Archives For functional training

people-spring-lift-ecard-someecardsI’ve been involved in a discussion lately on https://www.facebook.com/groups/pilatescontrologyforum/ around the subject of why we teach spinal flexion in Pilates. As is often the case, this discussion began to deviate slightly from the starting question, leading into other (for me) interesting territory. Namely, it made me wonder if there is a consensus within the Pilates teaching community as to whether Pilates is itself a functional movement/exercise discipline.

It’s helpful, if not necessary, to define what one is discussing – and so I realise that I have accepted in my own mind a rough definition of functional movement, derived from who-knows-what varied sources, that seems to make sense. If I have to pin it down, my definition would go something like this:

Preacher-Curl1A functional exercise is one that teaches, or reinforces a movement pattern that is useful, and health enhancing, beyond the execution of that discrete exercise.

For example, I would consider the Hundred to be functional because (amongst other benefits) it requires the maintenance of spinal stability under load (from our legs), and also the ability to disassociate our shoulder joint – to move our arms in our shoulder joints without uncontrolled spine or scapular movement. Both of these being very useful in a variety of scenarios (dare I say “fundamental movement patterns”?) I wouldn’t consider a bicep curl as pictured above to be functional, because the machine removes any requirement to create stability, or to transfer load into the centre (free-standing curls would be a different story, of course).

The Facebook discussion reminded me that there are other definitions. For what it’s worth, CrossFit has this definition, and if we turn to Wikipedia they do not have a page for functional exercise but will direct you to ‘functional training‘, which ties in to occupational therapy. Within the discussion, the thing that was slightly jarring for me was the idea that Pilates might not fall into some people’s idea of ‘Functional’, since it seems (generally speaking – more on that later) to fit that description very well.

I’m not a fan of ‘evidence-based’ exercise, because I think it’s naive to imagine that we can ever prove (to meet standards of proof in controlled studies) the efficacy of any given exercise. There are too many variables that cannot be controlled for when comparing even a small number of people practicing the same movement. At the same time, I think applying what, if we were clinicians, we might call ‘clinical reasoning’ to exercise selection is essential. Let’s call it ‘reasoned Pilates’ for the moment (for the record, I am not trying to create a new sub-genre – there will not be a trademark application). Teaching reasoned Pilates means, with your observation and your client’s input, assessing what they need most, choosing how to implement your assessment, and then evaluating whether your choice was successful. So if someone is kyphotic, and is new to Pilates, giving them the Swan Dive on the High Barrel may not be the best choice. The short version of all this is that I want to be able to explain why I’m teaching anyone anything, beyond “that’s what’s next in the sequence”, or “that’s how I was taught it”. In other words, “What’s the point?”

All that said, I do agree with a contributor to the forum referred to above, who said something along the lines of “sometimes people ask too many questions, instead of just doing the work”. I do think it’s often possible that doing the work will lead you to the answer to your question (“Why is it done this way?”, for example). I have heard Romana, on the excellent images“Legacy Edition” DVDs, quoting Joseph answering “What is this good for?” With the wonderful response “It’s good for the body.”I’m not suggesting that clients should be constantly questioning why they are doing things, and their teachers constantly explaining everything. Rather, I hope that they find the answers for themselves whenever they can, and that I have the understanding to explain the ‘why?’ if I have to. I believe I have a better chance of being an effective teacher if I have that understanding.

As an aside, I’d much rather be described as a ‘teacher’ than as an ‘instructor’. The first definition that my dictionary gives for instruct is: “to direct to do something; order”. The first definition that it gives for teach is: “to help to learn; tell or show (how)”. I think that the element of reasoning may be the thing that distinguishes between an instructor and a teacher.

‘Reasoned Pilates’ fits with my perception of Pilates as something that makes you better at other things, rather than Pilates as a thing to be good at. I don’t believe that Joseph Pilates complied the exercises in ‘Return to Life’ for people to practice in order to become very good at doing those exercises. The point was to practice those exercises in order to enhance one’s health (No?). I know that there are people that consider Pilates to be an art form, but I can’t call myself one of them. Seeing someone display a high level of competence in anything is usually enjoyable, but I find the many videos, that do the rounds of social media, of people working on the Reformer (perhaps with dramatic lighting) to be somewhat tiresome. (Equally, photos of lithe bodies on exotic equipment adapted from Pilates apparatus, rather than “Looks beautiful”, make me think “But why? What’s the point?”. It’s as if Pilates is being practiced for someone else other than the practitioner.

