B y E r i k D a l t o n

Figure 1. Following con-ception, a woman and herunborn child unite in anoceanic blend of energyand identity.Where oneends and the other beginsno one knows. Photo courtesyof the Freedom From PainInstitute. Dianna Pitman model.

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The miracle of motherhood is eloquently expressedwhen observing how perfectly the female body isdesigned to conceive, birth, and nurture a child.

Following conception, a woman and her unborn babyunite in an oceanic blend of energy and identity. Whereone ends and the other begins no one knows (seeFigure1, page 38). However, there does appear to be aninnate wisdom that uses the nervous system as a conduitto transmit electrical impulses of intelligence to all thebody’s systems that maintains mother and fetus in astate of homeostasis and balance. Regrettably, mechani-cal pressure on the central nervous system by distortedcranial bones and spinal structures can interfere withthe normal transmission of this vital intelligence. Sinceall of the mother’s systems and organs are now providingfor two, it is obvious that optimal posture and function-ing is critical for the baby's healthy development.

We begin our adventure into motherhood by introduc-ing some very intriguing theories detailing how thirdtrimester fetal positioning in momma’s womb may createaberrant adult postural patterns seen daily in our officesand clinics. Basic hands-on pelvic balancing and trunkstabilization routines taken from my AdvancedMyoskeletal Techniques textbook are also included sotherapists can aid expectant mothers in their quest for ahealthy happy delivery. But before introducing the vari-ous postural theories and techniques, a brief overview ofMother Nature’s remarkable art of birthing requiresthoughtful consideration.

Fetal Lie and Posture

The embryo enters the mother’s pelvis in what ismedically termed a left occiput anterior (LOA) or

left fetal lie position. The baby usually remains in this“normal” primary fetal posture throughout labor anddelivery although a variety of movements are commonthroughout the entire birthing process. In the left fetallie configuration, the baby’s head is inferior, flexedand rotated left with arms and legs curled to accommo-date restrictions in the uterine cavity. Figure 2, aboveright illustrates a typical vertex positioned baby withhead turned left. The small figure on the right showsthe left occipital ridge resting comfortably on themother’s pubic bone. However, as the embryo beginsnormal rotational movements in momma’s womb, theleft side of the head will eventually face posteriorly.

The most compact profile for the fetus is for thearms and legs to curl in opposing directions with aresultant rotation along a longitudinal axis. Someauthors including Ida Rolf, PhD, J. Gordon Zink, DO,and Fred H. Previc, PhD1,2,3 have found this rotationalfascial bias to be an important factor in determiningthe final shape of the fetus. It appears that as babygrows from infancy into adulthood, it expands in sizebut still retains ingrained embryologic rotational fascialpreferences (see Figure 3, page 40). When testing forrotational fascial patterns, bodyworkers typically findthe head rotates easiest to the left at the occipitoatlantal

joint and right in the lumbosacral region. Due to fetalpositioning, it is likely that fascial patterning does actu-ally begin in the mother’s womb during the finaltrimester of birth. Moreover, individual variations infetal lie seem to become increasingly important as theembryo’s body takes shape.

Cerebral LateralizationDuring the normal act of walking, maternal accelera-

tion repeatedly forces the baby’s head to translate poste-riorly through a process called fetal inertia (see Figure 4,page 40). Repeated left-sided cerebral stimulationincreases neurologic activity in the baby’s vestibular (bal-ance) apparatus. Prolonged left-sided inertial pressure isthought to cause increased secretion of connective tissuefibers resulting in early maturity and development of theleft side of the baby’s vestibular system and subsequentright motor dominance.4 Since vestibular informationtravels down the ipsilateral side of the body from innerear to the foot, when standing, most adults bear moreweight on the left leg than the right. Conversely, earlyleft-sided cranial development neurologically crosses tothe opposite cerebral hemisphere (right brain) resultingin right motor dominance.

