Defining, Assessing and Implementing Core Stability by Mel Siff

Posted by: Mel Siff Blog  :  Category: Biomechanics, Disease and Injury, Mel Siff and the Core, Mel Siff on Anatomy/Physiology, Training Theory

The following letter was sent to one of the professional physical therapy
groups. Since it focused on the rather trendy cuurent fad of “core
stabilisation”, I thought that this discussion would also be of value here.
Far too many self-proclaimed authorities on back pain, trunk stabilisation
and core stabilisation are proliferating some rather dubious beliefs about
these topics and it about time that some far more cautious science were
applied to them.

Here is the original letter:

<< I’ve just been awarded a research bursary and am planning to investigate
the possible link between hamstring strength and core trunk stability. I’m
planning to measure concentric/eccentric hams strength intially, send
subjects off to do hams strength work, transversus abdominus strength work
and placebo exercises. I’ve been able to get lots of literature re hams
strength, transversus abdominus (mainly Hodges, Jull and Richardson) and hams
injury prevention. What I haven’t been able to get is much information on
hamstring/muscular trunk control interaction. Anybody out there able to point
me in the right direction? >>

Here is my response:

***Just a small point about which I have written before – how does one assess
“core stability” statically or dynamically under conditions in which
peripheral stabilisation does not play a significant role in the overall
stabilisation process or confound the results? For instance, if one wishes
to assess “core stability” in a standing position, then how do we rule out
the major role played by the lower extremity musculature in the process?

Moreover, stability is not necessarily a result of adequate strength, but the
amount of “strength”, force or torque exerted at crucial stages of joint
action throughout any given movement. If someone produces inappropriate
patterns or timings of motion, then, no matter how strong a given muscle may
be, then stability will be severely compromised. This point often seems to
be forgotten in many studies of relationship between injuries and muscle
strength. Though the intrinsic strength of a muscle may be adequate in the
execution of a given task, it may not be utilised efficiently in that or
other tasks.

Moreover, if strength is adjudged to be adequate as estimated by static or
isokinetic tests in a given action, this does not imply that strength under
other conditions will be adequate. We simply cannot ignore the vital fact
that strength is not only the result of muscle action, but of neuromuscular
facilitation in response to specific stimulation in a given motor task. It
is not valid to extrapolate findings from isolated joint testing to a process
as multifactorial as dynamic stabilisation.

In this regard, articles such as the following can be very revealing:

Zajac FE & Gordon MF(1989) Determining muscle’s force and action in
multi-articular movement Exerc Sport Sci Revs 17: 187-230

Andrews JG (1985) A general method for determining the functional role of a
muscle J Biomech Eng 107: 348-353

Andrews JG (1982) On the relationship between resultant joint torques and
muscular activity Med Sci Sports Exerc 14: 361-7

What does all of this imply for the researcher? Well, it means that the
research protocol, and possibly the title of the project, needs to be devised
very carefully to take these problems into account. One has to be especially
careful as to how one defines and measures “stability”, especially the
“stability” of a portion of a dynamically linked system. So far, I am not
very convinced that many researchers are adequately addressing this problem -
maybe you could take a significant step forward to rise above the
perpetuation of some dubious traditional and relatively unchallenged
hypotheses. Best wishes in your task!

Mel Siff
Denver, USA

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Stability or Mobility? asks Mel Siff

Posted by: Mel Siff Blog  :  Category: Disease and Injury, Facts and Fallacies Blogging, Mel Sif vs ......, Mel Siff and the Core, Training Theory

.

