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3.7 Causes of OP: The balance and coordination system

1. Osteitis Pubis: an introduction
1.1 Symptoms and Stages of Osteitis Pubis
1.2 OP Diagnosis guide
1.25 Should I get a MRI/CT/Xray scan for OP?
2.0 Overworked Adductors: The true cause of OP
2.1 Rest: The worst treatment for OP
2.2 OP mechanics in detail
3.0 Faulty firing patterns: Weaknesses that cause OP
3.1 The Deep Front Line
3.2 Causes of OP: Weak arches
3.3 Causes of OP: Weak glutes
3.4 Causes of OP: Poor core activation
3.5 Causes of OP: Dysfunctional pelvic floor and Sacroilliac Joint
3.6 Causes of OP: Dysfunctional oblique chains
3.7 Causes of OP: The balance and coordination system

Refresh your learning:

  • OP is caused by the overload of your adductors due to dysfunction of the Deep Front Line.

  • The Deep Front Line (DFL) is the foundation of your body, responsible for the stability and alignment of your entire body.

  • The DFL relies on 6 biomechanical/functional systems (arches, glutes, core, SIJ/Pelvic Floor, Oblique Chains, Balance).

  • When the DFL is functioning well our body is held within its central axis or Centre of Gravity (COG).

  • Within our COG all the major joints are in alignment and each joint helps support the load of the body.

  • Without the support of our DFL the body will recruit other individual areas, such as the adductors, to help compensate for the lack of support.

There is one last system that helps coordinate and control all the muscles and joints in our body, balancing the activation and role of the 6 functional systems with the DFL. This system is our balance (proprioceptive) system and it is extremely compromised in OP patients.



Of all our senses, our sense of balance is the most ignored. Yet it is a vital part of every decision and movement we make. Think of a simple action like ‘walking to your car’. This one action involves thousands upon thousands of calculations and decisions that coordinate every square inch of your body with every piece of information from every sense organ (eyes, ears etc.) in your body. Your ‘sense of balance’ is not as simple as you think.


Unlike your eyes and ears, your sense of balance and coordination is not centered in one specific organ. Interoceptors, mechanoreceptors and other balance cells are distributed across your body. This information is sent to an area of the brain. There it is collated and coordinated with information from your other senses (visual, auditory etc.). Let’s call this area of the brain the ‘Master Movement Centre’ (MMC).

The MMC creates a ‘mechanical version of the world’. Your own mathematical genius constantly calculates angles, weight pressure and distances in your subconscious. Using this information you make balanced, coordinated movement decisions so you can navigate your environment safely and avoid physical injury (or simply falling over!).

Behind every action

Most people think of movement in terms of its positive or ‘effector’ part of the movement. ‘I want to walk to the car so I contract leg muscles to get to car’. But this is simply the ‘contraction’ or ‘power’ part of the equation. What about the rest of your body? What about making sure your chest and upper body doesn’t lean over too far and cause you to stumble?

Whenever you make a decision to move, billions of signals are being collected from the cells and senses across your body, and are integrated in the MMC. The MMC calculates and makes the billions of decisions required to complete a simple action like ‘walking to your car’. Some of questions and answers your body/MMC needs to make maintain your balance are:

  • Where is your foot in relation to the ground?

  • What angle is the ground (flat, bumpy etc)?

  • What is the relative strength and weakness of each muscle, i.e. how much can I rely on my calves versus my quads?

  • Where is each joint in relation to each other; how turned in is my knee, how turned out is my pelvis? How will this affect how far I can put my leg out in front of me?

Additionally your brain is preparing for any changes in the environment. It calculates possible changes in direction, what it will need to do if you have to start running in case of emergency.

All these calculations and decisions are occurring under the surface of your conscious brain. It’s a complicated system which, when working well, you have no idea is there. You just decide that you want to do something and your movement and balance system accommodates, making billions of calculations to get you there.

Unfortunately when you start to develop OP you don’t think about your balance (proprioceptive) system. You think about your broken adductors, or weak core. You don’t consider the larger issue at play. The system controlling your adductors and core is making bad decisions.


Fortunately most OP patients are aware that their balance is horrible! You don’t move with grace. OP patients describe their own movements as clunky and clumsy. This is because most OP patients have an extremely dysfunctional balance system.

