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Posterior Oblique Subsystem (POS) — Brookbush Institute | Brentbrookbush.com

Posterior Oblique Subsystem Integration:

By Brent Brookbush DPT, PT, COMT, MS, PES, CES, CSCS, H/FS

The Posterior Oblique Subsystem (POS) is comprised of:

Function (Brief):

The muscles that comprise the POS are the largest in the body. This subsystem plays a significant role in stabilizing the lumbar spine, sacroiliac joint (SIJ) and hip, as well as transferring force between lower and upper extremities. The POS plays an active role in all pulling and rotational movement patterns (especially turning out), multi-segmental extension (with less lumbar extension – excessive lordosis), and eccentrically decelerates spinal flexion and rotation, as well as hip flexion, adduction and internal rotation (knees bow in and excessive forward lean). The POS is the functional antagonist of the Anterior Oblique Subsystem (AOS).

  • Concentric Function: Pulling, rotation “outward”, multi-segmental extension with less reliance on lumbar extension
  • Isometric Function: Transfer force between lower and upper extremities, stabilization of the SIJ, lumbar spine and hips
  • Eccentric Function: Decelerate spine flexion and rotation, as well as hip flexion, adduction and internal rotation

Common Maladaptive Behavior

  • Under-active

Signs of POS Dysfunction

Practical Application

Relationship between the Latissimus Dorsi and Gluteus Maximus via the Thoracolumbar Fascia. Posterior Oblique Subsystem a.k.a. Posterior Oblique Sling a.k.a. Posterior Oblique Synergy

Relationship between the Latissimus Dorsi and Gluteus Maximus via the Thoracolumbar Fascia

Research Corner:

Thoracolumbar Fascia:

The superficial laminae of the posterior layer of the thoracolumbar fascia is the fascial structure communicating the force between muscles of the POS. The superficial laminae of the posterior layer is continuous with the latissimus dorsi, serratus posterior inferior, gluteus maximus, lower trapezius, and gluteus medius via the gluteal fascia (1-7). Medially and cranial to L4, the superficial layer is bordered by the supraspinous ligament and spinous processes; however, some fibers cross mid-line to attach to the contralateral sacrum, posterior superior iliac spine (PSIS) and iliac crest (6). Fibers of the TLF arising from the gluteus maximus (caudal to L4) also cross the mid-line, attaching to the opposite sacrum, PSIS or lateral raphe (1, 2, 6, 26). A study by Vleeming et al. demonstrated that force imparted by invested musculature would result in significant creep/displacement of TLF tissue, including across mid-line (10). This displacement of TLF tissue is an important finding because it demonstrates that force may be communicated through the TLF from one muscle to another:

A study by Levangin et al. demonstrated that a chronic low back pain group showed approximately 20% less shear strain of TLF tissues than asymptotic controls (92). This implies that dysfunction may result in a reduction in the ability of fascial layers to glide over one another, which would reduce the amount of tissue displacement noted above. Although the TLF tissues were not directly tested for chemical, cellular or structural changes between layers, it was hypothesized that mal-adaptive cross-bridging by collagen fibers in response to damage and inflammation limited fascial motion.  Note, the application of “shearing forces” to disrupt mal-adaptive cross-bridging has been proposed as a primary mechanism and benefit of many myofascial shear (myofascial release), instrument assisted soft-tissue mobilization (IASTM), and pin-and-stretch techniques.

Gluteus Maximus and Gluteus Medius:

Studies have demonstrated that the gluteus maximus and gluteus medius work synergistically, that force may be transferred between the latissimus dorsi and gluteus maximus via the TLF, and that these muscles may contribute to sacroiliac joint stabilization via the TLF (1-7, 10-23, 26). Continuity between the TLF and gluteus medius occurs via an extension of the superficial layer of the TLF known as the gluteal fascia (2).

Studies have demonstrated similar recruitment between POS muscles. Kim et al. demonstrated contralateral muscle activity of the latissimus dorsi and gluteus maximus during gait, which increased when speed increased or weights were held in hands (42). Stevens et al. demonstrated the co-contraction of various muscles investing in the TLF during a “quadruped” exercise (43). The gluteus maximus and gluteus medius are larger muscles recruited at higher intensities (“law of parsimony”), and may not act as prime movers during low intensity tasks (motion without additional external resistance) (24). Studies have demonstrated that the POS is not recruited alone, and must work in conjunction with the Intrinsic Stabilization Subsystem (ISS) and Deep Longitudinal Subsystems (DLS) (24, 25).

