Client Core Habit: Move Well #1

Live In Neutral Alignment

Question: Is My Hip Alignment Neutral?
How To Know You’ve Done This: Have a coach check your Adduction Drop Test
How Often To Check: Daily until neutral. Once a quarter once you’ve gotten neutral.
Master the self check and self reposition


“Do you think it's connected?” Marley asked curiously. Although she had come in for low back pain, Marley had just told me about some lingering knee pain, shoulder pain, and neck pain. “Oh! And sometimes my back hurts between the shoulder blades!” She added, scrunching her arm awkwardly to try to point behind her back. 


“Yes,” I confirmed, “and you can relax your arm, I know exactly what spot you’re referring to!”


As physical therapists, we are trained to assess and treat virtually every joint in the human body. This is good, because every patient we see has unique pain and symptoms. However, there are a few root patterns that lurk behind nearly ALL of the different impairments we see. Like many of our patients intuitively guess, it's rare that multiple symptoms are unrelated (the exception would be if someone came in with low back pain, leg pain, and a rabid looking chihuahua latched onto their leg in a death grip. That person’s back pain and leg pain would be unrelated, well, unless a second chihuahua was hidden beneath their shirt…).


How are most symptoms related? It all has to do with the asymmetries present in every human being. The two major sources of asymmetry in the human design are the internal organs and the hemispheres of the brain. Think about the last time you sang the national anthem or said the pledge. You put your right hand over your left chest because that is where your heart is! And it’s not just the heart, most of our internal organs are asymmetrical, including the liver, lungs, stomach, and digestive tracts. These organs have different shapes, weights, and connections to the rest of the body. In the brain, the left hemisphere tends to be better at analytical and precision tasks, while the right hemisphere is better at creativity and artistic functions. Since the hemispheres control the motor function of the opposite half of the body, muscles on the right side of the body tend to be more controlled and dominant than the left (this is why most people are right handed). 


Before we say anything else, it is important to point out that this asymmetry is a good thing! It allows us a greater variety of skills and allows us to adapt to many different environments and activities. Much like a car needs to be able to turn right and left, our asymmetries allow us to navigate life’s many roads. But what happens when we lose the ability to turn one direction? They say two wrongs don’t make a right… but will three lefts? 


Over the course of our life we face many stressful, demanding situations. As children we are more flexible in our approach to problem solving and will try many different methods of accomplishing the same task. The older we get, the more we tend to utilize only the path of least resistance. As crazy as it sounds, the way we pattern our movement on a day to day basis becomes so dominant that it is the functional equivalent of making three lefts to turn right! Not only is it inefficient, it causes uneven wear on our bodies in a predictable pattern. 


Indeed, it is this very pattern that is behind nearly every impairment and pain problem our clients face (besides the occasional rabid chihuahua, of course). And it is correcting this pattern that leads to extraordinary outcomes compared to many traditional medical approaches. The solution is to restore a child-like flexibility in approaching different movement tasks; it is restoring the freedom to choose left and right, up and down, forward and back in any combination, at any time. 


So what is the pattern? And how do you correct it? The simplest explanation requires a basic concept of the rib cage and the pelvis. Think of them as two ovals stacked on top of each other. They should be able to rotate, side-bend, and tilt forward and backwards without losing orientation to a neutral center point. The “ribcage oval” positions itself primarily based upon breathing patterns and abdominal activation. The “pelvis oval” positions itself primarily based upon activation in the pelvic floor muscles and weight-bearing patterns (how the body centers weight over the feet). When breathing is stressed, anxious, or in any way chronically labored, the rib oval ends to tilt backwards, flaring in the front. Correcting its alignment has to do with stress management, diaphragmatic breathing, and activation of the side abdominal walls. Similarly, when digestion of food is chronically upset and when weight bearing occurs more towards the front of the foot and legs (or worse, when weight bearing occurs mostly on the tailbone due to excessive sitting), the pelvis tilts forward. Correcting its alignment has to do with improved nutrition and learning how to access muscles on the back of the legs and pelvis when standing and moving. 


