Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
13: Should We Teach Alignment?
445 Plays3 years ago
In this episode, Laurel answers a listener’s question of whether or not it’s within a movement teacher’s scope of practice to help people with their posture. Her answer is yes and no depending.
Here’s what else this episode gets into:
- How Laurel formerly identified as an alignment-based teacher and why she no longer does.
- The difference between “default-mode” alignment versus deliberate alignment.
- Alignment less in binary terms of good v. bad and more as a neutral tool for helping to restore variability and influence adaptations toward specific skills.
- Theory-induced blindness and the difficulty of noticing flaws in theories that inform your professional work.
- How our beliefs about posture can produce a nocebic effect.
- How Laurel sees posture and alignment instruction as well within a yoga teacher’s scope of practice, but how she also sees movement teachers stepping outside of their scope of practice in providing instruction.
Reference links:
Paper: Therapists Perceptions of Optimal Sitting and Standing Posture
Todd Hardgrove: Great New Paper on Targeting the Brain for Treatment of Pain
Sign up here for the Movement Logic Newsletter for course discounts and sales and a series of free pelvic floor exercises.
Watch the video of this episode at: www.movementlogictutorials.com/podcast
Want more Movement Logic?
- Follow us on IG: @movementlogictutorials
- Get on our mailing list for tons of free content
- Contact us (we're super friendly)
Thanks for listening!
Recommended
Transcript
Introduction and Mission
00:00:06
Speaker
Welcome to the Movement Logic podcast with yoga teacher and strength coach Laurel Beaverstorff and physical therapist, Dr. Sarah Court. 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yoga, movement, and physical therapy worlds, we believe in strong opinions loosely held, which means we're not hyping outdated movement concepts. Instead, we're here with up-to-date and cutting-edge tools, evidence, and ideas to help you as a mover and a teacher.
Role of Movement Teachers in Posture
00:00:40
Speaker
Hey y'all, it's Laurel coming to you solo today to address a topic near and dear to my heart. It's the topic of alignment and posture. A listener to the podcast, who is also a Pilates teacher,
00:00:55
Speaker
emailed Sarah and I with a question about the role movement teachers have in teaching posture. She actually asked a couple of really good questions that Sarah and I are going to do one or maybe even two more podcasts around in the future, but I thought I'd kick us off by addressing just one of her multi-part question in her email to us, which is whether or not it's within a yoga or
00:01:22
Speaker
rather, movement teacher scope of practice to work with students on their posture. Maybe she would be asking from the context of a Pilates teacher, but we'll just say, is it within a movement teacher scope of practice to work with students on their posture?
00:01:37
Speaker
Also, just want to jump in and say if you have a question for us, Sarah or I, if you have a topic you'd like us to address, you can do what this Pilates teacher did and you can email us. But you could also, what would be really cool is if you just left a review for the podcast and five stars and requested a topic in the review because we actually read them.
Terminology and Contexts
00:02:01
Speaker
So back to our topic is it within a movement teacher scope of practice to work with students on their posture so what stood out to me in this person's question is that she use the word posture.
00:02:14
Speaker
And in the context of scope of practice and what's within our scope of practice and teaching movement as a yoga teacher, I probably would not have used the word posture. I probably would have used the word alignment. But then if I consider my role as a strength coach, I'd likely have not used the word alignment or posture. I would use maybe the word form or technique. So, you know, interesting to think about how these different words are used in different contexts kind of maybe mean
00:02:42
Speaker
the same thing or something similar. When I think about posture and alignment, I think of what we would teach in a more statically held position, whereas when I think of form or technique, I think about what we would be teaching or focusing on in a moving or more dynamic exercise, which is, you know,
00:03:06
Speaker
common in strength right we're often picking up and setting down a weight or lifting and lowering a weight whereas within yoga we're holding postures a lot of the times um when it comes to like transitions in yoga like moving from one post to the next i probably wouldn't use alignment i would probably again use something like technique or even transition to describe uh this this idea this concept of posture or this this idea related to posture um so considering her question
Observing and Influencing Student Bodies
00:03:36
Speaker
It got me thinking, obviously, about the difference in meaning between these words. And not necessarily the dictionary meaning, but how I hear these words used, when I hear them used, who's using them in working with students on things like alignment and posture. And I think all of these terms, posture, alignment, form, technique, what they have in common is they have something to do with what we as teachers can observe
00:04:03
Speaker
about our students, and then, of course, what we do with that information, how we allow what we observe about our students to inform our teaching, and how we allow it to inform what we believe about our students' bodies, about the human body in general, and what our role is in influencing that.
00:04:27
Speaker
you know, if I go back and think about my earlier years teaching yoga, I definitely identified in fact, I called myself an alignment based teacher. So I did place a lot of emphasis on this concept of alignment. And I identified I remember in part as somebody who helped people
00:04:51
Speaker
learn yoga postures in in my class so that they didn't get hurt or suffer negative consequences of their suboptimal or even bad alignment. I also thought that I was influencing their posture outside of class like their daily life posture
00:05:15
Speaker
And that I was doing that in the class on the mat through some kind of conditioning like maybe it was enhancing their postural awareness in class. I thought maybe if they were more aware of their posture in the class that that awareness would carry to their awareness outside of class so that they would be able to maybe make
00:05:35
Speaker
Adjustments to their posture in their daily life while standing or sitting and and you know Avoid those suboptimal postures that might cause them pain or cause them injury. I also thought I might be strengthening postural muscles You know the ones responsible for for good posture by practicing good posture in in the class and
00:05:56
Speaker
And that this would then result in the students not having weak postural muscles, having strong postural muscles outside of my class. So this is kind of what I thought I was doing to help my students as an alignment-based teacher.