You may recall a post on the value of belts in lifting which requested that I
review a series of articles which Paul Chek, a regular speaker on the fitness
circuit, recently wrote on the subject in Testosterone emag (see the archives
of the Supertraining eGroup). Relying on some rather dubious biomechanics
and clinical anecdotes, he deduced that all belt usage is detrimental to
lifting. Well, he posted some rather unhappy reactions to my review on
another weights user group. In one of these letters, he stated:

<<In summary, it is not a case of believing in the belly button “going in, or
going out”, it is a case of the order of events. If the body functions
correctly, segmental stabilization via the inner unit will prepare the system
for force generation. This is why I often say in my lectures, “in order for
the musculoskeletal system to stay healthy, stabilization must always precede
force generation”. >>

My response may be of interest to some of you:

*** “It is totally incorrect to state that stabilisation precedes
mobilisation. Neither is this taught or applied clinically in physical
therapy (e.g. in the application of PNF, Bobath etc), nor is it supported by
scientific research into the mechanisms of motor control. The annual
series of Bernstein memorial lectures on motor control offer just one source
of an extensive body of information which shows that stability is established
via ongoing feedback or error-correction processes acting on a foundation of
ongoing, varying levels of movement. If you have information to the
contrary, then you would be able to revolutionise the entire world of control
theory, not only in biology, but also in aeronautics, space exploration and
many other fields of human endeavour. And you would become an enormously
wealthy man in industry! ”

It is important to note that a system that is completely stable or following
a precisely described regular pattern (e.g. an unmodulated sine wave) carries
no information, so that it becomes very daunting to try to control a system
that tells you nothing about its current state. It is also fairly well known
that systems which are very close to equilibrium can display catastrophic
changes of state in response to very small perturbations (e.g. see work on
non-equilibrium systems by Nobel Prize winning scientist, Ilya Prigogine).

The process of stabilisation is by no means as simple and clearcut as Chek
seems to imply. Once again,this stresses how important it is for public
lecturers and authors in the fitness and training world to understand the
science behind the ideas and methods that they are trying to teach, sell or
apply.

Mel Siff
Denver, USA

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TVA and Breath Control by Mel Siff

Posted by: Mel Siff Blog  :  Category: Disease and Injury, Mel Siff and the Core

One member of the Supertraining mailing list at Yahoogroups wrote:

<…. Also, it is not uncommon to see respiratory disease patients with
chronic low back pain, since they cannot effectively utilize their TVA to
help control the segmental stability (note I did not write “core stability”)
of
their spines. I had never considered that resistive breathing might be a
training aid, but it sounds very interesting. >
Mel Siffs response was as follows
*** That is why I have hypothesized for many years that TVA activity is
really a secondary effect produced by appropriate control of intra-abdominal
pressure via involuntary or voluntary breath management. Most of the time I
even consider that the TVA activates quite automatically when the body is
forced to stabilise or react to any positional or movement changes. I have
often quoted EMG work by Basmajian to remind people that TVA activation is
intimately linked to any actions which elicit changes in breathing status,
especially if forced breath holding or exhalation takes place.

Remember Beevor’s Axiom, namely that the body (generally) knows of actions
not muscles? So — just learn some appropriate methods of controlling one’s
breath in different situations or carry out dynamic activities which compel
the body to produce such breathing actions, and the rest will follow quite
naturally! Anyway, in suggesting this, I fully appreciate that some ancient
Eastern guru (not the fitness type!) several thousand years ago would have
reminded me that all of this is really nothing new! Let’s not keep putting
the TVA cart before the breath-control horse and, for once and for all,
restore some sanity to this “Transversus in Wonderland” saga.

Mel Siff

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Pilates Explained? by Mel Siff

Posted by: Mel Siff Blog  :  Category: Mel Siff and the Core, Other Mel Siff Gold

Here is one of several similar letters which I received privately after my
article entitled “Pilates Naked” appeared in the www.dolfzine.com magazine:

“Dr Siff — I enjoyed your discussion of the Pilates method. You are the
first person I found on the Internet who seemed willing to look at their
claims logically.” [from Dr R M G]

No sooner had this letter arrived than I came across a magazine article which
proclaimed that it had been written to help the fitness professional to
really understand what Pilates is and what its benefits are. For a brief
moment, I thought that some genuine validation of their often exaggerated
claims would be forthcoming, but I discovered before reading to the end of
the first column that this was not to be.

