Is Flexion the Devil's work

I was prompted to write this article after an email exchange with a fellow professional - and it seems its a subject that provokes a great deal of emotive debate - so here is my tuppence worth:

 

[caption id="attachment_108" align="aligncenter" width="300"] Keep your back straight[/caption]

Go to any gym,  sports club S&C facility, or even watch the New Year exercise DVD of whoever most recently traded in their dignity to eat kangaroo balls in the jungle  - and you will continually hear the same 'chest up, shoulders back' instructions over and again for every movement - and more often than not its explained that this is to help prevent back injury...

[caption id="attachment_106" align="aligncenter" width="207"] Chest up, shoulders back - does this look remotely sensible to you?[/caption]

I do understand where this has come from - we live in a society where people spend far too much time sat down hunched over a keyboard or  humancentipad (yeah its a thing - google it), and the majority of folks complain of a bad back....  Well then that flexed spine must be the culprit right?

Quite possibly yes - but does that mean we take everyone to the other extreme and force them into permanent extension?

Well that would just be silly now wouldn't it...

[caption id="attachment_107" align="aligncenter" width="225"] Silliness - almost never a bad idea[/caption]

Unfortunately the world of health and fitness seems to be one of extremes and fads, we as a collective group of fitness professionals don't seem to be able to take the middle of the road on just about anything.  Again, I get it, yeah Ive been in and around this business for knocking on for 20 years, and these days don't give a monkeys' what the current trend or 'approved school of thought' is  - but I have certainly been guilty of throwing myself onto several bandwagons in the past - without necessarily applying some common sense first.

[caption id="attachment_109" align="aligncenter" width="275"] Not always the safest place to be - but at least it means you can see both sides[/caption]

The problem we have with a one size fits all approach to postural correction is that, in driving everyone into a permanent state of extension, we are creating more problems than we solve...  The dropped (or anteriorly rotated) pelvis is - in my opinion - far more likely to lead to potentially debilitating back pain than a moderate amount of spinal flexion.  After all, spines were designed to flex!  (I'll get into who designed us at a later date).

[caption id="attachment_75" align="aligncenter" width="300"] Anterior pelvic tilt - or 'lower body cross syndrome'[/caption]

Cueing and coaching people to extend all the time will, undoubtedly, worsen the alignment you can see above - termed by Janda as 'Lower Body Cross Syndrome'. This is short or over active spinal erectors and quads, weak or inhibited gluteals and anterior core.

[caption id="attachment_96" align="aligncenter" width="300"] All you need for a stable spine[/caption]

Anyone who has ever read anything vaguely health related will know that the big hitters for stabilising a lumbar spine and preventing / rehabilitating low back pain are....  GLUTES AND ANTERIOR CORE!  So why would we be constantly cueing people into a position where these guys can not do their job!?

[caption id="attachment_110" align="aligncenter" width="300"] It just seems so obvious now[/caption]

The simple myokinematics of an anterior pelvic tilt, or lower body cross - not allowing the main spinal stabilisers to adequately recruit is, however, only the start of the problem...  A position of extension is known by the clever folk at the Postural Restoration Institute in Nebraska as a state of 'permanent inhalation'.  A simple overview of respiratory biomechanics demonstrates that for adequate exhalation a ribcage must 'oppose' a pelvis.   Think of this as the bowl of the pelvis, and the arch of the lower ribcage forming a stable spherical shape....    Now why is this important?  The diaphragm is attached around the ring of the lower ribs, and down the thoraco-lumbar fascia...  what else is attached to the thoracolumbar fascia?  The iliopsoas of course!  In fact, in cadaver studies the crurar fibres of the diaphragm are almost impossible to distinguish from these major hip flexors. When one contracts the other gets pulled - think of them as George Dubya and Tony Blair.    If we elevate these lower ribs in a position of extension, the diaphragm will still contract,  but instead of pulling the ribs in, it will pull the lumbar spine forwards (extension) and pull the hip flexors even tighter.

[caption id="attachment_111" align="aligncenter" width="224"] Follow the line of the waistband. Hips are in about 15 deg of flexion[/caption]

Apologies to whoever this guy is, I pulled this pic from an article on the interweb titled 'how to deadlift correctly to avoid back pain'.  Not like this is the answer, sorry dude.

so...

An anteriorly rotated pelvis is in a position in which major spinal stabilisers and respiratory muscles can not adequately function.   What do we want people to do when they are trying to recover from a lower back injury, or brace themselves for a maximal lift?   Breathe and stabilise!

What should we be cueing people to do?  Get neutral!  Get the ribs down, brace and breathe.