00:06:15
Speaker
Now today I don't identify as an alignment-based teacher anymore, but I do definitely teach alignment. And the story I tell myself now about what I'm doing when I teach alignment or why I teach alignment is very different than it was when I was a so-called alignment-based teacher.
Transition to Teaching Form and Technique
00:06:36
Speaker
Now as a strength coach, I help people, as I said, with form or technique, which are just kind of terms that sort of mean alignment, but in the context of strength training in my mind. And I help them with their form and their technique while lifting weights so that they lift that weight maybe with more efficiency, but maybe more specifically so that they lift that weight
00:07:01
Speaker
using muscles that we're targeting for strength within that exercise, or they are targeting strength within a specific movement pattern within that exercise. So I want them to adopt that movement pattern that we're trying to make stronger. So if it's, you know, a squat, I want them to adopt the alignment or the form or technique of a squat so that they may be targeting more the muscles that we target in a squat like our
00:07:28
Speaker
the quads, the quadricep muscles, whereas if it's a hinge I'm teaching, I might cue them toward a particular form or technique of, say, the deadlift so that they're targeting maybe the muscles more at the back of the hip. Just as an example of why I would teach technique or form in a strength and conditioning context.
00:07:48
Speaker
In addition to kind of investigating the differences between these words, posture, alignment, form, technique, I also started to wonder a little bit about the role that people's attitudes around posture play in the PT world.
00:08:03
Speaker
While I'm not the host of this podcast who is also a PT, that is Sarah, that is definitely Sarah, and Sarah's not here today. I decided to go on to one of my favorite educational websites, the Physio Network, and do a little digging around this topic of posture and see what the physical therapy world
00:08:24
Speaker
uh has has studied and to read some reviews of these studies around the influence that posture plays in physical therapy. I'm going to share that with you today as well and hopefully ultimately you know give this teacher this Pilates teacher who
00:08:40
Speaker
came to us with this question my opinion and as a teaser my opinion off the top is yes it is within our scope of practice and no it's not depending okay so you're gonna have to keep listening to find out what the heck i mean by that all right so we've kind of already done this but let's let's kind of go back and define terms my personal working definition of alignment is is the positioning or adjusting of body parts relative to each other
00:09:06
Speaker
in space and this can be you know alignment is interesting it can kind of be this thing that we do unconsciously like someone just kind of comes into their default mode version of plank pose right in the yoga maybe context and um you know this is the plank pose that sort of comes naturally to this person's body and and you know they're not really trying to influence that that default mode at all that's just their plank pose
00:09:34
Speaker
And then on the other side of that coin, alignment can also be this conscious kind of deliberate effort to create a more specific shape to kind of take a different route than the default mode route. So if we use plank pose again as an example, let's say the default alignment in plank is to kind of have
00:09:58
Speaker
this sagging torso type thing in plank where the torso is kind of sagging below shoulders and and to align plank in a different way you might refine that position a little bit and have that person maybe take a different route which is instead of letting their torso sag maybe you cue them to lift their hips up to shoulder level or maybe use a tactile cue and you take a yoga block and place it
00:10:26
Speaker
on their back between their shoulder blades and you invite them to lift their rib cage up into the block and so then they're not in that torso sagging plank they're maybe in more of a little bit more lifted or buoyant plank and you can even hear like the words that I'm using to describe the torso sagging plank is sagging and like
00:10:46
Speaker
There's a little bit of, you know, it's a little bit deprecating. And then the buoyant plank like, ooh, buoyant, like that sounds kind of somehow like freer or nicer or better. So just, you know, I'm noting that about even just the language I'm using right now that I've already kind of
00:11:04
Speaker
assign value to these two different ways of doing plank. But to really just share with you what I hear and what I feel is kind of very common with regards to addressing alignment. And how we think of alignment is that there can be the kind of unconscious alignment and there can be the conscious alignment and oftentimes in yoga at least we're trying to make the unconscious more conscious.
00:11:27
Speaker
When I think about my working definition of form or technique in strength training currently, I haven't been strength training people for as long as I've been teaching yoga, but it's kind of similar to my idea of alignment in yoga in that form or technique in exercises, the position or
00:11:48
Speaker
the positioning or adjusting of body parts relative to each other, but while moving usually, although some strength exercises are isometric, they're not dynamic, they're statically held. But for the most part, it's kind of directing effort or directing position in a specific way to influence what muscles, what movements are targeted for strength within an exercise, and often a dynamic one.
Challenging Traditional Posture Views
00:12:11
Speaker
okay so let's say a student's performing a kettlebell deadlift but when they're doing their deadlift it looks more like a squat and so i might cue them to hinge more in a particular way or might cue position in their legs in a particular way to kind of get them more into a hinge through their hips so something that i might cue is like to
00:12:31
Speaker
hinge through the hips so that their shins remain a little bit more perpendicular to the floor i might ask them to crease their hips back toward the wall behind them to kind of usher them more toward a hinge and away from a squat even though you know both the squat version and the hinge version could be
00:12:47
Speaker
could be called a deadlift. They're all kind of, you know, these exercises can exist on a continuum of possible relationships of joint angles and whatnot. And that's kind of what's really interesting to me about teaching alignment, teaching form and technique is that there's so many shades of gray within a particular exercise. There's so many ways to do an exercise.