————–

What Is Pilates? — Understanding and teaching this popular movement method

By Colleen Glenn & Roberta Morgan

[Personal Fitness Professional Feb 2002: 12]

[Colleen Glenn is a managing partner at Goodbody's Wellness Center, director
of the GoodBodys Pilates Education Series and vice president of The Pilates
Method Alliance. Roberta Morgan is PR Director with Center Studio in Los
Angeles and is a board member of the PMA.]

Invented in the early 20th century by Joseph Pilates, Pilates was created by
combining Eastern modes of exercise such as Yoga and Tai Chi with Western
practices such as aerobics and weight training. Even with the boom in Pilates
that has taken place throughout the world over the last 10 years, there are
still many people, even in the world of fitness and/or rehabilitation, who
are not clear on how this method works and why a new trainer must study long
and carefully in order to teach it. >

*** It is amazing that so many folk make it seem as if their fitness or
wellness methods almost require the intelligence and training of a “rocket
scientist”. Even old Joe Pilates himself didn’t have a very good grasp of
movement science, even for those times. Moreover, the glaring lack of
scientific research into the alleged uniqueness of Pilates training means
that there is a great shortage of intellectual matter that has to be studied.
Even the “scientific” or anatomical material that has to be studied
produces such gems that Pilates “produces thinner, less tight muscles” than
weight training — what more needs to be said about education that seems to
be so impoverished?

This means then that the extensive time necessary to even teach one exercise
on the “Reformer” or the “Cadillac” has to be spent on simply practising a
human movement that certainly does not require any skill which even vaguely
compares with a single axel on the ice, an Olympic snatch, a baseball strike
or a back salto in gymnastics or diving. Anyhow, many groups try to create
an aura of mystique or complexity about their special training method because
this makes it more marketable and attractive to the easily-bored fitness
public.

Although the authors state that “there are still many people, even in the
world of fitness and/or rehabilitation, who are not clear on how this method
works”, a quick reading of this article shows that even the experts do not
seem to be very clear about “how” this method works and what science really
exists to validate their claims for uniqueness.

The article continues:

<The Pilates Elders, the original remaining students of Joseph and Clara
Pilates, have stated that, “Pilates is a movement technique as well as a
lifelong learning process of training your body with an expectation toward
health and wellness. ” Joseph Pilates believed that since the mind built the
body, training the physical in this way sharpens mental acumen as well.

Pilates promotes good posture through breathing, proper muscle use and
coordination building core strength and flexibility and the use of
resistance-based equipment developed by Joseph Pilates. The Pilates body is
not one of bulk and restricted movement or of the runner’s sometimes anorexic
appearance. This is a dancer’s body at its agile best – long, lean, toned and
trim. Many people claim Pilates actually adds an inch or more to their
height. Other benefits include:

- Relaxation and stress reduction, encouraging overall health

- Mental and physical control of the body, leading to actual re-training of
neural pathways and physical grace of movement

- Gentle, safe, yet challenging non-impact exercises that build abdominal and
back muscles, which stabilize the spine, protect the lower back and tighten
and strengthen the buttocks

- Improved posture and stability, better coordination and balance
Strengthened bones and improved circulation

- Prevention of body pains and limitations associated with aging. Increased
mental and physical stamina and energy

- Fewer repetitions that are indefinitely (sic) more effective in changing
the body

*** As usual, no references or web resources are cited which support any of
these claims (of course, we will be told that in such magazine articles,
these would be out of place). Instead, we read nonsense on “retraining”
neural pathways (whatever that is supposed to mean in the healthy person),
implications that non-impact exercise is safer and more effective than
impulsive exercise, claims that Pilates PREVENTS body pains, and implications
that the fewer repetitions of Pilates are more effective than higher
repetition training, irrespective of training goals. All other claims are
not unique to Pilates — many other forms of exercise can claim the same
benefits and even more.

