What is the Extension/Compression Stabilizing Strategy?
If you’ve ever attended an Athlete Enhancement course, seen me lecture at a conference, or even talked shop over a cocktail, it’s likely that the topic of the Extension/Compression Stabilizing Strategy (ECSS) came up. That’s because the ECSS is a pathological stabilizing strategy ubiquitous in the strength training profession. It is quite literally impossible to go into a university strength training facility, a CrossFit gym, or Olympic Weightlifting studio (really any gym) without seeing it everywhere. As a compensatory stabilizing strategy, it negatively impacts performance and increases the athlete’s risk of injury…and yet its prevalence is staggering. Today, I want to discuss this pervasive compensatory stabilizing strategy in detail.
Origins of the Extension/Compression Stabilizing Strategy
As you may have guessed, I was not the first to discover this pattern. Truth be told, it is a renaming of a pathological stabilizing strategy that several leading minds in the rehabilitation profession have identified over the years. To the best of my knowledge, it was Vladimir Janda, MD who first identified this pattern way back in 1979, calling it Lower Crossed Syndrome. Himself a medical doctor specializing in musculoskeletal pathology from the now Czech Republic, Dr. Janda is regarded by many as the father of the sensory-motor approach to rehabilitation. He started promoting this paradigm-shifting approach in the 1960’s, nearly 1/2 a century before it caught on the west. Early in his career, Professor Janda was interested in muscles, muscle testing, and muscle function, which lead him to his identification of Lower Crossed Syndrome. Lower Crossed Syndrome is a pathological posture highlighting a consistent pattern wherein the abdominals and hip extensors become inhibited and the hip flexors and spinal extensors become hypertonic.
The second clinician to identify the compensatory stabilizing strategy of focus here is Pavel Kolar, PT. Dr. Kolar is a protege of Professor Janda and the founder of Dynamic Neuromuscular Stabilization (more often referenced as its acronym DNS). Professor Kolar is the first researcher/clinician to spotlight the diaphragm’s roll in stabilization. For Kolar, optimal posture is one which maintains a parallel relationship between the diaphragm and the pelvic floor. A common pathological posture described in every DNS course is one in which the diaphragm and pelvic floor are oblique to each other in the sagittal plane. Dr. Kolar refers to this posture as an Open Scissor Syndrome. In this syndrome, the chest is elevated and the pelvis is anteriorly tilted. While Janda’s Lower Crossed Syndrome appreciates a consistent pattern where some muscles tend towards inhibition and others towards hypertonicity, and impact this has on musculoskeletal pathology, Open Scissor Syndrome appreciates postural positioning and its effect on stabilization.
Finally, Ron Hruska, PT, founder of the Postural Respiration Institute (also known more by its acronym PRI). As with Janda and Kolar, Mr. Hruska described a similar pattern to the Extension/Compression Stabilizing Strategy called the Posterior Extensor Chain….or PEC. PRI is based on the impact structural asymmetry in the body (e.g. the liver being on the right, only having two lobes in the left lung whereas there are three in right) has on movement, function, and pathology. Ron describes several postural syndromes in his writings and courses. PEC is one in which the erector spinae and latissimus dorsi are hyperactive. Because of concomitant inhibition of the abdominal obliques, the pelvis tilts forward, which flares out the Ilia (plural for Ilium…the bone in which the socket of the hip is located). Also secondary to this muscular imbalance, the ribcage becomes elevated. This change in the orientation of the pelvis and ribcage affects the patient’s function, often resulting in pain and/or pathology. Sound familiar?
No doubt other there have been others, but here are three intelligent clinicians all describing a similar postural pattern. Each pattern is slightly different from the others. I have been influenced by each of the aforementioned clinicians. My understanding of what I call an Extension/Compression Stabilizing Strategy is an amalgamation of the postural syndromes described above. Each of the other syndromes highlights different aspects of this postural syndrome. What they do not highlight are the internal focus impacting the spine, which I why I chose the name that I did. I am not implying that Vladimir Janda, Pavel Kolar, and Ron Hruska don’t appreciate the negative impact these forces have on pathology, function, and performance, it’s just that their names for the postural syndrome do not highlight it the extent to which I think they should.
What is an Extension/Compression Stabilizing Strategy?
So what is an Extension/Compression Stabilizing Strategy (ECSS)? The ECSS is when an athlete/patient uses hyperactivity of the para-spinal muscles (erector spinae, quadratus lumborum, etc.) to stabilize the spine in response to insufficient generation of intra-abdominal pressure (IAP). Proper spinal stabilization involves maximal leveraging IAP, whilst using a little activity of the spinal extensors as possible. Generating IAP requires coordinated integration of the diaphragm, the abdominal wall, and pelvic floor. While it is no doubt better on the body, this is a more complex stabilizing strategy than the ECSS, and one of the reasons why the ECSS is so common.
If the athlete is not generating enough IAP to execute a given task, say deadlifting double body weight, the brain has two choice: compensate or don’t compensate. If one chooses the later, then the spine becomes unstable and is subject to acute trauma, in this scenario that acute trauma is loaded flexion of the spine. Inevitably, athletes will choose the former, otherwise they don’t last. In response to the lack of adequate spinal stiffness (secondary to insufficient generation of IAP), the body hyper-activates the spinal extensors (aka the Posterior Chain). This muscle imbalance (more accurately, force imbalance) results in anteversion of the pelvis and elevation of the ribcage, which has a huge impact on pain, function, injury, and performance. Each of the postural syndromes mentioned above describes this. What they do not describe are the internal forces to which the body is subjected when an athlete utilizes this postural syndrome.
Because of the para-spinal muscles’ orientation to the spine, they apply a massive and chronic compression force on the spine which results in its hyperextension and axial compression. These forces negatively impact the athlete’s function, performance, and risk of injury, which will be covered in the subsequent article. What is painfully ironic is that both the rehab and strength training industries intentionally coach this pattern into their patients and athletes - also to be covered in a later article on why is the ECSS so prevalent.
For now, look around, observe your athletes/patients, and watch just how insanely common the ECSS truly is. More on why and the negative impact this pattern has on athletes later.
- Dr. Richard Ulm
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