00:13:10
Speaker
So let me go back and you know I shared with you that I used to identify as an alignment based teacher and and I no longer do but when I think back about you know how I used to think of alignment as a newer yoga teacher a lot of times I viewed it in really kind of binary terms like you know and I sort of I sort of shared with you like
00:13:29
Speaker
how I was describing these two different planks as one being kind of sagging torso and one's a more buoyant torso. But maybe even more overtly back then, I would think of alignment in even more binary terms as really generally just suboptimal, bad, and optimal, good.
00:13:49
Speaker
And I thought, you know, as an alignment-based teacher, it was really my duty to protect students, to help steer them away from the consequences of bad alignment, which was often like their default mode alignment, and toward more optimal alignment, toward more conscious alignment, and maybe safer alignment. A lot of the times I think I thought of alignment as existing in kind of one or two categories like that.
00:14:16
Speaker
Today I'm much more likely to see any given alignment, even stereotypically good looking alignment like a buoyant torso in plank or stereotypically bad looking alignment like a sagging torso in plank as neutral.
00:14:36
Speaker
I'm more likely to plan a whole class around the difference between a sagging versus buoyant plank not as a means by which to kind of hold up the buoyant torso plank is like this really optimal good kind of goal but rather to say like look we can move through a range of motion even in plank pose we can be strong in all of these different positions. I'm much more likely to kind of
00:14:57
Speaker
take that route in my teaching. I'm also less inclined to see what I do as protecting my students. I don't really think it's my job and I don't really even think it's within my scope of practice to protect my students. On the other side of that, I'm much more likely to see what I'm doing as giving my students, helping my students learn and acquire more movement options.
00:15:21
Speaker
helping them expand their movement repertoire, helping them build more tolerance and capacity for movement and load across that continuum of possible positions to be in. And I do believe that that is within my scope of practice. So, okay, that's a little bit of my history with teaching alignment, teaching form, teaching technique, and kind of what I used to think I was doing, what I think I'm doing now. So now let's shift to this word posture, posture.
00:15:49
Speaker
I'm going to share a definition of posture with you that I encountered actually in a review of a study on the physio network.
00:15:57
Speaker
This is an old definition of posture. It's from 1947. So it's like, I think more than 75 years old. And it's from the posture committee of the American Academy of Orthopedic Surgeons. So this is, you know, an authority on posture, clearly. And the definition is that posture is the state of muscular and skeletal balance, which protects the supporting structures of the body,
00:16:25
Speaker
against injury or progressive deformity. So right there, muscular skeletal balance is posture and it protects our body. This muscular and skeletal balance protects our body against injury or progressive deformity. And then it defined poor posture as a faulty relationship with various parts of the body.
00:16:52
Speaker
which produces increased strain on the supporting structures. So here it's like posture can either be protective or it can be injurious. This definition within this paper
00:17:08
Speaker
which I'll get into the details of more soon, was used as support or evidence for why PTs currently hold these beliefs about posture, which it is suggesting are outdated.
00:17:23
Speaker
And then why, as a result, the patience of these PTs, which is really kind of all of us, right? You know, our students, but also us, the teachers, if you're a teacher and you're listening, why we hold outdated beliefs about posture. So the review I'm referring to on the Physio Network was written by Jared Hall. And the paper he reviewed was titled Therapist's Perceptions of Optimal Posture.
00:17:51
Speaker
And it looked at this review, looked at a cohort of PTs in Greece and their attitudes toward posture specifically. And this is where it's a bit different than what I was talking about with alignment, form, and technique. It's specifically posture while standing and posture while sitting. So two statically held positions.
00:18:14
Speaker
And its aim, the paper's aim, was to collect and interpret the details of therapists' beliefs around posture as it relates to kind of how they think about it in treating their patients and in advising their patients. The study collected and evaluated PT's attitudes about posture using an online survey. Simply put, you know, there are no consistently agreed on parameters or standards.
00:18:44
Speaker
for optimal posture, which this review kind of went into, because there are currently no valid or reliable tools for measuring posture, meaning the tools currently used lack validity and reliability.
Subjectivity in Posture Assessment
00:19:03
Speaker
A valid tool is one that measures what it sets out to measure.
00:19:09
Speaker
And a reliable tool is one that produces consistent measurements time after time. But the thing about reliability is that a tool must be reliable to be valid. So if there are no reliable tools, there are also no valid tools for assessing posture.
00:19:30
Speaker
And this might seem counterintuitive because, of course, we can eyeball someone's posture. We can see that the torso is sagging below the shoulders or that the torso's level with the shoulders are buoyant. And we can get an idea of people's general shape in space.
00:19:49
Speaker
But the thing about that is that visual assessment and the value that we place on what we're seeing is kind of just an opinion. Like if someone thinks my posture is optimal, but then another person looks at me and says that it's not optimal, this lack of reliability, right, this is an inconsistent, these are inconsistent findings, right?