When observing vestibular and motor dominanceworking in harmony during a normal activity such askicking a ball, the individual typically balances on theleft leg and kicks with the right (see Figure 5, page 42).In support of the cerebral lateralization premise, scien-tists find that in the majority of the adult population, theleft leg is larger and has greater muscle mass.5 Due tothis early lateralization process, an interesting posturalpattern begins to emerge. During prolonged standing,most people will sideshift body weight over the vestibu-larly dominant left leg causing the trunk to sway to theleft. Compensatory scoliotic patterns are seen in thepelvis and torso as the body’s center of gravity shifts.

Figure 2. In the left fetal lie configuration, the baby’s headis inferior, flexed and rotated left with arms and legscurled to accommodate restrictions in the uterine cavity.Adapted from Bill Allen with permission.

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Left-legged weight bearing not only flattens lumbar lor-dosis and posteriorly rotates the left ilium, but alsocauses the right ilium to drop in an anterior/inferiordirection (see Figure 6, page42). Ordinarily this would pro-duce a long right leg, but as thecenter of gravity shifts leftward,the right knee moves medially;overstretching the medial collat-eral ligaments and twisting thelimb into a valgus position.Prolonged pelvic sideshiftingover the vestibularly dominantleft leg creates fascial, muscle,ligamentous, and osseous alter-ations that distort the place-ment of the femur in theacetabulum causing the rightleg to functionally shorten.

Several researchers have con-firmed that left vestibular domi-nance occurs in roughly two-thirds of the humanpopulation.6,7,8 Previc described apossible prenatal mechanism forthe origin of left vestibular dom-inance in this statement.“Because the right side of thebody faces outward in the leftfetal position, the acceleratorymovements during maternalwalk would, from the standpoint of the fetus, be regis-tered rightward. The more substantial inertial force

would consequently be leftward, providing for greaterstimulation of the left utricle; thereby promoting earlygrowth and development of the left vestibular system.”9

Structural Role of Pregnancy

The female pelvis supports the growing uterus withspecialized ligaments. When pelvic bones are bal-

anced and aligned properly, the uterus is able to enlargesymmetrically with the growing fetus. Regrettably,many women are unaware of the importance of main-taining proper structural alignment pre and post-par-tum and often suffer needless painful consequences(see Figure 7, page 43). If the three bones of the pelvisare pulled out of alignment due to upper or lower quad-rant imbalances, proper support of the uterus is placedin jeopardy. Unequal ligamentous support can torquethe uterus reducing the maximum amount of room forthe developing fetus. The term used to describe thiscondition is intrauterine constraint. Pelvic and respira-tory diaphragmatic restrictions also alter the baby’sposition and can adversely affect his/her developingspine and cranium (see Figure 8, page 43). Movementlimitations during pregnancy may prevent the babyfrom attaining the best possible position for delivery.Any birth position other than the ideal vertex, occiputanterior, left fetal lie position may produce the inhibit-ing effects of constraint. Such positions lead to longer

more painful labors withincreased chances for medicalinterventions. Often the motherand baby miss the many benefitsof a natural vaginal birth as physi-cians may recommend a C-sectiondelivery.

Hey, Mom…it’s tight in hereAs space in mother’s womb

becomes more compacted duringthe final trimester, the embryo’sarms and legs sometimes curl invarious positions and occasionallythe head finds itself stuckbetween the legs or “sunny-side-up” rather that turned to one sideor the other. “Sunny-side-up” isthe phrase assigned to babieswhose heads have drifted fromthe normal flexed and rotatedposition into a backward-bentstate of hyperextension. Today,more and more “sunny-side-up”presentations are showing up inhospitals around the world due tosuch things as:

Poor posture. Mother prone toslouching in soft-cushioned furniture causing loss orreversal of normal lumbar lordotic curve;

Figure 3. Fascial Bias in the Fetus and the Adult. Illustratedby Laura Maaske - Medimagery LLC. Reprinted with permission.