To make matters a bit more complicated, there is a second, left and right dimension at play. This has to do with dominance of activity in the arms and legs (such as always writing with the right hand or always kicking a soccer ball with the left foot). It also has to do with the neurological and anatomical asymmetries. For example, the positional opposition of the heart on the left and the liver on the right predisposes the rib cage to greater flare on the left than the right. Finding and practicing left and right neutral requires a keen understanding of one’s body and a lifelong practice of strengthening the less dominant patterns. In a perfect world, this would happen automatically and intuitively, but in our current, stress-filled world it requires training and intention. 


If any of you are Spiderman fans, you might Uncle Ben’s famous line: “With great power comes great responsibility.” Our asymmetries give us an incredible superpower: Adaptation. Think of all the incredible and DIVERSE activities humans are able to practice, from sewing to swing dancing, from cooking to climbing, from writing calligraphy to running marathons. But in order to do all these things without over-using certain parts of our bodies and making them vulnerable to chronic injury, we must find and practice neutrality. 


So, how do we test if our body is in a neutral position? 


At Village, we use a test with our clients called the Adduction Drop Test. It’s a fairly simply test which involves assessing how far back a leg can extend and how far it can drop down to the table or ground while extended. 


If you can’t extend your knee back so that your leg is in line with your body and drop your knee down past the level of your hip, you know your body is holding onto tension and is in a poor position. We call this a positive test as pictured below. 


A Positive Test. Knee at or near level of hip with the hip nearing full extension.

Conversely, if you ARE able to fully extend your hip and drop down to the table, you can infer that your pelvis is in a state of “neutrality”. We call this a negative adduction drop test. 


A Negative Test. Knee drops below hip with hip nearing full extension.

Ok, so what? What’s the big deal about being able to extend your hip back and drop your knee down past the level of your hip? Does it simply mean you are flexible?


It’s much, much bigger and more meaningful than that. A negative adduction drop text indicates that your brain feels stable and secure enough on that side of your body to allow you to access your full range of motion. It means you are not holding onto excess tension and are able to use your body and muscles like you were made to. 


Get to the point where you are negative on both sides and you can be confident that your body is aligned and ready to take on the rigors of lifting weights, running, lifting grandkids, hiking, or simply living life in the 21st century. 

How To Test The Adduction Drop Test Yourself:

  1. Start by laying on your side with your hips and knees bent. 

  2. Lift your top leg up and back. Check if your leg can go all the way back in line with the rest of your body. This is called hip extension. Be conscious of not extending your back. 

  3. Bring your leg back to the start position. 

  4. Next up, we check adduction (the legs ability to drop to the table). 

  5. Lift your leg up and start to bring it back into extension. Drop down to the table. See how far back you can get your leg while still dropping down to the table. Make sure you don’t let your entire pelvis tip down and instead isolate your femur.


Scenario 1: Both sides are tight. Perform exercise number 1. 


Scenario 2: The left is significantly tighter than the right. Perform exercise number 2. 


Keep in mind, this is a very subjective test. It varies person to person based on hip size, coordination, and numerous other factors. 


But, it’s extremely valuable when you use it to compare to yourself. If you feel really tight on the left side, do exercise number 2, and no longer have tightness, you can be confident that you have “repositioned” yourself. Pretty cool!


Live In Neutral

As we go through life as a kid or young adult, we can do, eat, and live in just about any way and bounce back. It’s as if life is a 6 lane highway and nobody else is on the road. You can go back and forth without a problem. But as we age, lanes in that highway start to close down. We get injuries, our bodies ability to process crappy food decreases, and things get stiff and weak. Therefore, it’s imperative that we open any and all possible lanes in the highway. Neutrality may just be one of the easiest lanes to open up. Once you’ve gotten yourself to a position of neutrality, you’ve given yourself another “lane” on the highway of life. 


Continue to check your hip neutrality every month, do the corrective exercises, and reap the benefits!