00:20:13
Speaker
And I haven't changed, right? I'm the same, but I'm getting two inconsistent findings, right? This means by which to assess posture, just eyeballing someone and kind of making a judgment call, it makes it an invalid assessment, since a construct must be reliable to be valid. A total of 544 PTs.
00:20:35
Speaker
participated in this survey. And when asked, almost 94% felt that postural education for their patients was very important, while 5% felt that it wasn't important. The paper noted that in this survey,
00:20:51
Speaker
Therapists selected different examples of good sitting and good standing postures and noted that among the 500 plus therapists who weighed in, there was no universal consensus on what good posture looked like. So there was that reliability issue again. Okay, interestingly to me, the study also pinpointed six themes that emerged.
00:21:15
Speaker
that therapists seem to focus on with regards to posture. And I'll tell you what these six postural themes are, but I found these really super interesting because they're exactly the same themes that I hear coming up over and over and over again when we discuss what is optimal or suboptimal in the yoga world with regards to alignment, but also probably within the Pilates world, right? Which is maybe what this Pilates teacher is kind of trying to get
00:21:42
Speaker
down to the bottom of with her question to Sarah and I, but also in the strength world as well. So here are the six themes that came up a lot in this survey conducted. And the first one is this theme of natural curves, natural curves of the spine. So there's this theme of natural curves that keeps coming up in this survey.
00:22:02
Speaker
and so if we're going to kind of think of like what stereotypically do we consider to be good with regards to curves and what do we consider to be not good or suboptimal with regards to curves and I think that in general in the movement world we tend to think that the sort of natural curves which I'm not really even sure what natural means in an individual's body because everyone's you know anatomically very very different but natural curves may be
00:22:32
Speaker
You know, these all exist in some proportion to each other. We're kind of looking for the like right proportion of curves. Then we go, okay, that's good. But if there's too much, for example, if there's too much lumbar curve, that's bad. Or if there's not enough cervical curve, that's bad. Or if there's too much kind of thoracic curve, like the thoracic spine is sort of too rounded, the lower back is too arched.
00:22:57
Speaker
Maybe the lower back's not arched enough. All these things, we see that stereotypically and we go, we kind of make a value kind of call on that or a judgment call on that as not being ideal. The second theme was muscle recruitment and energy expenditure. So this theme arose, kept coming up in that
00:23:19
Speaker
if i were to just think about like in the context of yoga or even strength training like when the glutes are firing it's good generally speaking stereotypically speaking i won't even say generally speaking i'll say stereotypically speaking we want the glutes
Debunking Posture Myths
00:23:32
Speaker
to fire but stereotypically speaking we really don't tend to want the upper trapezius to fire the upper trapezius the muscle that lifts the shoulders toward the ears right that's we don't want that
00:23:42
Speaker
But when the glutes are firing, yes, we want that, right? And so theme three was this theme of a pelvic position. This kept coming up a lot. There was a lot of interest in what the position of the pelvis was. And in general, I find in the movement world, we like a neutral pelvis. If the pelvis is tilted, then we want to make that judgment call.
00:24:05
Speaker
assign value to that. And and usually it's it's like not good, right? The pelvis is anteriorly tilted. Oh, the pelvis is tucked. Oh, but neutral. Okay, you're good to go. Maybe it's just me, but that seems to kind of be the stereotype, the value judgment that we place on the pelvis. And then there's the theme of neutral spine kept coming up a lot. So this kind of relates to the first theme, which was natural curves of the spine.
00:24:37
Speaker
Neutral spine was a theme that came up a lot. And if I think about the movement world, it just seems like neutral is almost always favorable. Like we want it to be neutral and then it's good. But if it's deviated from neutral, if it's a little bit flexed, for example, the lower back is flexed. Uh-oh, careful, that's dangerous. Or if the neck is flexed, oh, Tex neck, oh, be careful, that's dangerous.
00:25:04
Speaker
And then theme five, there was the theme of stereotypical spinal posture. So you see what there's a lot of actually emphasis on the spine, right? So natural curves, neutral spine, stereotypical spinal postures that didn't detail what these stereotypical spinal postures were.
00:25:23
Speaker
But here, you know, we could think of like stereotypical dancer posture, maybe ballet dancer posture, and what type of value we would place on that compared to a moody teenager's posture.
00:25:43
Speaker
or what is the value we place on standing up quote-unquote straight with a lengthened spine versus slouching right there's clearly some quality that kind of goes along with these descriptive spinal positions it's kind of you're leaning toward I like it or you're leaning toward I don't want that
00:26:09
Speaker
And then finally, line of gravity, this idea of line of gravity made me think of how in the yoga world, we want things to be stacked all the time. And like, when they're not stacked, it's, you know, all of a sudden, like, you know, not efficient or not optimal, right? There's a lot of, there's like so much inconsistency with that idea. But for example, in Tarasana Mountain Pose, we want the,
00:26:39
Speaker
head and the rib cage and the pelvis and the feet to all be stacked, right? We're in warrior two, we want the knee, the front knee stacked over the ankle. And then if the knee is past the ankle, it's not stacked, it's inefficient. Plank pose, we want the shoulders stacked for the wrists. If the shoulders are past the wrists or behind the wrists, it's inefficient, it's not stacked. But like, you know, then we can get into like poses where it's impossible to stack.