The article again:

<Pilates re-educates and promotes a process that truly enhances the mind/body
connection. Joseph Pilates promised that in 10 sessions of Pilates, you will
feel the difference. In 20, you will see the difference, and in 30, you’ll
have a whole new body. Given patience and persistence, you can improve
breathing capacities, align, stretch and strengthen the spine, improve
posture and tone the entire musculature. It has proven benefits for
conditions such as osteoarthritis and osteoporosis. Everyone from
post-rehabilitation patients to athletes see results.>

*** If ANY form of fitness training with or without weights did not produce
similar changes within those periods, something must be gravely amiss. For
the average gym user, 30 sessions is more than 3 months of training and, if
serious weight training were used for that time, I have little doubt that
most free weight trained subjects would visibly and in terms of physical
performance be superior to most Pilates-trained subjects. Muscle hypertrophy
(without those Pilates-condemned “bulges”), fat loss, strength, power and
even flexibility (if full range loaded exercise is used) invariably would be
greater.

The article once more:

<While some Pilates exercises can be performed on a mat with teacher
guidance, the equipment certainly enhances the experience and results. Most
of the equipment designs utilize spring mechanisms that the client employs
while moving the body, carefully noting its positioning. The spring system
assists and enables the body to achieve greater flexibility and range of
motion in the different planes of movement, thereby enhancing proprioception,
restoring joint mobility and providing an ultimate physical and mental
challenge.>

*** Springs offer resistance which do not load the joints and muscles in
optimal patterns of action, especially since spring resistance increases with
extension, whereas joint torque capabilities decrease after reaching a peak
well before any full movement is completed. Springs do not specially
“enhance proprioception” — I wonder if the authors would clarify what they
mean by proprioception and how one can alter it. I doubt if the Pilates folk
even know how one can combine elastics (or springs) with free weights to
enhance strength and power training, thereby extending the capabilities of
springs on their own. All that they seem to believe is that weights will
make you bulky, short-muscled, stiff and clumsy — now where have we heard
that before?

Do they really believe that spring training provides the “ultimate physical
and mental challenge”? If so, I am astounded, because even combined weights
and band training can be very wearisome if used very extensively in all
training. Maybe Pilates folk are just very easy to please! However, I would
rather not spend money on playing with spring laden machines, when I can do
many hundreds of exercises on a single free weights bar alone for nothing.

The article again (read my article on Pilates on the dolfzine.com site for
more information on these toys):

<The most well-known piece of equipment is the Universal Reformer. Other
visually simple but deceptively effective Pilates equipment includes such
items as Low Chair, Electric Chair, Trapeze Table (which Joseph Pilates
called The Cadillac, seeing it as the ultimate in his designs), Ped70-Pul and
Spine Corrector.

The Low Chair, sometimes called the Wunda Chair, was developed when Joseph
observed Chinese acrobats maneuver on a box. Since he had strong beliefs
about how people should stand, walk, sleep and sit to stay healthy, he wanted
the Low Chair to be in every hotel and home; he believed that modem chairs
compromised internal functioning and posture.

From its origins as a massage and therapeutic table, the Trapeze Table, or
Trap Table got its name from the circus trapeze. Pilates developed the table
to resemble a single four-poster bed with springs, wooden bars and hanging
trapeze-type equipment to challenge even the most physically fit individuals.
Concentration is very important to work the arms, legs, trunk and entire body
against the various spring tensions and positions this equipment affords.

A movement technique requires learning fundamentals to build upon, time to
physically acquire skills and mentally understand them. It is about
repetition, refining and a depth of understanding, something that requires
many hours of practice and apprenticeship. Professionals attending
introductory seminars and short programs do gain invaluable concepts and
preparatory exercises to incorporate in private and/or group settings, but it
is just a start. Teaching the Pilates’ concepts is quite different from
teaching exercises. The latter is surface; the former is unique and profound.>

***On many occasions I have openly requested just some scientific information
to validate the oft-repeated Pilates claims, especially regarding its alleged
uniquenesses, but none has yet been forthcoming, other than complaints about
“Dr Siff always picking on us – why, oh why?” (the usual sidetracking
techniques which try to disguise the likelihood that there is no information
available). If the science is not there to quote, what complexity and depth
can there be that one has to study?

