Finding the Weak Key Link

Kinetic Chain Assessment

By Erik Dalton
[Myoskeletal Alignment Techniques]

Manual and movement therapy blogs are abuzz touting the importance of thoracic spine (t-spine) mobility, as if it were a new discovery. But is it? Structural integration innovator Ida Rolf determined the effectiveness of her work could be enhanced by first freeing the rib cage, chest wall, and diaphragm. Similarly, another great educator, Philip Greenman, DO, dedicated two chapters in his textbook Principles of Manual Medicine to assessment and treatment of t-spine and rib cage mobility issues.1 So why is this suddenly a hot topic? Simply put: kinetic chain awareness.

Therapists are rediscovering how lack of movement in one area negatively affects function in adjoining tissues, and how the neuromyoskeletal system distributes abnormal tensions via kinetic chains. Everything in the body is linked, says sports-movement guru Gray Cook: “You can’t remove a major link from the chain without seriously impeding performance.” Our joints, limbs, and muscles represent a collection of fascially bound structures designed to manipulate objects and propel us through three-dimensional space. Because all segments of the kinetic chain require differing degrees of mobility and stability, it is essential that we assess all major junctions independently.

For instance, during gait evaluation, it’s easy to visualize how lack of ankle mobility may affect knee function, or how an adhesive hip capsule could cause pelvic bowl compensations that destabilize a sacroiliac joint or the low back. However, confusion often arises when one observes the t-spine and rib cage. Although the t-spine has twice the rotational capacity of the lumbar spine, it is sometimes hard to imagine this sturdy-looking structure being very flexible.

The Problem
T-spine hypomobility has become so commonly accepted in our society that people rarely notice they have a problem. Nearly everyone slumps when sitting, and few perform the types of exercises that require a full range of spinal motion. Those who spend hours at computers sacrifice t-spine mobility for stability, as joint and ligament proprioceptors designed to inform the brain where it is in space become lazy. Conversation between body and brain grows difficult and unreliable. Eventually, coordination, balance, and movement become limited and painful.
When you shoot a rubber band, it will be propelled a greater distance the farther back it is pulled. Similarly, the greater your myoskeletal mobility, the greater your range of motion, and the more tension (and therefore power) you’ll be able to generate. This particularly applies to competitive athletes.

Strength without the ability to move freely is pointless. Any compound movement requiring precision and communication between connective tissue, joints, and the brain will be more difficult, and the risk of injury—or reinjury—that much higher. Power, output, and speed are all compromised by reduced joint mobility.   

Breathing as a Mobilizer   
It’s virtually impossible to overstate the influence of breathing on t-spine mobility and postural stability. The diaphragm, abdominals, and accessory respiratory muscles produce upward of 21,000 breaths a day.2  With a strong, freely moving diaphragm serving as the primary muscle for respiration, auxiliary muscles are able to remain soft and relaxed. However, many clients with upper t-spine restrictions (such as a dowager’s hump) breathe primarily with the scalenes and upper scapular fixators.

A weakened diaphragm causes increased resting tone in upper rib cage muscles such as the scalenes, upper trapezius, levator scapula, and pectorals. This common muscle imbalance pattern creates shoulder girdle protraction, forward head carriage, decreased lumbar lordosis, and possible rotator cuff impingement due to glenohumeral joint decentration.3 Forward head posture may result in significant suboccipital and cervicothoracic pain, as these areas are now asked to bear excessive loads to compensate for the hyperkyphotic t-spine.

An often overlooked way of relieving nagging neck, shoulder, or low-back pain is to improve mid-back mobility. In Image 3, I demonstrate a rib-lifting release for the intercostal muscles and thoracolumbar fascia. This soft-tissue stretch helps create space between the rib cage and pelvic girdle. To activate an inhibited diaphragm, a webbing technique combined with client-assisted respiration helps open the costal arch myofascia, while mobilizing the rib cage.     

The body does what is easy, not always what is best. As we age and the thoracic spine stiffens, we compensate by over-rotating the neck and low back, sending shock waves throughout the kinetic chain. Bodywork historians have recognized one of the keys to relieving low-back, neck, and shoulder pain resides in improved t-spine mobility and kinetic chain awareness. It is exciting to witness this missing link return to the forefront of discussion. Hopefully, the epidemic of musculoskeletal problems among baby boomers will spawn additional research into kinetic chain compensations. Our clients will reap the benefits as these modern movement assessments are integrated into daily practice.

1. Philip E. Greenman, Principles of Manual Medicine (Baltimore, Maryland: Lippincott Williams & Wilkins, 2003): 229–307.
2. Lauralee Sherwood, Fundamentals of Physiology: A Human Perspective (Independence, Kentucky: Thomson Brooks/Cole, 2006).
3. Craig Liebenson, ed., Rehabilitation of the Spine: A Practitioner’s Manual, 2nd ed. (Baltimore, Maryland: Lippincott Williams & Wilkins, 2007).

Erik Dalton is the executive director of the Freedom from Pain Institute. Educated in massage, osteopathy, and Rolfing, Dalton has maintained a practice in Oklahoma City, Oklahoma, for more than three decades. For more information, visit

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