00:27:07
Speaker
The joints like then it wouldn't be the pose like triangle pose like you can't stack the knee over the ankle the front knee over the ankle triangle pose Because then you're doing half-moon pose, right? So there there's so many Inconsistencies with this idea of things needing to be stacked but in general we tend to like stacking things
00:27:27
Speaker
We tend to feel good about that as a goal, as an alignment goal. I'm also thinking about like Tex neck, right? When the head is held forward of the spine, then we see that and we go, uh-oh, you know, you're going to pay for that later kind of a thing. This is just sort of how I see these themes showing up in my area of the world. Maybe, maybe you can relate. Maybe you can't, but I thought these, these six themes were very, very interesting. And it got me thinking,
00:28:02
Speaker
Hey, it's Laurel. I got something I want to tell you. Do you feel like you need a little inspiration behind your teaching routine or that you're kind of stuck in a rut looking for something new, something fresh to offer? Do you feel like you couldn't possibly take one more training, but somehow you fall back on these rote cues, these old habits. We here at MovementLogic, we get it because we've all been there too. Unfortunately,
00:28:30
Speaker
You're in luck because we are launching a site-wide sale on all of our tutorials. The movement logic tutorials aim to enhance your problem solving skills so you can work more effectively with your students and clients who are injured or in pain.
00:28:47
Speaker
Every movement logic tutorial contains hours of anatomy, kinesiology, myth-busting, and most importantly, dozens of fresh exercises that will help you train strength, flexibility, and functional movement for whatever you or your clients want to do in life.
Promotions and Sales
00:29:06
Speaker
This Labor Day weekend, we're offering a site-wide sale on all of our tutorials. And the more you buy, the more you save, with up to 30% off our popular tutorials. This sale ends Monday, Labor Day at midnight, so don't delay. Click the link in our show notes to access the sale and start saving.
00:29:28
Speaker
Now, here's the kicker. What evidence has failed to show, like research has failed to show is that there is some universally optimal or safe posture.
Complexity of Posture and Pain Relationship
00:29:40
Speaker
First of all, because it's really like, there's no real construct for being able to say what like optimal is, okay? But also because there's been studies kind of run in a way that tries to get to the bottom of like, well, who ends up having pain? And like, what can their posture tell us about that?
00:29:56
Speaker
And in the context of pain and injury, it seems as though there really is no particular way of sitting or standing, no stereotypical good or bad way of doing this that has been shown to predict pain or injury, to have a really strong relationship to it.
00:30:14
Speaker
And so in the absence of this evidence, it's reasonable to conclude that any position could have the possibility of causing someone discomfort or pain. Any individual could have pain from a particular position, especially if it's held too long. But it seems like what the research suggests is that we can't simply look at someone and make a kind of a value judgment on their posture and go, because you hold your body in this way,
00:30:43
Speaker
or because you move in this way and unless you change it, you're going to have pain someday. It seems like the evidence doesn't support that way of assessing someone.
00:30:54
Speaker
And I think this is really difficult to grapple with because, you know, even though it confirms what these large bodies of evidence suggest that there's really no consistent evidence showing that there's like a universally safe or healthy posture to be in, it contradicts large bodies of work. It threatens whole business models. If my, if my trademark method is say like to help you release your psoas to fix your posture, maybe it's your anteriorly tilted pelvis,
00:31:24
Speaker
I'm going to have a really hard time hearing that posture and anteriorly tilted pelvis is not inherently predictive of pain. Because then what the hell am I actually doing by releasing the psoas? And also we could ask is the psoas causing the anteriorly tilted pelvis to begin with, right? So what I'm trying to say is that, well, let me use a great analogy from a book that I
00:31:49
Speaker
probably one of my top 10 books of 2022 is estrogen matters, which is that when we're accumulating facts to support an outdated theory, it's a little bit like fitting a queen size sheet onto a king size mattress. You can get all three corners to work, but that fourth one is going to give you some trouble.
00:32:10
Speaker
And eventually, you're either gonna need a new sheet, you're gonna need a new theory, or you're gonna need a new mattress. You're gonna need, what would that be? You're gonna need a new, I don't know, profession. I'm not sure what these like, the sheet or the mattress stands for. But you know, it goes on to say like, but if you're in the queen size sheet business, you're gonna fight like hell to get that fourth corner to work.
00:32:40
Speaker
I love that analogy. Another term that I learned from that book that I thought was really helpful is theory-induced blindness. This describes how when you've accepted a theory and you've used it as a tool in your thinking, it is very difficult to notice its flaws, to notice its inconsistencies.
00:33:02
Speaker
So within the physio network, I also, in my search of posture and trying to get a handle on what the PT world has to say about posture, I found a couple of papers that further muddy the theory
00:33:17
Speaker
about posture and this idea that there is an optimal posture. And if we're not in it, we're going to have problems. So listen to this. I found these on the physio network too. So there's a systematic review with a meta-analysis. That's a pretty strong piece of evidence right there. Meta-analysis is kind of like at the top of the pyramid in terms of strength as far as evidence goes. It found that flexion of the spine is not a predisposition in low back pain or injury.