These muscles are prone to under-activity, but respond well to specific intervention (activation techniques). Reduction in gluteus maximus and gluteus medius activity has been correlated with pain and dysfunction of the low back, sacroiliac joint (SIJ), and all lower extremity joints, including the hip, knee and ankle (28-33). Even in the absence of pain, gluteus maximus and gluteus medius weakness has been noted in those with functional knee valgus, a loss of hip extension, an anterior pelvic tilt, and/or a lack of forward lean during running (29, 30, 34 – 38). Pertinent to practice, greater gluteus maximus strength has been correlated with better landing mechanics, running mechanics, and squat mechanics (30, 32, 36, 38 – 41).

Latissimus Dorsi:

As mentioned above, Vleeming et al. demonstrated that force may be transmitted between the gluteus maximus and latissimus dorsi (2, 10, 50), and Kim et al. demonstrated similar recruitment during gait (42). In asymptomatic individuals the latissimus dorsi behaves like a larger muscle (similar to gluteus maximus recruitment), demonstrating a marked increase in activity when motion is resisted (48, 49). The latissimus dorsi has been implicated as a lumbar extensor via the thoracolumbar fascia; however, studies show that the potential contribution is relatively small (44 – 47). This may imply that more POS recruitment and less DLS (which includes the erector spinae) recruitment, results in less reliance on lumbar extension during pulling and rotation. This could be beneficial for those exhibiting signs/symptoms of Lumbo Pelvic Hip Complex Dysfunction (LPHCD).

A correlation between a loss of shoulder flexion and Lumbo Pelvic Hip Complex Dysfunction (LPHCD) has been noted clinically, which lead to the hypothesis that the latissimus dorsi may adopt a compensatory pattern over-activity. This hypothesis was based on the premise that the latissimus dorsi like lumbar extensors in those with LPHCD, and would behave similar to the commonly over-active erector spinae. However, based on the latissimus dorsi‘s limited ability to extend the spine, a study by Scovazzo et al. that demonstrated no change in recruitment with shoulder pain (51), and the inclusion of the latissimus dorsi in the POS, (a synergy dominated by commonly under-active muscles), this hypothesis may need to be reconsidered. Research is desperately needed to compare latissimus dorsi activity in asymptomatic individuals to those exhibiting LPHCD or Upper Body Dysfunction (UBD).

Lower Trapezius:

The lower trapezius invests in the superficial laminae of the posterior layer of the TLF, and as mentioned above may displace TLF tissue vertically (2, 10). The attachment and amount of displacement is relatively small when compared to the latissimus dorsi and gluteus maximus, but the effect TLF tension has on lower trapezius activity should be investigated further.

Several studies have demonstrated a correlation between Upper Body Dysfunction (UBD) and altered lower trapezius recruitment. Studies have demonstrated that shoulder impingement syndrome (SIS) (52, 53), neck pain, forward head posture (54-56), and the use of a computer mouse (57) increase lower trapezius activity. However, these studies do not consider the ratio of activation between the upper trapezius and lower trapezius. Several studies have demonstrated that although over-all trapezius activity increases, lower trapezius is lower than upper trapezius activity in those exhibiting dysfunction (58-60). Further studies demonstrate that the lower trapezius fires later in those exhibiting symptoms of SIS and during fatigue protocols, especially during high velocity movements (60-64).  Perhaps most obvious, is a marked decrease in lower trapezius strength in those with UBD including shoulder pain, neck pain and even lateral epicondylagia (64-66, 84).

Compensatory patterns of the scapula result in a relative increase in length of the lower trapezius during static and dynamic postures.  Several studies show an increase in anterior tipping, downward rotation, and internal rotation of the scapula in those exhibiting signs of shoulder dysfunction, and or during fatiguing protocols (67 – 71). The increase in relative length may explain the increase in activity noted in the studies above. An increase in length would alter length/tension relationships, decrease the amount of force achieved at similar levels of activity, resulting in an increase in activity to achieve similar force output during functional tasks.  This may be supported by studies that demonstrate a return to neutral cervical posture reduces lower trapezius activity (55-56)

Research has demonstrated the efficacy of specific interventions for addressing altered trapezius activity. Trigger points may alter recruitment of the scapular rotators, and injections into upper trapezius trigger points resulted in a decrease in upper trapezius activity and an increase in lower trapezius activity (72, 73). Kinesiology taping of the lower trapezius has been shown to improve scapular mechanics, reduce upper trapezius activity and increase lower trapezius activity (58, 74-77). Note, taping of the lower trapezius has no effect on healthy subjects (77). Thoracic manipulations result in an immediate increase in lower trapezius strength (and may affect the TLF) (79-80). Several studies have shown the effectiveness of ITY type exercises (cobra, abduction and scaption) for targeting the lower trapezius (81-88). Note, the lower trapezius of the serratus anterior are recruited similarly, likely due to their shared functions of posterior tipping and upward rotation (89, 90). Lower trapezius activation performed on one leg further increased lower trapezius recruitment (86).

