The Deep Front Line
The Deep Front Line
(Note from MR: Patrick Ward is someone that I haven't met, but I've followed for quite some time online. He's a pragmatic and rational coach/therapist, and that's why I knew he'd deliver a great piece of content to the site. Enjoy!)
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Thomas Myers, a former student of Ida Rolf (the founder of Rolfing), has done a wonderful job of bringing the concepts of fascia and movement into the mainstream strength and conditioning world.
The superficial back line has probably been the most talked about line from Myers' Anatomy Trains text - a book that details the fascial continuity of several lines or "trains" in the body - with trainers constantly showing the importance of this line to clients by having them roll the bottom of their foot with a tennis ball. The "trick" goes like this:
- Reach down and try and touch your toes.
- Roll the bottom of each foot for about sixty seconds.
- Reach down and try and touch your toes again to see if you improved your range of motion.
The goal of rolling the foot was to address the plantar fascia, since the plantar fascia starts this line, which in turn would have a positive effect on the entire superficial back line creating greater extensibility and allowing you to bend over further.
It seems that whenever a trainer talks about Thomas Myers or Anatomy Trains, the only thing they talk about is the superficial back line and how interesting it is that it connects the plantar fascia to the scalp and how rolling the bottom of the foot improves the toe touch.
While I wont discount the importance of the superficial back line, I think that trainers can learn a lot from digging deeper into some of the other lines. The deep front line, in my opinion, is really where all the action takes place!
Deep Front Line
Before understanding the implications of this line, we should first understand the path it takes from lower extremity, through the torso, and up into the cervical region:
Posterior tibialis > interosseuos membrane > Knee capsule > adductor hiatus > intermuscular septum > femoral triangle > psoas > anterior longitudinal ligament > diaphragm > pericardium > mediastinum > parietal pleura > fascia prevertebralis > scalenes
I have bolded some of the major players in this line. These muscles seem to come up frequently when we talk about training our clients, and the importance of these four structures is why I feel that the deep front line is where the action takes place.
It All Starts With A Breath
Breathing is essential to keep us alive, but breathing well is essential to good movement!
While this line starts at the lower leg with the posterior tibialis and moves upwards, Myers states that this line really starts on the front of the spine, as the deeper line parallels our ontogenesis (development of an organisms) to a greater extent and does not follow our bodies outer geometry as the more superficial lines.
While improper breathing patterns can create a variety of physiological problems (reduced availability to oxygen, respiratory alkalosis, "anxiety breathing", headaches, and general fatigue, etc.), these poor patterns can also have biomechanical implications as well.
Poor thoracic spine movement, increased forward head posture as accessory breathing muscles (SCM, scalanes, Upper traps) take over, altered shoulder function and scapular position/mechanics, increased tone of the erector spinae muscles and decreased pelvic floor strength leading to potential instability at the lumbar spine.
Do those issues describe a lot of your clients?
Poor Breathing and Implications to the Deep Front Line
Looking at the deep front line alone, poor breathing will have a negative effect on the entire line and especially on the four muscles I highlighted earlier - Posterior tibialis, Psoas, Diaphragm, and Scalenes.
When the diaphragm does not function properly and the client is an upper chest breather, the scalenes are one of the accessory muscles that take over to assist in normal respiration. These muscles can become hypertonic and develop trigger points that can refer symptoms similar to thoracic outlet syndrome, carpal tunnel syndrome, as well as aches/pains in the upper back (near the medial border of the scapula).
In an upper chest breathing pattern, the diaphragm does not move downward (think belly breathing), casuing the erector spinae to become hypertonic. This will often cause the client to become hyperlordotic, as there is increased tone at the thoracolumbar junction and the lower ribs are pointing upwards rather than remaining in a more caudad position.
Hyperlordosis is a common pattern we see in clients, and the increased tone in the erector spinae muscles will often lead to increased tension in the lower back, as well as an anterior pelvic tilt, which Janda termed Lower-crossed Syndrome. In lower-crossed syndrome there is decreased room for the diaphragm to move downward during proper breathing (diaphragmatic or belly breathing) as well as hypertonic hip flexors and weak/inhibited glutes.
The Diaphragm, Psoas, and Quadratus lumborum (QL) share a fascial connection at the lumbar vertebrae. When proper diaphragmatic breathing is not observed, these muscles are prone to disuse, weakness and trigger point development - all of which can play a role in back and hip pain.
It is also interesting to note that in the deep front line as Myers approaches the Psoas, he gives the option to take this line in a more medial direction upwards (as I laid out earlier in the article), or you can go from the psoas, to the iliacus, to the QL, which then takes us to the 12th vertebrae/rib and moves us upwards medially from there. So, the QL can be part of the deep front line as well.
Finally, in the a hyperlodtic posture, the anterior tilt of the pelvis will have an effect on the entire lower-extremity, as increased anterior tilt will often lead to greater pronation of the foot, causing the client to present with flat feet.