Balance, coordination and moving with your Centre of Gravity, it always comes back to the Deep Front Line.

When your balance system is functioning well, your body plans coordinated movements. Your MMC collects all the relevant data from the balance receptors and senses across the body. Integrating, calculating and making efficient ‘safe’ movement decisions.


Your MMC uses all this data and processing to move efficiently within the DFL/COG. An efficient balance system creates an efficient balanced squat.

  • The knee bends at an angle which takes advantage of the position of the foot.

  • With the knee aligned over the foot the lower leg is balanced and stable

  • The hip and pelvis focus on balancing the upper torso in alignment with the lower body.


Everything is working together, each joint moving in consideration of the other thanks to the great communication and integration provided by the balance (proprioceptive) system.

OP = bad balance processing!

This isn’t happening for OP patients. They do not coordinate and integrate their balance information well. The data they collect and its processing is poor. Their MMC fails to plan their movements to take advantage of their DFL/COG.

Muscular bracing: every man (or joint) for himself!

Moving outside of the DFL joints and tissues are exposed, unstable and unprotected from injury. In reaction the muscles around these joints brace. It’s an ‘every man for himself’ situation. The muscles around the knee are only interested in protecting the knee. The muscles around your ankle/foot focus on protecting the foot. No one is talking or helping each other. At times they might even fight each other.

This is why we see problems such as knee tracking issues. The muscles in the knee contract at different times, fighting each other as they fail to communicate and fail to create smooth movement for the kneecap.

Bracing burns you out

This bracing is tiring to the body. Whilst fascia can operate all day, muscles fatigue. They create lactic acid, develop trigger points and wear down. In the case of OP this is very obvious in the adductors. The combined weakness across the other 5 functional systems puts an unfair burden on the adductors and the poor balance system prevents the adductors from being used efficiently.

It’s a recipe for severe burnout and OP is the result!


It should be really really clear by now why isolation strength training will not work. You need your whole body to work together. You need your MMC to improve its ability to calculate, integrate and process the balance and sensory information from around the body to let you move efficiently and safely within your DFL.

Whole body functional rehab forces your balance system to do this. The very nature of the functional exercises makes it impossible to complete good form without a strong, efficient and balanced body.

Consider an exercise like the 180° ball slam (stage 8).

  • Arches give proper foot activation to stabilize your entire body and maintain a secure foundation as you rotate into the slam.

  • Glutes stabilize the hip joint (pelvic and hip stabilizers) and power you into a standing position (glut max).

  • Core stabilizes your spine and makes sure you don’t compress your discs through the movement (deep core). It unlocks the SIJ to allow for the rotation in a split leg position (Transverse abdominis and superficial core).

  • Oblique chains help power the rotation and help stabilize the pelvis and rib cage during the most powerful/dangerous parts of the movement.

  • Balance system connects, coordinates and ties all these systems together to work synergistically to complete an efficient, powerful ball slam.


Dysfunction in any of these systems will lead to an unbalanced, uncoordinated and … damn right …dangerous ball slam, especially as the weight of the ball increases. Isolated strength training only ‘isolates’ the function of each muscle, disconnecting each joint and essentially reinforcing the very habit that is causing your OP.

The balance system needs stimulation through the whole body, functional movement which challenges you to coordinate your whole body.

10 stage protocol: specific balance work included

It’s important that balance work progression happens in the right order. If you jump on balance pads in Stage 1 it will only serve to exacerbate your OP as your body would use your adductors to brace to keep balance. Your balance system needs to connect and integrate with your DFL, not fight against it.

Different stages of the 10 stage protocol include balance/proprioceptive work. Balance work is integrated at key moments of your rehabilitation, specifically planned to integrate the other 5 functional systems through the balance system.

The use of plyometrics, multiplane ballistic movements, balance pads, rolla bollas and other specialized equipment will ensure that you challenge and strengthen your entire balance system.


With a strong, functional balance system your body is ready for any emergency and any movement problem it faces. You will instinctively, automatically know how to move and position your body to safely control and balance yourself. Rather than simply slamming the load into your adductors, you will distribute load evenly across your body in every situation, no matter how challenging.

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