Neutral?

October 18, 2014 — 13 Comments

This subject may have been done to death, but the last post that I wrote garnered reaction from a number of people, specifically in relation to my writing that “I may have uttered the phrase ‘neutral spine’ at some point in my life” (as if that were a bad thing). So, it seems like something worth addressing, and having done some hunting in books and via the internet, there is plenty of (at least) potentially conflicting information available.

Neutral posture is defined as one “where the joints and surrounding soft tissues are in elastic equilibrium and thus at an angle of minimal joint load”.

(sorry, I’ve seen this quoted repeatedly but cannot find the original source).

If you’re going to be lifting weights, whether a barbell or bags loaded with a weekly shop, neutral is a fantastic place for your spine to be. There will be load on your spine, because it is the transmission from your arms (carrying the weight) to your hip joints, which should be moving the weight, but the load will be distributed evenly through the joints. If you are a Pilates teacher, or enthusiast, you probably know what Joseph Pilates believed about spinal flexibility – he wrote, in ‘Return to Life’ “If your spine is inflexibly stiff at 30, you are old. If it is completely flexible at 60, you are young.” In the lifting example though, the facility to maintain stiffness in your spine is very valuable.

One of the foremost proponents of spine stiffness is Prof. Stuart McGill (the link is to an article that he wrote) who has spent years researching spines, and apparently gathered lots of evidence that supports his theories.

I can’t disagree with a lot of what Prof. Mc Gill says in the video (and what right, as a layperson, would I have anyway?), especially in relation to the importance of lifting with the hips and not simply bending your knees. I heard recently of research on dancers showing a strong correlation between poor hip hinging (the ability to hinge the trunk around the hip joints without spinal articulation) and both back and knee pain – back pain especially. There would seem to be a strong case for making sure that the people we teach understand how to hip hinge (to powerfully extend their hips, you might say.)

Are there exercises in Pilates that involve the spine acting as a static transmission of load from one extremity to another? Absolutely. And there are also, of course, plenty that require us to sequentially articulate our spines, or to maintain spinal flexion. I suspect that the work of Prof. McGill has caused some teachers to believe that we should be avoiding lumbar flexion (it seems to be regarded as more sinister than thoracic or cervical flexion, presumably because the majority of disc injuries occur there). If you look you can find video online (try “the Pilates Nun”) of the Rollup being taught with a neutral lumbar spine, so as to keep it safe. If you peruse Professor McGill’s ‘Ultimate Back Fitness and Performance’ book you will see that he particularly advocates exercising with lumbar in neutral for people who have had back injuries or back pain: “Generally, for the injured back, spine flexibility should not be emphasised until the spine has stabilised and has undergone strength and endurance conditioning – and some may never reach this stage!” (page 47). This is not at all the same as never, ever flex your lumbar spine, yet this is what some people have taken from his work.

As a concept, neutral spine seems to be predominantly taught lying supine, which is curious to me because it seems to be the one position where neutral has least value or application. Under what circumstances, when lying down, do you need to maintain a neutral spine? If the only answer is ‘during exercise’, then we have to wonder what the purpose of the exercise is. I’m referring to mat based exercise, Footwork on the Reformer, and similar exercises with straps/springs being an exception, because you are applying force from your hip joint against mechanical resistance – they are mimicking deadlifting and squatting while supine. There is not a single exercise in ‘Return to Life’, beginning from a supine position, that calls for neutral spine, so it would seem reasonable to say that any pre-Pilates exercise (that is truly progressing toward an actual Pilates exercise) would not call for it either.

You might want to encourage a neutral spine in standing, in which case this is entirely dependent on the leg/pelvis relationship. If that is well organised – pelvis neutral – then cues related to axial elongation will surely help to achieve an appropriate spine position. After all, as Shari Berkowitz writes in her blog post ‘Neutral Pelvis and Neutral Spine: What are they and why do we care?‘, neutral spine is not a specific shape but unique to each individual. And, with that reference, ‘neutral pelvis’ rears its head.