In over-pronation, the posterior tibialis is being put on a greater stretch (as the posterior tibialis helps to supinate the foot and is an antagonist to the peroneals, which pronate the foot). This flat foot posture could create trigger points to develop in the posterior tibialis as well as other foot and lower leg issues such as plantar fascitis (although over-supination has been shown to create this problem as well) and shin splints or medial tibial stress syndrome.
Additionally, an anterior pelvic tilt and forward head posture, as common in those with an upper chest breathing pattern, will create an anterior weight shift to the entire body. This causes the plantar flexors - gastrocnemius and soleus - to become tight, as they need to work overtime, pushing into the ground, to ensure that we don't fall over forward. Hypertonic plantar flexors can inhibit ankle dorsiflexion, which will cause the individual to turn their foot outward (externally rotate) and pronate to a greater extent in order to obtain the needed dorsiflexion (or fake dorsiflexion) for gait.
What Do We Do?!?!
Teaching clients to breath properly should be a component of every training program and now that we have all the nerdy stuff out of the way, here are a few ways to assess diaphragmatic breathing, re-teach it, and (if you are licensed to perform manual therapy) some soft tissue techniques for the diaphragm, psoas, and iliacus.
Breathing Assessment
Breathing Corrections Part 1
Breathing Corrections Part 2
Diaphragm Soft Tissue Techniques
Psoas & Iliacus Soft Tissue Techniques
Conclusions
The deep front line plays a major role in unlocking our overall ability to move properly. The diaphragm is a large component of the deep front line and should not be overlooked in our client assessment and training programs.
Much like rolling the plantar fascia to improve function of the superficial back line; ensuring that the client is observing proper breathing patterns can be helpful in improving the function of the deep front line, decreasing the tone of hypertonic muscles, and increasing core strength and stability.
Hopefully you find the assessments and techniques in this article useful for observing and improving your clients breathing patterns and function.
Author Bio
Patrick Ward holds a Masters Degree in Exercise Science and is the founder of Optimum Sports Performance. He is a Certified Strength and Conditioning Specialist (CSCS) through the National Strength and Conditioning Association (NSCA), a Certified Personal Trainer (CPT) and Performance Enhancement Specialist (PES) through National Academy of Sports Medicine (NASM), and a USA Weightlifting-Certified Club Coach.
In addition, Patrick holds a diploma in massage therapy and is currently licensed in the state of Arizona (LMT #12232). He specializes in clinical, therapeutic and sports massage, is certified In Neuromuscular Therapy, and has taken courses in Active Release Technique.
Patrick's professional experience working with a diverse clientele ranges from training for general health, to rehabilitation, to athletes who want to take their abilities to the next level. Patrick has served as a strength and conditioning consultant for various athletes of all ages and status.
Comments on This Entry
Posted by Min at 11:44AM on June 04, 2010
This is awesome stuff! One of my goals for the end of this year is to finish Myers' book and finish watching the lecture DVDs. Wish I can be in Providence this weekend and hear him speak :(
Posted by Mark Young at 01:13PM on June 04, 2010
Great post Patrick!
Thanks for highlighting Patrick's work Mike. He's a wicked smart dude.
Posted by Patrick Ward at 05:36PM on June 04, 2010
Thank you for the kind words guys, and thank you Mike for posting the article.
I think the Myers stuff is interesting and has application to what we do in both the weight room and the treatment room. However, I think it is a bit of an oversimplified concept, and there are many more things going on that need to be taken into consideration to gain a full understanding of how this all works together. Most people read Myers work and stop there, but I think we need to look deeper than that as the true connections of the human body are far more vast than just the fascial system.
Patrick
Posted by Ernie O\'Malley at 11:55AM on June 05, 2010
Wow! This is brilliant stuff! Thanks for writing this, Patrick, and thanks for sharing, Mike! Patrick seems to know his stuff very well! Would be great to have more people like you guys in europe! Or maybe we have, but I don't know where they are?
You should defo get him on the podcast! Curious to find out more about his work!
thanks again.
Ernie
Posted by Patrick Ward at 03:39PM on June 05, 2010
Ernie,
Thank you so much for your kind words. I am glad you found the article useful.
Patrick
Posted by Anders Edberg at 06:55PM on June 05, 2010
Patrick,
It's great to see Mike leveraging your knowledge by having a guest post from you. I have been following your blog and articles for some time now, and I am routinely amazed at your knowledge base and insight, fully realizing that the stuff I've been privy to is likely barely scratching the surface of what you know and bring to the table. Of course it is remarkably humbling following some of your work, as it reminds me just how little I know! Thank you for being one of those expert who is always so willing to generously share some of what you know. It is a privilege to be exposed to it.
I do have one question regarding the techniques you demonstrated for the diaphragm, iliacus, and psoas. Is it at all possible for a person to execute a "poor man's" version on himself for times when treatment by a pro isn't available? Or would it simply not be very effective (if not entirely out of the question)?