Summary of Research Findings

Thoracolumbar fascia. Notice the lighter colored band of tissue. This is the fascia.

By Anatomist90 – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=17900177

More on Function:

Primary stabilizer during high intensity activity – During gait, the forward swing of leg and opposite arm lengthen the muscles of the POS and pull the thoracolumbar fascia taut. Concurrently, the opposite leg and arm concentrically contract from heel strike to  push-off, which in turn pulls the contralateral side of the thoracolumbar fascia taut.  The more intense (the greater the velocity) the movement, the larger the force imparted on the thoracolumbar fascia, and the more TLF rigidity increases.  This phenomenon ensures stability of the lumbar spine and SIJ, and enhances the transfer of force between lower to upper extremities, and from proximal to distal during walking, sprinting, jumping, and throwing.

Primary eccentric decelerator during high intensity activityThe muscles of the POS may also function as our primary decelerators of “total body pronation” (spine flexion and rotation &  hip flexion, adduction and internal rotation) during resisted/high-intensity activity.  During heel strike, landing from a jump, getting pushed in the back, stepping off a curb, or bending over to pick something-up, it is this subsystem that resists forces that would otherwise collapse someone inward. Further, the function of eccentric deceleration is coupled with increased rigidity of the TLF, which along with the optimal function of our Intrinsic Stabilization Subsystem(ISS) would enhance stabilization of the lumbar spine, sacroiliac joint (SIJ) and hip. This “eccentric function” could be argued as the most important function of the POS.

Prime, prime mover” – The POS is biased toward extension, pulling and turning the kinetic chain outward. The POS being comprised of the largest muscles in the body results in most individuals being far stronger at “pulling” and “turning out”, than “pushing” and “turning in”. Many daily activities require POS recruitment, including opening a heavy door, lifting groceries off the floor, or a “drop-step” move in basketball. Chop Patterns and Squat-to-Row are examples of exercise that can be used to target the POS during core and integrated movement patterns, with the intent of increasing strength and endurance.

Compensations and models of postural dysfunctionThe POS could be coined “the always under-active subsystem.” In the Brookbush Institute’s predictive models of Upper Body Dysfunction (UBD), Lumbo Pelvic Hip Complex Dysfunction (LPHCD), Sacroiliac Joint Dysfunction (SIJD), and Lower Extremity dysfunction (LED) this sub-system is under-active. Commonly, the under-activity of the POS is paired with over-activity of the Anterior Oblique Subsystem (AOS) and synergistic dominance of the Deep Longitudinal Subsystem (DLS). Evidence of DLS dominance may result in knees bow-in, knees bow-out, feet turn-out, and/or an asymmetrical weight shift during an Overhead Squat Assessment, where as AOS dominance may result in an excessive forward lean during an Overhead Squat Assessment, and/or an excessive kyphosis, spinal flexion, or an excessive forward lean during an Overhead Squat Assessment with Modification.  Dominance of the AOS and under-activity of the POS is generally most dramatic in those individuals exhibiting UBD and LED.

Practical Application

Based on available research on individual muscles, the Brookbush Institute’s (BI’s) predictive models of postural dysfunction, and observations in practice, this subsystem is categorized as “under-active“.  As subsystems are synergies, dynamic multi-segmental postural assessment is recommended for determining compensatory activity, and under-activity should be addressed with multi-joint exercise. The BI uses the research and theory of subsystems as a means of refining core and integrated exercise selection. Note, the BI’s Corrective-Template addresses individual structures prior to addressing subsystems to reduce relative flexibility, synergistic dominance and compensatory patterns.

