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Episode 54: Alignment Dogma - Spine
1.1k Plays1 year ago
Welcome to Season 3 and Episode 54 of the Movement Logic podcast! In this episode, Laurel and Sarah discuss dogmatic beliefs and myths around the lower back, upper back, and neck from the yoga, Pilates, and strength training worlds.
You will learn:
- That the spine is made up of over 360 joints so maybe we should move it in all the ways (instead of keep it neutral all the time).
- That people are really bad at determining what position the spine is in just by observing (says research).
- That movement variety and movement preparation > “fixing” someone's alignment in a movement.
- Most yoga teachers never learn how to help their students progressively overload the strength they'd need to actually do the poses they teach.
- Pain causes people to adopt certain postures, but then what happens is people often flip this in their mind and say that it's the person's suboptimal posture that caused them the pain.
- Posture neither causes nor predicts pain (says science.)
- Lumbar flexion is demonized while sitting (don’t schlump) or bending forward (don’t round your back!) but research has been unable to connect flexing the lumbar spine in these scenarios with low back pain or injury.
- Deadlifting and squatting have been fearmongered to people who flex their lumbar spines in these exercises, but laboratory equipment has shown that even when it looks like someone has a neutral spine in these exercises, their lumbar spine is actually quite flexed.
- Any exercise is better than no exercise for low back pain, but no particular exercise is better than any other for low back pain.
- Why thoracic/upper back “hyper” kyphosis (a rounded upper back) is not a pathology.
- That back-bending is probably just flat bending in the thoracic spine.
- That “tech neck” does not predict neck pain.
- The neck is not a crane, and so we cannot apply the same physics to predict how a forward neck will respond to holding the load of the head forward of the body that we’d use to predict how a crane will respond to holding a load forward of its foundation.
- People who force their necks to be neutral have more pain than people with tech neck posture.
Sign up here for the Live Strength Training Webinar on Sept 14th with 30 day replay
Research mentioned in this episode:
Spinal Degeneration in Asymptomatic Populations
Intervertebral disc herniation: studies on a porcine model
Arthrogenic neuromusculature inhibition: A foundational investigation of existence in the hip joint
Effects of load on good morning kinematics and EMG activity
Posture and time spent using a smartphone are not correlated with neck pain
Is neck posture subgroup in late adolescence a risk factor for persistent neck pain in young adults?
Recommended
Transcript
Introduction to MovementLogic Podcast
00:00:02
Speaker
Welcome to the Movement Logic podcast with yoga teacher and strength coach Laurel Beaversdorf and physical therapist Dr. Sarah Court.
Philosophy of 'Strong Opinions Loosely Held'
00:00:09
Speaker
With over 30 years combined experience in the yoga, movement, and physical therapy worlds, we believe in strong opinions loosely held, which means we're not hyping outdated movement concepts.
Hosts' Introduction and Banter
00:00:22
Speaker
Instead, we're here with up-to-date and cutting-edge tools, evidence, and ideas to help you as a mover and a teacher.
00:00:41
Speaker
Welcome to season three of the MovementLogic podcast. I'm Laurel Beiberstorff, CSCS, that's certified strength and conditioning specialist. Also, E-R-Y-T, experienced registered yoga teacher, 500 hours. And I'm here with my co-host, Dr. Sarah Court. She only has three letters though. D-B-T.
00:01:05
Speaker
I'm going to say my three letters are more expensive than all of your letters combined. Oh, a lot. I also have the E-R-Y-T. You do. You have as many letters as me. Oh, wait, no, C-S-E-S has four letters. It also always makes me laugh that the E of E-R-Y-T is experienced. That's such a weird word to put in your title.
Living in LA and Parenting Jokes
00:01:26
Speaker
To get it, you don't really need that much experience at all. No.
00:01:29
Speaker
If you were listening to the Jimi Hendrix song, Are You Experienced?, the answer would be no, not really.
00:01:39
Speaker
So we're still in LA. We are. Well, I live here. I mean, you do. Yeah. And I'm dependent on you for the next four days to keep me alive. Oh, boy. So I'm currently still living. Is this what it's like to parent? While I'm here. Shit. No wonder I never had children. Oh, yeah. I mean, if you want to rent me for like four days, you'll get a really good idea of what parenting is
California Weather and Seasonal Fruits
00:01:58
Speaker
like. I'm constantly hungry. That's true. One of my best friends, I went and stayed at her house for a couple of days and she was like, you are like a newborn. You need to eat every two hours. I was like, that's true. Yeah.
00:02:07
Speaker
I'm not going to deny that we're having fun. I mean, we, so far, like I slept about 10 hours last night. We're going to go on a hike later today. I ate a delicious chicken salad made by my mom. California is.
00:02:25
Speaker
really lovely weather all the time, even when it's, there's a heat advisory. Yes. Does not even compare to Alabama in the summer. So I'm having, I'm living my best life. Excellent. Yeah. It's also, it is a really good time to be here from the perspective of fruit.
00:02:43
Speaker
because it's late July and it's peak fruit season for things like berries and nectarines and we're coming up on fig season pretty soon. I think it's a little early for the figs, but like, you know, really good avocado. Just the word bountiful. Yes.
Listener Feedback and Appreciation
00:03:02
Speaker
Bountiful. It's bountiful. The flush of the buttocks of bounty. Oh, God. Yeah. All right. Hopefully you remember that.
00:03:12
Speaker
that joke from the first episode of season three. I thought you were talking to me. We were just joking about that a couple of hours ago because we're batch recording. Okay. Yes, we're having a good time. Another way that I like to have a good time is by humble bragging. Sure. One of the ways I like to humble brag is I like to read positive things that other people have said about me. That way it doesn't sound like I'm bragging. Right.
00:03:42
Speaker
It's what someone else said. I'm just reading
Debunking Alignment Dogma
00:03:44
Speaker
it. So I would like to read a review written by someone named Caitlin C. NYC. I know who this person is. I mean, so do I. Yes. She's a friend of the pod. She is a friend of the pod. And I would say also it wouldn't take much sleuthing for many people to figure out who Caitlin C. from New York is if you listen to any of our stuff or if you're in the movement world at all. Right. But anyway, she said lots of nice things. She gave us five stars.
00:04:12
Speaker
And then she wrote, thank you Laurel and Sarah for shedding light, humor, and curiosity on so many important topics in the movement nerd multiverse. Then she put the nerdy face emoji.
00:04:24
Speaker
I appreciate the evidence-based and inquiry-rich approach. Laurel's SI joint episode gets a big yes from me. As a former yoga teacher, now physical therapist, I can totally relate to Laurel's story. I found myself nodding my head through the whole listen. Five stars, highly recommend. That's a five-star review. The episode on the SI joint was also very popular.
00:04:52
Speaker
What I like so far is you've said that every episode is very popular. Well, the ones we talk about. Yes, but so far you've only talked about episodes that are very popular. I don't know where I'm going. You can edit that out. Okay. I'm not going to talk about you. All right, I'm editing this episode. You are. Let's stop the banter. Let's get down to brass tacks here. Okay. Well, I like that now that the editing is your problem, now you're really concerned about waffling. We have to stay on topic.
00:05:21
Speaker
Please, I'm all ears. I'm just kidding. Today we're talking about alignment dogma and specifically alignment dogma about your spine. So if you listen to episode one of season three or 48, episode 48, you heard us discuss alignment dogma of the pelvis. So today we're talking about the spine. We'll probably spend the majority of time talking about the lower back because that is the hottest of dogma hotspots.
00:05:49
Speaker
And then we'll discuss the upper back and the neck a little as well. Okay.
Anatomy of the Spine
00:05:55
Speaker
Alignment dogma is basically when we take something like our ability to cue people into a particular alignment or even just our ability to observe a particular alignment and ascribe some meaning to it that has not been supported by evidence. We're calling this alignment dogma. What we're not saying is that alignment
00:06:19
Speaker
Paying attention to alignment, observing alignment, describing alignment, or teaching alignment is a bad thing. Not at all. I think really the aim of these episodes is to raise awareness around the fact that it is just not borne out in the research, in any evidence, that alignment predicts pain
00:06:36
Speaker
or that posture or even you could say movement quality, we'll use these terms interchangeably, predict pain. We're going to share some background around where people might have gotten this idea that it does though.
00:06:50
Speaker
And like I mentioned, we're going to focus quite a bit on the lower back because there's an awful lot of vilification of lower back position, flexion, rounding the lower back. An awful lot. Okay. But before we talk about spinal alignment, dogma, let's actually tour the spine.
00:07:11
Speaker
from an anatomical perspective and talk about what are the bones, what are the way these bones kind of fit together, and what are the joints involved in this thing that we call the spine. All right, so first of all, before we get into the different regions of the spine, the curves of the spine, the discs even, let's just take a moment to appreciate how many joints
00:07:33
Speaker
make up the spine. Before we do that, let's actually, what is a joint? I love a joint. Yeah. I mean a joint in your body. I think joints are fascinating. Right. I love them. Oh yeah, me too. Me too. Oh yeah, that's what I thought you were talking about. I don't know what you, oh, the other thing I'd be talking about. Yeah. Oh yeah, me either. Okay, nevermind. So there are 364 joints, one for almost every day of the year. Or, uh, wait, is a leap year 364? Yeah.
00:08:04
Speaker
Is there an extra day in a leap year? Yes. There's February 29th. That's right. Sometimes I forget things that I learned a long time ago. I'm sure some people have 366 joints in their spine. Definitely. Yes. So 366 joints, 65 joints, 64 joints, somewhere in that range. A year's worth of joints. A joint is a place where two or more bones meet where movement happens. Yes. And we have 364. Okay. Give or take a few.
00:08:33
Speaker
in the spine. It's wild.
Posture and Pain Misconceptions
00:08:36
Speaker
I can think of a couple of other areas of the body where we have a preponderance of joints. Preponderance. The feet. Yes. One foot has 33 joints. The hand, probably somewhere in the 33 joint. I'm not really sure how many, but somewhere in there? Sounds good. Whenever I think we see a lot of joints in a particular area of the body, a body part, the torso being a very large body part,
00:09:01
Speaker
we're going to go, okay, I think that area should probably move a lot because it's designed to move a lot. It probably depends on the fact that we move it a lot or hopefully move it a lot to maintain its level of health and functionality. Each vertebra of the spine, there's seven in the neck, there's 12 in the thoracic, the neck is the cervical spine, the thoracic spine is what we would call the upper back,
00:09:31
Speaker
And then the lumbar spines, which we call the lower back, there's seven in the cervical spine, 12 in the thoracic spine, five in the lumbar spine. These are all movable segments. And there are many joints just within one spinal segment. There's the disc joint, there's the facet joints, which are posterior facing and determine basically how much your spine can move in any given direction. There's even rib joints.
00:10:01
Speaker
And all of these places where movement happens, where two or more bones meet, allow for some movement. Some allow for more movement than others.
00:10:11
Speaker
Then there's also the discs, which are not bone. Can you tell us about the disc, sir? Yeah. So the discs are cartilage based and they are in between the body of each vertebra to the next, right? The body is the big fat part. And the discs, I'm not going to go too much into the anatomy of the disc, but essentially it has a tough outer part and a softer inner part.
