This is an excerpt from my write up on my second visit to the Washington University in St. Louis. I wanted to give this its own post.
A highlight of my trip was the direct conversations I got to have with Shirley.
As far as I know, I was the only non-therapist at this course. Oddly, not many questions were asked. I’m not sure if it was because people were lost (you could tell this course was brand new information for many of the students), it was a weekend course, people were forced to go to this for CEUs, or what, but after the first hour of lecture I thought, “Well, screw this. I didn’t come all this way to not speak” and I started raising my hand.
We were at the beginning of assessing the lower back, talking about standing alignment, and my question was:
“You touched on this in the last slide, and you have a sentence in your book stating to be careful extrapolating certain alignments with certain lower back issues, or really, any lower back issue. That standing a certain way rarely correlates with someone having lower back pain, or the types of movements they do. Could you elaborate on this?”
For those who don’t know, there’s a good amount of research showing standing in a certain alignment doesn’t necessarily cause lower back issues. A particular pelvic tilt is not the devil people make it out to be. This is important because it should be a wake up call to those who obsess over posture. Who pick apart every single thing on somebody, making them feel less coordinated than Lorde’s Grammy performance.
Of course, you have the groups who take this too far the other way. “Posture doesn’t matter at all! Stand however the hell you want!” This is pretty silly. If you make someone with good posture stand with excessively poor posture, you see right away how it can make someone feel. (Like shit.)
Next, what you also find is say someone stands in a posterior pelvic tilt, with their lower back a bit flexed:
What Shirley and I discussed is the above posture doesn’t mean the person has or will have a lower back flexion issue. In fact, even if this person flexes their lower back during many activities, that still doesn’t guarantee flexion is a problem for them. They could very well have an extension issue.
Going with the principles I went over earlier -the site of what moves too much and what direction it moves too much are the pain provocateurs- standing with your lower back in flexion does not mean you 1) Flex your back too much 2) Will have pain flexing your lower back. Standing with your lower back in flexion often means you have pain into extension!
As we age our spinal discs tend to atrophy. With less of a disc there’s less room for our facet joints to move, particularly into extension.
The facet joints become more likely to jam into one another when going through extension.
If you’re someone who has done a lot of lower back extension throughout your life, you can accelerate this process. Just like the tires on your car wear down the more you drive, you may wear your discs down the more you do stupid crap, like obsessing over deadlifting.
It’s natural for our lower back to have a little lordotic curve. This is our spine’s “neutral” to start out with. However, if you’ve become sensitive going into extension, say due to age, or by doing a ton of extension work (oh hey, deadlifting again) what’s a natural response? To keep your back a little flexed. You’re better able to avoid extension, and this way when you do go into extension, you have a little more room before causing pain. You’ve effectively altered your “neutral.”
“But what about a herniated disc? Too much flexion can cause a disc herniation.”
As I mentioned, this isn’t only caused by your movement patterns, age plays a role. I asked Shirley what age she felt extension is pretty much universally contraindicated, “About 60.” Meaning you could have lucked out and had a great back for 60 years, but it’s going to wear out where certain movements still aren’t going to agree with it. (Extension and rotation. Flexion is less of a concern.) This is why you can worry less about flexion at a certain point. Especially in an older person, they don’t have enough of a disc left to herniate! Something like stenosis -extension issue- is going to be much more of a concern.
Maybe now the internet can stop telling me how grandmothers need to arch their back and deadlift more.