Figure 4. During the normal act of walking,maternal acceleration repeatedly forcesthe baby’s head to translate posteriorlythrough a process called fetal inertia.Repeated left-sided cerebral stimulationincreases neurologic activity in the baby’svestibular (balance) apparatus. Adapted fromPsychological Review by Fred Previc.

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Weakened trunk stabilizers.Inadequate support in transversusabdominus, multifidus, obliques,and rectus abdominis; and

Lack of proper manual therapy.Poor structural alignment before,during and after delivery, i.e., pres-ence of aberrant upper and lowercrossed patterns, spread rectus abdo-minis muscles, pelvic obliquity, etc.

Rectus Abdominis and Low-back PainAs the baby develops, the moth-

er’s rectus abdominis muscles andsupporting ligaments develop a greatdeal of extensibility (stretch). Therelease of a hormone called relaxinis a fundamental part of MotherNature’s plan to assure a comfort-able resting environment for thefetus and a safe normal delivery.However, a common problem occursas the belly grows and the recti mus-cles begin to wander off laterallyfrom the midline. This is usuallydue to excessive abdominal wallpressure overstretching (or tearing) the linea alba—atendinous median line designed to separate the tworectus muscles. When workingproperly, the tendon effectivelybinds the recti muscles close tomid-line providing optimal abdomi-nal support (see Figure 9, page 43).Diastasis recti abdominis is theterm used to describe the separa-tion of abdominal wall musculatureduring some pregnancies.

If mother and therapist allow thisslow lateral recti migration as theabdomen expands, vital trunk stabi-lizers including transversus abdo-minis, internal/external obliquesand multifidi become stretch-weak-ened. Gravity begins pulling thebelly forward placing great strain onthe low back extensor muscles. Inthe absence of proper front/backmuscle balance, the posterior lum-bar erectors tighten in an effort torestrain gravitational pull from theheavy unsupported belly.Regrettably, this only increases lum-bar “bowing,” compressively loadsthe intervertebral discs and posteri-or facet joints, and creates greaterlow back pain. Any alteration in themother’s abdominal support system

not only adversely affects fetal posi-tioning but also causes our pregnantmothers to cry out for help as mus-cles, ligaments, joint capsules, anddiscs loose the battle with the unre-lenting force of gravity.

Fortunately, mothers receivingmanual therapy from trained practi-tioners usually experience little lowback pain through their pregnancies.Specially designed sidelying tech-niques performed weekly or bi-monthly can really help take pressureoff the low back (see Figures 10 and11, page 46). Expectant mothersexperience greater trunk and lowback stability as the therapist’s softextended fingers gently hook the rec-tus abdominis fascia and move thetissue medially back toward the mid-line (see Figure 12, page 46). After afew sessions, the weakened abdomi-nal support system “wakes up” as therecti regain muscle memory. With therecti muscles toned and back in themid-line, the pubis and ribcage are

pulled closer together which posteriorly rotates thepelvis and reciprocally reduces lumbar lordosis.

Ligamentous Support or Collapse Provided the pelvis is in a bal-

anced state, the ligamentous webattaching to the uterus maintainsan equalized, supportive, antigravitysuspension system. Any type ofpelvic imbalance that causes the lig-aments to become torqued andtwisted, results in uterine con-straint which limits the space avail-able for the developing baby. At theleast, any compromised position thebaby must endure during pregnancycan have some sort of detrimentalaffect on his or her optimal develop-ment. Conditions such as torticollisare not uncommon in babies suffer-ing uterine constraint. If the shapeof the woman’s uterus becomes dis-torted as birth approaches, the babyis prevented from getting into thebest possible position for birthing.And even if the baby manages toplace himself in the desirable headdown position, a tight uterine cavitycan prevent the baby’s head frommoving into the ideal presentationfor delivery. The head can become

Figure 5.Vestibular and MotorDominance. Illustrated by Laura Maaske/Medimagery LLC. Reprinted with permission.

