Why Asymmetries and Imbalances Exist

Why it's restrictedThe mid-back is the segment built to rotate, and it's the segment modern life never asks to. Hours of sitting hold it in flexion, which mechanically blocks rotation before muscle length is even a factor — a flexed thoracic spine cannot rotate well no matter how loose the tissue is. Add rib stiffness from shallow breathing, and lats and obliques that shorten on the side they use most. When the range isn't there, the body takes it from somewhere else: the elbow caves in or the hip hikes off the table. That compensation is the real finding.

What it changes in your sessionRotation work here pays off faster than almost anywhere else, because you're often restoring a range they simply stopped using rather than lengthening truly short tissue. Open the ribs and extension first, then rotation.

Why it's restrictedNeck rotation borrows heavily from the segment below it. If Step 1 was limited, Step 2 usually is too — the neck is paying for the mid-back. On top of that, the neck is the first place stress lands: upper traps and levator hold tone all day in people under load, and those muscles limit rotation directly. Then add the one-sided habits — the shoulder they carry a bag on, the side they sleep on, the direction they turn to look at a monitor, and any old whiplash or fall, which leaves protective tone that outlives the injury by years.

What it changes in your sessionNever chase neck range with force. A limited, guarded neck responds to breath, slow entry, and freeing the thoracic spine and shoulder girdle first. If one side is dramatically worse and the client reports headaches or arm symptoms, note it and route them out.

Why it's restrictedThis is the clearest example of "the shape held longest wins." Sitting holds the hip flexors at a shortened length for the majority of a person's waking hours, day after day, for years. Tissue adapts to that. Each of the three findings has its own story: A (psoas) is the sitting signature and shows up in nearly everyone with a desk job or a long commute. B (quads) tracks with load — cyclists, runners, and squat-heavy lifters. C (TFL) is different and more important: the TFL only takes over as a hip stabilizer when the glute medius isn't doing its job. That one is a weakness finding wearing a tightness costume.

What it changes in your sessionA and B respond well to stretch plus a homework change. C tells you to flag lateral hip strength — stretching a TFL that's compensating gives temporary relief and it comes right back. That's a coaching conversation, not just a table one.

Why it's thereTwo very different reasons, and telling them apart matters. True (structural) difference means the bones are actually different lengths — common, usually small, and frequently present with zero symptoms. Functional difference means the bones are equal but the pelvis is rotated or tilted, so one leg presents shorter on the table. Most of what you see is functional, and it's driven by habit: standing on one leg, carrying a child on one hip, sitting with one leg tucked, sleeping curled to one side, or holding tone on one side after an old injury.

What it changes in your sessionNever call it a leg length discrepancy to a client — that's a diagnosis and it isn't ours to make. Record what you observed, work the pelvis and the hips evenly, and re-check at the end of the session. If it changed within one session, it was functional.

Why it's restricted"Tight hamstrings" is the most over-called finding in the whole assessment. Three different things stop that leg, and they need three different responses. First, genuine tissue shortness from load and habit. Second — and far more common than practitioners expect — protective tone: the hamstrings hold tension because the pelvis is tipped forward, which puts them on stretch all day, so they defend against more. They're not short, they're already at their limit and guarding. Third, nerve sensitivity, where the restriction is the nervous system objecting to tension rather than muscle length; that one presents as a sharp, electric, or burning line rather than the broad pulling of a stretch.

What it changes in your sessionIf aggressive hamstring stretching hasn't worked for this client before, it's option two or three. Slow it down, work the hip flexors and pelvic position first, and note anything sharp or electric rather than pushing through it.

Why it's restrictedThe sheet already notes most clients have very little available here, and there's a reason it's so universal. The single biggest cause is an old ankle sprain that never got rehabbed — after a sprain the joint capsule and the way the joint glides get restricted, and almost nobody completes rehab past the point where it stops hurting. Everything else stacks on top: shoes with a raised heel reduce the demand for the range so the body stops maintaining it, standing and running jobs keep the calves under constant tone, and for some people there's a bony block at the front of the ankle that simply ends the movement.