Posted by Anders Edberg at 07:05PM on June 05, 2010
Patrick,
It's great to see Mike leveraging your knowledge by having a guest post from you. I have been following your blog and articles for some time now, and I am routinely amazed at your knowledge base and insight, fully realizing that the stuff I've been privy to is likely barely scratching the surface of what you know and bring to the table. Of course it is remarkably humbling following some of your work, as it reminds me just how little I know! Thank you for being one of those expert who is always so willing to generously share some of what you know. It is a privilege to be exposed to it.
I do have one question regarding the techniques you demonstrated for the diaphragm, iliacus, and psoas. Is it at all possible for a person to execute a "poor man's" version on himself for times when treatment by a pro isn't available? Or would it simply not be very effective (if not entirely out of the question)?
Posted by Patrick Ward at 08:22PM on June 05, 2010
Anders,
Thank you for the support and wonderful feedback.
Regarding your question, yes, you can do self treatment of the diaphragm. You would want to do it seated, so that the hips are flexed, decreasing the tension in the abdominal region. Use one hand and reach under the last rib that you feel. From there, you can sort of hunch yourself over a little bit to help get the fingers a little deeper. Don't force yourself and don't try it if it is really painfully. Additionally, you should know that there are several contraindications to doing diaphragm work, so if you are going to do it on yourself, you want to make sure you in the clear. Contraindications include - liver disease, hepatitis, kidney disease, recently broken ribs or damaged costal cartalige, a recent surgery, and obviously if you are prengant you would be doing this.
Hope that helps!
Patrick
Posted by Mike Robertson at 05:38AM on June 06, 2010
Everyone -
Thanks for taking the time to comment, and I will definitely try and get Patrick on the Podcast ASAP. He's a great resource and someone that all of us can learn from!
MR
Posted by Bret Contreras at 01:05PM on June 08, 2010
Great videos Patrick and Carson! I agree with you Patrick; people need to go deeper than just looking at the myofascial meridians. Good stuff!
Posted by Patrick Ward at 01:07PM on June 08, 2010
Thank you, Bret.
You are correct. There is a lot of stuff to think about and consider besides just fascia. I have notes all over my apartment now looking at all kinds of connections. My head feels like it is going to explode!
Patrick
Posted by Bret Contreras at 01:07PM on June 08, 2010
Great videos Patrick and Carson! I agree with you Patrick; people need to go deeper than just looking at the myofascial meridians. Good stuff!
Posted by erica at 06:36PM on June 28, 2010
thought this was great reading. i am seeing a massage therapist who practises myer's work of fascial trains and has made wonders on me. after suffing a lifting injury as a nurse 9 years ago.. my next line she will be working is deep front line and after reading your blog i'm sure this is my major issue. thanks so much!!
Posted by Patrick Ward at 09:09PM on June 28, 2010
Thank you, Eric. I am glad you enjoyed the blog and I am happy that you are getting some quality work.
If possible, do you think you could email me your therapists information, or maybe have her email me - patrick@optimumsportsperformance.com - I am always looking for therapists to put into my network, as I frequently get asked for referrals all over the country, and I hate when I can't help someone because I don't know anyone in their area.
Thank you,
Patrick
Posted by John Elway at 08:10PM on July 18, 2010
Hi Patrick,
Awesome write up! I was wondering, is diaphragmatic breathing something we should be doing at rest, or during activities as well? Thanks!
Posted by Patrick Ward at 06:07AM on July 19, 2010
Hello John,
Thanks for your question. I typically program some specific breathing work prior to our warm up. Then, I want to see that the individual can control their breathing through the warm up, and not loose it and go into a poor pattern. So, we stop the reps in the warm up if proper breathing is lost and then move onto the next warm up activity, or rest, re-group, and repeat. The goal is to build it in so that it becomes automatic and they can maintain proper breathing during their workout.
Thanks,
Patrick
Posted by John Elway at 03:10PM on July 19, 2010
Thanks for the reply Patrick.
I am also wondering how diaphragmatic breathing would integrate with an abdominal brace given that a brace would seem to restrict the ability of the diaphragm to expand. Thoughts?
Also, could you recommend a book that pertains to diaphragmatic breathing and exercise/movement?
Thanks again!
Posted by Patrick Ward at 03:22PM on July 19, 2010
John,
The goal is to learn how to breath and brace. The brace should not impede your bracing abilities - this often happens when people try to draw in, as it doesn't allow the diaphgram to move caudally. The brace should happen overtop the breath and it just takes a little practice and cueing to be able to get it down, but it isn't that hard to learn. Just practice, and remember to not just practice lying on the ground, but moving into quadraped, half kneeling, standing, and then during functional movement.
A great book on the topic is by Leon Chaitow, Breathing Pattern Disorders. I highly recommend checking it out.
Patrick
Posted by Mike Robertson at 05:40AM on July 20, 2010
I'm picking that one up for myself - great find Patrick!
MR