00:10:35
Speaker
The purpose of the disks essentially is to help absorb some of the impact of that ground reaction force when you are walking or running so that it doesn't shake your brain essentially. It absorbs some of it and it redistributes it laterally out to the sides or circumferentially all the way around.
00:11:01
Speaker
It also creates separation between the vertebrae so that you can move them relative to each other potentially more. It's like a little mattress in
Influences on Pain Beyond Posture
00:11:10
Speaker
between. Yeah, and it helps to create sort of a smoothness in the relationship of those vertebrae so they're not like ching, ching, ching to each other, but there's actually kind of like a more like a garden hose quality. Yeah, I like that. I like that image.
00:11:22
Speaker
Yeah, and the spine can move in all three planes. Some of the regions of the spine move more or less than others, but just generally speaking, your spine can flex. It can extend, and that's in the sagittal plane. You stoop or bow or round forward. That's flexion. When you back bend, that's extension. It can side bend. We call that lateral flexion. When one side of the spine gets shorter, the other side gets longer in length or
00:11:52
Speaker
You can side bend to one side or the other side is lateral flexion, lateral extension, and then rotation. So the top part of your spine can rotate relative to the bottom part. The bottom part can rotate relative to the top part.
00:12:05
Speaker
Three planes of movement. You want to tell us about the curves? So if we think about the sections of the spine, the cervical, the thoracic and the lumbar, each section is going to have, has a different type of a curve potentially, and also different range of motion, partly based on that curve. So the cervical spine and the lumbar spine both have lordotic curves or lordosis, which means
00:12:27
Speaker
And this is where I every single time does this happen to you with like certain things you learned as a child where every time you have to do the trick to remember what it's called so Convex versus concave so concave is like a cave so it goes in so that's what a lordosis is if you're viewing it from behind right the Concavity of your neck and your low back is going into the cave and
00:12:49
Speaker
of your body and then your thoracic spine and your sacrum to some extent do the opposite. They do something called kyphosis or kyphosis depending on who's talking. And that is a convex curve that moves out of your body towards you if you're facing the person from behind. So the cervical curve and the lumbar curve are kind of like if you view somebody in say all four
00:13:12
Speaker
all fours or four-point pose or tabletop look like valleys. Yeah. Then the kyphosis would look more like hills. Yes. Each part of the spine does have different amounts of range of motion in different directions. It is totally natural to have curves that are very curvy, and it is totally natural to have curves that are almost not even there at all. I've had patients where I run my hand down their spine and it's practically a straight line.
00:13:41
Speaker
And that might cause some, you know, scapular issues around the shape of the scapula in relation to the rib cage, but nothing major. So just something to think about. Like if you're like, well, my, I don't think my spine curves very much at all, you're probably still fine. Nothing's going to happen.
00:13:56
Speaker
Yeah. So when you go to the chiropractor and they X-ray your spine and tell you that your low back pain is because you have a flattened lumbar curve, maybe get a second opinion. A hundred percent get a second opinion. Yeah. So each part of your spine does have a different amount of range of motion available to it. Generally speaking, your cervical spine, your neck has the most range of motion in every direction.
00:14:19
Speaker
And this is both, this is a sort of like form follows function in that the neck only has your head on top of it. So it doesn't have to hold the weight and possibly be more stable the way that like your low back does when it's got your head and your trunk and your arms.
00:14:39
Speaker
all sitting on top of it, right? And the other part of your cervical spine is your neck has maximum like tilt and angling available so that you can see every direction for either a predator or for your lunch, right? Or perhaps your dinner, any meal. Or for when you're shopping and you want to find the sale rack or the cashier to purchase your pants.
00:15:04
Speaker
That's those two reasons are the only reasons that your head moves three reasons. Pants purchase, predators or prey. Lunch. Uh, your thoracic spine.
00:15:17
Speaker
does not have as much movement available to it, although it has in some ways more available than the lumbar spine. Some of that is a function of, like if you look at the thoracic vertebrae and you look at the spinous processes on the back, they point down. The spinous processes are like the stegosaurus spikes. Right. They're the ones you can feel if you touch your spine. Those are the bumps that you feel. In your thoracic spine, they generally point down.
00:15:39
Speaker
your rib cage area is quite good at flexion, which makes sense because that's the shape it lives in, that kyphosis, kyphosis. It's not great at extension. It's medium, it's side bend. It's quite good at rotating.
00:15:56
Speaker
A lot of that is a function of your ribcages there to protect your
Yoga Alignment and Safety Debate
00:16:00
Speaker
heart and your lungs and some of your other organs, but mainly your heart and your lungs. So there is a real reason not to have a ton of mobility in this part of your spine.
00:16:10
Speaker
And then your low back spine, your lumbar spine has some, in the sagittal plane, flexion and extension, it has quite a bit of movement available to it. It has some amount of side bend available and it has almost not zero, but has very, very little rotation. Yeah. And I'll say too that like sometimes we think that the lower back can do like a ton of flexion and a ton of extension.
00:16:35
Speaker
But when we watch someone move, say if they're doing a forward bend or a back bend, like a lot of times what we're really seeing is the rib cage and the pelvis moving and it's very deceptive. And we got into this when we talked about pelvic tilt and like really even being able to assess what the position of someone's pelvis is as an outside eye looking in.
00:16:53
Speaker
The same goes with the lower back. We can think or any part of the spine. We think we know what positions it's in based on what we see someone doing with their posture, but a lot of times when we compare that with what really expensive lab equipment is able to measure in a research setting, we see that there's a big gap between what we think is happening or what is moving or what position something is in and what it's actually in.
00:17:19
Speaker
So this knowledge gap is a really, I think, ripe topic to weave into a discussion about alignment and its relationship to safety and or injury and the types of dogmatic beliefs that we can develop around alignment because from the standpoint of epistemology, right, which is the study of what we can know and how we measure what it is that we think we know or how we know what we know,
00:17:47
Speaker
We have to take into account the limits of our ability, even know the thing we're trying to draw conclusions about. A lot of times we're drawing conclusions about something that we don't even realize we don't know, which is part of being a human being. We like to tell stories about things without fully understanding them, but it plays into why we might maybe over
00:18:10
Speaker
interpret. Yes. Thanks. I think we over interpret. Well, you know, the things we don't know, it feels much more comfortable to make up a story and then feel like we know. Oh, yeah, way more comfortable, way more comfortable. And sometimes more fun too. Sure.
00:18:25
Speaker
So a little bit about the muscles. There's tons of musculature that moves the spine, not just on the back. I think we focus a lot on the back musculature, but also on the front that wraps all the way around the sides of the rib cage, which attach to the spine. But generally speaking, it seems like from the back,
00:18:43
Speaker
from the posterior side of the trunk, the muscles tend to get bigger as they get more superficial. So you've got the tiny little rotatoris, the multifidi, really close to the spinal bones, and then we've got the bigger erector spinae, we've got the really big latissimus dorsi muscle, and so these muscles, most of them run all the way from
00:19:04
Speaker
the sacrum, the pelvis to the to the head, some of them just run halfway, you know, from the say the latissimus from the shoulders to the to the sacrum. But for the most part, these are massive muscles that kind of work more globally on the entire spine. So even just separating out like
00:19:21
Speaker
lumbar movement from upper back movement. We think we're doing it, but a lot of times we're not. Same thing with the lower back and the way it moves relative to the pelvis. Pretty much, I'm going to say, anytime your pelvis is moving, your lower back is probably moving too. We're talking about alignment dogma. Again, as a reminder, when we use alignment, this term is used interchangeably with posture and with movement quality.
00:19:49
Speaker
So Sarah, can you quickly explain slash maybe review what the relationship is according to research, according to population size bodies of evidence where we're looking at large populations of people, not just looking at like this student in your class or your personal experience. Like this is like.
00:20:11
Speaker
Lots of people. What is the relationship that science has found between alignment slash posture slash movement quality and pain? Well, yeah, I can answer that. You said to do it briefly. I can do it very briefly. Great. There is none. Oh, my God. I'm going to role play with you here. Please. I love
Scientific Skepticism in Movement Inquiry
00:20:36
Speaker
it. I'm the person who has
00:20:40
Speaker
been told my whole life that, you know, lots of negative consequences arise from bad posture. Like neck pain comes from Tex neck. Lower back pain comes from lifting with my back or round or schlumping in the chair.
00:21:00
Speaker
My upper back is super hunched and rounded and that's causing all types of negative consequences for my neck and lower back or whatever. But you're actually telling me that my suffering has no relationship to my posture? Well, your suffering has more relationship to the lack of changes and the lack of
00:21:29
Speaker
variety in the way that you sit or stand or move and lift and the way that the muscles around your spine are being used repetitively. Like any repetitive injury is something where you've misused something or just overused it beyond what it can tolerate over time, right? So people who say like, oh, I'm really, you know, people come into the clinic all the time and they're like, I'm really worried about my posture. I think my posture is really bad. I need to fix my posture.
00:21:57
Speaker
And it may be that that person spends 10 hours a day without a break sitting in front of a computer. That sounds like an exaggeration to a lot of us, but it's not. I see a lot of people who do that and who maybe get up once or twice. So they're basically doing the same thing as being on a long-haul flight every single day, right?
00:22:21
Speaker
That is, that part is what's going to potentially cause them pain and suffering. The shape itself, for want of a better term, is neutral. Right? So, but it's the, how much time? When you say neutral, you mean it's like not inherently bad. The shape is benign. Right.
00:22:39
Speaker
How much time are you spending in that shape? What other shapes are you maybe now not able to do because of the quality of how your muscles are working? That's where the potential for pain is coming from. Right. But a lot of people in conventional wisdom would have us believe, a lot of people believe that you can look at someone, notice their postural uniqueness or their postural tendency and know kind of where they probably have pain. And it turns out this is not the case.
00:23:08
Speaker
So it's difficult to wrap our minds around this because I think it's a real human tendency to take two events that seem to happen simultaneously or one happens before the other,
Understanding Alignment's Effects
00:23:22
Speaker
right? Because this happened first and then this happened, that's the post hoc fallacy, right? And then two events that occur simultaneously that they must be related, right? And so we ascribe meaning to things
00:23:37
Speaker
based on other things that happened concurrently or preceded the thing. So if we get pain, we go, I must have had pain because
00:23:46
Speaker
I have this bad posture, this tendency towards slouching, or it's like I'm a person with a maybe more posteriorly tilted pelvis, and because of that just way of being in my body, that is occurring simultaneously with my pain, they must be related. And so this is a logical fallacy, actually, because it's not the case. Just because two things happen concurrently, or one thing precedes another does not mean that
00:24:13
Speaker
there's any relationship between them. Absolutely. It could just be coincidence, nor does it mean that the thing happened that that happened prior to the other thing caused the second thing to happen. You know how when people watch sports and if they're very superstitious about it, they'll be like, I have to wear my team scarf or whatever while I'm watching the game. And if I don't, they're going to lose. Right. That's about the same level as saying I have to sit with good posture all the time. And if I don't, I'm going to have pain.
00:24:41
Speaker
Right. Not only is the green sweatshirt, that was the color?
