(Golgi tendon organs, muscle spindles, and joint receptors). These neurological structures play an essential role in postural control. Any damage to these structures can affect overall spinal stability, and lead to chronic back problems.
In order to get a better understanding of the importance of these neck muscles and their role in controlling body posture and gait, let us consider the suboccipital muscles (located at the base of your skull).
The suboccipital muscles (rectus capitis major and minor, superior and inferior obliques) are extremely important since they contain very high concentrations of muscle spindle fibres. Muscle spindles are the part of your nervous system that provide postural information to the central nervous system. Damage to these structures can result in gait disturbances and ataxia (an inability to coordinate voluntary muscle movements).
When we compare the density of muscle spindles that pass through or occupy the suboccipital area, to that of other muscles in the spine, it becomes obvious just how much this area affects whole body function.
Take a minute to review the density of muscle spindles per gram of muscle tissue:2
Table 1: Density of Muscle Spindles per gram of muscle tissue
The higher the density of muscle spindles/gm of muscle tissue, the greater the involvement of this area in maintaining whole-body postural control.
Given this, you can see that the inferior oblique muscle (located at the base of your skull) contains 242 spindles/gm of muscle tissue, while the very large latissimus dorsi (large back muscle) only contains 1.4 spindles/gm of muscle tissue.
Even though the inferior oblique is located at the base of your skull, due to the density of muscle spindles in this area, a restriction in this muscle can affect far distant structures; from your neck through to your lower back.
The key point is that any exercise program or treatment protocol must address and resolve issues within all the structures making up your neck’s kinetic chain. This is required in order to deal with the consequences of restrictions which impact the neck’s physical kinetic chain and cascade into your neurological control mechanisms.
This is why you need to perform all the exercises recommended within each routine, even when you cannot see its connection to your particular problem. We have found this method to be the most successful approach for treating our patients.
Your Shoulder’s Kinetic Chain
Your shoulder’s kinetic chain is made up of a complex series of related structures (links) which connect your shoulders to your neck, arms, core, hips, and lower extremities. These connections include muscles, ligaments, tendons, and connective tissues.
Your shoulder is a truly amazing piece of engineering. When functioning correctly, force and energy are easily transferred from your hips and lower extremity, through your core, and into your shoulders.
But, as remarkable as these interconnections are, they can also be the root cause of many chronic dysfunctions. That is why our exercise routines focus on key areas of power transference with a focus on whole-body stability.
As we discussed earlier, your body’s kinetic chain can be viewed as a synergistic chain of links. When one part of the link goes down, the whole chain loses function.
The Shoulder’s Kinetic Chain
Your shoulder joint is a complex ball-and-socket joint consisting of three major osseous structures (scapula, clavicle, and humerus), as well as numerous connecting soft tissue structures (muscles, ligaments, tendons, arteries, veins, and nerves). Injury or restriction to any combination of these structures can result in restricted mobility and inability to use your shoulder.
To understand this principle as it relates to your shoulder, let us consider one of these links — the Latissimus Dorsi muscle.
Normally, the latissimus dorsi functions to extend your arm, adduct your arm (bringing your arm towards the centre of your body), and internally rotate your arm at the shoulder joint.
The latissimus dorsi originates at the crest of your pelvis (iliac crest), connects to the spinous processes of the thoracic vertebrae (T7 to T12), and inserts into your upper arm (intertubercular groove of the humerus) as part of the shoulder complex.
Because of the latissimus dorsi’s numerous attachment sites, any restriction in this muscle has the potential to cause problems from the hips right up to the shoulder. Restrictions anywhere along this path can result in reduced shoulder function. Yes, we recognize that it is strange to imagine that a restriction in your hip is contributing to all those shoulder problems, but it occurs quite often.
Examine the image in The Shoulder’s Kinetic Chain - page 28 to see how all the depicted structures affect the function of your shoulder. Once you understand these kinetic chain inter-relationships, it becomes obvious why our exercise recommendations focus on much more than strengthening or stretching isolated muscle groups in just the shoulder joint.
The exercise recommendations we have given are based on the execution of functional movement patterns which increase total body motor control and integrate all the elements of your kinetic chain. These same exercise routines have delivered great results again and again at our clinic (Kinetic Health – Calgary).
So do yourself a favour, and perform all the exercises in each routine. Even if you don’t understand the connections, trust that they are there, and carry them out! The results will be well worth your effort.
Case Study - Shoulder Kinetic Chain
One of the best ways to explain the shoulder’s kinetic chain relationship, and some key therapeutic concepts, would be to introduce you to the case history of a young baseball pitcher by the name of Josh – a very talented pitcher with great potential in the game.
Josh presented to our clinic with complaints of shoulder pain with intermittent bouts of neck and jaw pain. He had a slowly progressing shoulder injury that severely affected his pitching speed and accuracy. To say the least, he was very distressed by the increasing pain and decreasing performance in his sport.
I ran Josh through the usual orthopedic and neurological tests, and found that they all showed negative (no significant findings). With hands–on palpation, I could feel muscle tension throughout the shoulders, neck, and jaw. There were no apparent signs of muscle tears, impingement syndrome, or overt muscle weakness.
We then went outside and I took a video of Josh pitching a few balls. A video analysis is a great method for obtaining biomechanical information that is not easily identified with standard tests. During the video analysis, I looked at each section frame–by–frame.
You can break down the phases of a baseball pitch into: windup, late–cocking, acceleration, and follow-through. Here is what I saw on Josh’s video.
Windup Phase - During this phase, the pitcher simultaneously flexes the torso, and lifts the lead foot off the ground.
At this stage, Josh’s left hip seemed to be restricted and his weight seemed to shift a little too much to the right, as if he were off balance. This indicated a possible muscle imbalance or a problem with his core stability.
Late-Cocking Phase