00:33:47
Speaker
what when lifting now this wasn't about heavy lifting right it was about lifting boxes i guess in a kind of like postal service personnel type workplace uh it's not about power lifting but it found that the biomechanical evidence for keeping the back straight right like all the posters in the back room where people are lifting boxes to like you know proper lifting technique it found that the biomechanical evidence for keeping the back straight to prevent injury was lacking
00:34:19
Speaker
Mind blown. That's got to produce some cognitive dissonance for some of you folks listening. Do you feel that sheet corner not fitting your mattress right now? It's kind of uncomfortable. It's really annoying, right? But I've got more for you here. So another cross sectional study on young adults found no connection between the duration of daily cell phone use
00:34:43
Speaker
Neck flexion the position of neck flexion what we call Tex neck right where your head is kind of like bent forward You're just staring at your screen. It found no connection between daily cell phone use neck flexion and pain despite the study even being conducted in a somewhat biased way and
00:35:02
Speaker
and kind of attempting to really find that relationship. Despite that, it didn't find that relationship. On the same topic, another one looked at neck posture in late adolescence and whether or not an adolescent's neck posture was a risk factor for neck pain in early adulthood.
00:35:24
Speaker
And this one actually found that for adolescents who sat upright, they had more neck pain later in adulthood than adolescents with forward head posture. So there's a finding actually that posture did play a role, just not the stereotypically bad posture we would assume. It was the stereotypically good posture that may be implicated. And get this, the study found that neck pain
00:35:47
Speaker
Neck pain during adolescence was a better predictor of neck pain in young adulthood. Not neck posture, neck pain. Yet another study looked at foot posture and ankle dorsiflexion, which is a position that your ankle's in when the top of your foot is moving toward your knee when you're wearing like a really flat shoe, versus
00:36:08
Speaker
ankle plantar flexion, which is the position your ankles in when you're wearing a healed shoe. And it looked at foot posture and ankle dorsiflexion to determine the role foot posture and ankle dorsiflexion differences might play in people with plantar heel pain. And the study found no significant difference in foot posture or ankle dorsiflexion between people with and without plantar heel pain.
00:36:37
Speaker
So those are maybe some sort of confusing, inconvenient truths for folks who seem to hold beliefs where there is like an optimal ideal position that we should try to be in to avoid pain. If we think back to the 1947 definition of posture, like posture is the state of muscular and skeletal balance.
00:36:59
Speaker
which protects the supporting structures of the body against injury or progressive deformity. Like this balance in muscle is going to keep us in a position that's going to protect us against deformity. Or poor posture is a faulty relationship with various parts of the body which produces increased strain on the supporting structures, a faulty relationship.
Reevaluating Posture Beliefs
00:37:24
Speaker
increased strain but then we look at all of this all of this evidence that suggests that posture is not like really good or bad or optimal suboptimal universally speaking that it's a little bit maybe more neutral and context dependent it makes you wonder if maybe this word posture needs an update
00:37:47
Speaker
Maybe posture actually exists outside of such dichotomous terms. Maybe posture and its role in an individual's anatomy and pain experience is actually a little bit more complicated than that, more complex than that.
00:38:04
Speaker
All right, I think investigating our beliefs about posture and reevaluating them is important for movement teachers. Hey, I think it's probably important for PTs too, but I'll stay in my lane and talk about why it's important for movement teachers. I think it's important because if we have this belief that there are good and bad postures to be in, we may start pathologizing the stereotypically bad postures, whatever our opinion is that those are, and we may start targeting the stereotypically good postures with our instruction. But meanwhile, someone might be perfectly adapted to and fine in the stereotypically bad posture.
00:38:35
Speaker
And it might not be an issue for them. And someone might be fine in that posture, but then when we try to move them toward the stereotypically good posture, this might be actually particularly unhelpful for them, or they're not ready for that position. We might also run the risk of causing potentially negative beliefs in our students' bodies about their body.
00:38:55
Speaker
and about their movement and about their posture. And this can result in what's called the nocebic effect, right? A placebo is the expectation of something good happening, something pleasurable happening from an otherwise kind of
00:39:11
Speaker
neutral event, not necessarily a good or bad event, we just expect this thing like a sugar pill to heal us and therefore does, right? And a nocebic effect is when we expect something bad to happen from an otherwise kind of neutral stimulus, right? So something that would not otherwise be dangerous or harmful, we perceive it as dangerous or harmful.
00:39:37
Speaker
And believe it or not, because pain is really quite complex, and it's very much a psychological process that takes place. These beliefs that something will hurt us, even though it's something that is not inherently bad, can actually cause us pain. So instilling fear in our students' bodies
00:39:56
Speaker
around their bad posture or their bad movement can make them fearful of movement, which may actually prevent them from moving, which can be sort of a vicious cycle of decline, right? When we don't move enough, we tend to have some issues, but it can also actually produce pain. So I think investigating our beliefs around posture are really important for that reason.
00:40:19
Speaker
And it's also that we might just be focusing on something that is ultimately not as important as we think it is, or maybe more so it's important, but it's not important for the reasons we originally came to believe. Like instead of needing to fix someone's posture, the way they look while standing or sitting, or even the way they look in terms of alignment and technique during yoga or some movement modality,
00:40:40
Speaker
Maybe it's worth more of our time and energy to consider the smartest progressive way to expose that person over time to novel loads and maybe more load gradually.
00:40:55
Speaker
so that they can adapt and be comfortable in whatever posture that is. And in this way, we maybe give them more movement options. So like I said, maybe posture is important, just not for the reasons we initially were led to believe. Instead, maybe it's important as a means by which to enhance or restore variability, right? Maybe then we can see how any one posture could be valuable toward this end.
