Key Concepts: The inverted "T"

1. Aim

To introduce the inverted "T" and to explain its importance in fundamental human movement.

2. Intended Audience

The general public.

3. Key Points

• Extension over flexion
• Must learn to be relaxed into extension
• Extension patterns are for performance, flexion patterns are for protection
• The inverted "T" creates the foundation for all other structures to work from. Without it you will use compensations to achieve the movements required in your chosen activities.

4. Introduction

So this is a concept I have developed over the last 5-10 years after working with professional/aspiring athletes alike and backed up by my own studies into human movement and development. It became clear that those with a strong inverted "T" were more athletic in their movement and got less injuries. So here it is!

5. A little bit of background

Traditionally when talking about the skeleton in terms of academics, we break it into axial and appendicular. 

Source: https://anatomyinfo.com/appendicular-skeleton/

This is fine for studying the skeletal anatomy but for understanding function it isn't really ideal. In reality muscles, nerves, nerve sheaths, fascias, tendons and ligaments link different parts of the body creating global movements but also creating smaller subunits through out the body that work individually or with other subunits. This is often done through force couples - see my last post Movement Hacks - 4 easy ways to decrease back pain - muscles working in concert to bring about the same movement at a joint or joints. Pelvic stability in the sagittal plane (looking at you from the side) for example occurs by force coupling your abdominals (pulling the pelvis up at the front) with hamstrings (pulling the pelvis down at the back) and your lower back muscles (pulling up at the back) with your hip flexors (pulling down at the front). When the body and brain gets this wrong you get something termed lower cross syndrome, with weak abs and glutes and over active or tight hip flexors and lower back muscles.

Schematic showing how different force couples around the pelvis can create anterior and posterior tilt.

These muscles not only have to work with the muscles in their force couple but they must also counter the opposite force couple, to maintain a balanced pelvis. As if that is not enough, all of these muscles will have a role to play in other force couples and antagonistic pairings (this is when one muscle contracts another relaxes to allow the movement). The point I'm making is that it is an integrated system working on global patterns of movement co-ordinated by your HQ (the brain). 

So when we look at global patterns there are two big ones. Global extension and global flexion.

Global flexion is protection, nurture, unsure of yourself, submissive, being safe, small and cosy. There is some evidence to suggest that sleeping in the fetal position for example is associated with anxiety and a stress response. From a body language perspective we can all picture someone who is cowering, crouching down in a non-threatening manner, to show submissiveness. 

Global flexion patterns

Source: http://boringoldwhiteguy.blogspot.com/2016/11/still-in-fetal-position.html

Global flexion/extension patterns are visible in most animals. Here a fearful dog cowers in global flexion

Source: https://www.pinterest.com/pin/9148005470132477/

Global extension on the other hand is associated with confidence, strength, power and leadership. It can at times be misconstrue by onlookers as cocky and arrogant or even internalised by the individual as such. The fact is you can assume correct extended posture without being cocky or arrogant. But this is getting slightly off topic. The point is, out of the two postures below, which looks more confident, strong, assertive and ready for action? If you were designated a team captain, who would you choose for your touch rugby side?

Source: https://purelyeasy.com/good-posture-benefits-your-health-and-self-confidence/

Quite clearly the lass on the right. Guess what? She has better extension patterns then the image on the left. Below is a picture of people celebrating taking a wicket in cricket. This "star jump" type pattern that we move into is universal through out people of all cultures and backgrounds. It is also proven to be innate and not a copied behaviour learnt from others. People who are born blind will still celebrate by shooting their hands up into the air, despite never having seen this pattern of movement.

Global extension patterns

Source: https://www.quora.com/What-are-some-of-the-interesting-rules-of-cricket-that-fans-don’t-know

The muscles involved in global extension are all the most powerful muscles in the body. Calfs, quads, glutes, erector spinae (back muscles). Flexion muscles, however, are far weaker by comparison. They can still create lots of force by training them up, but they have nothing like the potential output of the extensors. So we need to make sure we can effectively access extension patterns if we are talking about moving around with any purpose. This doesn't only mean running and playing sports. Even walking we need to have strong extension patterns.

6. So what is the inverted "T"

The Inverted "T"

Source: Adapted from - https://www.pinterest.com/pin/695524736179793139/

The Inverted "T"

Fundamentally it includes all the dorsal (back) and hip structures but these are the key ones.

• Transversospinalis muscles - rotatores, multifidus and semispinalis
• Erector Spinae
• Latissimus Dorsi
• Quadratus Lumborum
• Glute medius and minimus
• Glute maximus 
• Internal/External hip rotators
• Iliolumbar Ligament
• Sacrotuberous Ligaments

Source: https://www.pinterest.dk/pin/354165958170125112/

This inverted "T" creates the base for all other movements to occur from. Without a strong and stable inverted "T" all other movements become compromised. To achieve a strong and balanced inverted "T" requires a primary focus on extension patterns both in our training and in our daily lives.

