Stratification or Layer Syndrome

[문형철]

결국 블라드미르 얀다, 크레이그 리벤슨 등 biomechanist들의 자료가 정말 귀한 것이로구나. 

Stratification or Layer Syndrome (also see Ch. 8)

Described by Janda,3–5 strata or ‘layers’ of muscle hyper and hypoactivity can be observed within the flexor and extensor muscle systems. When both the pelvic and shoulder crossed syndromes are evident they are also expressed in this syndrome. Janda felt this was the most important of his ‘syndromes’,55 its presence a sign of poor prognosis because the fixed patterns of muscle imbalance reflect severe and deeply fixed CNS dysregulation accompanied by very bad movement patterns.3,4 However, he also says ‘this syndrome is not rare. On the contrary it can be seen quite often in sportsmen who have trained heavily without precise check ups’.3 Janda’s genius is confirmed! Observing the posturomovement patterns of subjects with spinal pain disorders consistently reveals common patterns of response

in the manner he described. The presence and related effects of this syndrome explains the frequent coexistence of cervical and lumbar and other pain syndromes in many patients.

The construct of the layer syndrome helps simplify

and see at a glance the more common patterns

of response and to predictably know what

responses to expect when retraining posturomovement

control. Viewing the patient’s torso

from the front and particularly from behind, we

see layers or bands of overactive and hence bulky

muscles alternating with regions of under active

muscles with flattened contours. This provides

clues to the probable habitual activation patterns

of various muscle groups. Essentially there is

‘emptiness’ and poor contribution from the muscle

groups over the posterior aspect of the proximal

limb girdles and excessive yet variable

central axial activity.

It is more easily observed in the posterior view

(Figs. 10.22 & 10.23 and also Figs. 8.21 & 8.22).

In the anterior view Janda thought the most

striking symptomatology was in the anterior

abdominal wall where rectus abdominis and

transversus show weak whereas the obliques are

hyperactive.3 This is seen as a groove on the lateral

edge of the rectus (Fig. 10.24). Imbalance

between the upper and lower abdominal wall is

also apparent.

In the posterior layer syndrome there is poor

muscular stability over the lumbopelvic and the mid

dorsal/interscapular region and consistent hyperactivity

in the cervicothoracic and particularly the thoracolumbar

extensors. A normal study found that the

lumbar fibres of longissimus thoracis and iliocostalis

lumborum fatigued more than the thoracic fibres.56

In the anterior Layer Syndrome there is poor muscular

stability and support over the front of the cervical

and lumbar regions.  It is important to appreciate that this pattern of

trunk muscle activity consistently plays out in all

posturomovement’s e.g. reaching up, bending over,

when on all fours and so on. Predictably, in time,

this more obligatory pattern of muscle activity

causes some regions of the axial skeleton to become

hyperstabilized and stiff while other regions become

undercontrolled and relatively mobile.

Appreciating this pattern of response in muscle

activity presents a significant challenge to relearning

effective therapeutic movement control. Attempts

to facilitate activity of one hypoactive group will

invariably risk early and over activation of the

already dominant muscles, e.g. gaining activation of

lumbar multifidus or lower scapular stabilizers without

dominance of thoracolumbar extensors (CPC)

and/or cervicothoracic extensors.