Rethinking Lumbar Flexion Concerns
00:24:46
Speaker
Oh, I didn't pick a color, but sure. Not only does the green team sweatshirt or whatever it is not cause the team to win, there's actually also no relationship between wearing a green sweatshirt and teams winning or losing. Yes, I agree. That was a good example. I was also thinking of the example where they did a really poorly designed study about people
00:25:06
Speaker
Getting up off of the floor. Yeah, and if they the claim was that if you can get up off of the floor without using your hands This is a predictor of longevity. Can you tell us like yeah? Well, my favorite thing about that is I I mean my least favorite thing about it is a lot of people still point to that study as like you should be able to do this movement and if you can't
00:25:28
Speaker
Good luck you're gonna die or whatever maybe they don't say that but they they're like this is really important that you can do this and I'm like well is it or are there things around most of the time that you can use to help yourself get up but regardless that's not the point the point is the study said if you had to put down like a hand or a knee while you're getting up off of the floor then that was a sign that your life was going to be shorter and
00:25:53
Speaker
But what they found was that the people who had to put a hand or a knee down were the people who were older. Not the 50-year-olds, but the 80-year-olds. And the thing is, when you're 80, your life is already going to be shorter than when you're 50. If we're talking about natural causes.
00:26:15
Speaker
That was a very green sweatshirt equals team wins kind of an understanding. They tried to show a relationship between putting your hand down on the floor and living for less time when really the relationship was probably more about age and having to put your hand down and age and not living as long. Is that kind of what we're saying? So the relationship was like misplaced.
Critique of Lumbar Flexion Research
00:26:41
Speaker
So there's not a relationship, let alone
00:26:43
Speaker
causal one between posture and pain. But there are ways of predicting, not necessarily to a T or hyperactively, but ways of maybe looking at a situation, taking someone in context and going like, I think that might not go well for you. And it's not really about their posture. Rather, it might be more about how prepared they are for the activity or movement at hand.
00:27:10
Speaker
History in their life do they have doing the thing like I'll give you an example like I used to run a lot when I was 20 Stopped running for many many years every once in a while in my like 30s I would get a hankering to go out and like I had like nostalgia for like the years that I would
00:27:26
Speaker
be running around New York City as a 20-year-old and was like, I want to run again. It was so great for me then. It should be great for me now. And I would go out and I would go from not having run for 10 years to running three miles. And not only did it hurt, it just was really uncomfortable to do that. But the next day, I often would have like, ooh, my hip flexors are really sore or my knee doesn't feel great or my lower back doesn't feel great because I was not prepared. I had not been
00:27:52
Speaker
ramping up my capacity to be able to engage in running for three miles, it probably should have gone out and maybe did a walk run for 20 minutes, right? Or something like that. So movement preparation is a pretty, a much better predictor of whether or not an activity is going to cause someone some issues. Also, you know, maybe alignment slash posture matters more if we're engaging in activities where loads are relatively high. Okay, so if we're
00:28:20
Speaker
going to lift a heavy weight or if we're going to sustain high amounts of impact or move really quickly, like the rate is high, the rate of loading is high, the magnitude of load is high. Posture might matter more, but then the question becomes, is someone who's going from never lifting a weight or never moving quickly or never sustaining any amount of impact going to suddenly subject themselves to high loads? It's possible, but I think most people are rational, reasonable people.
00:28:48
Speaker
and they understand that they need to build up to these things, unlike me. So, I don't know, most of the patients I see who are people who come in with stories like yours, where they're like, well, I used to run in college, and then I'll look at my notes, and it says they're like 38 or something. And they're like, so I thought it'd be fine, so I went for a five-mile run, and now my knee won't stop hurting. Okay, you're right. People just really aren't that rational. And then this makes me think, like, why is it then, from my perspective, why does it seem like yoga teachers and Pilates teachers who teach, like, what I would,
00:29:18
Speaker
I think is pretty, hopefully people understand like that's a fairly low load activity when compared to things like strength training or field sports or things like that. Why are they so protective of people's spines? And so fear mongering around like the safety that people are in or not in while doing yoga and Pilates. And I mean, I don't know, what do you think Sarah? Like why do you think that yoga teachers, most
00:29:44
Speaker
Maybe speak from the yoga teacher perspective. Maybe you have something to add about polities. Why does it seem like there's so much attention to how unsafe or safe people are in, in the class? Yeah. I mean, I think from the perspective of a non-clinician when you look like if I was running a
Interpreting Pain Signals
00:30:01
Speaker
yoga teacher training, for example.
00:30:04
Speaker
And I knew I was about to unleash, you know, potentially 20 new yoga teachers on the world. And I would assume that they have little to no understanding of anatomy, biomechanics, kinesiology, all that kind of stuff. I would be really hyping the things that I knew were the most safe, quote unquote safe for the most people, right? The most, the most benign things that I can think of. And also I'm probably influenced by my teacher training myself, right? So for example,
00:30:33
Speaker
If I have my yoga teachers, my new yoga teachers all teach Warrior II with the cue of aligning your knee over your ankle, that is generally a place that most knees can handle. I would argue most knees can handle most things, but if they're teaching, this is about let's be as blanket and broad as possible and let's keep everything as absolutely benign as possible.
00:31:03
Speaker
for that reason, but then they'll go and teach a headstand. So I'm like, well, pick your battles here. It doesn't make any sense to me at all. There's a lot of inconsistency. And the other thing is that I wanted to say as well is this whole idea about posture and pain and how they're not actually aligned.
00:31:18
Speaker
The reason why they don't correlate is pain is an incredibly subjective experience, right? It's a biopsychosocial experience. Right. We get really hung up on the bio part of it. We do and forget about the psychosocial. Yeah. And, and you know, again, I see people come into the clinic all of the time with any variety of spinal positions and, and, and the same variety of pain up and down the spectrum where certain things people are unbelievably sensitized to. And then I'll see the same thing on someone else and they're like, yeah, it doesn't hurt.
00:31:48
Speaker
That's part of the issue is that we can't call pain the same for everybody because it's not. Right. One of the things you notice, if we just put everyone in this kind of mid-range position like knee over ankle, then that is a less risky place for all knees to be in.
00:32:08
Speaker
you could argue the opposite,
Role of Exercise in Pain Management
00:32:09
Speaker
which is that if we don't actually expose the knee to a variety of positions and loads, we create more risk for that knee when inevitably in our lives, we have to be in that particular position or sustain that particular load with our knee. So in other words, movement preparation, strength training, for example, is a really potent way to prepare your body to handle forces and to move
00:32:37
Speaker
with resilience and durability. Strength training is a proven way to reduce the risk of injury. It doesn't necessarily prevent injury because we don't, injury could happen for any given, any time spontaneously. Like you could get injured because someone runs into you or whatever and like it's not necessarily gonna prevent injury, it's not gonna prevent those things from happening, but it is going to reduce the risk. Let's say if someone ran into you,
00:33:03
Speaker
you probably will be able to catch yourself potentially better if you're strong and prevent yourself from falling and therefore the risk of injury is reduced. But here's the thing, yoga teachers don't teach strength training. Yoga teachers don't progressively overload their students in the same way that you would in a strength training format. And so it's maybe one of those things where we want to use the tool that we've been trained to use. Well, and I think that many yoga teachers, Pilates teachers are excellent actually at teaching.
00:33:33
Speaker
Alignment and they're really good at raising students awareness in like this mindfulness based way about where their body is in space and enhancing proprioception in that way. And this has a absolute ton of value, but you cannot alignment someone or align someone out of a strength deficit. You cannot align someone out of a tissue capacity
00:33:56
Speaker
Now, this isn't to say that you can't build tissue capacity in yoga. You absolutely can. I mean, yoga can be a significant load for some people who've been sedentary most of their life or have been, you know, just not engaging in exercise at all, actually. Like when you come into plank pose, having never done plank pose before, you're going to feel your muscles working significantly. You might only be able to hold that plank for a couple seconds, right? Same thing with the standing poses, but eventually we kind of top out, we reach a ceiling and our ability to continue to progressively enhance the capacity of our tissues and
00:34:26
Speaker
become more durable. And so I think that what happens then is like teachers lean into the thing that they can teach. Of course. Yeah. Right. And they try to use the tool of alignment in a way that's not really that well designed or it's not designed at all to be used. We cannot align someone out of a strength deficit. And especially in yoga, you know, the alignment essentially is an aesthetic.
00:34:53
Speaker
It is not an anatomical requirement, right? If I do let my knee go past 90 degrees, it's not going to explode. If I do let my lower back go into flexion, it too is not going to explode.
00:35:06
Speaker
I think there's an aesthetic component too, but I think it goes beyond aesthetics in that if I am teaching somebody to align their knee over their toes in Warrior II rather than over their heel in Warrior II, I'm exposing that knee to a different load profile and I'm preparing that knee in a very different way.
00:35:29
Speaker
I am if I'm aligning the knee over the hill and not neither one is better or worse than the other there are different ways of preparing the knee to handle a Particular load and so we could we could make the case for for yoga teachers being like the people who expose people to loads for sure the difference is not in loading that the difference between string training and yoga is not in the a variety of ways we expose people to loads and
00:35:54
Speaker
in terms of position and alignment, it's in how much magnitude of load we're able to expose people to. Because when we're working with yoga, we're working with body weight. We're not working with external loads. So when you do a melasana, which is a deep squat, you're only ever squatting your body weight. When you do a melasana in strength training, you could be squatting hundreds of pounds, right?
00:36:17
Speaker
So this is where the difference between the direction of forces we're exposing the joint to are different than the magnitude of forces we're exposing the joint to. But I think if you ask an average yoga teacher, what is the purpose of alignment? I like to tell people that the alignment in yoga is an aesthetic mostly because they all then look at me and their eyebrows go up because that's a very
00:36:45
Speaker
That's not something that they have heard before or necessarily believe. They think- Provocative. Yeah. Thank you. It is provocative, but what they have been led to believe, and this goes back to the like, if your tool is alignment, then every hammer is a nail. No, that's not how that goes, but something like that. If you're a hammer, everything's a nail. Yeah. If you're an alignment specialist, then everything that needs to happen is alignment, right? Every problem that can be solved can be solved.
00:37:10
Speaker
by alignment and I don't have tools like I don't not in my yoga class being like okay let's go get the kettlebells like there is no magnitude variation in the load it's all body weight so all I have at my disposal is alignment and I think that's why a lot of yoga and Pilates teachers or other movement based teachers tend to get into this alignment as safety idea because they don't have anything else to use.
00:37:35
Speaker
I also want to say that this isn't to take a big shit on people who teach yoga as not being this good enough thing to teach. Not at all. Not at all. Not at all. Yoga delivers benefits that strength training could never. Absolutely. It creates an environment that strength training could never.
00:37:55
Speaker
And it invites a population of people that would never consider stepping foot into a gym. And so it also just has so many other things that it does that strength training could never do. I think what my aim is as an educator and why I think we create these podcasts is to help people get out of their own way. You know, it's like if you're a yoga teacher,
00:38:17
Speaker
get out of your own way. So that the brilliance of what you teach and the brilliance of who you are as a teacher can really more fully shine through. And one of the ways we do that is we stop conflating alignment with safety. And we talked about this in the Paul Viss episode, one of the negative outcomes of doing that, of trying to align someone into a safe, quote unquote, safe position as we create fear avoidance in our students. We instill in them this idea that they're actually inherently not safe.
