Refresh your learning:
- Osteitis Pubis is caused by your adductors being overused and overworking. Chronic overuse leads to their degeneration.
- Your personal biomechanics, the ways that you fire your muscles/move your joints lead to the OP mechanics (hip drop, pronation, anterior pelvic tilt, locked SIJ and knocked knees) that lead to OP. Your personal biomechanics must be corrected to correct these conditions and therefore stop overloading your adductors.
- The Deep Front Line (DFL) is the foundation of your body. It stabilises and aligns you. The DFL relies on 6 functional systems (arches, glutes, core, SIJ/Pelvic Floor, Oblique Chains, Balance).
- Dysfunction/lack of coordination in and between these 6 functional systems leads to the poor OP mechanics that cause OP.
6 functional systems which fail in OP
OP patients exhibit weakness, dysfunction and a lack of coordination in the 6 functional systems listed above (glutes, core, arches, SIJ/Pelvic floor, Oblique chains and balance). These dysfunctional systems cause the body to move poorly using OP mechanics that overload the adductors and lead to OP.
Deep Front Line (DFL) and the 6 functional systems: strong together, weak apart
The DFL connects and coordinates these 6 functional systems. All of the 6 functional systems are part of or linked to the DFL. Each individual system relies on the activation/strength and assistance of the other 5 systems. This is why the OP mechanics are so interconnected. They are interdependent, that is, the strength of each system is augmented/amplified by the contraction and activation of the other systems. Weakness in one system will contribute/lead to weakness in another system.
An issue such as over pronation is caused primarily by weakness in the arches. However your arch system may not able to fire correctly because your dysfunctional core is operating with faulty firing patterns. It is all connected.
You cannot simply remove/strengthen one part and expect it to fit back together with the rest. You have to strengthen the entire body together, through functional, whole body rehab.
The Deep Front Line: the web that connects them all
The DFL is a Web
Consider the DFL a web, a long set of interconnected muscles and fascia. When you pull on one part of the web it communicates with and changes the entire structure. This allows load to be evenly distributed through the entire DFL rather than isolated in one area (such as the adductors). A functional DFL allows load to be dissipated across the entire body, from head to toe.
DFL strength depends on 6 functional systems
The strength and integrity of our DFL ‘web’ is dependent on the 6 functional systems (the firing patterns). It’s the strength of the arches, glutes, core, SIJ/pelvic floor, oblique chains and balance system which ensures a stable you.
The failure of the integration of these systems leads to the telltale OP mechanics. The more dysfunctional these systems are and the longer these conditions persist, the more load is placed on your adductors, leading to OP.
Rehabilitation is about strengthening the coordination and connections between these systems, not isolating and focusing on each system individually. Balanced coordinated firing and activation of each system will ensure even and efficient distribution of load and stability across the body, de-loading the adductors and allowing them to heal.
OP= The collapse of the DFL
Obviously fixing OP means reactivating and strengthening the DFL to stop overloading your adductors.
Each of the 6 functional systems is either included in, or has a connection to the DFL. That doesn’t mean that everything is a part of the DFL.
Anchors/conduits to the DFL
For example the glute max is a big part of the ‘glute system’. It is not a part of the DFL. However the smaller obturator externus and a few other deeper glute (hip) stabilisers are a part of both the glute system and DFL. Additionally the oblique muscles (a part of the oblique chain system) are not part of the DFL, but the adductor longus is a part of the oblique chain and the DFL.
The obturator externus and the adductor longus are the anchors for the glute and oblique systems into the DFL. They act as the conduits, transferring and connecting the power of each functional system together in the central DFL.
Don’t let the names confuse you. For now, understand that it is these anchors/conduits that ensure coordination and communication of the 6 functional systems with the DFL.
When these anchors/conduits are dysfunctional the strength of each system cannot stablise the DFL, leading to its collapse and the development of OP.
Isolation training disconnects, functional training connects
Isolating/strengthening individual systems will only amplify the lack of communication, coordination and balance between these systems. Fixing OP is about improving the connection of these ‘anchors/conduits’ with the DFL. This can only be achieved by firing two or more systems together. This forces each system to communicate with each other through their anchors to the DFL.