Another element to the consideration of ‘functional’, that I was reminded of whilst trying to follow some of the Reformer work demonstrated on the aforementioned DVDs, and may have been missing from the definition I offered above, is fun, or feeling great. It’s sort of covered by the ‘health enhancing’ idea, I think, but deserves its own mention. Something that makes you appreciate, or helps you bask in the joy of whole body movement surely performs a valuable function? To return to the bicep curl analogy, I’m no body builder, but it’s hard for me to imagine that anyone ever had much fun doing sets of bicep curls. Yes, viewing the hypertrophic results in the mirror afterwards may result in a flush of pleasure, but actually doing the sets of curls? Surely not. I don’t know whether the response to doing the various rowing exercises on the reformer was musculo-skeletal, hormonal, emotional, or what. It felt marvellous.

If you think that Pilates doesn’t fit under the heading of functional movement, or functional exercise, I’m sorry, but I don’t understand.

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71064I have heard Kelly Starrett describing functional movement as ‘a wave of contraction from core to extremity’. This seems to fit very well with the theory of local and global muscles. The idea that we need to stabilise our spine prior to loading/moving is embedded in Pilates. It is easy, too, to find ‘scholarly articles’ on the internet (Paul Hodges, to name one author) exploring this idea, and correlating poor stabilisation in anticipation of movement with lumbar disfunction and injury.

It all seems very logical, but could it be flawed? Things seen in a lab may not have a strong relationship to ‘real life’. The fact that turmeric added to cancer cells in a Petri dish has a measurable negative effect on those cells, does not equate to consumption of turmeric ‘killing’ cancer cells in a living body. Similarly, the research that supports the concept of an anticipatory, local muscle stabilisation strategy may struggle to replicate real life situations, simply because it’s hard to measure a lot of human activity whilst accounting for variables. I imagine it’s really hard to wire someone up to any kind of measuring device and gain significant data if they’re engaged in anything other than fairly pedestrian activity. One of the challenges to the straightforward ‘centre-to-periphery’ concept that I’ve had is its failure to take into account the influence of part of our body coming into contact with the ground, or some other surface. That contact will send feedback to our brains, perhaps triggering further stabilisation strategies, for further anticipated movement or force through the joints. Therefore, the periphery is triggering the action at the centre. Where does that leave our ‘wave of contraction’? Is it blown out of the water, or can it be salvaged?

In the last couple of weeks I met two people who, separately, caused me to start to ruminate on this. One was explaining that her strategy for getting from sitting on the floor to standing was the way it was (alarming, I thought) because she had issues with both her foot and her knee. She was endeavouring to find stability in her foot, and then her knee – working from periphery to centre – on the basis that she needed to have a stable foundation of foot-to-ground before she could stabilise more proximally. It kind of makes sense – you can’t stand a vase on a wobble-board. The other instance was someone who, to my eyes, clearly had habitually internally rotated femurs and matching externally rotated tibias, and was talking about the orthotics that her podiatrist had recommended/prescribed. The podiatrist was apparently relatively disinterested in what was going on at this person’s pelvis (i.e. hip joints) because the thing that needed dealing with was her point of contact with the ground. It felt like a mini-epidemic of periphery to centre thinking. And again, there is a certain logic to this – the lady in question had knee pain. Every time she planted her foot on the ground her inability to stabilise her foot caused an inappropriate load at her knee joint, ergo: stabilise the foot with orthotics.

I should perhaps acknowledge at this point that I’m not at all a fan of orthotics. I can see that they may be a stepping stone toward getting someone’s joints into better positions, but they aren’t a substitute for actually sorting out alignment and strength issues that can have a lasting effect. I’ve worked with too many people who have orthotics for life (i.e.. someone in their 60s who’s had orthotics since their 40s). It seems akin, to me, to putting someone in a neck brace as a long term solution for poor control of their head position.

So, do we have compelling evidence to support an argument that stability actually works from the periphery to the centre (and then back out again)? I don’t think so. In both cases the idea is that a stable point of load, or contact with the ground, is more significant than a stable trunk. I can only assume that the idea is that in that case the trunk will take care of itself. I’ve used the workshop “Pilates Made Simple” to explore the idea that there are three basic demands of any Pilates exercise (that, of course, relate directly to real life) – these are: Stabilising your spine/trunk while moving your extremities; sequentially articulating your spine; and transferring load from your extremities to your centre. The latter is the one that I’m most interested in here – it seems to me to be fundamental to what we teach in Pilates, to functional movement, joint health, longevity etc.