00:38:47
Speaker
that movement is dangerous and that there's one or a select few amount of safe positions to be in. This has been shown, beliefs about pain have been shown to be a predictor of pain. If you believe that your body is fragile or incapable of handling the loads of your life or that movement is dangerous, you're actually more likely to have pain.
00:39:11
Speaker
So that that's the psychological component of pain, right? There's also other predictors of pain, which include history of injury. So injury and pain are not the same thing. We have a whole episode about that, right? Your solo episode about. I'm trying to remember which episode it is. Yes. And then also we talk about injury and pain in yoga and strength training in season two, but injury and pain can be connected. And the thing about.
00:39:41
Speaker
Injuries, one of the best ways to predict whether or not someone will have an injury is if they have a history of injury. So that injury. Yeah, that injury. Right. So if you have a history of ACL tear, you're more likely to tear your ACL. The ACL is a ligament of the knee.
00:39:58
Speaker
So that's one. Another one is, what are your stress levels like? Like I mean your psychological stress levels, like how's work going? How's your home life? How's your marriage or your partnership or your relationship with your kids? Do you have friends where you live?
00:40:14
Speaker
I'm asking for a friend from me, my friend Laurel. Do you have a social network? Do you have people you can call and talk to? Do you have financial issues? There's so many ways that our environment and our relationships can impact our stress levels and cause us actually to have a higher propensity for pain and injury and then also how have you been sleeping?
00:40:36
Speaker
And finally, there's just external factors in the environment. Was the floor slippery? Did you go from playing tennis on clay to playing tennis on a lawn? Or do you prefer to work out in cooler temperatures and now suddenly you have to work out in a really hot environment? Do you feel like the people you're working out with in any given day are kind of sketchy and they're kind of throwing you off or whatever? These are all also
00:41:02
Speaker
factors that can play into how safe we actually are, like how much pain we're going to experience or whether or not we even get injured. Notice that on that list, there was nothing about forward head posture or rounded lower back. All right, Sarah, what are some of the reasons you notice people, they come to you, they're in your clinic for a reason, typically they have some type of pain or maybe injury or both. What are some of the reasons you've noticed people end up with maybe some low back, some upper back, some neck pain?
00:41:35
Speaker
I do think this is a good opportunity for us to actually talk about our six month progressive overload strength training bone density course, don't you? Yeah, I do. So our bone density course is a six month course and it includes a six month program within it. It also includes bonus courses like strength training 101 and all about osteoporosis, but the
00:42:03
Speaker
bulk of the content is really the program. And the program is six months because why, Sarah? Because six months is in the research when you are able to start seeing changes to bone density. So if you are going to start doing this kind of progressive overload, no matter what weight you're starting from, you're not going to see any change in your bone density typically until you're past that six month mark. Right. And so we need at least that amount of time to make a change.
00:42:32
Speaker
It's properly programmed, which means that we start you where you are. So in the beginning, we're going to be focusing a ton on techniques. So you might be lifting what would be more moderate or even lightweight in the beginning for you so that you can really dial in the technique of working with a barbell. Now it is a barbell.
00:42:49
Speaker
specific program, but that doesn't mean that you can't take a lot of the information we're sharing and apply it to using dumbbells and kettlebells. You certainly can. We just simply believe that a barbell is the best, most logical piece of equipment that you would want to become familiar with if you want to be able to progressively overload for life. And so this is the other thing too. This is a six month program, but that's not to say that you are going to
00:43:15
Speaker
ideally lift weights for six months and then stop. This is basically us helping you get started over a course of time where you will have ample time to learn how to use weights, learn how to strength train,
00:43:29
Speaker
learn how to progressively overload, learn how to progress toward lifting heavy weights. And barbells are the best way to be able to progress for life. But then we want you to keep going when this program ends. And we'll give you ways of continuing to use our program to continue going. So it doesn't end at six months. It's something that we can continue to cycle back.
00:43:51
Speaker
on and use. You know what it reminds me of? Sorry to break in, but I was just thinking while you were talking about that, it reminds me of like, you know, when you see someone, a parent helping a child learn how to ride a bicycle with no training wheels. And I mean, I remember this is how I learned my dad held onto the back of the bike.
00:44:08
Speaker
And I started pedaling and he's running alongside me and at some point he lets go and I kept going, right? And it's that moment where like, you don't know as the person I'm like, when did that happen, right? So in that metaphor analogy story, Laurel and I are like your parent. We're going to hold on to you. Is that weird? We're going to hold on to your bike, your metaphorical bike. And we are going to hold your hand the whole way through.
00:44:30
Speaker
And then our goal is to make ourselves no longer necessary so that you can then continue to work on your strength for the rest of your life. The course is called Lift for Longevity for a Reason. Yeah. And two things that are really important. One, you own the course when you buy it. So it's yours forever. It'll always live in your computer. And then number two is that this course is structured in a way that we have not encountered any others. First of all, there are no six-month programs that are guided.
00:44:58
Speaker
with live option and recorded follow along classes included with it. So a rude awakening for me when I was going from yoga into the strength training world and like I wanted to get stronger. It's like, Oh, I need a program. Okay. I finally got that through my head. I can't just be one off classes all the time. So then I invested in a program and I got emailed a PDF. I was like, wait, where's the program? Where, where's the content? Literally all the PDF. So the PDF was linked to videos on Vimeo.
00:45:23
Speaker
So yes, you're like, how do I do a bent over row? Let me click over to this one minute demo video on Vimeo. And look, that's a fine way to be given a program. The thing is that it's actually very, very different, though, than how yoga practitioners
00:45:41
Speaker
Even Pilates teachers are used to being taught movement. We're used to going to a class where there's a group of people and being guided step-by-step through what to do in the class.
00:45:54
Speaker
I think that it's more yoga slash Pilates teacher friendly to do the course the way we're doing it. We're offering one live class a week. You don't have to attend live. It's all going to be recorded. We're going to ask you to strength train more than one time a week, but we are not only going to provide you with a demo video of every single exercise that you're going to do in the program, we're also going to provide you with a full length class of every single workout in the program.
00:46:19
Speaker
So you will always have the option to just watch a quick demo and workout on your own like the rest of the strength training world is doing, or you will always have the option to take the workouts as though it were kind of like a yoga class or a Pilates class for it to be a guided follow along experience.
00:46:36
Speaker
This I cannot find anything like this not to mention the fact that we have a physical therapist Who's that and a strength coach? Who's that teaming up? Who are they to provide you with this content? It's it's Sarah and I you know we have a a breadth of knowledge and a breadth of expertise and a breadth of qualifications that it's
00:46:56
Speaker
you also don't always find, right? So we have something for you that will give you a taste test of what this program is going to be, which is a free webinar. And the webinar is just basically a workout. The way this workout will work is that you'll show up with whatever equipment you have. So if you have barbells, great. If you just have a broomstick, that's also good. And maybe if you have a couple dumbbells and kettlebells, we're going to take you through the experience of a workout. We're also going to do
00:47:22
Speaker
exactly what we're going to do in the course, which is leave time at the end of the workout for Q&A. We're also going to do exactly what we're going to do in the course, which is provide individuals with form check feedback and take questions. So it's going to be very interactive and basically an exact replica or slash. It's going to be an example of how this program will be for you to take in its longer form. This is a free webinar. You get a 30 day replay. It's happening on September.
00:47:51
Speaker
14th if you want to attend live if you can't attend live again, you will get emailed the replay
00:47:56
Speaker
You'll be able to take the class a couple of times, get a feel for what it's going to be like. And then knowing that's the bulk of the content, like you'd be able to make a better decision about whether or not this of course is something that you want to invest in. Absolutely. So alternatives to this are obviously like to get one-on-one personal training sessions, which I will never not recommend. It's a great idea. But in terms of costs, sometimes that can be a major valid objection. Like people just don't have
00:48:22
Speaker
a couple hundred dollars every month lying around to pay their personal trainer and I think that you know that warrants longer discussion. If you don't have that type of money the cost of this longer form course that
00:48:34
Speaker
that we're presenting to you is a fraction of that cost with a lot of this. It's not the same thing as working with a personal trainer, but it has a lot of the same benefits because there's that live real time personal feedback component to it. So if that's interesting to you, make sure you go to our show notes where you can sign up to get the zoom link.
00:48:57
Speaker
for our webinar that is taking place on September 14th. I'm really looking forward to it. I'm looking forward to it too. I think it's going to be a lot of fun. And the other thing is, if you have been listening to this podcast, this is who Laurel and I are. This is not like, these people are showing up in that class as well. So just get ready for- They'll be there. These people will be there. By they, we mean we. We'll be there.
00:49:27
Speaker
What are some of the reasons you've noticed people end up with like maybe some low back, some upper back, some neck pain? When it's a sort of chronic non-specific, which is like what a lot of people have when they have their pain. It's been going on forever, but there's no like immediate injury that they're pointing to. Sometimes people are coming in with something like a herniated disc, but then I have to explain to them that's actually not why they're having their pain and that's a whole
00:49:51
Speaker
other conversation, but you know, it really is this repetitive overuse of a specific position and not enough time in alternate positions, not enough strengthening in different ways. And so that's usually what starts it. And then I often also see people who because they're having pain, they've just locked their body into one shape, and they're not moving it. And that is not helping. And in fact, it's hurting. So in that way, it seems like pain can predict posture.
00:50:21
Speaker
So in other words, like if someone has pain, the pain might actually be causing the posture, not the other way around. We want to go posture causes pain, but actually it looks like maybe pain can cause someone to have a particular posture. Yeah, I had a patient recently who came in and who was completely like her rib cage was completely shifted to one side because of the low back pain that she was having on the other side. Like her body literally was like trying to move away from the pain.
00:50:46
Speaker
It was protecting against the pain. It was trying to. Right. It wasn't successful. No. But this was the best strategy it had was to put himself in this different posture to try to not be loading the painful side. Yeah. I see that often. Do you ever use alignment strategies to help people?
00:51:07
Speaker
find some relief from some of the pain they're experiencing? Or let's say postural strategies, alignment strategies, or movement? I mean, movement, obviously, yes. Would you say movement quality? Yeah, I would say it's a loaded term. It is. But I would know it's more- It's more about preparation. It's more about not like, I'm going to put you in this one alignment and this is the one where you're going to feel better and you should always live here, right? Because I think
00:51:31
Speaker
Listeners, you understand at this point that that's not what Laurel and I are about, but I use movement and I use a variety of movement and different positions as a way to relieve their pain for sure. Yeah. Again, alignment can be a really effective tool for varying the load, for preparing someone for movement, for giving them strategies to move differently, and maybe that's going to enhance their skill in movement.
00:51:59
Speaker
It's also impossible, I think, to get someone to...
00:52:01
Speaker
do a pose in yoga if they've never done yoga before without teaching some alignment. So just coming back to this idea that alignment is not a dirty word. Not at all. And when I'm starting to, a lot of my patients, as they're getting towards the end of the rehab phase of their treatment, and we're starting to move into more like, OK, now I'm training you. It's like I'm taking the kitty wheels off, and I'm teaching you to ride a bicycle. I don't know why I'm using that example. But what I mean is I use a barbell.