What it changes in your sessionAnkle restriction travels upward — it changes how the knee tracks and how the hip loads in every squat and every step. It's high-value real estate. Ask about sprain history on the restricted side; the answer is yes more often than not.

Why it's restrictedThis is the finding where structure matters most. The angle of the femur and the depth and orientation of the hip socket vary enormously between people, and those two things set the ceiling on internal rotation before soft tissue is even part of the conversation. Some clients will never reach 30° on one or both sides and nothing is wrong with them. On top of that ceiling sits the changeable part: deep external rotators holding tone from sitting, and sports that live in external rotation — skating, dancing, goalkeeping, martial arts — that train the body out of the inward direction.

What it changes in your sessionRead the end-feel. Soft, gradual, with a stretch sensation means there's tissue to work with. Hard, abrupt, painless bone-on-bone means stop — that's their architecture, and forcing it is how clients get hurt. Note the asymmetry and work within it.

Why it's restrictedThe adductors do far more than pull the legs together — they're major stabilizers of the pelvis in walking, and in people who sit all day and never load side-to-side movement, they take on stabilizing work the glutes should be sharing. Muscles doing extra stabilizing work sit at higher resting tone, and higher tone reads as tightness here. Groin strain history is a second big one; that's an injury that leaves protective tone behind for a long time. And as with Step 7, the hip capsule and the bone shape put a ceiling on it.

What it changes in your sessionCompare 7 and 8 together. A hip that's limited in both directions is more likely capsule or structure. A hip that's limited in only one direction is more likely a soft-tissue and training-pattern story, and that one you can move.

Why it's thereThis is almost never actual arm length. What you're reading is where the shoulder blades are resting. The dominant side typically sits slightly more forward and rounded from a lifetime of more use — mousing, writing, carrying, throwing — and a scapula that sits further forward makes that arm present longer at the fingertips. The rib cage underneath it matters too: if the trunk is rotated even slightly, the whole shoulder girdle on one side is delivered forward. Old shoulder injuries or a clavicle break will do the same thing.

What it changes in your sessionTreat this as a shoulder-position finding, not a limb-length one, and connect it to Steps 1, 10, 11 and 12. If the arm difference and the thoracic rotation limit are on matching sides, you've found a pattern rather than two separate problems.

Why it's restrictedGetting the arms overhead is a whole-torso movement, not a shoulder movement — the spine has to extend and the ribs have to move. A thoracic spine that lives in flexion takes range off the top before the arm even gets involved, and lats and teres that are short from pulling-heavy training or from a rounded working posture pull the arm back down. The arch in the low back is the most useful part of this finding. It means the range isn't available up top, so the lumbar spine is donating it — the same borrowing you saw in Step 1, just in a different direction.

What it changes in your sessionWatch the ribs, not the hands. If you cue a client to keep the ribs down and the arms suddenly can't get anywhere near the table, you've found their real range — and that's the number worth re-testing later.

Why it's restrictedThis is the most reliably one-sided finding in the assessment, and the dominant arm is nearly always the restricted one. Repeated overhead and throwing work — baseball, tennis, volleyball, swimming, and any overhead trade — thickens and stiffens the back of the shoulder capsule over years. Sleeping on that side compresses it night after night. And the external rotators hold protective tone after any rotator cuff irritation, which is common enough in this population that you should assume it's on the table.

What it changes in your sessionA large side-to-side difference here is worth documenting carefully and re-checking every few sessions — it's one of the findings most likely to change measurably with consistent work, which makes it excellent proof of value for the client.

Why it's restrictedThis is the desk-and-bench finding, and it's usually bilateral. Every hour spent with the hands out in front — keyboard, steering wheel, phone, tools — is an hour spent in internal rotation, and the pec minor and subscapularis adapt to it. Press-dominant training programs load the same direction hard while the opposing pulling and external rotation work gets skipped. Add a flared, elevated rib cage from shallow breathing and the shoulder blade has nowhere good to sit, which limits the movement before the muscles do.

What it changes in your sessionSteps 11 and 12 together tell you the whole shoulder story. One-sided at 11, bilateral at 12 is the classic overhead-athlete-with-a-desk-job profile — and both need work, for different reasons.