AssessmentSigns of POS under-activity is based on the research, eccentric function and motor behavior described above, and signs are considered relative to the BI’s preferred dynamic postural assessment, the Overhead Squat Assessment (OHSA). Specifically, the POS contributes concentrically to multi-segmental extension with minimal lumbar extension, which may imply that excessive lordosis (anterior pelvic tilt) is a sign of dysfunction. Further, the POS eccentrically decelerates spinal flexion and rotation, as well as hip flexion, adduction and internal rotation implying knees bow in and excessive forward lean may be signs. Last, the inclusion of the commonly under-active lower trapezius in the POS implies anterior tipping and downward rotation of the scapula are signs of dysfunction, noted as shoulders elevate during an OHSA. In summary, the signs excessive lordosisknees bow in, excessive forward lean, and shoulders elevate may imply POS under-activity.

Core Exercise: Mooney et al. demonstrated the effectiveness of targeting the POS with rotatory exercise for the treatment of sacroiliac joint pain (92). This is the only study that could be located that makes specific mention of targeting the POS with the intent of addressing an orthopedic issue. Due to this study and benefits noted in practice, the BI recommends Static Chop Progressions during core exercise routines in those exhibiting signs of POS under-activity. Further, due to the under-activity of the gluteus maximus and gluteus medius the BI also recommends Bridge Progressions to aid in optimal recruitment of the POS

Integrated Exercise: The BI suggests ending sessions with multi-joint exercise/activities (integrated exercise) to reinforce new motor patterns. The BI refines “integrated exercise” selection with research and theory on subsystems, focusing on subsystems hypothesized to be under-active. As mentioned above, the muscles of the POS are biased toward extension (without lumbar extension), implying exercise that incorporates “legs with pulling” would be ideal for enhancing coordination, strength and endurance of the muscles of the POS. The “Squat-to-row” is a commonly recommended example, and a POS integrated exercise progression (with videos) can be found below.

Instrument Assisted Soft Tissue Mobilization (IASTM) of the TLF: Fascia’s response to specific intervention is complex.  Responses may include strain hardening with repetitive or constant tension, enhanced shear and a reduction in cross-bridging between fascial layers, changes in both muscle tone and fibroblast mediated pre-tension (with sustained pressure), and/or altered transmission of force of multiple muscles acting to stabilize a joint (93-95). As mentioned above, a study by Levangin et al. demonstrated that a chronic low back pain group showed approximately 20% less shear strain of TLF tissues than asymptotic controls (92). These finding may suggest that techniques with the potential to improve shear are worth attempting in clinical and performance settings. IASTM is hypothesized to improve shearing, although research does not currently exist to support or refute this claim. Careful re-assessment is recommended (as recommended with all techniques) to determine efficacy on an individual basis. The BI has noted that IASTM of the TLF may not have a large impact on the OHSA, but may be generally effective for improving lumbar flexion, extension and rotation range of motion. Care should be taken in addressing these tissues directly, as there is evidence to suggest that the TLF could be a source of nociceptive input for those suffering from chronic low back pain (94 – 99).

Subsystems Summary

Subsystem Common Behavior Core Integration 
Intrinsic Stabilization Subsystem (ISS)
Under-active Transverse Abdominis (TVA) Activation N/A
Anterior Oblique Subsystem (AOS) Over-active

Chop Progression

Avoid: planks, crunches, resisted hip flexion

Legs with Push
Posterior Oblique Subsystem (POS)
Under-active Chop Progression and Bridge Progression Legs with Pull
Deep Longitudinal Subsystem (DLS) Over-active Avoid: leg curls, lumbar extensions Avoid: straight-leg deadlifts, kettle bell windmills, Nordic curls

 

 

Signs of POS Under-activity

Practical Application

POS Integration “Legs with Pull” Progression

  1. Ball Wall Squat
  2. Squat to Row
  3. Squat to Unilateral Row
  4. Squat Unstable to Row
  5. Squat Unstable to Unilateral Row
  6. Static Lunge to Row
  7. Static Lunge to Unilateral Row
  8. Static Lunge Unstable (Front Foot) to Bilateral Row
  9. Static Lunge Unstable (Front Foot) to Unilateral Row
  10. Reverse Lunge to Row
  11. Reverse Lunge to Unilateral Row
  12. Reverse Lunge Unstable (Front Foot) to Bilateral Row
  13. Reverse Lunge Unstable (Front Foot) to Unilateral Row
  14. Single Leg Squat to Bilateral Cable Pull Down
  15. Single Leg Squat to Alternating Cable Pull Down
  16. Single Leg Squat Unstable to Bilateral Cable Pull Down
  17. Single Leg Squat Unstable to Alternating Cable Pull Down

Ball Wall Squat:

Squat to Row:

Step-up to Row

Static Lunge to Row:

Reverse Lunge to Row:

Power Squat to Row:


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    • Latissimus Dorsi
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