00:52:31
Speaker
as a, you know, now we have progressed enough for you to use a barbell kind of a tool. And when I'm teaching barbell, I'm teaching alignment because the load itself that I work with for them is, you know, I use the technique bar, it's 15 pounds, and I reiterate to them, this doesn't matter right now while the load is quite light, but learn the alignment now so that you have it when the load is a lot heavier and it's going to make a huge difference if your feet are two inches behind the bar
00:52:59
Speaker
Versus if your feet are under the bar absolutely and also I mean a couple things about that if that's the deadlift example Yes, if you set up with your your mid foot under the bar, you're probably gonna have better leverage Not only does that help prepare them for you know, maybe more Let's say comfort in deadlifting down the road when the loads get heavier. It's gonna allow them to lift heavier Yeah, it's gonna allow their muscles to be able to produce more force which is going to enhance their strength It's a it's a more effective way to get stronger to set up well, but also
00:53:29
Speaker
in the squat, a lot of times you might hear, and this relates to low back posture and dogma about the squat. You'll hear instructors insisting that people need to have a perfect body weight squat before they add any amount of load. Because again, there's this connection they're making erroneously in their mind between posture and future injury. They're saying if your body weight squat posture is not just so,
00:53:59
Speaker
you are at greater risk of injury when we put load on you. And I know that just a couple of minutes ago I said that when load and rate of loading and when magnitude of load increase, alignment matters more. But here's the deal.
00:54:15
Speaker
someone is not going to squat with the same posture or slash movement quality or alignment with body weight as they are when they're holding onto a weight. And where you hold onto the weight is going to have a huge impact on what your squat looks like. So if you've got a weight held in front of your body, it's going to look different than if you have the barbell on your back.
00:54:32
Speaker
It's going to look differently if you are holding onto two kettlebells like suitcases and like your feet are up on blocks. I mean, it's going to totally change the way that your body looks while it's squatting because the load is a self-organizing tool. It's going to help your body figure out where it needs to be reflexively without a whole lot of thinking or cueing from the teacher. If that was the case, I would not be able to squat any amount of weight because my body weight squat
00:55:00
Speaker
when I get all the way down is very rounded in the spine and oh no, I better extend the spine. Oh, but if I do that, I fall over backwards. What am I going to do? Oh, it's my ankle dorsiflexion that I have to work on. Well, turns out I'm at the end of my ankle dorsiflexion. I'm still falling over backwards.
00:55:17
Speaker
But the second I hold on to something as little as like 20 pounds, the whole thing organizes itself completely. So I decided not to spend a lot of time working on perfecting my body weight squat. Instead, I just started lifting heavier. Nice. And now I can lift pretty heavy. I was going to say, too, my ankle dorsiflexion was limited when I started lifting. And then as I've gotten
00:55:36
Speaker
to be able to lift and squat heavier and heavier, my ankle dorsiflexion is so much better. Yeah, what a shocker. As I put more weight on top of my ankle dorsiflexion, I get more ankle dorsiflexion. I don't believe it. That's amazing. All right, so we're in service of not getting too dogmatic about not being dogmatic about alignment. We're going to use a five question process of inquiry. We're probably not going to go like point by point through all five questions. But in the beginning, just to read these five questions,
00:56:05
Speaker
This is what we're kind of using as our way of kind of reasoning our way through like why certain types of beliefs about alignment are potentially dogmatic, meaning they're lacking in evidence. So here are the five questions that we'll ask about quote unquote this dogmatic alignment.
00:56:23
Speaker
Number one, first of all, we want to give everyone total benefit of the doubt. And so we're going to ask, what is the purported goal of aligning the spine in this way that we are calling dogmatic? So what is it trying to achieve slash fix slash avoid?
00:56:39
Speaker
Okay, question number two, does aligning the spine in this way actually achieve that goal? And if it doesn't, does it actually, you know, conversely, does it interfere with the goal? Question number three, if it achieves or interferes, either one, let's talk about why. Why? And then number four, if it interferes with the goal, if it actually creates an additional obstacle,
00:57:02
Speaker
Are there circumstances where it could also, in some cases, be helpful? So if it maybe creates an obstacle for most people, are there exceptions to the rule? Are there some people who would benefit from aligning their spine in this way? And if so, who? And under what circumstance? That's the fifth question. So we're not going to painstakingly answer each question. That would get kind of boring and tedious. But this is how I would like to inquire into alignment dogma. I don't want to make bold,
00:57:30
Speaker
It's like hyper certain declarative statements around why certain ways of aligning the spine are dogmatic because honestly that's not a very scientific way of looking at things. Science is really not interested in making bold confident declarative statements about things.
00:57:45
Speaker
Science is interested in making very wishy-washy, very couched in a lot of potentialies and maybes and more studies are needed. That is what science likes to do. Science lives in uncertainty. It sure does. I think that's why people don't like it. Exactly. I think that's right. It's really way easier to latch onto a story. Totally. And of one, sample size, one person's story, especially if it's compelling and emotional.
00:58:13
Speaker
more dispassionate and boring to look at the evidence from a large population of people that have been studied over maybe the course of many years. Okay. So this is what we're up against here. It's actually really counterintuitive to think scientifically. It's much easier to think like a human. Sure. We're going to try to think about thinking. But this is also like, I mean, just to break in for a second, this is a big part of what I learned in PT school was how to think scientifically.
00:58:36
Speaker
It really did change the way that I think. When I hear a declarative statement and immediately my brain comes up with a series of questions about why I think it's wrong. You're skeptical. I think it's good to live in that skeptical place. You can also be there a little too much. You can overdo it. Let's start with the lower back and the alignment dogma that is probably the most famous alignment dogma of all, which is that you shouldn't flex your lower back.
00:59:03
Speaker
In some cases, this alignment dogma is used in every circumstance, like ever. Like never flex your back even when you're sitting at your desk. You should sit up straight to, you know, situations where, yeah, okay, you're deadlifting a heavy weight. You should not flex your spine. You should not do a Jefferson curl, for example. A Jefferson curl is kind of like a really rounded back version of a deadlift where you roll down your spine holding onto a weight. It's a kettlebell, barbell, whatever it is. Like a lot of people get really concerned about the Jefferson curl. It's like, oh no.
00:59:32
Speaker
you're flexing your spine under load. That's dangerous. This is the dogma we're discussing. So let's actually start with daily activities or activities of daily living, ADLs, right? What do we often hear cautioned around spinal flexion in daily life activities? Like what is something that's kind of like, careful. Don't lift with your back. Right. And that means like,
01:00:02
Speaker
don't round your back really and it's like all of those pictures that you see a like an X and the person rounding the back and then they'll like check mark and they're doing a big old squat and their spine is straight and they're able to pick the thing up that's yeah don't round your back and then also what you just said about like just posture generally like don't sit with a slumpy schlumpy spine which is usually spinal flexion with your whole spine not just your lumbar spine
01:00:26
Speaker
Right. So these are two different examples. One is really low load. You're not even standing. You're sitting and your back is rounding. And that is sometimes people say that that could be harmful to your low back health or neck health or whatever it is. And then the other one is actually lifting an external load like a box. OK. In yoga, oftentimes
01:00:48
Speaker
lumbar flexion is cautioned against in forward bends, obviously, because in a pose like Pashimottanasana where you're sitting on the ground with your legs straight out in front of you, it's a big hamstring stretch, big back of the body stretch, I was taught to cue people into as much hip flexion as possible without letting the spine round. And then at the very end, it's okay. It's maybe okay to let the spine round. And so the idea was sometimes like, oh, we want to actually maximize hip flexion and really get the hamstring stretch.
01:01:16
Speaker
kind of at the forefront of this experience and in that way I kind of agree like yeah let's try not to flex the back first let's flex the hips first and kind of maximize that range of motion at the hips and then let the spine round but a lot of times also this this alignment dogma was presented as a way to keep the lower back safe.
01:01:32
Speaker
And then also in Uttanasana, Paschimottanasana, or I already said that one, Prasarita Padottanasana, any type of forward bend, Parsvottanasana. So what about in strength training? Where do you see lumbar flexion showing up as like a big no-no in strength training? Well, like you said with like the Jefferson curl, people don't like that. There's a lot of, you know, well, in theory, your deadlift is your spine is staying
01:02:01
Speaker
Some people think it should be neutral, not flex. We're going to talk about that. The dreaded butt wink is also a lumbar flexion activity. We talked about that in the pelvis one where the pelvis posteriorly tilts at the bottom of the squat and that pulls the back into lower back flexion. What about Pilates? Is it something that's fear-mongered in Pilates? What's actually interesting is in Pilates they love it.
01:02:21
Speaker
They love, love more flexion and Pilates. Yeah, they love it. They'll there's in mat Pilates and reform Pilates, there's movement in both directions. They'll do lots. They'll do really big spinal extension moves, but they'll also do full on spinal flexion in all kinds of positions sitting down in, you know, what would be sort of the equivalent of like a shoulder stand type shape. Um, meanwhile, nobody in plow ever told me like, make sure your spine is straight when you, you know, anyway, uh, yeah, there's, there's tons of spinal flexion in, in Pilates. They're all about it.
01:02:51
Speaker
Oh, yeah. Plow pose and yoga? Yeah. Is plow pose at Pilates move? No, no, no. But there's a move on the reformer called short spine that involves plow-ish type shapes. I see. Okay. And actually rolling down out of it really, really slowly on purpose with a ton of Lamar flexion. Yeah. You know what? This is making me remember that when I did a couple of Matt Pilates classes, when I was in the peak of the heat of my must practice yoga six days a week,
01:03:20
Speaker
a lot and also teacher train and also teach classes and my body was in pain, I would take a mat Pilates class and feel so much better afterwards. And I'm like, oh, maybe it's because they were asking me to flex my spine. Maybe it was. So I want to just say for a second, like kind of go back to this idea of like correlation causation. It's possible for people to have pain when they simultaneously are also lifting a lot of boxes. It's possible to have low back pain after about of lifting a lot of heavy boxes. It's possible to have low back pain after about
01:03:49
Speaker
of sitting with a slouched posture. It's possible to have low back pain after doing a lot of forward bends in yoga. It's possible to have low back pain after hinging, squatting, doing a Jefferson curl. These two things can happen concurrently. One, the movement, the exercise can happen before the other, the back pain. It doesn't necessarily mean that the movement caused the back pain. It could have though.
01:04:15
Speaker
I guess what we're trying to separate out here, is it the lumbar flexion inherently as a way the spine can move that caused the pain or was it potentially these other things? Lack of variability, history of injury, history of chronic low back pain.
01:04:34
Speaker
Could it be movement preparation related? Did you go from never doing yoga and then sign up for two weeks for $20 at your local studio and start doing yoga, the Ashtanga Primary Series, which is all forward bends, five days a week? Or how's your marriage? How's your financial situation? How's your job, right?
01:04:58
Speaker
And you kind of know where I'm going here, right? Like I'm going through all the lists of questions we could ask ourselves that would maybe help us get more accurately to the heart of why someone has lower back pain.
01:05:10
Speaker
But instead what happens is people go, don't flex your lower back. That causes back pain. Here's the other thing I want to break in with. Where did this idea come from is what I want to talk about. But break in. Thank you. Real quick break in, which is also our idea of any pain being a problem. The interview that I did with Dr. Chris Rayner-Lust
01:05:37
Speaker
season was a lot about pain and it was really awesome. One of the phrases I got from him that I now use all the time is that pain is a low-level language. Maybe you lifted a bunch of boxes and your back hurt the next day. What that back pain the next day is telling you is, I was not ready for that. That's it. I'm a little upset because I wasn't ready.