The DFL is responsible for stabilizing every major central joint through the body. Ankle, knee, hip, pelvis, spine, rib cage and the neck all gain their stability and control from the DFL. Remember that no individual muscle/system can stabilize and control a joint in isolation. It is the collaboration that helps compensate for the relative weakness of each system.
Parts of the DFL: stabilizing from head to toe
|System||Joints stabilized||Muscle/fascial anchor within DFL|
|Arch (deep toe flexors)||Ankle, knee||Deep Toe flexors, adductors|
|Glutes||Pelvis and Hip||Piriformis, obturator internus|
|Core||Pelvis, lower spine, rib cage||Transverse abdominis, Pelvic Floor, Hip flexors, Diaphragm|
|Sacroilliac Joint/pelvic floor||Pelvis, lower spine through sacrum||Pelvic Floor muscle group|
|Oblique chains||Assistance in rib cage, pelvis and hip (femur) in split leg positions||Adductor longus|
|Balance system||All joints at all times||Proprioceptive (balance) receptors densely populated across all tissues of the DFL|
* For the purposes of OP we do not discuss the functional systems related to the shoulders and arms.
Your successful recovery from OP will depend on your ability to strengthen the 6 functional systems, coordinating and connecting them to the DFL to create a perfectly stable, well aligned moving machine!
The DFL, good posture and the Centre of Gravity
Everyone wants ‘good posture’. But what does it actually mean? And why does good posture mean a healthy body?
Your body is a moving machine. Like a train on its tracks our moving machine only works well when it moves within its limits, in ‘good posture’. When you bend your back to pick up a heavy weight you’ve lost your posture. Moving outside the ‘tracks’ you place undue pressure on your spine.
Your DFL sits in your central axis. It is a fascial line that connects the 6 functional systems responsible for keeping your entire body stable and upright. The DFL holds you within the ‘tracks’ or ‘rails’ of good posture.
Within these ‘rails’ your joints, ligaments, muscles and tendons are balanced. Joints remain firmly in their sockets, load is distributed evenly across the body and no one area is overused. You are aligned in your Centre of Gravity (COG).
Centre of Gravity (COG) and the DFL
Your DFL is the mechanism/fascial chain to achieve good posture, and your COG is how we measure that good posture. The DFL, functioning well, holds the weight of your body within your COG.
Moving in good posture, within your ‘tracks’ means that load is distributed evenly across your entire body. Your Centre of Gravity (COG) is a simple way to measure the movement of each independent bone/joint to make sure it stays in line and on ‘track’ with the rest of your DFL/body.
In the first picture above you can see an anatomical skeleton side on. The red dots represent all the major posture, or movement points in the skeleton. The line drawn through the centre of your skeleton is your Centre of Gravity (COG). Your COG is the central axis of your body. When all the red dots align with your COG line then your body weight stacks evenly on itself like a column, strong and secure.
Unfortunately for most of us our posture doesn’t align with our COG. As seen in picture 3, as our joints move out of our COG the load starts shifting, and different body parts are strained.
Picture 2 is a side on image of the DFL. If you compare picture 2 to the skeleton you can see that the DFL runs straight through our COG. It is the job of our DFL to engage and hold us within our COG with no one body part being overloaded or strained.
From this perspective good posture, alignment, COG and the DFL are all interchangeable terms. To move in good alignment you must be in good posture, with your DFL engaged to keep you balanced in your COG. In order for your DFL to function well, you need all 6 functional systems working and communicating well with each other.
DFL: think rubber band rather than muscle
When most people think muscles they think ‘concentric contraction’. That is muscle contracts (shortens), one joint moves closer to another.
The DFL is comprised of muscles, but you should consider these a different ‘type/style’ of muscles. The muscles on the outside of your body are ‘big and showy’. That is they pulse, bulge and look good whilst moving a lot of weight. They can create power but they generally need a rest in between efforts or they start to burn with lactic acid!
The muscles in your DFL however are the unsung heroes. They are small, hidden ‘hard workers’. They provide you with the stability to fire those strong muscles and not lose balance. They also have great stamina. They ensure your balance and stability all day.
