Rotational Patterns. Is the problem where the pain is not?

When I think about rotation in the body I like to think about it kind of like a Rubix cube. In locomotion when the right foot steps forward, the thoracic spine (middle spine) rotates to the right, the cervical spine (neck) rotates left, and the lumbar spine (low back) rotates to the left (L-R-L). Kind of like if the middle section of the rubix cube was rotated one way, the top and bottom we could say are performing the opposite rotation and remain where they are. Not exactly…. but I hope you get my point. (plus its fun to think I am working with an xxxl rubix cube when I am actually working with humans)


Humans rotate in locomotion. Walking, running, rolling on the ground, swinging a golf club, surfing, doing the dishes, vacuuming, swimming, dancing, intercourse, nursing, all sorts of stuff…. try and wipe your ass without rotation 😉 The point is, we do it all the time. Which way do you do it most often? Do you visit both sides?

If you are dominant in one side rotational pattern, and can’t access the other side quite as well, what effect can this of on the rest of your body? Where within the rotational pattern is limiting your ability to access the other side?

Here is an example.. Now this is just an example, though this is exactly the type of scenario I work with all the time! 🙂

A client comes in with hip flexor pain and low back pain. They work seated at a computer, and play golf most weekends. They have been struggling with their golf swing recently, experiencing some low back pain, and the L hip flexor is sore when walking around the course. No injuries or surgeries to note. On rotational assessment we find that they have a hard time performing L thoracic rotation. Limited neck rotation to the R. When I watch them walk I see limited hip extension on the R, limited hip flexion on the left, limited back swing in the L arm, the hips have a hard time shifting L. In single leg stance they go to the R foot first and it supinates. Balancing on the L leg is a struggle unless they pronate hard into the ground. The right hip sits higher than the left, and the left shoulder is hiked up sitting higher then the right.

With the client on the table I perform some movement pattern testing to delve deeper into what I saw was missing within their movement, and why. I test the abdominal obliques. The R internal oblique (contributing to R thoracic rotation) tests nice and strong. The L internal oblique (contributing to L thoracic rotation) tests inhibited. No matter how hard the client tries, they just can’t seem to perform this pattern (and thats ok, because that is exactly what we want to find out). Interesting that the client plays golf and needs to swing to the L to drive the ball, yet can’t engage their L internal oblique.. Oh dear…


We get talking about the clients position at work. Spending long hours in an office chair using the mouse. The client mentions they have been particularly flat out at work recently. I ask them to show me the position they work in. They take a seat and the R hand grabs a mouse and moves around. “What about when your tired?” I ask. The clients head slumps and turns to the left. The left shoulder shrugs high up towards the L ear. Bingo… lets test how that position is effecting your body.

Back on the table we retest the L internal oblique. It still tests weak. Now I ask the client to rotate their head to the L, and shrug their left shoulder towards their ear. Whist in that position we retest the L internal oblique. KAPOW it tests strong as an ox. Its a miracle!


“Now take your head back to the centre and relax your shoulder”.. we retest the L internal oblique and there is no communication from the brain what so ever…. The client looks at me funny…

We get good at what we do often. From the stress and constant postural positioning at work the motor control centre in the brain has gotten use to the L Levator Scapulae being turned on, and is now relying on it being turned on all the time. The L Levator Scapulae is a muscle of L rotation of the neck, and elevation of the scapula. As a L rotator of the neck, from what we discussed earlier about the Rubix cube example, you could see how L neck rotation pairs with R thoracic rotation and L lumbar rotation ( L-R-L)
The client has an inhibited L internal oblique which contributes to L thoracic rotation, R lumbar rotation which pairs with R cervical rotation in locomotion (R-L-R).

So the client is somewhat stuck in L-R-L, and has a hard time visiting R-L-R.
Can you visualise how this could effect L hip flexion, R hip extension, L arm back swing, R neck rotation, L thoracic rotation, R lumbar rotation etc…?

Using the NKT-protocol we teach the motor control centre that its ok to communicate with the L internal oblique without having the L levator scapulae engaged. The left internal oblique comes back to life. The right external oblique comes back to life. L hip flexors, R hip extensors, L lat dorsi, L tibialis posterior all come back to life! The single leg stance looks amazing. The neck can rotate both ways. The client can access L thoracic rotation. they go for a walk and everything dances nicely. Awesome!

The clients homework would be to stretch/release L levator scapulae, followed by activating L internal oblique. Start simple, do their homework, and return for a re-evaluation. Then work up to something like a Pallof Press with the band anchored to the right. Also of high importance is to have the client re-evaluate their posture at work. If they are tired can they get up and go for a little walk around the office. Can they perform some visual reset drills and breathing to help them relax, refresh and get back into work with good posture. It was this working posture that got them in this predicament after all. To make change, something must change.

Now this is just an example, though this type of scenario is very real. I hope it helps you see how important a global approach to working with the human body is. I hope it helps you see how the problem can be where the pain is not. I could have massage the hip flexors and low back all I liked… but until I taught the L internal oblique to work, and feel safe, that massage might be a bit of a time and money waster.

Do not run with this example and expect to see it in every individual who works at a desk/computer. Humans are highly complex and individual, and deserve a full assessment and evaluation to understand their specific needs based on THEIR body and THEIR history.

Enjoy exploring rotational patterns in your own body, and if you have pain, consider that the problem might be where the pain is not, and get assessed.

Have fun!