01:06:03
Speaker
You didn't prepare me enough. And now I'm having a bit of a fit about it. But it doesn't mean you injured yourself. You should never flex your spine. Any of those things. In his world, any pain lower than a six is fine, which is a really high number on the pain scale to be fine with. And it always makes me laugh when people are like, well, I felt that. And I'll be like, well, where? What number? No, I'm like, you're fine.
01:06:29
Speaker
Really? I would also maybe ask, in this case, it's not that he's not being compassionate. Of course not. Saying like, oh, whatever. You're fine in that, stop having your experience. Your experience doesn't matter. It's more like, you don't need to catastrophize this or even intervene in some really special, specific, or, God forbid, expensive way, because this will go.
01:06:57
Speaker
This will go away. This will go away. Your relationship to this is what he's talking about, not the this itself. This psychosocial relationship to pain, which by the way, is another predictor of pain, right? If we have fragileistic ideas about what our body can and cannot handle, and we ascribe meaning to pain that
01:07:15
Speaker
isn't really shown to be true. Like, oh, my back hurts. I must have blown out. My disc must have exploded, or whatever all the terrible language that's used in the medical community. You slipped a disc. Your disc is hurt. What are the scary words? Well, people say things like, I threw my back out. I threw my back out. I slipped a disc is terrible. Slipped a disc is terrible. Whoopsies. Yeah, where'd it go? I slipped on a banana peel and my disc slipped out of my back. A hockey puck just slid into the bed.
01:07:42
Speaker
Yes, pain is a low-level language. It's telling us something, but it doesn't tell us exactly why it's there, right? It doesn't even tell us how serious the issue is. Not necessarily, no. People take lumbarflexion and go, because lumbarflexion was somehow a part
01:08:06
Speaker
of the picture of when I started having lower back pain. They kind of pick it out of everything. They don't look at how long they slept. They don't really necessarily examine all their personal relationships or even stop to think about their past history of injury or whether or not they were prepared to do the thing. They go, no, it was because I was flexing my lower back. Why do people think lower back flexion is the cause of lower back pain?
01:08:31
Speaker
Well, I think part of why it gets so demonized is related to actual disc herniation because the generally accepted story is that if you flex your spine too much, you're going to get a disc herniation. Most disc herniations happen posteriorly and laterally, right? So somewhere in that sort of back part of the spine. Does that mean that flexion caused those disc herniations though?
01:08:55
Speaker
It, it will have been related to it in some way, but it's also not necessarily like I probably have a herniated disc in my low back, at least one, if not more, you probably do as well, but I don't have any pain. Right. So it's this whole idea of the, it's like being able to point to the disc herniation on MRI and say, that's why you're having your pain.
01:09:14
Speaker
and you're having your pain because you sit in front of a computer, duh, duh, duh. So we're gonna improve your posture and that's gonna take away your pain and that doesn't end up being true pretty much ever. Right, you can have a herniation without pain. You can have pain without a herniation. And I think I heard something where like 20% of 20 year olds have degenerative disc disease. Oh, I believe it. 30% of 30 year olds, 40% of 40 year olds, right? 50% of 50 year olds. And then I think it's like something like 90% of 80 year olds or whatever.
01:09:44
Speaker
there's a higher likelihood that you're going to have some type of thing going on with a disc the older you get, but like something 20% of 20 year olds, that's one in five. And they probably don't have pain with zero symptoms. Right.
01:09:57
Speaker
Okay. We got to talk about Dr. Stuart McGill. Who's that? Okay. I think you know. I do know. I do know. Okay. Dr. Stuart McGill is a very famous, well-respected foremost researcher on the lower back and has done research looking at spinal flexion and its role in disc herniation.
01:10:19
Speaker
This research was super influential. Again, many see him as an authority and keeping the spine safe. Specifically with activities that would like put you in a position where you're gonna be maybe flexing your spine, like lifting weights, even yoga, like he's actually, I think partnered with Bernie Clark and done like a course with Bernie Clark. Like he's someone who's well known across like multiple different movement worlds. And he, unfortunately, I think the conclusion is drawn from his research, whether or not we can like
01:10:48
Speaker
hold him accountable or the people who interpret his research count, who knows? He did research on pig spines. Now, when people hear that, they're immediately probably going to feel bad for the pigs. The pigs were dead, which is actually the bigger problem because you can do research on animal bone. You can do research on animal structures and get a pretty good idea of how it would be for humans.
01:11:11
Speaker
and the reason you can research animals is because there are not the same ethical considerations made for animals as humans for better or for worse. I think the more important limitation about the research McGill did was that these were deceased. They were dead pig spines as I will now refer to them. DPS, dead pig spines. Is that another t-shirt? Dead pig spines. So what did he do? He took some dead pig spines.
01:11:41
Speaker
and he moved them through, I think it was like something like 80,000 plus continuous cycles of lumbar flexion. Research can be super ridiculous in this way. Like it will take something to its maximum to figure out the breaking point, to then be able to kind of pull back from that breaking point and go, okay, what can we reasonably extrapolate about the outcome of this to humans in like a real life scenario. So it's all kind of extrapolated out.
01:12:10
Speaker
But let me repeat, this is a pig spine that's dead. They did 80,000 plus continuous cycles of spinal flexion and noticed that some discs herniated. My question is, Sarah, what do you see as being potentially problematic about over-predicting the results of this and basically taking what happened to dead pig spines and
01:12:34
Speaker
predicting what will then happen to humans. Well, there's a couple of problems, Laurel. Problem number one, the pigs were dead. Dead tissue does not behave the same as a live tissue. No. What is the biggest difference between the way a dead tissue behaves versus an alive tissue? It does not change in any way in response to what's happening, except it degenerates under the 80,000, did you say, repetitions? More than 80,000.
01:13:04
Speaker
Of course it's going to break down, because what organic material wouldn't break down after 80,000 repetitions? Or inorganic. In fact, a dead organic material, I think, probably behaves more like inorganic material. Yeah. And in this way, it is maybe more like a machine. It's not an animated object. No more animus. So yeah, that's part of the problem. It can't adapt. It can't adapt. The other part of the problem is, in no world is anyone doing 80,000 spinal flexions in a row. No.
01:13:32
Speaker
You might do 80,000 spinal flexions in a year and there are going to be many bouts of rest breaking up those sets, maybe, of the movement in question. During those periods of rest, what's happening is that the tissues affected by the movement are
01:13:56
Speaker
are probably remodeling to some extent and potentially getting better at handling those stresses. That's not happening. Any dead spines, pigs, humans, it's not happening. But then what happened with this research is that people took it to mean that lumbar flexion was dangerous. Nobody should ever do it.
01:14:21
Speaker
Now this research I think was done in the 80s. There's been a lot more research since then. People are still kind of stuck in the McGill model though and they think that this is like the current working model that people are using to like figure out what are like good and bad or safe and unsafe ways to move. A lot of more recent evidence has shown that there is actually really poor correlation between lumbar flexion
01:14:46
Speaker
and these things happening that we want to avoid, right? I still have, on a semi-regular basis, I see a lot of people who come into the clinic with low back pain. It's a very common thing for people to come to PT with. And some of those people will tell me when I'm talking about their history and everything, they'll be like, well, and then I did the McGill method for X amount of time. And that really helped. And then in my head, I'm like, well, if it really helped, it wouldn't be here. But anyway.
01:15:11
Speaker
Um, it's not, it's not, but again, again, I'm like, I'm not here to like trash talk this person's work or this, you know, I don't know enough about the method, but it's, it's essentially, can you back up? So he actually hadn't had a method. So he's done research showing not, not very well that there's a relationship between lumbar flexion and disc herniation or injury. Yeah. Okay.
01:15:35
Speaker
But he also has a method. Tell us about that. I don't know a ton about it, but my understanding is it's mostly extension-based. I think there's no flexion movements anywhere in it. I do remember, I'm like casting my brain back to PT school when we learned mobilization techniques. We learned how to do these like they're called PAs because it's just shorthand for posterior.
01:15:58
Speaker
to anterior mobilizations of the spinal joints. The theory was like if you do PAs on somebody's low back, that's in the same conceptual direction as having them do extension or even while they're doing extension that you are going to get the disc to go back into where it was. I don't know.
01:16:19
Speaker
If that's true in terms of like, is that a thing you can even do? But bigger picture, my understanding of his work is that it's a lot of spinal extension based exercises. Is his theory that these exercises are going to push your discs back? I don't know. I don't want to say that for sure. But what do we know about exercise in low back pain? Any exercise is better than no exercise. Are some exercises more effective than others? No. OK. Right.
01:16:50
Speaker
If you were having pain in your back and you stumbled across McGill, like you googled low back pain help and McGill's thing was the first thing that came up or you were like, oh, this looks good and you start doing it and your back stopped hurting, that's awesome. That's great. End of story. He also did some research on
Humor in 'Gluteal Amnesia' Myth
01:17:06
Speaker
Gluteal amnesia, if you've heard of that. Oh, I've even talked about it. Okay. As if it was a thing to, I would get a lot of laughs out of my, my groups. Yeah. When I taught group, group yoga. So I kept, I kept talking about gluteal amnesia. I was like, Oh, this is, this is really positive feedback. Yeah. People think I'm hilarious. I'm going to keep talking about how their butts asleep. And of course I was teaching like bridge poses. Sure.
01:17:25
Speaker
Resistance bands and yeah, yeah, that's not a
Joint Issues and Neuromuscular Impact
01:17:28
Speaker
thing though. It's not a thing I mean the thing about this idea of gluteal amnesia if You see someone who really does not have any control of a muscle like they've had some like a spinal cord injury or a stroke Then fair, but if you walked into the clinic your butt is doing something If you dragged yourself by your arms into the clinic, then I would say yes. Yeah, so this study it was called arthrogenic neuromusculature
01:17:55
Speaker
inhibition. Can you translate that for muggles? Essentially, this idea of arthrogenic neuromuscular inhibition is the idea that if there's an issue at a joint, like inside the joint, it's going to impact the neuromuscular ability of the muscles around it. It's arthrogenic neuromusculature. I'm going to interrupt you a couple more.
01:18:24
Speaker
arthrogenic neuromusculature inhibition colon, a foundational investigation of existence in the hip joint. So we're looking for, we're investigating the existence of inhibition on the neuromuscular level of joints. So what do they do? They took some fluid and they pumped it into the joint and the joint stopped working that well. Why do they pump fluid into the joint?
Misinterpretation of Research Findings
01:18:49
Speaker
They're like recreating. Yeah, sorry. I'm just sighing because I'm frustrated. They're recreating inflammatory conditions. Yes, process. They're trying to make the joint more uncomfortable to move, essentially. So again, research kind of takes things to a ridiculous level.
01:19:06
Speaker
to provoke something, to show that something, even when we have to take it to this ridiculous level, can indeed cause this thing to happen. That's fine. It's fine to know that. It's good to know that. But what's not fine is then when we over interpret the results of this study to say that
01:19:26
Speaker
The reason people have lower back pain is because they have cutial amnesia. Where did that come from? How do we get there? How do we get anywhere? There's the game of telephone about research among, I'm sorry to say this, but non-clinicians.