In order to transfer load from your foot to your centre (core, if you like) you need to have control over all the joints in between. If there is a ‘break’ in that chain of force transfer then the load gets absorbed by the more distal joints. This is easy to see in people doing all fours exercises who are not able to effectively stabilise their shoulder blades against their ribcage and consequently feel the load most in their wrists and elbows. (When training I learned that, if a client was injured, Pilates always worked away from the problem – Kelly Starrett talks about “upstream” and “downstream” implications of poor positioning/control. I think the ‘fix’ for an elbow problem will more often than not be found at the shoulder than the wrist – proximal, not distal.) In the medially rotated femur/laterally rotated tibia/orthotic scenario, the orthotics may wedge the foot into a better shape but this won’t transfer into improved hippo control. However, working on laterally rotating at the hip joint whilst maintaining a straight foot (please try this yourself) will have a significant effect on foot activity. This is (for me, at least) very challenging to achieve in open chain exercises, but working on closed chain exercises on Pilates apparatus and standing work in mat classes, seem to really help to manage knee/ankle/foot alignment in open chain exercises.

The short version of all of the above: Yes, feedback from our periphery is instrumental in establishing positions, but we cannot effectively create stability and control from the periphery to the centre, it HAS to work the other way.

There’s not enough THRUSTING

In a recent conversation with a personal trainer, he made the observation that the components of functional training are: “pushing, pulling, lunging, squatting and twisting”. Similarly, Mark Sisson refers to PEMs (Primal Essential Movements): Squats, Pull-ups, Push-ups & Planks.

A search of the web for components of functional exercise offers up the following “4 Pillars of Human Movement” (coined by ‘fitness maverick’, JC Santana): Standing and locomotion; Level changes in the body’s centre of mass (e.g.. squats, lunges etc.); Pushing & Pulling; Rotation.

Dr. Richard A. Schmidt (author of various books on motor control and learning) defined the six basic human movements as: squat, bend (deadlift), lunge, push, pull and twist.

CrossFit’s Training Guide describes Functional movements as those: “…that mimic motor recruitment patterns that are found in everyday life….Squatting is standing from a seated position; deadlifting is picking any object off the ground.”

You’re probably getting the gyst, and may be wondering what this has to do with Pilates. Well, Pilates is about teaching movement, and hopefully we can all agree that it’s a much better idea to be teaching functional movement over non-functional (isolation) movements.

One of the common themes to these lists is the presence of hip extension, which the CrossFit Training Guide (yes, I’m preparing for my Level 1 certification…) describes as”..the foundation of all good human movement” adding: “..without powerful, controlled hip extension you are not functioning anywhere near your potential.” Perhaps as a result of what I’ve learned from regular sessions of CrossFit, I’ve become somewhat obsessed with hip extension, and aware that the great majority of people that I see, both in classes and in the street, seem to be lacking ‘normal’ hip function.

Surely this is where Pilates should be coming in, and spanking everyone into good function? There’s lots of hip extension in Pilates, certainly when it comes to the equipment repertoire, (not so much in the mat work), so what am I on about? Here’s the thing – we typically approach hip extension, in Pilates, from a static trunk position. Take leg springs lying supine, or feet in straps on the reformer – both great exercises for teaching people how to move at their hip joint without compensating with their spine – but not allowing full hip extension. This doesn’t teach us that much about being upright. In addition, legs move in relation to the trunk, and there is very little Pilates repertoire that requires us to extend our hip joints by doing the opposite (trunk moving in relation to legs, or both moving simultaneously).

It’s been amazing to me to discover, both in myself and other Pilates teachers, how common the inability to dynamically extend the hips seems to be. When I was first asked, from a standing position, to flex at my hips and my knees, keeping my trunk stiff (something like the appropriate position from which to pick an object up from the ground), and then extend at my knees and hips to return to vertical, I couldn’t seem to do it without adding in some kind of spinal articulation. The short version of that rather wordy sentence is: ‘ I couldn’t thrust my hips’. Wanting to consider myself moderately virile, that’s a pretty humiliating discovery.

