Obliquity: The Source of Intolerable Cruelty!

Ever heard of this before?
In all my years of schooling and advanced courses that I have taken since my degree I had not heard of obliquity in the human body until 2011 when I started to learn NeuroSomatic Therapy with Paul St. John. Through this unique therapeutic approach we were taught there are six dimensions to a postural evaluation. Now stick with me because there is a test for you!

POSTURE PATTERN	FORCE CREATED
Tilt	Lateral Compression
Rotation	Torque
Flexion	Anterior Compression
Extension	Posterior Compression
Projection	Anterior Shearing
Obliquity	Lateral Shearing

Table 1 - The six primary posture patterns and their related forces

Now only if was that simple. In every patient that I have evaluated I commonly see a mixture of several of these posture patterns some of which are created as the body attempts to counterbalance another posture pattern elsewhere (a.k.a. compensatory stress). I have measured many patients that have multiple postural patterns (bad posture) and yet the patient has little or no pain to speak about. On the other hand, I've measured and found patients with minimal postural distortion (good posture) and yet they complain of chronic pain in one or more areas of the body. The difference has typically come down to the presence of obliquity in those with minimal postural patterns.

Posture Chart 1 - An example of a Posturology chart for one of my patient's. Note the multiple posture patterns that essentially misalign the whole body.

The common site of obliquity
Obliquity creates the greatest havoc in the regions of the pelvis and the temporal bones of the skull. According to the 'Lovett Reactor Relationship' (I hope you are taking notes for that test that will be coming!), the pelvis has a strong line of communication with the bones of the skull. In particular, the ilium bones (A in image 1) work in opposition to the temporal bones of the skull. Think of when you walk. Ideally, the opposite arm swings with the opposite leg. In essence this same pattern of working in opposition applies to the example here of the pelvis and skull. 

Image 1 - The Human Pelvis - the ilium bones (A) on either side can turn in (inflare) or turn out (outflare) creating a tremendous force through the sacro-iliac joint and compensatory stress elsewhere.

Image 2 - The Temporal Bones of the Skull (red) - similar to the ilium bones of the pelvis these bones can also turn in (inflare) or turn out (outflare) creating a tremendous force through the joints inside the skull and compensatory stress elsewhere.

The Righting Reflex
Naturally, if you stand up and push your hips to one side your shoulders will move in the opposite direction to attempt to balance your body, thus preventing you from falling over. This is known as the righting reflex. This can happen on a very subtle level as I often measure between the pelvic bones and cranial (skull) bone relationships. Here is where it gets interesting. There are occasions when I've measured obliquity in the skull and the pelvis but they've essentially 'cancelled' each other out which tends to lead to a patient having little or pain. However, when the forces between the pelvis and skull have not cancelled themselves out, a patient typically has a greater experience of pain. This can be an all distinguishing factor between a patient with no pain and a patient with chronic pain. 

Action steps
Two simple home techniques to measure if any of this applies to you is to have a friend measure for obliquity.

To measure obliquity in the cranium:
1. Lay on your back.
2. Have your friend use a pair of noodle sticks or two pencils and place them on either side of the skull where a pair of glasses would position above the ears toward the eyes.
3. Note the angle difference between left and right side. The side with the greater angle would said to be an inflare. The example in the image to the right is a patient with left side temporal inflare.
4. If both angles are equivalent then this would be an optimal alignment of these two bones.



To measure obliquity in the pelvis:
1. Lay on your back.
2. Have your friend place their index fingers on the inside of the Anterior Superior Iliac Spine's (ASIS) (bony protuberances of the pelvis). 
3. Using the belly button as a centre line, note the approximate distance from left ASIS to the centre line and then the right ASIS to the centre line.
4. The side with a greater distance from the centre line to the ASIS is said to be outflared and the side with less distance from the centre line is said to be inflared. The example in the image to the right is a patient with left side ilium inflare.
5. If both measurements are equal then this would an optimal alignment of these two bones.

These images are a great example of a patient who has is not meeting the demands of the righting reflex as both the left temporal and ilium are flaring in. In this situation a patient typically presents a higher level of pain. Ideally if the body is meeting the demands of the righting reflex we would see either the temporal and ilium bones are equally centered or left temporal inflare is counterbalanced by right ilium inflare (or vice versa that right temporal inflare is counterbalanced by left ilium inflare).

Congratulations on learning something that most patients are unaware of and in my experience a lot of therapists have also yet to discover.

Yours In Health,

Jason Barlow, B.Sc. (Hons), RMT