Proclaiming that “teaching the Pilates’ concepts is quite different from
teaching exercises” is yet another gross exaggeration, unless they mean that
it is even simpler to teach Pilates exercises. Further, it is massively
misleading to add that teaching exercises is “surface”. Have they really
tried to teach the physical and mental skills necessary to master any complex
skills in any coordinated sport or even the more demanding weights exercises
such as the snatch?

The article continues:

<Pilates could not come of age in a better time. In 10 years, over 76 million
people in the US will be middle-aged or elderly. Older populations require
low-impact programs laced with variety that also address physical
limitations. Emphasis needs to be placed on health, function, quality as well
as prevention. Pilates addresses the needs of the current aging exercise
populations. As a result, Pilates is one of the fastest growing forms of
exercise today. As a professional, the question is not if you need to learn
Pilates but rather when and how.>

*** Once again, they proliferate the belief that low-impact exercises
necessarily are superior and safer (for people of all ages), even though
research shows that moderate levels of impact or more heavily resisted
exercise seem to play a very important role in increasing the degree of bone
mineralisation and halting the progress of skeletal deterioration. Bone
scans, for example, show that lifters who have used weights for several years
have significantly greater bone density than members of the general public –
I would be interested to see a comparison of the bone scans of lifters and
Pilates practitioners of comparable experience.

Although many older folk who have spent rather sedentary lives may be quite
frail, it is incorrect to assume that ALL older folk should avoid more
demanding forms of exercise. As a professional, it is more of a question if
you know enough about strength and fitness training in general, than if you
know a great deal about how to teach only a single limited form of training.

Sure, there can be a very useful role for Pilates, but it is not universally
superior to all other forms of exercise. To suggest that it can serve as a
total replacement for other systems of training or that it is definitely
superior in most ways to weights and other forms of overall training is
irresponsible and misleading, unless, of course, your aim is to attract more
business the way of Pilates!

The article went on:

<Formed last year, the Pilates, Method Alliance (PMA) is as international
non-profit organization of teachers, teacher trainers, studios, manufacturers
and facilities dedicated to preserving the legacy of Joseph and Clara
Pilates. The PMA states that, “The Pilates Method is an exercise process that
creates an internal physical transformation and integration of mind and body.
In order to be a teacher, one must experience it (the transformation) first,
understanding that it’s never complete but & constant evolution of learning.”>

*** Once again, we are exposed to this so-called “New Age” mind-body
integration mantra, as if this is unique to Pilates. Even though some sports
will not specifically pay attention to making deliberate efforts to integrate
the use of the mind into their physical training, this integration usually
happens quite naturally without effort by simply taking part in the sport
seriously. It is inconceivable to lift heavy weights, run long distances,
swim for hours, sprint a 100m in less than 11 seconds, sink a golf put from
15 metres, do a somersault on a skateboard……without mind-body
integration, so that claim is redundant. In fact, it is virtually impossible
to take part in any physical activity (and yes, that includes sex!) WITHOUT
mind-body interaction.

The article once more:

<The PMA recommends that anyone who would like to teach the Pilates method of
exercise attend a comprehensive training program and maintain a commitment to
education. Here are some questions to help you find a training program that
is right for you.

1. Are there any requirements for entry into the program? Most comprehensive
Pilates programs require prior Pilates exercise experience, knowledge of
anatomy and/or an entrance exam for a prerequisite.

2. Does the training program offer instruction on a pieces or just a specific
piece of equipment with a limited repertoire of exercises?

3. Does the program meet weekly or monthly? How long does it take to complete?

4. Are lecture, observation, apprenticeship and practice hours involved?

Pilates is a time-proven and enormously effective movement technique that
greatly enhances the mind, body and spirit.>

*** Now we note that Pilates also integrates the SPIRIT into the whole human
equation! — maybe if they returned to a soapbox at that famous street
intersection in San Francisco, Haight-Ashbury, or on the grass at Woodstock,
a few more people might buy that line, but, even in the hugely gullible
fitness and health world, that really is stretching one’s luck a bit far.