01:19:43
Speaker
is a lot. This study is basically saying, if your hip hurts, your glutes aren't going to work so well. But people have taken that and flipped it and said, the reason why you're having pain is because your glutes aren't working, right? So that's not what this study found.
01:20:02
Speaker
It's similar to that idea of posture doesn't predict pain, but pain might explain posture. Exactly.
Spinal Flexion Myths and Disc Health
01:20:10
Speaker
Also, we're out here talking about, oh, you sit too much, you have gluteal amnesia, but not necessarily involving any pain experience or joint degeneration. We're pathologizing normal. My favorite is sitting is the new smoking. I'm like, oh, hell no.
01:20:26
Speaker
You know, what is the new smoking? What smoking? Thank you. You're welcome. Uh, so here's the kicker. Here's where it kind of, we're bringing in that like epistemology piece of like the study of how we know what we know. It's like, even while we're trying to avoid spinal flexion, it's happening. It's happening a lot. They looked at the exercise called the good morning. Can you tell us what this exercise is? The strength training exercise. Yes.
01:20:52
Speaker
Good morning is essentially a hip hinge with weight. And you're holding the weight maybe a barbell across your shoulders or maybe a kettlebell into your chest. And you are attempting to do hip flexion movement only. Yeah, you're trying to keep your spine neutral. The researchers looked at the good morning to see like, okay, are people actually able to maintain a neutral lumbar spine and they found they weren't? Can you can you guess how flex these people's spines were?
01:21:20
Speaker
I mean, it's going to be more than I think. But yeah, no. Well, it's like 26 degrees of flexion. Do you know what like, what is the total amount of flexion the lumbar spine can do? I think like 40? 60? 60, maybe? 60. I don't remember. OK, so that's like not a little bit flexed. No. OK. I mean, regardless of how much it can do, it's not a little bit flexed. It's not a little bit flexed. And that, when you look at somebody who has maybe lots of experience doing the good morning and has what people would call like really good form,
01:21:51
Speaker
and they're doing the good morning and you think their lumbar spine is neutral, it's not. It's flexed. It's so wild. I love it. Okay, so if we're going to take this alignment dogma of it's really kind of like an anti-alignment dogma, it's like don't flex your spine, which is like it's an avoidance cue, right? Yeah. Or just this dogmatic belief that lumbar flexion is dangerous.
01:22:15
Speaker
If we give people the total benefit of the doubt, okay, we're going to engage in that five-step process of inquiry. And we go, what is the purported goal of avoiding spinal flexion? What is it trying to fix or avoid? What would you say? The purported goal is that avoiding spinal flexion is how to avoid injury and pain. Okay. And then question number two, does aligning in this way or not aligning right in that way achieve that goal?
01:22:39
Speaker
Okay. And if that's the case, if no is the answer, does it interfere with that goal of keeping? Potentially. Yeah. How? Because you're, if you're not allowing your spine to move all the way it's supposed to move, you know what happens. What do we gain? What do we gain specifically for the discs when we allow our spine to flex? Like what happens to the discs? They get squeezed. Thank you. And the discs are largely vascular. So squeezing the discs through movement is one of the ways that the disc actually gets to
01:23:09
Speaker
get rid of waste products inside of the disc and get fresh nutrients into the disc. If we're avoiding spinal flexion, we're missing that whole way of squeezing the discs and nourishing the discs. But then also like if we're avoiding spinal flexion because we feel like our back can't handle flexing, this is an example of fear avoidance or like maybe possibly harmful beliefs about our body and pain that could potentially make our pain worse. Okay, if the goal is achieved
01:23:37
Speaker
or if the goal is not achieved by avoiding spinal affliction. We've determined that it's not achieved. We just answered why. Basically, the disc doesn't get to be squeezed in all the ways it should be squeezed. Also, like other tissues aren't stimulated in the same way. Maybe we also develop fear avoidance.
01:23:57
Speaker
However, given this question number four, could it still be helpful for some people in some circumstances to avoid spinal flexion ever? Yeah, some people in some circumstances. Sure, but those are very specific people in specific circumstances and it's not the majority of people.
01:24:14
Speaker
It's probably not within a movement teacher's scope of practice to be advising these people to avoid spinal
Lumbar Extension in Yoga
01:24:22
Speaker
flexion. However, they might take the advice of that person, their student's doctor, and craft a class that avoids spinal flexion. That's cool. Totally. We can move on to talk about spinal extension specifically at the lumbar spine. I think this one, it deserves a little attention. Sure. Won't get as much as flexion.
01:24:44
Speaker
Anterior tilt, often blamed for low back pain. This relates to spinal extension. But I was taught in my yoga teacher training that when we do back bends, we should minimize lumbar extension. And so there was a lot of emphasis on tucking the tailbone. So tucking the tailbone.
01:25:01
Speaker
make sure that you can comb the flesh of your buttocks away from your lower back to minimize arching or crunching. The word was often crunching of the lower back, compressing of the lower back.
01:25:16
Speaker
Yeah, I thought, yeah, that makes sense. We don't want people arching their lower back. It's going to cause lower back pain. And a lot of people would do backbends and have lower back pain. I mean, I've definitely had lower back pain after big backbending practices, and not really pain necessarily. It's like soreness, and it goes away after a couple of days. If we were to give the benefit of the doubt of this cue to avoid lumbar extension in backbends,
01:25:42
Speaker
We could say, well, total benefit of the doubt. What is the purported goal of not extending the lower back and back bends? The purported goal is? Not hurting your back. Okay. It's trying to avoid lower back pain. Does it achieve this? Well, but here's also, the other thing that I've been thinking about when you've been talking about this this whole time is the other cue about back bends, which is like relax your glutes, right? So I can't, I have to use my glutes if I'm going to create this
01:26:08
Speaker
tail tuck posterior tilt to protect my back, but then I'm also supposed to turn it off supposedly. I don't get it. No, it's really confusing because then some people will get really on the like engage your glutes train where it's all about glutes engaging, engage your glutes more and more and more and more to protect your lower back.
01:26:29
Speaker
One is asking for more posterior tilt, the glute engagement. One is actually relaxing one of the primary muscles of posterior tilt, which is relax your glutes. I think what we can do is go back to that checklist of like, what are some good predictors of pain, right? So maybe history of back pain, preparation.
01:26:47
Speaker
movement preparation with someone prepared for this, this amount of back bending that you had them do. Is this their first time doing Urvid on your asana wheel pose? Um, we could also ask like, what was the environment like in your classroom? Did they feel like you were being a little bit insistent or domineering
Pelvic Movement in Backbends
01:27:03
Speaker
or
01:27:03
Speaker
There's a number of ways in which we could say that tucking the pelvis or posteriorly telling the pelvis in a backbend will not decrease someone's sensitivity, low back pain sensitivity in backbends. But I think there's an argument too to say like if someone
01:27:22
Speaker
hasn't been engaging their glutes, has been super anteriorly tilted in a back, and maybe posteriorly tilting the pelvis is gonna allow some other segment of their spine or some other region of their spine to extend more, and maybe that's gonna take some of the load off their lower back in some way, so I think it's a case-by-case scenario. I think it interferes with the goal of keeping people feeling good in their body or feeling safe in their body when we make this connection between
01:27:50
Speaker
lumbar extension and risk of injury or pain because you're creating this fear avoidance. I also think that, like I said, there are some potential reasons to cue tucking the tailbone for some people some of the time. I know that it's funny, my whole history with back bending was that in the beginning, I found posterior pelvic tilt helped me have a better experience in back bends, but then the longer I practiced yoga, I found that that
01:28:20
Speaker
tendency or that habit of constantly tucking my tailbone in a back bend started to not feel great. And then I went to some classes where teachers were like, telling me to deliberately anteriorly tell my pelvis and arch my lower back sequentially, like before lifting up into Urdva Dhanurasana before doing bridge pose.
01:28:38
Speaker
And I was like, my mind was blown because my experience was so much better. Like I felt so much better in the back then, but I was like, wait a second. I'm really arching my lower back a lot. So it created a little cognitive dissonance. And now I think I understand why that happened, right? So in one case, tucking my tailbone in the beginning of my yoga journey was a novel movement. It exposed my body to novel loads that it really maybe liked experiencing because I too am an anteriorly tilted individual.
01:29:05
Speaker
But then I did that for six years straight, fastidiously, hypervigilantly. I had fear avoidance around lumbar extension. I would say probably you were tucking your pelvis at other times that had nothing to do with backbends. All the time. Right? Just walking around, always be contracting. Stopping, sticking my butt out. Yeah.
Strength vs. Spinal Alignment in Yoga
01:29:22
Speaker
And I had the opposite experience because, again, variability, varieties of spice of life. That's right. And then I started doing bridge pose in backbends and just articulating my pelvis through both.
01:29:33
Speaker
like moving my pelvis, anteriorly and posteriorly tilting my pelvis. And that felt even better, right? Sure. So it's not about one position being the safe or right way, I think is what is hopefully coming through in this conversation.
01:29:49
Speaker
Um, also I will say you can't align someone out of a strength deficit. So another big reason I think I had low back pain in backbends is I just wasn't strong enough in my upper body. And maybe in other areas, like my back strength was not strong enough to support the position and no amount of pelvic queuing alignment, queuing around what to do with my lower back was going to help that.
01:30:11
Speaker
Well, because it maybe had nothing to do with your lower back. It had to do with the capacity that I had not been training to sustain those positions. Sarah, upper back. Yes.
Rethinking Kyphosis
01:30:22
Speaker
Let's move away from the lower back. Okay. Have you heard of the term hyperkyphosis used to describe people with maybe more rounded upper backs?
01:30:33
Speaker
I'm trying to think if I've heard that exact term. I've heard kyphosis used as a negative term. Oh, yeah. They have thoracic kyphosis, that the actual natural position is in itself a pathology. Yeah. Okay. Pathologizing normal. I've heard hyperkyphosis in that sort of acknowledging that kyphosis is the norm for the upper back, but then saying like, now you have too much. Too much. Maybe it's more of a too rounded of an upper back.
01:31:00
Speaker
maybe sometimes you could call it like a hunchback or like a slouched. How is this different? How is hyperkyphosis then different from a flex thoracic spine? Or how is kyphosis if you don't want to talk to, you know, kyper kyphosis as a thing that exists in the world. How is kyphosis different from a flex thoracic spine? Is there a difference? Your kyphosis is how your bones are aligned when you're not
01:31:29
Speaker
actively doing anything, right? If you're just standing or sitting or whatever, there's just a shape that your spine is going to adapt. That is not a pathology versus if I think about flexing my spine, my upper back spine, then I'm actually going into the movement of flexion. Right. But sometimes people will use those terms interchangeably. Like a flexed spine is used to describe a posture, uh, like posture in the term, not in the term of like a pose, but in the term of like the resting position of your spine. Yeah.
01:31:59
Speaker
I've noticed that a rounded upper back is often demonized as like a way that you don't want your upper back to be. And I noticed this a lot in just like standing positions like Tadasana, someone has kind of a rounded upper back, maybe in plank pose, maybe a rounded upper back is blamed as being the reason why someone has low back pain and back bending. And there could be some truth to that, right? Like if someone just,
01:32:30
Speaker
has difficulty accessing thoracic extension. It might be that the lower back has to do a little too much of that to do to do the pose bridge or or nirasana, sometimes in baby cobra, for example.
