Upper Body Dysfunction:

Predictive model of upper-body postural dysfunction

By Brent Brookbush MS, PES, CES, CSCS, ACSM H/FS

In this article we will discuss a predictive model of upper-body dysfunction as it relates to movement impairment, injury prevention, and performance enhancement. Specifically this article will relate these concepts to the selection of exercise.

For an introduction to Postural Dysfunction and Movement Impairment please refer to this article:
Introduction to Postural Dysfunction and Movement Impairment

Upper Body Dysfunction:

“Upper-Body Dysfunction” (UBD) is a purposely chosen title for the impairment discussed in this article.  This reduces the risk that the title itself will imply a certain set of joint actions, muscle activity, or length/tension relationships that may prove to bias or limit the future advancement/evolution of this model as more research becomes available.  Common compensation patterns leading to upper-body impairment have been previously described as upper-cross syndrome and/or a portracted shoulder girdle (1,2,7).  However, the titles themselves may be inaccurate in describing upper-body dysfunction.  For example, protraction may not be the primary “action” noted at the scapula, and newer models of dysfunction describing muscle activity do not follow a “cross” pattern.  Giving credit where it is due, the underlying precepts of Janda’s work are the foundation of much of my work on postural dysfunction and movement impairment, and I am thankful for his inspirations.  The model asserted in this article closely resembles the compensation patterns described by Shirley A. Sahrmann in Movement Impairment Syndromes with a few notable exceptions (7).  The largest exception being the attempt of this model to illustrate a common thread between all upper-body impairments and present one primary compensation pattern.  The corrective exercise strategies discussed later in this article are used by B2C Fitness (www.b2cfitness.com), have their foundation in the corrective exercise model (CEx) developed by the  National Academy of Sports Medicine (NASM), and described in the text “NASM Essentials of Corrective Exercise Training” by Dr. Mike Clark & Scott Lucette (7).         

Why do we need a better model?    

            The Search for Congruence – my revision of this model is nothing more than a search for congruence – an explanation that can find congruence between theory, research, observation, practice, and chronic conditions.  That is, a better model would be evidence-based, accurately describe what we see during assessment, predict exercise and techniques that will enhance performance, and contribute to our understanding of the etiology of common upper-body pathologies.  For more on my views of evidence and the development of this model click here – Search for Congruence

Note: The model discussed and developed in this article may not describe the compensation pattern adopted immediately post acute orthopedic injury (ex. impact injuries) or accurately describe neurologic dysfunction (ex. stroke); however, they may be useful in describing some of the compensation patterns adopted weeks, months and years post injury.

Somewhat ironically, the common conditions that may be explained by UBD, may also help to refine our model of movement impairment.