The muscles within the DFL are heavily fascial, with high amounts of slow twitch (marathon) fibres. Fascia operates differently to muscles. Muscle operate like a car engine. You provide the fuel (glucose) and when you press the pedal the muscle fires. Run out of fuel and the car/body stalls!
Fascia on the other hand operate more like rubber bands. Whenever you jump, run or change direction your body weight lands through your feet with speed. Your fascia absorbs this load, collecting it as potential energy. It then rebounds/springs this load back, essentially allowing you to bounce. When you stretch a rubber band/load a spring it actually becomes more stable, rigid and tense like a string on a guitar.
This is essentially how the DFL stabilizes the body. It absorbs load like a spring and uses that tension to stabilize the joints across the centre of your body. It then rebounds this tension like a spring, propelling your body forward. Best of all, this is all achieved without burning through any fuel. Meaning you can remain stabilized with your DFL/COG all day!
The DFL creates the stable base for your powerful muscles to do their job! Most importantly the DFL can maintain that stability all day.
Centre of Gravity Math
So if we can engage our DFL and maintain our COG then we can evenly distribute load across the body, as opposed to concentrating the work in your adductors. Relatively easy to achieve when you’re standing. But what about when you’re moving? Or when you’re twisting, bending or changing direction. What about something as simple as a squat?
Squatting: distributing load evenly according to our COG
In a squat your bum is moving backwards as your knees move forward, all while balancing on your feet. Those yellow dots from our skeleton are moving in all directions, so how do you stay balanced within your COG?
We can consider this as COG math; the ability to efficiently balance the distance and relationships of your joints (dots), so that your DFL can remain active and your COG balanced.
Good squat ‘math’
Have a look at the squat picture above. COG math is simple. The squatter’s bum goes backwards, so he/she shifts the knees forward a specific amount to counterbalance the bum movement. He/she keeps his/her neck straight, because if the neck is rounded, then the shoulders and back will round. He/she keeps the dots, COG math equal, and maintains balance and load evenly across the body.
Bad squat ‘math’
Now lets compare this to our bad squat technique. Here the bum doesn’t move out far enough, overloading the knees (and therefore the adductors which stabilize the knee joint). The lack of glute engagement (bum not out far enough) destabilizes the pelvis, and therefore the Sacroilliac joint (which is the base of the spine). The spine therefore rounds and receives excessive pressure.
Move within your COG= Activate your 6 functional systems=correct your faulty firing patterns
Unfortunately OP patients move with ‘bad calculations’. The position of your joints determine which muscles/system will fire. If you stick your bum out, your glutes are more likely to fire. If you push your knees too far forward, your quads and adductors will fire.
OP patients arrange their joint/bones in an alignment that discourages the activation of their 6 functional systems/DFL (in bad COG math).
A big part of fixing OP is relearning and respecting this COG math. You learn to move your body so each joint supports the next and load is evenly distributed across the body, rather than centered in the adductors.
What if one system is significantly weaker than another?
All OP patients have a collapsed DFL, leading to the inability to move in good alignment and the overloading of their adductors. The degree of weakness of different areas of the DFL differs from patient to patient. Some patients struggle to activate their core, others their feet.
Let’s take one of our first rehab exercises from the 10 stage program; a deadlift. A deadlift involves using 93% of the muscles in your body. If we know that your arches are dysfunctional, then we need to make sure that you correctly engage your arches in every repetition.
As you perform a deadlift me might notice your hips moving poorly and your glutes failing to activate. But we know that your arches are significantly more dysfunctional than your glutes. A closer look will reveal that your arches are not activating and engaging; preventing your glutes from firing correctly. A weak link in one part of the DFL (your arches) can cause problems in the other parts.
Assessment will identify your arches as an issue. Correcting and strengthening your arches will involve reconnecting them to the DFL.
Your OP is being caused by a collapsed DFL. The whole 10 stage rehabilitation and treatment protocol is designed to develop a coordinated, functional DFL which can distribute load evenly across your body, reversing your OP!