Visual Cues and Misleading Alignment
01:32:45
Speaker
Right. People, people will try to speak, will try to cue their students out of this
01:32:52
Speaker
rounded upper back position. And so I'm wondering can we definitively say that someone's hyperkyphosis or overly rounded upper back posturally speaking is to blame for some of the pain they might be experiencing?
01:33:07
Speaker
Yeah. I mean, I'm thinking about a patient of mine who is now deadlifting a barbell and she's in her seventies, late seventies. Posturally, she has an excess of what we would consider maybe an excess of kyphosis. She has quite a rounded upper back. We've done tons of work on the alignment and form of a deadlift with a barbell. She can activate her spinal extensors.
01:33:33
Speaker
the amount that she needs to to do the deadlift. No kidding. Yeah. Turns out you can activate them, even if your spine is in a position that's not moving into that position. And she's fine. So we do tend to demonize this kyphosis. I've recently discovered that I have something called pectus excavatum. And it's a thing. And it turns out it's related to being hypermobile.
01:34:02
Speaker
What is pectus excavatum? It's basically when your sternum kind of caves in a little bit. Oh, yeah. Yes, I've seen that before. And mine doesn't do it a ton, but it does it some. And I've often sort of looked at my back in various poses in yoga and been like, wow, my upper back is like super rounded.
01:34:18
Speaker
I don't like that, right? But what I have discovered is like, well, yeah, it's rounded because the front is excavated, right? Amazing. And that is related to a system wide condition of my body. I have benign
01:34:34
Speaker
Hypermobility, which means I just don't have like EDS or any of the pots all that kind of stuff Yeah, I'm just super bendy, but it does then impact other structures in your body, right? But that doesn't mean there's anything wrong with any of these structures They're perfectly fine and they're able to support a heavy squat and a heavy deadlift. So What's the matter with that? Yeah, also like when you're looking at someone in some post like Cobra or baby Cobra, it's really deceptive
01:34:59
Speaker
you're seeing in the upper back because we've established that like the norm is probably to have a little kyphosis which is that hill shape from from the back and you watch someone do baby cobra or cobra they press their hands into the floor their hands are alongside their rib cage and they start to extend their lower back they start to extend their upper back and it looks like
01:35:22
Speaker
there's a great deal potentially of extension happening through their upper back because we see the rounded or curved shape of their rib cage from the front. And we associate that rounded curve shape from the front with what might also then be happening in the back. But as it turns out,
01:35:38
Speaker
When people are in full thoracic extension, their back is at its end range, typically just flat. So back bending in the upper back is actually flat bending in the upper back. So that kyphotic curve turns into a plateau, right? When we emphasize or maybe glorify the ability to extend the thoracic spine, I wonder if what we think we're seeing is what
01:36:09
Speaker
what we're actually seeing, right? Like when we see, we see somebody who's like got this big thoracic arch happening in Urdhva Dhanurasana. Is the thoracic spine, is it a valley from behind now? Is it flat? Is there even still a little kyphosis? And are we just being deceived by the shape, maybe the breast tissue, right? Just a breast tissue rib cage shape is very rounded from the front. When you, when you think about it, when you watch someone do a back bend,
01:36:37
Speaker
because of what their shoulder blades are doing because of what their arms are doing you can't really see what the spine curves look like at all and also to your point about good mornings from a moment ago we're not very good at telling what's happening with the spine with our eyeballs so it can look like something and be not that
01:36:56
Speaker
Yeah, so just because someone has pain in a back bend does not mean it's because of their hyperkyphosis or kyphosis or anything to do with their upper back necessarily. It's good to have a little bit more mobility in the upper back rather than less. It's good to load the upper back just like the lower back in all the ways that it needs to be strong and resilient. What we don't need to do is limit our ability to help people by creating problems where there aren't any. And holding open this idea that we don't actually know what the position of the thoracic spine is.
01:37:25
Speaker
regardless of whether or not we think we do. The fact of the matter is I think we can be a better service to our students.
01:37:34
Speaker
And we can do more good than harm when we just continuously recognize the limits of what we can even know, even if it's something we're seeing with our own eyes. Looks can be very deceiving, especially when we're looking at a structure like the spine, which is deep to so many large muscles. And there's other big body parts influencing what we see like the rib cage and the pelvis. Now finally, our last and final topic,
Debunking 'Tech Neck' Myths
01:38:02
Speaker
the neck. Tech neck. Did we do a whole tutorial on the neck? Oh my gosh, we did. Our most epic tutorial. The Movement Logic neck tutorial. I think it is the most epic. With our friend, Jaisal.
01:38:16
Speaker
The neck tutorial looked at this topic of tech neck or text neck. What is this idea around text neck, Sarah? So text neck or tech neck is this idea that everyone is now walking around with a what's called forward head position, which just means your head is in
01:38:33
Speaker
front of your body. If you were Bob the drag queen, it would be called head first instead of purse first. But anyway, and that this position of that forward head is being caused by people staring at their phones, right? That's the text, text neck. And I do, I mean, you see it, I see it all the time where people have their phone kind of down by their belly button, and their head is completely flexed, and they're looking down there to do whatever they're doing.
01:38:58
Speaker
Yeah, you can also have a situation where if it's tech neck, it's like any type of tech where you're sitting at your computer, desktop, right? And you're creating your face closer to the screen, but your simultaneously also.
01:39:11
Speaker
peering upward. So you've got a little bit of flexion at the lower cervical vertebrae and then some extension at the upper cervical vertebrae. So there's a variety of positions within it, but they all involve your head being in front of your body in some supposedly damaging way. I've heard it compared to a crane. Yeah.
01:39:31
Speaker
can you tell us like a little bit about this comparison where like the further with every inch in your head there are even like graphs on instagram of like i shared one once where i think i did too outline of a person
01:39:44
Speaker
and it just showed their head progressively moving more and more forward till at the end their head just falls off. Like literally falls off, yes. No, and I think also like the images got like redder and angrier the further forward your head went. This is a very, you know, people talk about it like a crane with the idea that, I mean, your neck is not a crane because not only is your neck not inanimate,
01:40:12
Speaker
But all of the tone of the muscles in your body is responding to this neurological input as far as where to hold and where to not hold. And again, it's the same thing of like, if the only place you ever put your head is way far forwards, then yeah, that's not ideal.
01:40:32
Speaker
But in and of itself, it does not contain pain. Right. That's not ideal to always have your head in one position. Exactly. But it'd be whatever position is. That's a lack of variability. Exactly. Right. Right? It would not be ideal to always be staring at the ceiling. No. That would hurt. That's me, probably, after a while. It reminds me of our tendency to want to think of the body as a machine.
01:40:53
Speaker
It's like this inanimate object that just wears down with use. It also reminds me of tensegrity, how the body is a tensegrity structure. If you've ever seen a little tensegrity model toy for babies, it's a bunch of dowels that crisscross each other in this beautiful
01:41:11
Speaker
geodesic type structure and then there's rubber bands holding all those bones apart but also connecting them. When a tensegrity structure like the body falls over, it doesn't crumble into a million pieces like a skyscraper. When the body falls over, it's held together. Tension is distributed in ways that are very different with soft tissue physics because of the tensegrity of the tension members, which are
01:41:41
Speaker
ligamentous soft tissue viscoelastic structures, and then the compression members, which are the hard mineral bone, because of the way this structure functions together, we cannot apply the same physics, really, calculations, predictions, to tensegrity structures as we can to like
01:42:00
Speaker
non-tensegrity structures like buildings or machines.
Promoting Movement Variability in Yoga
01:42:04
Speaker
Buildings and machines don't have viscoelastic material holding them together. Not yet. So the calculations could potentially be more Newtonian in nature involving trigonometry and the rules of
01:42:17
Speaker
you know basically like lever arms and gravity making predictions about like how how these buildings or structures like basically engineers are really good at this but as soon as you start to try to make those same predictions about the human body you're gonna run into a lot of trouble because it just doesn't
01:42:33
Speaker
it just doesn't work so nice and neat well and and what is the research around tech neck and pain okay so surprisingly counter intuitively okay the story that you've been told about tech neck is
01:42:49
Speaker
Not so neat and tidy either because there's a couple of research papers we'll link in the show notes, but I've already talked about these in past episodes. One is looked at smartphone use and found that the posture that people had while holding smartphones and the time they spent holding smartphones in that posture had no relationship to their neck pain.
01:43:07
Speaker
So again posture and the relationship to pain is like non-existent. And this was looking at young adults and then also they found in another study, this is really interesting, they found that people with quote unquote good neck posture had higher incidences of neck pain than people who had that forward head posture.
01:43:28
Speaker
Well, it keeps going back to this thing where we're finding people who are like more, quote unquote, neutrally aligned are having more pain. And I think it, I mean, this is a guess, but it seems to me that the reason is not that the neutral position in and of itself is a bad position. It's this idea that people have got that they need to get into a neutral position and never leave it. And it's the never leaving of any posture.
01:43:50
Speaker
My friend, Trina, our friend, Trina, and she's probably not. Well, I heard it from her the most. Somebody else probably coined this, but she says often your best position is your next position. And I say that to my patients all the time because they'll be like, what's the best way for me to sit in front of the computer? And I usually say as many different ways as possible. And they're like, huh? And then I'm like, let's try them all. Totally, totally. Also, what was I going to say? The psychosocial component.
01:44:18
Speaker
the ramifications psychosocially of always thinking that you need to hold your body in a position are potentially detrimental. Because what the beliefs around that might be is that your body is not safe or capable.
01:44:33
Speaker
And also that there are expectations for how you should look, and that you're displaying some type of moral failing. Right. You're lazy. You're lazy. If you slouch. Yeah, or it's not like the male gaze. It's unattractive. It's not ladylike. Right. Stand up straight. Obey. So all these ideas around how we should be can create a lot of suffering that can show up as the expression or the feeling of pain in the body.
01:45:02
Speaker
All right, Sarah. I think that's it. I think we pretty much busted the dogma around the spine, and now everyone knows how to have perfect spinal posture. Oh, fantastic. I hope that we have single-handedly helped people find the single one right position to be in at all times. I think if people take anything away from this episode, it's that.
01:45:24
Speaker
I hope so. Me too. We're being terribly sarcastic. Thank you for staying with us on this deep dive into some of the dogma and the origins of said dogma around where our spine should be. And hopefully, really, truly, sincerely, the takeaway is that we can get out of our own way by insisting that people adopt all position for safety or injury prevention, because there's no relationship between those two things.
01:45:54
Speaker
Also, step into your power as a teacher knowing that in teaching alignment, you're really teaching variability, you're teaching proprioception, you're helping people learn about their body, move their body in new ways, and there is tons of value in teaching alignment, and I think we get out of our own way. We stop valuing alignment for things that it doesn't actually achieve or predict or do.
01:46:16
Speaker
You can check out our show notes for all of the references that we mentioned in this episode. There are many. And please come on over to the MovementLogic website. Check it out. We got some new pictures up there. We haven't mentioned the new pictures. Oh, we got new pictures. Such nice pictures. They're so good. Check them out. All right. Thank you so much. Please, if you like this episode, subscribe, rate, and review. And we will see you next week.