May 10, 2012

Where is Superman?

How many times have you tested prone extension/superman during an assessment?  I’ve done it more often than I can count.  But it wasn’t until I began thinking about the typical development of the inner and outer core muscles that I fully understood why so many of my clients have difficulty with this.

First let’s remember the sensory contribution: the vestibular system, which is stimulated by lifting the head off the support surface in prone, contributes to anti-gravity postural tone. Further, the Landau reaction is stimulated by vestibular input, neck proprioceptors and the visual system and is present after 4 months in typical development.  These sensory inputs lay the foundation for the development of prone extension.

Next we need to understand that the Superman position, which typical infants display consistently somewhere around 5 months of age, is actually the culmination of skills.  As alignment changes in the first months after birth, the inner core muscles become increasingly active in prone and supine and create spinal and pelvic stability prior to movement.  The Posterior Oblique Synergist outer core muscle group  (POS = contralateral latissimus dorsi and gluteus maximus) activates in prone in combination with the inner core muscle team.  As soon as the POS activation begins, there is a counterbalance in anti-gravity flexion as the Anterior Oblique Synergist (contralateral obliques and adductors) activate. And as anti-gravity strength increases even further, babies can then activate these muscle groups external to weightbearing and lift their arms off the surface, demonstrating the superman position.  This combination of vestibular input with inner core and outer core muscle activity creates anti-gravity function.

Children with movement challenges learn quickly in infancy that they can create postural stability (in the absence of good anti-gravity postural tone) by breath holding.  This takes the inner core offline leaving the outer core muscles without an anchor and therefore the activation of the POS/AOS is significantly delayed and/or inefficient.  This creates a domino effect creating poor anti-gravity strength and endurance and the inability to complete “superman”.

In treatment, our clients do not need to repeat the Superman activity in order to build anti-gravity function, they need to build the underlying sensory and motor skills by combining vestibular input with alignment, inner core activation and strengthening of outer core POS and AOS.  With these components all working together, quality anti-gravity function emerges.  And that’s when Superman flies through the air.