Neutral pelvis, defined by Ms Berkowitz in her article as: “ASIS and pubic bone in line with each other in the Coronal Plane”, seems to me a more appropriate thing to be talking about than neutral spine, but do we really need to talk about it at all? Yes, it may well be a helpful cue to some, and my discomfort with the term may be a little irrational. (I’m much happier talking/thinking about organising one’s pelvis on the top/end of one’s legs..) Once again, I have to wonder if the term have a place in Pilates – particularly the matwork?

maxresdefaultMany gymnastic exercises involve the hollow body, or ‘dish’ position, and it seems to be central to gymnastics foundational strength programs (Gymnastic Bodies, for example). Having been introduced to the hollow body position it became apparent to me that this was the basis for a number of Pilates exercises – The Hundred; Single & Double Leg Stretches; and even The Push Up (ask any gymnast – push ups aren’t done in ‘neutral’). In fact, the second picture accompanying The Double Leg Stretch in ‘Return to Life’ is identical to the picture above. According to gymnastics coach, and author Carl Paoli, the hollow body is fundamental to learning to control your lumbar spine against the natural tendency to excessive flexion. It seems entirely natural to me that Joseph Pilates would have adopted this idea from gymnastics, which was particular popular in Germany.

One of the most valuable elements of the hollow body position for me was the understanding that my spine is organised by my glutes. My abdominals can then go to work to help to sustain that organised position but, under load, my glutes (the auto spell check is determined that I use my flutes to organise my spine…) are paramount. In a supine position this has the effect of lengthening my lower back into the ground, rather than jamming it down, and it becomes a much more sustainable position than it used to be for me. I would go as far as to say that my abdominals depend on the efficient functioning of my flutes (see?) to be able to function efficiently themselves. This does not equate to neutral pelvis.

Aside from it not seeming to be what Pilates himself was teaching, the problem with ‘neutral pelvis’ is that, once you take yourself away from either vertical or horizontal, the term has no meaning, except in relation to your spine. So, when a teacher calls for a variety of exercises from the original repertoire to be performed in ‘neutral pelvis’, I suspect that what they are really saying is ‘lumbar neutral’. If that is what’s intended, why stop there? If you flex your thoracic but not your lumbar then one would think that there would necessarily be significant intervertebral compression in the lower thoracic. If it is truly important to keep the lumbar in neutral, then why not the thoracic and the cervical? Where does that take us? Everything neutral in the sagittal plane only allows us to include The Twist, Side Kick Lying and Kneeling, and The Leg Pull (if you’re careful).

Under those circumstances, Pilates, as an exercise method, is dead – killed by the creeping influence of physiotherapy and disc injury and rehabilitation research. If you think that gymnastics may not hold all the answers to sound movement then I’d agree – practiced at an elite level it’s probably not fantastic for your health. That doesn’t mean that the basics haven’t been worked out over a long period of time – at least a century more than Pilates has been around. Gymnastics, like Pilates (I hope) is also very much concerned with having control over one’s body in movement. Can the same thing be said for the advocates of ‘neutral’?

 

 

 

 

 

 

Advertisements

13 responses to Neutral?

  1. 

    I’m not exactly sure what point you are trying to make, but here are my thoughts on the topic. Gymnastics is for athletes and like any sport carries inherent risks. Most of my clients are not athletes. They sit at desks or walk about slumped, dumping their weight into their pelvis causing loaded lumbar flexion. Joe didn’t have the data that Dr. McGill has. I’d like to think he would have adapted his method accordingly. Many of the Classic Pilates exercises can be performed honoring and not reversing the natural curves of both the lumbar and cervical spine. The thoracic vertebrae have smaller range of motion due to being stabilized by the ribs and are at less risk of disc rupture. How many times have you ever heard anyone complain of mid back pain? Zero for me. It’s always neck or low back. If we know that discs are ruptured by cumulative damage from loaded flexion (you are the load), why would we teach exercises that add to that? Practicing Pilates while maintaining the natural curves teaches bracing and reinforces good movement patterns when not exercising, prevents excessive pressure on the pelvic floor, and will make you freakishly strong. You don’t have to move your spine around to strengthen the muscles around your spine.

    • 

      Thanks Jill
      Please tell me how you think that your body weight loads your lumbar spine during an exercise like the Hundred? Is it loading it in flexion?
      You may claim, as it appears form your website, that ‘neutral spine’ adaptations of Pilates DO NOT water down the method – we’ll just have to disagree on that.

      • 
        lexingtonpilates October 18, 2014 at 8:24 pm

        If you imprint your lumbar spine and lift your chest, you are loading the lumbar spine -it’s measurable. Read Dr McGill’s book for a detailed explanation.
        Don’t disagree until you’ve tried maintaining the natural curves while practicing pilates. Rebecca Leone has some great classes on Vimeo you can try and many are free!