Do they really believe and KNOW that indulging in physical games on Pilates
devices is magically going to enhance what happens in the spiritual realms?
Maybe this little-known Pilates prayer has something to do with it:

Our integrated father-mother which art in Pilates heaven,
Hallowed be thy games
Thy playground come,
Thy exercises will be done on the mat as it is in the Cadillac heaven
Give us this day our daily flat muscles
And forgive us our trespasses for using free weights
As we forgive them that trespass on our machines
And lead us not into temptation to use heavy weights or ballistic bounces
For thine is the Pilates kingdom
The commercial power and the physical glory
For ever and ever
Aum!

————-

Mel Siff

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Mel Siff on The Spinal Stability Paradox

Posted by: Mel Siff Blog  :  Category: Biomechanics, Mel Siff and the Core

For several years I used to run on many user groups a forum that I called
“Puzzles and Paradoxes” in Exercise Science, with a total of well over 100 of
these being produced and being used at many educational institutions. I
thought that some of these would be of interest to our list members, so here
is one to consider.

PUZZLE & PARADOX 119

INTRODUCTORY NOTE

For newcomers to this forum, these P&Ps are Propositions, not facts or
dogmatic proclamations. They are intended to stimulate interaction among
users working in different fields, to re-examine traditional concepts, foster
distance education, question our beliefs and suggest new lines of research or
approaches to training. We look forward to responses from anyone who has
views or relevant information on the topics.

———————————————

PUZZLE & PARADOX PP119

Understanding and management of spinal problems may be confused and impaired
by the misleading use of certain definitions and models of spinal stability.

PREAMBLE

The back has probably generated more concepts and models of postural
management and rehabilitation than any other part of the body, undoubtedly
because of the prevalence of back pain, dysfunction and disability in Western
populations. Entire courses, clinical rehabilitation regimes and treatment
‘protocols’ have been developed to manage back problems, with a myriad of
experts gaining almost demi-god status for their particular approaches. Thus,
we are confronted with methods such as the manipulative schemes of
chiropractors and physical therapists, as well as Alexander technique,
Maitland, McKenzie, Pilates, Feldenkrais and a host of other models which are
specifically or partially devoted to back care.

We learn about neutral spinal posture, abnormal curvatures, ‘correct’ pelvic
tilt, ’swayback’, hyperlordosis, kyphosis, ‘proper’ lifting techniques and
numerous other issues relating to how we think that the trunk work., yet
agreement on all issues is by no means universal. Many folk with so-called
‘abnormal’ curvatures or postures do not suffer from debilitating back pain
and disability, years of heavy weightlifting does not lead to the expected
high incidence of injury or malfunction, and some methods of spinal
management have minimal success with some subjects.

DEFINITIONS

The foundation of all schemes of back use and care begins with definitions of
neutrality, the spinal curvatures, balance, abnormality and pelvic
disposition. Definitions of neutrality are bandied about so casually that
one would think that neutrality in the standing position is the same as
neutrality in seated, lying, walking, running and other situations. Are we
really entitled to apply such universal definitions of neutrality, bearing in
mind that spinal disposition is the result of dynamic processes throughout
the body?

Why is neutrality in the standing anatomical position considered to be more
fundamental than neutrality in the relaxed supine position? Is it
appropriate to apply concepts of neutrality in the static standing posture
with neutrality in the more dynamic cases of walking or running? Or does
neutrality disappear when one deviates from this ‘neutral’ standing position?

Many folk refer to normal lordosis or kyphosis, yet there appears to be no
such thing as normal scoliosis. Why this discrepancy? They consider lordosis
to refer to the normal concave curvature of the lumbar spine and kyphosis to
mean the normal thoracic convex curvature, but the suffix “-sis” always
refers to some form of pathology. Thus, lordosis should be used only to
describe excessively concave lumbar curvature, while kyphosis should be used
solely to mean excessively convex thoracic curvature. Scoliosis needs no
such attention – nobody uses that term to describe normal lateral curvature
of any part of the spine.