00:41:25
Speaker
Even stereotypically bad postures. Okay, so back to alignment. I used to worry about my students alignment in poses because I believe that it had some bearing on their safety, their likelihood of injury, their future experience of pain. And I used to try to get them all towards this optimal posture.
00:41:47
Speaker
And so things like helping them protect their knee, I would use that phrasing in warrior two by making sure it was stacked over their heel, right, or find length in their lower back. Okay, moving away from
00:42:02
Speaker
extension of the lumbar spine or flexion of the lumbar spine, you know, really looking for that neutral position to prevent low back pain, right? I may even say that, or aligning their head over their rib cage perfectly so as to not strain their neck, okay? I now realize that whether or not any of these alignment goals, these really quite stereotypically prized positions,
00:42:31
Speaker
would be useful beyond aesthetic preference, say like useful for preventing pain or injury, would entirely depend on what the individual who is practicing needs more or less of in their movement or loading diet to restore that variability to have more movement options, to have greater capacity. So for variability to increase tolerance and capacity,
00:42:58
Speaker
Some individuals might have really benefited more from allowing their knee to drift inward or outward of their heel and warrior too.
Alignment as a Variable Tool
00:43:08
Speaker
Some may have really benefited more from having like really deliberately flexed or extended their lumbar spine or just moved dynamically between those two positions more often or they may have really benefited from having deliberately and regularly taken their neck out of neutral.
00:43:28
Speaker
So I no longer believe there is a universally correct, safe, or even optimal alignment for everyone, not only because it doesn't hold up to evidence, but it's also one of those limiting beliefs that I feel like has caused me to miss opportunities to help my students. And so for me, when I had pain from my yoga practice,
00:43:52
Speaker
You know, I had a lot of different types of pain, shoulder pain, neck pain, but really the most concerning was the SI joint pain. One theory I have is that back then in always seeking to adopt the same quote unquote optimal preferred alignment, the same even posture and standing and sitting in my daily life as well, I was constantly, you know,
00:44:17
Speaker
Vigil into my posture making these adjustments in my posture to kind of sit up straight or stand up straight because of this belief that that those were really universally favorable positions for me to be in They actually ended up becoming uncomfortable for me
00:44:32
Speaker
and actually painful for me. And you know what, pain is a great teacher sometimes because it was then when I really had this pain that kind of prevented me from doing what I wanted to do in my life, like my yoga practice, for example. It became really obvious to me through trial and error that it was time to change position. And more profoundly, it was really time to change my beliefs about posture and what I was doing with it.
00:44:59
Speaker
So does this mean we don't teach alignment at all? Right? Or does this mean that we don't teach form or technique at all? Is it outside of our scope as movement teachers? Not at all. So to finally answer this teacher's question, I think that it is well within a movement teacher's scope of practice to teach alignment, form, technique, whatever word you want to use, even posture. They all kind of mean the same thing. I actually think it's our bread and butter. What is within our scope
00:45:29
Speaker
is to teach movement and helping students organize their body in space and effort in specific directions is teaching movement. That's what it is. Not only that, but movement is transformative. How we direct students to organize their bodies in space and effort affects how they adapt or change or learn as the result of moving.
00:45:52
Speaker
Specific alignment and postural choice can alter the movement experience for individuals in important and helpful ways. It can also alter the adaptations that take place as a result too. For one, alignment, namely changing it away from what our default or habit might be, can provide our bodies with a novel sensory input
00:46:20
Speaker
And this can enhance our proprioception. And this is one way that we could help people reduce pain by helping them map their bodies differently in their mind through this novel sensory input. Google cortical maps and smudging and pain and read a little bit about that. Maybe we'll do a podcast episode on that.
00:46:43
Speaker
And I'll link to some resources in the show notes. But another thing teaching movement can do is target specific tissues for load to strengthen them or stretch them, or more generally speaking, load them. And this can improve
00:46:58
Speaker
and enhance different capacities in our body like strength mobility and more so for example using example from from earlier the deadlift right a deadlift can be done lots of different ways along a continuum of joint angles to be in from more of a hip hinge to more of a knee hinge so more of a hinge to more of a squat more what we would maybe call a hip dominant to more of a knee dominant deadlift
00:47:27
Speaker
if you were to hinge from the hips, but keep your knees straight.
00:47:32
Speaker
you'd be targeting potentially more your hamstrings for strength. Whereas if you hinged from your hips, but also let your knees bend, you'd maybe be targeting your glutes more. Conversely, if you did a more knee dominant deadlift, you kept your torso angle a little bit more upward. As you lifted the kettlebell off the ground and set it down, you'd potentially be targeting your quads more. So yeah, alignment matters. It definitely matters. Form or technique in this case, I guess, matters.
00:47:59
Speaker
It can also, in the moment, help students, individuals avoid sensitive positions, avoid painful positions, and, or maybe like the kind of reframe of that is it can help people experience a movement or a pose in a way that actually feels good in their body. So I used to think that I should try to square my hips to the side of the room in Warrior II.
00:48:28
Speaker
And for me, personally, that was like trying to shove a square peg into a round hole. It hurt. It hurt my body to try to do that. And so when I let go of that and just let my pelvis turn in the direction of my front knee, gosh, that felt a lot better. And then I could work a little bit more twist in my spine. So alignment, alignment matters.
