We’ve slowly transitioned our operational definition of “ instability” to “motor control deficits”, led by the ever-growing amount of evidence on this matter. This has been wonderful for me and it has dramatically changed how I treat. This includes applying neurodevelopmental principles and treating in patterns much more than with isolation (I hope the BP cuff business has rebounded since we stopped isolating the TA).
Consequently, maybe we should begin to be more clear with our definition of “mobility” or “tightness”. The reason being that these are often consequences to a bigger issue. And just like we stated looking at the bigger picture for stability to motor control, we can continue our journey with mobility into “postural mobility control deficits”. The reason being with mobility issues we only look at at isolated incidences and no the big picture, similar to the drawing below: 
While its good to find an isolated Tissue tightness/extensibility or joint mobility issue they are unfortunately only consequences of a true cause. These are simply consequences often of “postural mobility control deficits”, be it prolonged positioning deviations from computer work (white collar) or from repetitive manual labor (blue collar). Like the picture above we can find one issue and stress the importance without taking in account the effects of posture.
Take for example something like limited internal rotation mobility loss (TED/JMD) found while utilizing the SFMA (DN, unloaded active and passive ROM). However, research shows that shoulder position influences that IR mobility issue (Borstad et al,Phys Ther. 2006;86:549-557). This is because structural and muscular alterations can be a consequence of alignment deviation. So the tight posterior capsule and tight infraspinatus is due from the postural control deficit (anterior tilted scapula) of the shoulder and shoulder blade in that pattern. In addition, the shoulder complex may have no ‘postural control deficits’ in other motions like overhead or with MSE. We can't assume posture will affect all motions and patterns. Conversely, we can't assume isolated mobility issues aren’t due to posture. We don't magically lose mobility! Sometimes it may look like this but the postural stresses eventually pass the threshold of pain, or pass the yield point (below) leading to the a new, learned position and therefore a change in tension/motion loss on a specific pattern. Similar to the stress-strain curve we learned for stretch, the tension in a shortened plastic region will change the length of a muscle.
Let me try an analogy to explain this better. My dog Tank freaks out with a particular hamper bin is brought close to him. This may or may not be because as a puppy I would put it over him like a cage (which looking back on I do sincerely regret). However, a nearly similar basket and he’ll jump into just to get a toy. So the stresses put on him over time (repetitive abnormal motions) made him change his particular behavior (like limiting range of motion) to this specific basket (or pattern) as a protective strategy. Similar to Tank, our postural control deficits were done simply to protect. This is why we can move through other motions without pain, and those other movements may allow the body to stop protecting itself if we can let the body potentially relax and stop protecting a specific pattern. This is some of the basis of MDT/Mckenzie and finding rapid responders.
My original train of thought would be to isolate that mobility loss with the likes of mobilization with movement, joint mobs, dry needling and PNF then follow with retrain and reloading. However, I need to consider how posture affects that specific pattern. Here are a few specific ways:
- Take advantage of regional interdependence and examine other nearby joints involved and how they have been effected in that pattern. Don't assume posture mobility deficits are isolated. Find other motor control of postural mobility control deficits with the breakout. Use manipulation and IASTM and DN at other nearby areas and patterns to get the improvement you want and possibly less protective mechanisms in the involved pattern.
- Work good patterns (FN) so the body knows it doesn't have to protect. This is part of reinforcement. Not just reinforcing new motion and the involved pattern but other patterns. Explore positional preference despite if its not better immediately as a result, it will continue to cue the brain that you can move without pain.
- Integrate motor control on the new postural mobility you get during isolations/resets. regardless of how unloaded or passive it needs to be.