There are some who take all of this one stage further by referring to
‘hyperlordosis’, when lordosis already happens to be a ‘hyper-’ condition.
At a popular level, the term ’swayback’ is used as a synonym for ‘lordosis’,
but some therapists attempt to distinguish between hyperlordosis and
swayback. This distinction is by no means universally accepted, yet it is
sometimes used to offer different types of therapy to treat what is
considered to be abnormal spinal posture.

LAY TERMINOLOGY

A major part of this confusion is that the colloquial word ’swayback’ is not
a clinical term and that it is inappropriate to base kinesiological or
therapeutic analyses on lay terms being used in a clinical setting. This is
tantamount to comparing a cartilage operation with a menisectomy, because the
layperson thinks that cartilage is necessarily the same as meniscus.

Thus, it would appear to be meaningless to even consider comparing ’swayback’
and lordosis – either that or an acceptable clinical term has to be
introduced to accurately describe so-called ’swayback’ which is not the same
as the colloquial use of the same term. If some believe that swayback is
different from lordosis because each has a different characteristic degree
of pelvic tilt, then we are going to get nowhere, since virtually all
anatomists just use them as clinical and non-clinical synonyms.

The tendency towards swaying back in the so-called swayback posture is
increased among those whose knee joint tends to ‘hyperextend’, while it is
used quite comfortably as a standing variant when one stands with the hands
on the hips or presses a load overhead.

Some well-meaning postural experts advise us that adults need to become more
childlike in standing or sitting, because children have not yet lost their
‘natural’ tendency to have the ideal posture. It needs to be pointed out
that it is entirely meaningless to compare adult and child postures, since
the typical human spinal curvatures are consolidated only in adulthood and
that the more flattened spinal posture is unsuitable for the greater stresses
of adult life.

IMBALANCE?

Then, when so-called imbalances are found between the different muscle groups
involved in stabilising the spine, a large array of static hands-on tests of
muscle strength are used to identify these imbalances (such as the impressive
inventory of tests of Kendall). Yet, we know that the ’strength’ of
muscles depends on joint angle, velocity of movement, region of action,
degree of neural activation and fatigue. Are we justified in extrapolating
these static tests to identify imbalances which may or may not appear under
more dynamic or explosive conditions?

Why is balance or homeostasis considered to be so precisely defined that any
small deviations from fairly rigid ‘norms’ may be blamed for leading to a
host of back problems? One therapist swears that postural realignment will
solve the problem, another swears by mobilisation, others by manipulation,
pelvic re-education, myofascial trigger point therapy, ‘active release’,
McKenzie, shoe inserts (orthotics), Pilates, acupuncture and even
reflexology. Is the success or failure of any such system due more to the
possibility that the spine is such an imprecise functional system that
numerous strategies can affect its operation?

SOLUTIONS?

Is it not possible that no posture which deviates moderately from the ‘norm’
really will cause any problems provided that it is not held for too long or
subjected to prolonged or excessive loading in any given direction? After
all, the body is in constant motion, even during sleep, which may well be the
body’s natural way of preventing any given structure from being excessively
or inappropriately loaded.

So, if we move around regularly from one posture to another, no matter how
poor each may appear to be, are we not then minimising the occurrence of any
dysfunction – as long as we don’t load the spine excessively or hold the same
posture for too long in any one state? Is it only when we forget to shift
around regularly in seated and other positions that problems begin to emerge?
Is the prevalence of back pain and dysfunction more a consequence of lack of
adequate postural variation than any single ‘correct’ posture?

Though our models of optimal spinal functioning may well be quite accurate,
is it that essential to implement them so precisely, when regular shifting
from one position to another may tend to offset most of the alleged risks of
imprecise spinal usage? Does this then imply that many of the popular
therapies and methods of spinal use and rehabilitation are unduly
prescriptive and in many cases, redundant?

—————-

Mel Siff

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