November 11, 2013
You Can’t Have One Without The Other
Each time I teach a continuing education class, there is at least one person who isn’t interested in learning about pelvic and rib cage alignment. But postural control is an essential component of every single motor skill; gross motor, fine motor, oral motor – you name it, every skill depends on our ability to control our body in space and orient to the task (1). And we now understand better than ever before that a critical component of postural control is central stability. Central stability, as created by the inner core team, depends on alignment (2,3).
If you are looking for activation of the infra-hyoid musculature during oral motor function, many of those muscles attach to the clavicle, which sits on top of the rib cage. So if the alignment of the rib cage is altered, so too is alignment and length and function of those muscles. Similarly, if you are looking at upper extremity function, many muscles at the shoulder attach to the scapula. But the scapula also sits on the rib cage so the alignment of the rib cage alters the position of the scapula and therefore, the length, alignment and function of these muscles. And finally, if you are looking at lower extremity function, the position of the pelvis alters the alignment, length and function of the muscles at the hip. We’ve also discussed quite recently that the research is beginning to reflect that alignment is important when discussing balance (see Alignment Matters ).
The rib cage and the pelvis have a relationship by virtue of the soft tissue connections to the spine and many muscle attachment in the trunk. So altering rib cage alignment can alter pelvic alignment and vice versa. Historically, we’ve been aware of assessing pelvic position but not consistently rib cage position, and we have certainly not discussed the relationship between these two. However, the research on inner core muscle function was a game changer. Central stability created during anticipatory postural control is dependent upon the respiratory diaphragm and pelvic floor as the first responders of the inner core team (4). If we have a rib cage that is not in neutral position (in all planes) then the diaphragm isn’t in an optimum position to work. And if we have a pelvis that is not in neutral then the pelvic floor musculature is not in its optimum position either.
So no matter whether you are a pediatric Physical Therapist, Occupational Therapist or Speech-Language Pathologist, if you are working towards improved motor function, we all need to be able to assess and treat for optimal rib cage and pelvic alignment, as central stability is required for optimal motor function – you can’t have one without the other.
Our eyes can play tricks on us because we are not experienced at assessing the pelvis and rib cage together. Begin by putting your hands on your client to assess the pelvic position. The first step in looking at rib cage position is to note whether the rib cage is stacked over top of the pelvis. You may wish to go one step further and change the pelvis position into a more neutral position and reassess the rib cage – does it change (is it better or worse), does it stay the same? Consider taking a quick photo on your smartphone as a picture can give you time to consider what you are seeing. These observations are the first steps in assessing rib cage and pelvic alignment.
This blog was written for PediaStaff, a great resource for therapists. You can find them at www.pediastaff.com.
1. Shumway-Cook A, Woollacott M. Motor Control. Translating research into clinical practice. Philadelphia, Lippincott, Williams and Wilkins, 2007.
2. Claus AP, Hides JA, Moseley GL, Hodges PW. Different ways to balance the spine: subtle changes in sagittal spinal curves affect regional muscle activity. Spine. 2009; 34(6): E208-14
3. Sapsford RR, Richardson CA, Stanton WR. Sitting posture affects pelvic floor muscle activity in parous women: an observational study. Aust J of Physiotherapy. 2006 52 (3): 219-22.
4. Mannell S, Wiebe J. Applying the Evidence: Core stability in the child with motor challenges Part 1. San Diego, APTA CSM 2013.
photo credit deviantart.com