For athletes, coaches, and clinicians it can be very frustrating when a tool/technique that often works for one person fails entirely to help another. You think you see another tight hip flexor Lower-Crossed client but "releasing" the psoas and doing the couch stretch isn't cutting it. The improvement is temporary at best.
You give glute bridges and tell them to foam roll their quads. It isn't working. They still feel stiff in their hips the next day, they cannot fully descend into a squat, they feel tight in their mid-back, they still have headaches... and on and on.
The multifactorial nature of the human body is what makes treating clients so frustrating, yet so rewarding. Humans do not have a blueprint. No clinical education, higher education, or continuing education has the algorithmic schematics for successfully managing all MSK pain. The nuance of the individual sitting before you, despite your assumption of understanding their problems perfectly, is incredibly vast and complex. Clinicians will often promote Occam's Razor as an excuse to find the simplest answer. Sure, if that works. Rather, better utilization of Occam is to, when facing several hypotheses, choose the solution with the fewest assumptions. This doesn't mean behave the simplest.
We assume far too much based on our own desire to simplify things. We simplify for the sake of time, for the sake of attenuating our mental faculties, we simply for ease, and because we don't know any better. However, it is laudable to have a clinical or coaching goal to continually strive for a solution that requires the fewest assumptions.
Too often we mentally attach a simplified default schematic for our clinical operating system. For example:
Your low back is hurting, you need to stretch your hamstrings.
Your headaches come from Tech-Neck and being on your phone too much.
You have adhesions and we need to release them.
Your poor posture is causing your issues.
This bone is out of alignment with the rest of your body and causing you pain.
The pain is all in your head, you need to learn to cope with it.
Let us use the Latissimus muscle to highlight an example of a muscle that is often overlooked due to assumptions and oversimplification. I show this example at the risk of highlighting its importance to the extent that we start to "see" problematic lats everywhere.
If we analyze our assumptions about lower-crossed syndrome we may notice we began with assuming the hip flexors were tight and the abs were weak. But what if those are only results or consequences of another primary driver? We may have noticed their hyperlordic lumbar spine and their poor strength in holding a dead bug position and then from there created an entire belief system from that basic information. Let's say we also have an X-Ray confirming the strong anterior pelvic tilt. We need to ask, what else contributes to such a pattern and what else could be restricting the pattern from being improved from the current home program?
The problem could be respiratory. Are the other curvatures compromised? It could be proprioceptive. Maybe a ventral hernia or rectus diastasis is a rate-limiting step for core stability rendering the home core program moot. And for the sake of this posts title, maybe some pec minors and lats are so tight that the work downstream cannot overpower the pattern upstream.
A toned-up Lat can prevent thoracic abduction, limit spinal rotation, restricting sacral counter-nutation, promote anterior expansion, restrict posterior mediastinal expansion, limit diaphragmatic function, destroy the ability to properly brace in training, contribute to aberrant rotator cuff function, contribute to overloaded plantar flexors, limit hip internal rotation, drive an anterior head carriage and...you get the point.
The point isn't to say the latissimus is the worst and commits all these crimes simultaneously and often. The point is to show how complex a single (and less often, IMO, assessed) muscle can complicate the recovery of a client.
To conclude: if a manual release of the psoas and a couch stretch isn't relieving someone's extension based low back pain and they continue to display a poor ability to descend into a squat, it is time to expand your range and diversify your clinical ability to rule in or rule out contributing factors. By all means, begin simply. But when it doesn't create the change you seek, look to break free from your presuppositions and expand on possible contributions. You may just have a client who has a lat or lats that restrict counter-nutation of the pelvis, posterior visceral translation, posterior mediastinal expansion, and a posterior thorax tightness inhibiting a serratus reach which could allow for enough center of mass shift to successfully descend to a full-depth squat.
Or maybe they just suck at squatting and sleep on their belly. Welcome to your job. It is hard and multifactorial and tedious. But how boring would it be if it were easy? How lame would the universe be if it was simple and completely known?
Disclaimer: TAOT is not responsible for any clinical depression as a result of the tone of the blog post. Now go get'em.
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