One of the things that I consider it my job, as a Pilates teacher, to convey to the people I’m teaching, is how to avoid substituting moving with their spines for moving in their hips – yet there I was, incapable of avoiding that substitution, when asked to do an unfamiliar hip movement. This is the crux – do we, or does Pilates, do a good job of teaching people to effectively use their hip extensors when they’re not lying down?

It’s not as if there’s an absence of standing work in the studio (again, mat work is a different story), and maybe I just don’t teach enough of that repertoire – though there’s a lot more squatting and lunging involved in my classes than there used to be. Working from the basic premise that spinal articulation exercises are only to promote flexibility (thus facilitating stability), I wonder if we don’t tend to overemphasise articulating the spine, at the expense of efficient, powerful hip extension. You may argue that powerful hip extension (‘PHE’, from now on) isn’t a part of optimal posture, but I’m willing to bet that someone that has the facility for PHE has a reasonable alignment of their pelvis on the top of their legs. I was tempted to insert pictures at this stage, but it feels too objectifying. Suffice it to say that I was watching a promotional video (from a very well-known manufacturer of Pilates equipment) for a new piece of equipment. The model, who in fairness may not be a Pilates practitioner (though I know of a number of Pilates teachers whose shape is similar), had a pronounced angle at the front of her hips in standing, that speaks to me of lack of hip extensor activity – again, this feels like a common sight to me – generally more noticeable amongst women, but that may simply be down to clothing. In contrast, the elite female CrossFitters seem not to exhibit the same posture, but are ‘flatter’ through the front of their hips. Typical CrossFit movements: dead-lifting, squatting, kettle-bell swings, even gymnastic movements at speed like pull-ups and rope climbs, are dominated by PHE.

Could it be that we could help more people improve their hip function overall, and their posture specifically, by incorporating more standing (& lying) PHE?

For suggestions on how to achieve this (without doing CrossFit) please look out for a forthcoming project, that aims to help make Pilates easier, simpler, and possibly, dare I say it, more effective. Readers of this blog will be the first to know about it.

Many different people have tried to find their own niche in the world of Pilates, fusing with, or adding elements of other disciplines; or perhaps trying to make their classes specific preparation for another sport, or activity. (Yes, I have seen ‘bikinilates’ advertised). I think this may be missing the point, but more of that later.
There are also signs that some teachers feel that Pilates is not enough in itself – that it needs to lead to something more – and I’d number myself amongst them. One of my teachers and trainers early in my Pilates career, James d’Silva, has created the Garuda Method, which was advertised at one stage along the lines of “where Pilates ends Garuda begins”. (One might debate the idea of Pilates ‘ending’ somewhere, I can imagine some sticklers for tradition and the original work rejecting the idea wholesale.) For me, CrossFit begins, not where Pilates ends, but overlapping, and happily coexisting. Perhaps this is the time to answer the ‘What is Crossfit?’ question.

The answer is: “Constantly varied, high intensity, functional movement.” (…”Functional movements are universal motor recruitment patterns; they are performed in a wave of contraction from core to extremity; and they are compound movements -i.e. they are multi-joint.”), from ‘Understanding CrossFit’ by Greg Glassman.

Greg Glassman is the creator of CrossFit and, like Joseph Pilates, a maverick figure with a solid conviction that what he is doing is valuable and should be disseminated as widely as possible. The strongest link that appears to me between the two disciplines is in the intended outcome. My understanding has always been (though I can’t find it in either of Pilates’ books, I’ve heard it from first generation teachers) that Pilates’ intention, after years of practicing a variety of different disciplines, was to create an exercise program that was non-specific. In other words, his exercises were for overall fitness, in readiness for whatever challenges life may bring. More recently the concept of GPP – general physical preparedness – has emerged, and this is central to CrossFit methodology. One trains a wide variety of activities in order to be prepared for as wide a variety of potential challenges as possible. Glassman seems to be fond of the idea of preparation, in as much as one can, for the “unknown and unknowable”.

