A student of mine recently asked me if I noticed a pattern between patients sitting with their legs crossed and dysfunctional sideglides. I told him I never noticed it, but hadn't really been looking either. The more I thought about it, I remembered I regularly prefer to sit with my R leg crossed over my left. I have a history of dysfunctional sideglides to the L in the lumbar spine, which is equivalent to I prefer to not load the L side of my body. In crossing my R leg over my L, my lumbar spine naturally goes into a R lumbar sidebend, thus, unloading the L side of my lumbar spine.
For those of you unfamiliar with the concepts of repeated motions, each joint and the nervous system have a "norm" for stimulation and, when altered regularly, can become symptomatic. The most common example is flexion and extension in the lumbar spine. Most people spend excessive amount of time in lumbar flexion (think about how much we sit, slouch and bend forward) and become hypersensitive with loading the spine in extension, especially with an injury into flexion. As a result, extension becomes both limited and painful. In order to treat this restriction, we have to reset the nervous system back to the "norms" for lumbar extension. The same applies to my personal example. I have a loss of loading on the L side of my lumbar spine and prefer to sit in a cross-legged position that unloads the L side of my lumbar spine. I have also noted that when I stand with my weight shifted to one side, it typically is to unload the L side.
How does this apply to you? One thing could be to regularly observe your patients with dysfunctional sideglides if they prefer static postures that unload the involved side. At this point, we need to educate our patients on proper posture and regular body mechanics (and repeated motions), particularly during the symptomatic period. It's not that our patients cannot return to behavior unloading the spine in various directions, but we have to find a balance, especially when in physical therapy.
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