      • 

        Hmm, I replied once, but it’s not here… Mike, if you want to know more about the science I recommend reading Dr. McGill’s book, Low Back Disorders. When you lift the chest with the lumbar spine imprinted (flexed, compressed), the weight of your chest loads the discs. Dr. McGraw measured the load from various exercises (curl ups would be similar to the hundred position) and the numbers are all in the book. Add to that the weight of the legs off the ground and pumping arms which done poorly can cause see-sawing of the pelvis. Another good resource is Blandine Calais-Germain. Her book Anatomy of Movement was required reading for my Power Pilates training program (and many others). She addresses the perils of loaded lumbar (and cervical) flexion in her books Risk-Free Pilates (apparatus work) and Risk Free Abs (more pertinent to mat teachers).
        Oh, and before you disagree with me on the challenge of doing the work without reversing the spinal curves… give it a try. Rebecca Leone has several classes on her video channel that you can watch for free.

      • 

        I was asleep, and hadn’t had the chance to ‘approve’ your earlier comment.
        You may well be able to measure a load on the lumbar spine as you describe, but this seems a simplistic view to me. Firstly, I am not suggesting that anyone should be forcing a posterior pelvic tilt and jamming their lumbar down. Imprinting, to me, equals a moderate amount of flexion (depending on the individual) with elongation. It does NOT equal compression. It allows the whole spine to contribute to the flexion, and an even load distribution (a smooth conduit for your spinal cord). As I wrote in my earlier reply, if you hold your lumbar in ‘neutral’ and flex your thoracic you must load one or two segments more, I would guess T12/L1 particularly (a kink in your spinal cord’s conduit). I see a lot of people who are already in a pattern of defaulting to that segment for most of their spinal articulation. Another group that I see a lot of are people who are ‘lower crossed’ – held in an anterior pelvic tilt by short hip flexors and correspondingly short lumbar extensors – teaching them to hold a ‘neutral’ position when supine is not at all what they need.
        You mention the “perils” of loaded lumbar flexion (great use of language if you want to make people fearful of movement). Is loading your lumbar spine inherently bad? Exercise is about creating stress for your body to adapt to, and one of those stressors is joint loading. We need to load our joints.
        The load on your lumbar is applied by muscles concentrically contracting, in that scenario, not by the weight of your upper trunk. You would have to be sitting or standing for the weight of your chest to load the discs during spinal flexion – I don’t know if you’re misrepresenting McGill, but this is simple physics. In supine, gravity acting upon the weight of your upper trunk wants to push you lumbar into extension. It’s a curious notion to me that our muscles may become so strong that they can cause harmful loading to other tissues. You mention the impact of adding the weight of the legs to the Hundred position – this again acts with gravity to send the lumbar spine more into extension. It is not adding to the flexion load.
        I don’t dispute that McGill has lots of data to support his theories. The trouble with any studies on human subjects is that we have very limited ability to control the variables. There are many factors that could influence disc health, including nutrition and hydration, not to mention the conditioning of the subjects. How were they being taught to perform the movement described? Were they all performing the tested movements in exactly the same way?
        I was taught that intervetebral discs are shock-absorbers, which I have no reason to disbelieve. I also accept that we lose that which we don’t use. If we don’t allow movement of the lumbar joints then we will surely lose the capacity. My goal, for myself and my clients, is to be strong and stable throughout all of my joints full range of movement. I have no interest, nor find any value in limiting my joints range of movement. You say that exercising in neutral will make you freakishly strong, and I’d agree that deadliest and squats can do wonders for the strength of your posterior chain. In terms of your spine freakishly strong in neutral is not very helpful when you go out of neutral – rolling, tumbling, slipping, falling, heavy impact etc. In this regard I think Ido Portal has a lot more to teach us about movement than Stuart McGill does, unless you want to be a teacher of stasis, and not movement.
        Oh, and don’t assume that I haven’t tried something that I’m writing about. I’m not disagreeing about “the challenge”, I don’t think that is the point at all.

  2. 

    Thanks for this post and I totally agree with your conclusion about Pilates potentially “dying”, which obviously makes me sad.
    I’m sure you saw the ab exercises that McGill suggests should replace all ab exercises (I remember reading a comment about how they actually made someone feel weaker than before).
    The only comment I have to add as an instructor is that especially for beginners or people with low back issues, the only way to make sure they are working their abs without hurting their backs is to keep their backs on the floor. Neutral is not an option for these cases in my opinion and I think the potential damage of suggesting they work in neutral (assuming they get it) outweighs the damage that McGill talks about (especially since we don’t spend all day doing Pilates or do a million repetitions).
    And a personal note: In my initial training 12 years ago we didn’t even know of the term “neutral” and personally I had the best body during that training and zero low back pain, as most of my clients since then. Working with neutral might be better for my back (McGill is definitely an expert) but I’m really not sure about the rest.