Alignment's Role in Personal Transformation
00:48:51
Speaker
Alignment is, I think, one tool among a great many that we have to work with.
00:48:55
Speaker
in our toolkit as teachers. It definitely matters but I think it's important to realize there is no universally safe or correct alignment or posture or form or technique for everyone. Typically when that is what is being communicated that there is one right way. The goal is usually aesthetic preference in disguise and then as students and teachers we have to ask like is that
00:49:20
Speaker
We're prioritizing is aesthetics what we're prioritizing and if it's not then we should instead investigate the implications of what the different alignment choices are and maybe seek to facilitate
00:49:36
Speaker
the actual goals of our movement instruction of our practice. And if these goals revolve around strength, mobility, skill development, relaxation, pain relief, and we let go of aesthetic ideals, we may be able to use alignment as a means by which to solve problems for the individual.
00:49:56
Speaker
or to enhance the practice for the individual, not by trying to get everybody to do the one optimal thing in the exercise, but really ask, like, what is working for this person and what is not working? And then try to give them more of what's working. And in this way, I think alignment can become a far more transformative tool in our toolkit.
00:50:19
Speaker
So let me answer this Pilates Teachers question. I absolutely think it's within our scope of practice, if that's not clear already, to work with students on alignment. I've said it already. Or form, or posture. I think that the caveat here is that we should avoid pathologizing the posture, the form, the technique that our students have come to us with.
00:50:39
Speaker
because when we start to pathologize their posture we start to diagnose it in a way as being kind of the problem that's causing maybe other problems for them like maybe they have back pain and so then we go oh it's your anteriorly tilted pelvis that's behind that or maybe more technically under that um that's when i think we start to step outside of scope
00:51:03
Speaker
And the same kind of way, when we start prescribing good alignment as the solution, as the kind of pill to take, I think this is also when we cross align. Let me give you an example. Like, let's say that someone's doing a squat and their knees are drifting inward.
00:51:23
Speaker
and this student has knee pain, right? It's really tempting, and it's maybe not wrong. It's also maybe not wrong, but it's really tempting to want to go, oh, your knee pain is because you let your knees drift inward in the squat.
00:51:38
Speaker
And I think that this is not a skillful way to help this student with their squat because it starts potentially to create stories in the student's mind about their knees and about their pain and about squatting, but it may also not be the case. Like their inwardly drifting knees may not be causing their knee pain because pain is just a lot more complex than that. And the student's anatomy is also their own. It's individual.
00:52:06
Speaker
and it's just not that simple. What if instead, when we're working with a student on their squat and we notice that their knees are drifting inward and we know that they sometimes have knee pain, then instead of telling them that they have knee pain because of this alignment or technique in their squat involving their knees drifting inward, maybe if instead of saying that, we said, hey, let's try something, let's try something in the squat, let's try something a little different. What I notice happening when you squat is that your knees drift inward.
00:52:35
Speaker
i'm gonna have you this is just you know off the cuff an idea why don't you put this resistance band around your thighs this is the kind of quintessential trick used for knee drift in squats right put this resistance band around your thighs and let's practice a couple body weight squats with this with this mini band around your thighs and you're gonna work to move your thighs out into the band as you squat low
00:52:56
Speaker
and so i haven't said that your knee drift is causing your knee pain i've said that your knees drift inward right because i noticed that they do and now i want to try to give you another way another route to take and then they do that a couple times you go well how did that feel oh it felt different oh i felt like i was really you know working my muscles differently in that in that in that exercise and whether or not that actually ends up reducing their knee pain we don't know we'll find out right but
00:53:23
Speaker
instead of telling them that their posture is the problem and it's causing their pain, which I can't possibly know, instead of like really just flip the script, haven't really talked about that at all, and I've just helped them learn a new way to move. I think that this is the role that alignment instruction can play. And I think when we use it in this way, when we open up possibilities for students to learn a new way of moving in their body, a new way of really being in their body, that's when we're really doing our job well.
00:53:53
Speaker
When we help students get to know their body, trust their body, get curious about their body, appreciate their body, not fear their body. I think we do our job well. Alignment, form, posture, technique, whatever word you want to use, can be a way for us to do this. They are tools in our toolbox. And like all tools, their value really depends on how we use them.
00:54:19
Speaker
So there it is. My episode, maybe more my manifesto on alignment and posture.
00:54:30
Speaker
I am endlessly fascinated by conversations around this topic and I hope we can continue to have them. A note to you listeners that you can check out our show notes for references that I mentioned and even references that I didn't mention in this podcast. I'm going to link to all of those papers that I referenced to the Physio Network and to that bit on cortical maps and smudging.
00:54:59
Speaker
in the show notes and maybe a couple more. You can also visit the Movement Logic website where you can get on our mailing list to be in the know about sales on our tutorials. You can watch the video version of this podcast and see me talking to myself in my basement on our website as well.
00:55:20
Speaker
And as a reminder, please, if you have a request for an episode, why don't you drop it into a review of our podcast as an aside and give us five stars while you're at it. That would be super duper helpful. Thank you so much for joining us on the Movement Logic podcast today. Finally,
00:55:43
Speaker
Last but not least, it really helps us out if you subscribe to the show. We would be super appreciative for that, some ratings, some reviews, and that you join us again next week for more movement logic and more of our strong opinions loosely held. Until next time.