Dooley Noted: 6/21/2016
Multi-segmental flexion (MSF), otherwise known as a toe touch, is a commonly misunderstood movement pattern that can prove to be quite useful for the study of sagittal plane movement.
Just because someone reaches the toes – it doesn’t make the toe touch ideal.
Within Gray Cook’s SFMA system, one analyzes the MSF in all of its parts:
1. Feet stay planted and approach plantar flexion
2. Knees extend without hyperextending
3. Hips flex to create a sacral 80 degree angle from the floor
4. Lumbar, thoracic, and cervical spines load share to flex, without one dominating movement
5. Shoulders avoid hiking to stay relaxed on protraction to reach the toes
The key to a healthy MSF is proper load sharing between the parts 1-5.
Some common mistakes:
1. Toe lift: showing anterior crural compartment compensation for a lack of abdominal stability and/or a lack of weight shift into the heel.
2. Knee flexion: showing hamstring/gastroc concentric tightness at knee. Other muscles locked short at the knee may include sartorius, gracilis, and popliteus.
3. 81-90 degree sacral angle: eccentrically loaded hamstrings at the hip allow lumbar spine permission not to flex of that motor control is missing.
4. Lumbar extension: erector spinae failing to eccentrically load and permit lumbar flexors to engage.
5. Neck extension: erector spinae and other cervical extensors acting as abdominal stabilizers that also limit more forward movement of body
6. Scapular elevation: compensating for a lack of abdominal stability by reaching with arms
The following includes some case samples we found in a recent NKT study group, which you may use as guides to help improve the MSF:
1. T6 flexion hinge, 90 degree sacral angle
– Compensators to suspect: thoracolumbar erector spinae
– Down-regulated muscles: TVA
2. Neck extension
– Compensators to suspect: cervical erectors, extensors
– Down-regulated muscles: TVA, longus colli
3. T8-12 lack of flexion
– Compensators to suspect: erector spinae at those levels, QL
– Down-regulated muscles: psoas, TVA, IAO, multifidus at those levels
4. Knee flexion, lumbar extension T12-S1
– Compensators to suspect: erector spinae at those levels, hamstrings
– Down-regulated muscles: TVA, multifidus, psoas
5. 90 degree sacral angle, extension of thoracolumbar junction with no flexion of lumbar spine
– Compensators to suspect: Primary – diaphragm, Secondary – iliacus
– Down-regulated muscles: TVA, multifidus, psoas
7. Toe lift, L4-S1 back extension instead of flexion
– Compensators to suspect: hamstrings at knee, lumbar extensors
– Down-regulated muscles: multifidus (esp with toe lift), TVA
Focus on what dominates the MSF, and consider that the load sharing of all parts may be limited by the over activity of one segments of the MSF.
As always, it’s your call.
– Dr. Kathy Dooley