assess and understand our clients’ movement patterns, and the mobility and functional integrity of their inner core. And to understand and assess our client’s emotional bodies, and their ability to be grounded and centered – which is, of course, much more difficult.