I cannot think of a single Pilates exercise that works a joint or muscle in isolation, and the idea of a “wave of contraction from core to extremity” sounds exactly like Pilates. Joseph’s own principles for his method were: breathing; whole body movement; and whole body commitment. I haven’t come across anything in writings about CrossFit specifically related to breathing, but it is very much to do with whole body movement, and total commitment. In a divergence of the two methods, Pilates prescribed his exercises lying or sitting to “relieve your heart from undue strain” (from ‘Return to Life‘). This is one of the areas that leaves some of us feeling that Pilates alone is not enough, and CrossFit workouts certainly put significant strain on the cardiovascular system. (Whilst I think the tired “no pain, no gain” slogan is a crass one, I believe it’s true to say that you can’t have adaptation without stress.) In this context CrossFit also profoundly effects breathing, and full use of lung capacity. Anyone who has tried high intensity exercise will most likely be aware that breathing to full capacity doesn’t require cueing…

The video is self-explanatory, if you jump straight to 3:20 you’ll see how well her lungs are functioning. (In case anyone is concerned, the video above is of an elite athlete performing at an advanced level. This does not represent the kind of work that beginners would be asked to do.)

Many Pilates exercises involve maintaining a stable trunk (spine) whilst moving arms and/or legs. Typically the weight of the limbs and their movement act as a challenge to that stable trunk position. Similarly, one of the fundamentals of many CrossFit movements is ‘midline stabilisation’ – the idea that, particularly under load, you keep your trunk stiff, and move from your hip and shoulder joints. The only difference between the two is that Pilates doesn’t add load to the same degree. Had he been faced with current levels of osteoporosis, for instance, who’s to say that Joseph wouldn’t have favoured picking some weight up?

Another element that CrossFit and Pilates share is an emphasis on precision. Sadly, if you make only a cursory search of the internet, you will find plenty of alarm expressed over the dangerous nature of some CrossFit workouts – and, indeed, plenty of YouTube video clips of people doing very demanding movements with eye-wateringly poor form. Just like so many articles about Pilates being bad for you, I don’t believe that this is a reflection of CrossFit, but one of either poor coaching, or simply poor performance. Just as Pilates insisted on his exercises being done with precision, both videos of training seminars, and conversations with Crossfit luminaries make it clear that ‘Form is everything’. In fact, one of the particularly interesting challenges for me is that CrossFit workouts ask questions along the lines of: ‘We know that you can lift that heavy barbell off the floor with good form, now can you do that multiple times, quickly, with good form? And how about keeping your form and doing that when you’re gasping for breath because you’ve just been doing another challenging movement at speed?’

Rich Froning – ‘Fittest Man on Earth’

Joseph Pilates – tattooed health visionary

What else is there to lead me to the conclusion that Joseph Pilates would have embraced CrossFit? Followers of both methods will attest to the remarkable transformations in body composition, energy levels and overall well-being that are there for the taking. He didn’t seem to be interested in  great analysis of his method: one of my favourite Pilates quotes (as recounted by Ron Fletcher) is, in response to a question about the purpose of an exercise, “It’s for the body!”. CrossFit celebrates becoming faster, stronger, more agile – and does not dwell on the exact mix of muscles required. Perhaps most significantly Joseph, tattooed as he was, would have fit right in with a great number of CrossFitters, for whom ‘ink’ seems de rigeur.

I’m convinced that Joseph would have been involved in a movement like CrossFit, had he the chance. The truth is, while I couldn’t bring myself to give the post this heading, I believe (with apologies) that ‘CrossFit is the new Pilates’.

I just tried an internet search for “pilates low back pain” and Google returned 1, 380, 000 results. Google scholar also offers hundreds of ‘scholarly articles’ that touch on the subject. Amazon offers several DVDs of Pilates for low back pain, but their offerings are dwarfed by the hundreds of YouTube videos on the same subject. Another Google search for the same terms but in the News section suggests that in the last month English language newspapers and magazines have also had hundreds of articles on this subject. Coupled with my own experience of Pilates ‘fixing’ my low back pain, is it any wonder that I’ve spent years believing that Pilates offered the best solution for anyone suffering from this nearly ubiquitous affliction?

The Dummies.com website has a page, attributed to Ellie Herman on: ‘Easing Your Back Pain with Pilates‘ in which she explains that the causes of back pain are “faulty posture” and “sedentary lifestyle”. While we might like to suggest some other possible causes, I don’t suppose that many Pilates teachers would disagree with her – it seems like pretty basic stuff: you sit and/or stand badly, your postural muscles get lazy, you ability to stabilise your spine is compromised, and from there you’ll be very lucky if you don’t wind up in pain.

So, why is Pilates so good at helping relieve low back pain? Well, of course, it targets your ‘core’, deep postural muscles that give your lower back its stability. The less uncontrolled movement that you have in your lower back, the less likely it is that you will have pain. As your stability improves Pilates can help to develop efficient movement of the whole of your spine, encouraging good posture during a variety of activities. In addition, helping areas of relative stiffness to become more supple, and areas of relative ‘looseness’ to become more  stiff (stable) can help to bring more balance to our structure, and integrate our limbs into our trunk.

