Last year, I started studying some of the movement philosophies of Ida Rolf and Moshe Feldenkrais. Both did advanced studies in science disciplines before devoting their lives to their respective systems, Rolf in physics and math, and Feldenkrais in engineering. Both looked at the human body and its relationship with gravity as a way of determining how force was distributed. It is not unusual for practitioners in these disciplines to place someone in a supine position, apply pressure to one of the feet, and watching how the body responds to the outside load. At rest, the body should absorb the force easily, and there should be movement all the way up the spine. It should feel spongy, as though the force were being readily absorbed, but not too spongy. If the body is rigid at rest and doesn’t absorb the force at all, this might tell you something about how the body absorbs load during walking (or it might not. I recognize how a body moves and deals with things standing is different than when it is at rest. However, I do think this can be a decent starting point). For some, one side will be spongy and the other won’t, indicating the person potentially deals with load differently on the two sides. This isn’t uncommon, considering we are asymmetrical beings with habitual patterns due to work, handedness, and our hobbies.
This simple idea of load absorption has changed how I view movement, particularly when I consider what someone experiences during movement. I discussed my back bending issue in my blog on fascia; for years, I didn’t have good control over my ability to extend my spine. The movement of extension was not dispersed, it was localized to the bendiest part of my back. Not surprisingly, this caused discomfort when I did full backbends. Coincidentally, my standing posture was a more extended position. My spine was already dealing with a fair amount of muscular load from my erector spinae on a regular basis. Adding more didn’t exactly make “my heart sing,” to borrow from the yoga world. To be clear, I don’t believe that simply because someone holds himself a certain way, there will be pain. I was completely pain free, except when I did backbends. As a result, I limited the number of backbends I was doing and focused on LOTS of deep anterior core work. After a bit of time (because old habits die hard), I was no longer in an extended position all day, every day. The muscular activity in my torso changed and my back muscles were no longer working as hard as they previously were to keep me upright. This changed the way I performed backbends, and seriously limited my mobility for a while. My strategy to bend backwards changed and no longer caused discomfort.
There is a lot of discussion over the role posture has on pain. The short conclusion to this based on research is none*. However, I am going to argue that if you take someone with a specific postural tendency, say, lateralization, and you ask that person to rotate towards the lateralized side, it isn’t going to feel good. This is like taking someone with FAI and asking that person to move into a deep squat. The femur is already forward. Moving it further forward increases sensation. I have discussed before the fact that sometimes people experiencing pinching during flexion, internal rotation, and adduction, can have a significant reduction in sensation with a well designed exercise program emphasizing motor control and posterior hip engagement. Whether or not there are physical changes in femur position, I don’t know. I only know subjectively what my clients experience. My point is that maybe the significance of resting posture is activity specific, and it is worthwhile for the trainer to note resting posture position as a way to choose exercises and listen to client feedback. The guy with a posterior tilt who shows up at Crossfit and wants to start deadlifting 1.5 times his bodyweight but has no sense that his back is rounding further every time he bends over might be more likely to end up with a sore back after deadlifting than the person that hip hinges like a champ (the hip hinger might have other issues, but not the point).
A few months ago, an interesting study floated across my laptop. In it, individuals with scoliosis were asked to perform vasistasana (side plank) on the side with the curve. After 6 months, subjects experienced an average of a 32% reduction in the curve, and some performing the posture more regularly experienced a 49% reduction (Fishman, et.al, 2014). Participants performed the position for approximately 90 seconds a day. This is pretty amazing. 90 seconds daily was enough to alter static posture position. One can only speculate the impact this must have had on other activities. Interestingly, on the other end of the spectrum in the strength and conditioning world, Tony Gentilcore recently had a guest post by physical therapist Dr. Erica Mundinger that discussed how to implement movements like bending and twisting safely into a client’s program. Her very well thought out conclusion (which can be found below) was by doing this to the side that doesn’t hurt, eventually you might be able to do it on both sides. In any case, you should train the side that is pain free. If you work with the general population, eventually you are going to come across someone while doing gentle thoracic mobility work that says, “it hurts when I twist that direction,” or, “I can feel sensation in my back when I go further than this.” Obviously, this tells you to eliminate that motion from your program (and if you don’t screen for passive mobility before loading someone to assess pain free ranges, I am scared for your clients. If you are the client, don’t move into places of pain). What it doesn’t tell you to do is eliminate the movement from the other side.
Why am I bringing up a study on scoliosis and a blog on rotation? (If you read my posts regularly, you know I don’t usually cite blogs. This one just got me thinking). What these two ideas suggest is if you have someone that is weaker on one side than the other, it is okay to train the weaker side a little more than the stronger side. This is one of the most valuable things I have taken away from PRI. We do not have to train symmetrically if things are different on the left and right side. This segues nicely into the idea that if there is pain on one side, it’s okay to train the pain free side. As trainers, teachers, coaches, or even just the lay person trying to figure things out, this doesn’t mean we are trying to “fix” or “change” anything. It simply means we are listening and honoring what someone can do in a pain free way. And if a by product of that is that eventually the motion that was painful isn’t anymore, or that the person notices postural improvement, that’s a wonderful thing.
*Todd Hargrove wrote a good blog discussing what the science shows regarding this topic a few months back. It can be found here: https://www.bettermovement.org/2014/does-bad-posture-cause-back-pain/
Fishman, L., Sherman, K., & Groessl, E., (2014). Serial case reporting for idiopathic and degenerative scoliosis. Global Advances in Health & Medicine, 3(5), 16-21.
Link to Dr. Mundinger’s article: http://tonygentilcore.com/2015/06/rotation-helps-improve-si-joint-pain-a-doctor-even-says-so/