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Figure 6.Vestibular dominance pro-duces left-legged weight bearing thatnot only flattens lumbar lordosis andposteriorly rotates the left ilium, butalso causes the right ilium to drop inan anterior/inferior direction. Courtesyof Erik Dalton.

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slightly tilted to one side or even moretraumatically, present in the posteriorposition. Any fetal position that altersthe baby’s correct habitus even slightlyduring birth will slow labor and addpain to both mother and baby. Womenare often told that their babies weretoo big, or labor “just slowed down”when it was really the baby’s presenta-tion interfering with the normalprocess and progression.

Because excessive body weighttends to exaggerate ingrained aber-rant postural patterns, therapistsmust address all soft tissues andosseous tissues (beginning with thefeet) that may alter pelvic balance.Mothers with a tendency for footpronation and valgus knees are par-ticularly susceptible to ligamentouslaxity when the relaxin hormoneenters the system during the thirdtrimester. As the woman’s weightincrease and medial ankle ligaments(spring and deltoid) become lax, thealready pronated talus bone contin-ues its medial glide off the calcaneuscausing the foot and arch to drop into

hyperpronation. Figure 13, page 46, demonstrates avery therapeutic myoskeletal technique for bringingbalance to a misaligned talocalcanea joint due to weak-ened ankle ligaments. Recall that ligaments like stressbut do not like strain. Ankle, knee, and pelvic align-ment should be assessed and corrected during eachsession.

HomeworkHome retraining exercises that focus on restoration

of proper tone in the trunk stabilizers, diaphragms,and pelvic floor muscles are essential therapeuticpieces of the pregnancy puzzle. Transversus abdomin-is, pelvic-clock and Thera-Band toning routines boost

therapeutic outcomes when performedon a regular basis between sessions.Pilates, yoga, Rolf Movement andother trunk stabilizing programs alsoseem effective in helping the body’sinnate self-regulatory mechanisms pro-duce a healthy happy baby.

Best Possible Scenario

The mother’s best chance for a normalleft fetal lie delivery requires that:

• No pelvic bowl asymmetries exist,i.e., sacroiliac, iliosacral, orsideshifted dysfunctions;

• Proper tone be present in the deep trunk stabilizers and lumbarmultifidus;

• No spreading (past three fingers’width) of the recti muscles at midline;

• Obstetrician or midwife directedtherapeutic exercises be practicedregularly for adequate abdominaland trunk stabilization support.

These and other factors will not onlyhelp determine the habitus, presenta-tion and delivery of the child, but willalso play a major role in proper devel-opment and shape of the adult verte-bral column. As stated above, earlyembryologic positioning often formsaberrant fascial rotational preferencesthat can become exaggerated duringone’s lifetime due to life’s little microand macro traumas. This compensa-tory process manifests as a loss ofrange of motion, tissue texture abnor-malities (fascial contractures, fibrosis,etc.), and posturally initiated pain.

During the final trimester, fascialrestrictions can encumber properblood and lymph flow and create neu-rological interferences that travel

Figure 9. Linea alba laxity allowsthe recti muscles to spread later-ally.The resulting abdominalstretch weakness increases lum-bar lordosis resulting in low-backpain. Adapted from Primal Pictures,2003. Reprinted with permission.

Figure 8. Intrauterine con-straint caused by pelvic mis-alignment can alter thebaby's position and adverselyaffect the developing spineand cranium. Adapted from BillAllen with permission.

Figure 7.The therapist corrects a leftunilateral flexed sacrum by bracing theinferior sacral border with his left handwhile the client shrugs her shoulderagainst the therapist’s resistance. As the client relaxes, the therapist’s lefthand scoops the sacrum anterior andsuperior.This imbalance is a common SIjoint pain-generator in pregnant women.Courtesy of Erik Dalton.