I was lucky enough to receive a pretty high level of training as a Pilates teacher (certainly by UK standards), and to work with some truly brilliant teachers from the UK and the US. I hope that I can reasonably consider myself to be well steeped in the principles of Pilates, and how to apply them when faced with clients with chronic pain and/or injury. I know about ‘working away from the pain’, and I’ve particularly enjoyed Ron Fletcher’s anecdote on that subject in his conversation with Kathy Grant (I referred to this DVD in a previous post) – Fletcher (a dancer at the time) explains that he went to see Pilates for help with a knee injury. Every time he went to Pilates’ studio he would be given exercises to do that had nothing to do, and Pilates would ignore Fletcher’s protestations that it was his knee that was the problem. After a few sessions Fletcher discovered that his knee was better.

So, I think my training has equipped me to help clients deal with back pain fairly well. I also believe that I understand a lot of the potential causes of back pain, as well as the importance of posture in maintaining a healthily functioning spine. I’ve been fixated (in my teaching) with hip mobility for years, and ‘get’ its importance relative to spinal stability and functional movement. I know, too, that most of us could do with working on upper back extension (and probably rotation and side-flexion too), and that the consequence of that will be less pressure on our necks. The list could go on, and that’s not really the point. In short, I felt that I had the basic understanding that I needed to do my job well, and that Pilates taught well was the ideal solution for all manner of problems. I certainly didn’t imagine that the world of strength and conditioning would have much more to offer in that regard.

More recently my perspective has been challenged. First of all by learning some of Mike Boyle‘s ideas (if you follow the link you’ll see just the kind of website that fit my prejudice completely – all it’s missing is advertising for protein powder) from his book ‘Advances in Functional Training’. (Actually this info is second-hand since it was my wife who bought the book and then explained it to me – I am nothing without her.) Boyle explains the body from the ground up as a series of joints that require, alternately, mobility then stability: ankle joint needs mobility, knee needs stability, hip needs mobility, lumbar/pelvic joints need stability, thoracic spine needs mobility, cervical spine (neck) needs mobility. Genius!

Being peripherally involved in a Pilates teacher training programme I understand how tricky anatomy and physiology can be to get to grips with, not least because it rarely seems to be straightforward, and how often students crave some dependable, simple answers. I’ve suffered the frustration, and seen it in many students too, of different books giving different answers for muscle functions. I know now that anatomy is an evolving subject, not a science in which all the answers have been found and set in stone. Thus, an explanation of what we need from our joints, expressed as simply as Boyle does, feels like a wonderful breath of fresh air. Mobility: stability: mobility: stability….It also seems to fit perfectly with ‘working away from the pain’ – you leave the problem area alone, and look for the adjacent compensations/weaknesses/stiffnesses. I think I had learned the same thing previously, but perhaps in a way that meant I didn’t see the wood for the trees – I knew it in pieces, and had never heard it said so succinctly. Lots of bits of information fell into place as I mused on this idea, and it’s become a constant reference point when I’m teaching.

Following that I was listening to a podcast recently in which the two hosts (one a strength and conditioning coach and the other an olympic weightlifting coach) were answering a question about exercising with a herniated lumbar disc. In discussing the question they came up with an equation something like: “If your hip joints are mobile, and your thoracic spine is mobile, you probably won’t have low back problems. If your hip joints aren’t mobile, and your thoracic spine isn’t mobile, you probably will have problems with your lower back at some point”. More genius! 

It’s just like Mike Boyle said! (Mobility, stability, mobility, stability….) Again, I knew already what they were saying, in fact I’ve probably been saying the same thing to clients for years, just not in such a clear and straightforward way. Perhaps I’ve just been lagging behind all these years, thinking I knew more than I did – certainly I need to view other disciplines with a little more humility than I have in the past. In any case, when trying to learn more about what I do for a living, casting my net wider has definitely been rewarded.

To return to the Ellie Herman piece on http://www.dummies.com, posture may well be a part of the picture, but there’s more to it, and you may be able to make a significant difference to your risk, or management of back pain, by going beyond her advice to:  “sit and stand up tall, keep your belly pulled in, and keep your shoulder blades pulling down your back”. Maybe even by listening to the advice of weightlifters.