    • 
      lexingtonpilates October 19, 2014 at 12:49 am

      Pilates need not die, but it certainly needs to recognize and incorporate valid scientific data that can make the method safer and more effective. While “conventional wisdom” has been telling fitness instructors that folks should tilt their pelvis while doing crunches, etc. to protect their backs for as long as I can remember, it has no basis in fact. The data supports that bracing and maintaining a natural curve is in fact protective. If a beginner cannot maintain that position while lying on their back, then their progression needs to be slow (Dr McGill has a good plan in his book). Remember what it is that you are protecting… Your spinal cord! Maintaining a position that equalizes disc pressure will keep it safer than a flexed position that pinches them anteriorly. The yoga industry is beginning to recognize and incorporate this information. Pilates needs to be responsible and do the same. No, we don’t do pilates all day (well, I kind of do since pilates is more than just an hour’s workout) and we don’t do a million reps, but if you add up all the repetitions of loaded flexion in the average mat or apparatus 1 hour session, it’s a lot. After spending a week with Rebecca Leone, reading Calais-Germaine’s books, and studying Dr. McGill’s findings, I cannot with a clear conscience teach pilates the way I was taught to teach pilates. Trusting the method and doing it the way we’ve always done it is not good enough anymore.

      • 

        I think I responded to all of these points below. One more thought: see if you can find someone to teach you the hollow body position.
        Data supports opinions, it doesn’t always make facts.

      • 
        lexingtonpilates October 19, 2014 at 3:56 pm

        Shew Mike. You are over complicating this subject. I don’t have time to address all those points and I’m quite sure that I am not going to change your view anyway, but I will address your statement regarding stress. Not all of our parts benefit from stress. Bones get stronger when stressed, muscles get stronger when stressed, joints wear out from stress when overloaded or poorly aligned, verterbral discs do not get stronger with stress. They become less resilient simply from age. I do not want to contribute to that with exercise. I choose exercise that brings awareness and mimics the movement patterns that reduce the stress on the discs. Work out the way you want to walk out. For me, that does not include walking or sitting in a slump.

      • 

        I’m sure we won’t change each others minds, so this will be my last reply. Who says discs get less resilient with age? This may be common, but it doesn’t make it normal/natural. Articular surfaces can lay down more cartilage in response to stress – that’s why surgeons will sometimes hammer articular surfaces with a mini pick axe.
        If you want a less complicated answer, watch a cat move, a big cat if you like, and ask yourself how much time they spend bracing neutral.

  3. 

    I think you can use your Inner Unit (TA, Multifidus, etc) in any way you like and it is never against nature… But if you want to work on your stabilization system, if you want to (re)program it, as we do in Pilates all the time, you do need to work that system in a physiological way, that is to say, as it is most efficient and “natural”. All these studies are based on ontogenetic studies, the observation of the child development and in children you can see that they never shrink their waist when they perform any effort that needs spinal stability. The fact is that the perineum muscles work physiologically in an eccentric way, they respond (they withhold) to the pressures from within. This pressures comes from the descent of the diaphragm if the ribcage is placed parallel to the perineum. After the inicial descent of the diaphragm, in order for the stabilization system to work properly (and also for the diaphragm to work to its full capacity), there needs to “happen” a contraction (eccentric too) of the abdominal wall, multifidus, paraspinals, etc, to “contain” and “produce” the desired intra abdominal pressure. During effort the two “functions” of the diaphragm must be working properly – stabilization and breathing – and so there must be space for it to descend, contracting to its full capacity, during in breath. If we do the “pull in and up” of the umbilicus when we need spinal stability during effort we loose part of the proper stability system work.
    My english is not good enough to explain all my thoughts on this subject that I think is one of the most misinterpreted in Pilates world. I did my three training seminars with Romana Kryzanowska and she never told me to pull my umbilicus in and up during the “series of 5” for example. If you look in other (as old as Pilates) disciplines like weight lifting, no one pulls their umbilicus in and they all (the best at least) do full abdominal breathing.
    Nuno Gusmao Bells&Spring, Lisbon

Trackbacks and Pingbacks:

  1. Is there too much flexion in Pilates? « paleolates - March 11, 2015

    […] This may well be coupled with a faith in the research of Stuart McGill (yes, this is a favourite topic of mine), which may be taken to mean “never flex your lumbar spine under load of any […]

  2. Is there too much flexion in Pilates? Part 2 « paleolates - March 15, 2015

    […] about chest expansion (thank you Kathryn Ross-Nash, this was so helpful to me). I’ve argued elsewhere that the position of this exercise is essentially the gymnastic ‘hollow body’ or […]

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s