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throughout all the body’s soft tissues. Fascial dis-tortions frequently generate pressure gradientalterations in the thoracic outlet, respiratory, andpelvic diaphragms and are major contributors tostagnation in the vascular, lymphatic, endocrine,and respiratory systems. Myoskeletal ZoneTherapy incorporates special techniques for elim-inating stagnation by restoring optimal diaphrag-matic function.

To help guarantee a successful and unremark-able delivery, the baby needs the maximumamount of space in the mother’s uterus and

pelvis at exactly the time it is need-ed. The baby will make a verydetermined effort to achieve thecorrect position for birth, but canface resistance if a mother isunaware or unsure of her role inassisting the baby throughout theprocess. The third trimester of preg-nancy, commencing at sevenmonths gestational age, heralds theperinatal period. This critical stageis of greatest concern due to thepropensity for adversity in the fetalpresentation, position, and attitude.The biomechanical implicationsaffecting fetal well-being during thethird trimester, and for the prepara-

tory phase for labor and delivery, embraceany fetal alignment other than the optimallongitudinal lie, vertex presentation, and flex-ion attitude. Fetal positioning during thethird trimester is not only crucial to anuneventful delivery but possibly to the finalconstruction of the baby’s posture from ado-lescence through adulthood.

Erik Dalton, PhD, originator of Myoskeletal AlignmentTechniques and founder of the Freedom From Pain Institute,shares a broad therapeutic background in Rolfing and manip-ulative osteopathy in his innovative pain-management work-shops. Visit www.erikdalton.com to view additionalMyoskeletal Alignment Technique articles and new productsand to register for a free monthly technique newsletter. Call800-709-5054 for more information.

Notes1. R. Louis Schultz and Rosemary Feitis, The Endless Web: Fascial Anatomy and

Physical Reality (Berkeley: North Atlantic Books, 1996).2. J. G. Zink, “Applications of the Osteopathic Holistic Approach to

Homeostasis,” American Academy of Osteopathy Yearbook, (1973): 37-47.3. Fred H. Previc, “General Theory Concerning the Prenatal Origins of Cerebral

Lateralization in Humans,” Psychological Review 98 (July 1991): 299-334. 4. Ibid.5. S. R. Chhibber and I. Singh, “Asymmetry in Muscle Weight and One-sided

Dominance in the Human Lower Limbs,” Journal of Anatomy 106 (1970): 553-556. 6. M. Lacour, et al. “Spinal Effects of Electrical Vestibular Stimulation in Humans,”

Acta Otolaryngologica 78 (1974): 399–409.7. B. Milojevic and J. Watson, “Vestibular Asymmetries in Right- and Left-handed

People,” Acta Otolaryngologica 60 (1965): 322–330.8. R. J. von Baumgarten and R. Thumler, “A Model for Vestibular Function in

Altered Gravitational States,” Life Sciences and Space Research 17 (1979):161-70.9. Previc, Psychological Review.

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Figure 13.Thetherapist’s webbedhands and kneesgrip the talus asthe client gentlyflexes her kneeagainst resistance.The client relaxesand the therapistligamentously bal-ances the talus oncalcaneus to cor-rect foot hyper-pronation. Courtesyof Erik Dalton.

Figure 10.The thera-pist hooks the lumbarfascia and holds whilethe client performsslow pelvic tilts.Courtesy of Erik Dalton.

Figure 11. The therapist’s leftforearm hooks latissimus dorsifascia and the left hand pro-duces a counterforce by grasp-ing the client’s ASIS.The clientinhales while gently pulling upon the top of therapy table tothe count of six and relaxes.The therapist’s forearm cre-ates space between the client’sshoulder and pelvic girdles.Courtesy of Erik Dalton.

Figure 12. Softextended fingersgently hook the rec-tus abdominis fasciaand move the tissuemedially backtoward the midline.Courtesy of Erik Dalton.

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