It must be said that a primarily extension driven approach does raise concern for some. This is due to the effects on our nervous system. There are various subsystems with in our nervous system that take on different roles. Two of the major subsystems being the parasympathetic and sympathetic nervous systems. The general understanding of these two systems has long been held that they oppose each other with the parasympathetic system being responsible for slowing things down, rest and digestion and the sympathetic system being responsible for speeding things up, in particular the "fight, flight or freeze" response (1). This means that the sympathetic nervous system has been associated with big large extension patterns to help you explode into running away or throwing a punch etc. But it also means it has been associated with stress responses. So extension patterns became synonymous with stress responses. For example, think about if something takes you by surprise and makes you alert. You tend to stiffen up,  grow tall, take a short sharp breath in and hold it for a second or two. I like to call it "meerkating". These are primarily extension patterns. So there is some truth to this link up between extension, stress response and the sympathetic nervous system, but it doesn't give the whole picture. For a start, recent research into the sympathetic and parasympathetic nervous systems shows that it is far more complex and integrated then simply speed up (excitatory) and slow down(inhibitory), with both systems being involved in both excitatory and inhibitory processes (1). So extension patterns only have a part to play in stress responses not the sole cause of them. It must also be pointed out that although we have discussed at length about global extension and flexion patterns, the Inverted "T" is actually about central extension, not global. 

Let''s go back our analogy where you get taken by surprise. You may stiffen your back muscles and take a breath but you may also use flexion patterns to raise your arms to cover your face or assume a semi-squatted position, ready to move from your current position. Well these all require a co-ordinated response utilising flexion and extension patterns. 

So all these actions we have mentioned above are reflexive actions, which are important to understand but the inverted "T"concept is more concerned with general postural control, which is very different. So the idea that encouraging extension patterns in a individual is in someway encouraging a stress response just isn't the case. We need to get comfortable in extension patterns but being relaxed at the same time. This comes through corrective exercises. The two most critical points here are 1. ensuring relaxed breathing during extension patterns and 2. balanced extension patterns left and right. When they extend, most people will breath in and then hold their breath during the movement. Sometimes the hold will come at the end of the exhalation. Regardless of where the breath hold happens, this is nearly always because they lack stability in their backs and use their diaphragms to try and aid stability by pressing down into the abdominal cavity and increasing pressure from the inside. This action is acceptable when lifting maximally - i.e. the heaviest weight you can lift in a deadlift or squat for 1-2 reps - effectively in extremis and is understandable. You need every bit of strength and stability your body can muster to lift such loads. The problem arises when people do this subconsciously as the "go to" strategy for all movements, even at sub-maximal loads. It is not uncommon for people to hold their breath just to bend down and put their socks on! If this is you its a recipe for disaster and needs correcting. 

The second point was balancing the inverted "T" left and right. This is critical in order for the inverted "T" concept to work. Effectively the inverted "T" is a lot like a keel on a wooden boat. With out a structurally sound and balanced keel, then everything else attaching to and working from it, will be sub-optimal and/or fall apart. Likewise, if some of the ribs on the right hand side of the keel were slightly shorter or weaker then the ribs on the left, then they will create imbalances and weakness through out the foundations of the boat. Pretty simple when you think about it but often this most basic and intuitive of ideas gets over looked. This is why single limb exercises are so important - see my post Go single early - the importance of unilateral work

Keel in a boat with the frame attaching to it

Source: https://roeboats.com/2010/06/01/roeboats-at-the-ilen-framing-out-and-baltimore-wooden-boat-festival/

We need to teach ourselves how to relax into global extension. We need to disconnect the posture from fight or flight. We can do that by getting comfortable in global extension in daily life.

5. Summary

Create a strong inverted "T" but first and foremost ensure it is balanced before loading it. With a stable, balanced and strong inverted "T" your body is ready to face whatever movement challenges you place on it. Without it, your injury risk increases and your performance diminishes. Even if you are not partaking in any physical activities, having a functional inverted "T" is part of the foundation of human movement and will improve the quality of your daily life, preventing/treating back pain on the way.

Any questions, feel free to comment and I will reply as soon as I can. I am continuing to write about the concepts and techniques i have developed over the next few posts so stay tuned for more. However if you have any specific questions related to fitness, training or rehabilitation get in touch and will either write a post on it or reply in the comments. 

All the best

References

1. Malpas S. Sympathetic Nervous System Overactivity and Its Role in the Development of Cardiovascular Disease. Physiological Reviews 2010;90:513-557. doi:10.1152/physrev.00007.2009