Neutral Spine

Posted to rec.equestrian by Anne Howard Tue Aug 22 10:19:33 1995

Per requests on the subject of spinal happiness on horseback: I'll post a bit of what I present when I teach a Back School for my patients or riding students. This is a rough off the top of my head outline of points made during a general back school session, it isn't a substitute for a medical evaluation. If you have any back trouble it should be evaluated by a medical professional to rule out serious problems.

This is part 1 of ? (probably 2 or 3)

(maybe this will serve as a springboard for actually getting that book started!) You need to understand a bit about anatomy (structure), kinesiology (how structures move), and physiology (how the living structure responds). I'm a firm believer in education - one doesn't need to be a brilliant scientist to understand some basics about the scientific principles that apply here.

My goal is for you to understand what neutral spine *is*, why it works to keep your back healthy, and to hopefully teach you some exercises to help you get & use neutral spine on and off the horse. (gosh, I wish I could draw pictures here!) This is usually presented in a 4 hour course format with live bodies to demo the postures...a picture's worth a K of words, but I'll try to economise...

Neutral Spine: the position of an individual's spine where every joint is held in a optimal position to allow an equal distribution of force through the entire structure. (my definition on the spur of the moment...)

The correct alignment of a joint optimizes its use, minimizes risk of injury, and basically extends the useful life of the structure. Body tissues are constantly changing in response to the demand placed upon them - if no demand, the body downsizes to the lowest possible level of metabolism to "survive" (biologically/evolutionarily speaking, the body doesn't have faith in the availability of Safeway supermarkets). This is a concept most folks recognize: use it or lose it. Applies to muscle mass (hypertrophy is the state of developed muscle - it atrophies with disuse), bone density (osteoporosis - mult. factors), ligament toughness (increases with stress response), and other systems (cardiovascular efficiency, epithelial thickness, etc.).

OTOH, if demands are placed on a tissue it will adapt accordingly. Use a muscle and it responds by increasing its contractile ability (given appropriate training). Apply stress to bone and it changes its density and even its shape to accommodate the imposed forces. This is all well and good if the forces & demands applied are appropriate. If the loads are applied in a poor alignment (I'm focusing on the spinal joints here) the response of the structure is one of reflecting that faulty alignment: bone, muscle and ligaments change to be stronger in the way that the body's owner uses it.

No problemo - dude! Right? WRONG! In many joints, the structure is strong enough or forgiving enough to last many decades of misuse. Knees, hips, shoulders, these are the "largest surface area" joints we have and are designed to tolerate a wide range of motion.

The spinal joints (the small joints on either side of the spinous process, that large bump we consider the "backbone") are quite small, about the size of your fingernail (in req.eq. I'm presuming no one has Mega- nails! :-) ). Put the fingernails of your two thumbs (or choose another pair) so that they're nail to nail with the most surface area possible in contact - this is about the size of your largest spinal joints: pretty weenie joints for what most people ask of them. How far can you slide your nails apart and maintain any contact? Not very far. Contrast this with the surface area maintained on a "ball and socket type" joint. (Visual: rolling a fist in a cupped opposite hand.) Joint sprains occur when the structures that hold the bones together are overly stretched (&/or damaged).Can you see using the fingernail model that it doesn't take much movement to place the connective structures on strain? If you had a elastic band snugly around your paired fingernails that can mimic the connective tissues, that might make the available strain-free excursion more clear.

Repeated low level sprains/strains are the most common cause of back pain, and lead to bigger and nastier problems. In addition, the small joints of the spine (facet joints) respond to the incorrect alignment by growing new bone in the regions strained, and eventually change the shape of the joint...and the structures that are nearby, nerves, capsules, etc. now have a roughened and "non-original parts" piece of anatomy to contend with....often not happily, = pain.

[The big "joints" between the vertebrae (where the intervert- ebral discs are) aren't really joints in the traditional sense, the discs act like spacers, not cushions. This area can have problems due to incorrect alignment, too, but reacts differently from a true joint.]

Getting back to the NS concept: To place the bony and connective (read ligaments and joint capsules) tissues on a neutral position, most of the world will have 3 curves in the spine.

From the lower back up:
  • A lumbar lordosis, the bottom region of the back will curve forward, "swayback",
  • a thoracic kyphosis, the midpart of the back where the ribs attatch, will curve backwards, "slumping",
  • a cervical lordosis, your neck, will have a slight lordosis, or forward curve.

    In addition, the classical alignment we've all heard of somewhere, that plumb line of ears, shoulders, hips, ankles, will be a requirement.
    The art of neutral spine in to get these three distinct curves to balance out each other; much like an arch that is correctly constructed, a balanced distribution of stress. A spine in a neutral position will not collapse, will feel solid when compressed, and will not cause pain of a ligamentous origin. Pains of other origins may ease dramatically in neutral spine.

    *** if you have active back pain, compressing your spine may be dangerous****


    With a friend, try the following. Sit at the edge of a hard chair with your feet well placed on the floor. Have your friend examine your posture from the side view. The questions to ask are:

    1. Do I see three curves to this person's spine?

    2. Is one curve much larger or dominant?

    3. Does the ear-shoulder-hip line fall vertically, or does it zig-zag...

    4. When I compress the spine (see directions below), does one of the curves bulge (or collapse), does this feel like a solid structure or a soggy one? Do I sense a lot of muscular guarding to "hold the position"?

    Compression Test: Standing behind the seated subject (*on* the chair) place your hands on the shoulders, as close as is comfortable to the neck. The compressor's shoulders must be directly over their hands to press straight down, not angling forward or backward. Gently press down in a slow oscillation of down-up-release about 3 times, (ask if you are causing any pain) and see if you can see a change in the "bird's-eye view" you have of their trunk. Often a crease in the belly will become more pronounced (trunk sagging backwards) or the shoulders will move backwards (trunk arching forward). In neutral spine, the feel is very stable, very little compression is achieved, and no creases or "giving way" is noted.

    Play with how much bottom curve you have first, then experiment with the middle backward curve, the neck curve is usually quite small and while important to overall balance, clearly is not a big factor in this particular test. (No NOT compress the head onto the neck!!! DO NOT -- DO NOT!!)

    See if your subject can sense the difference between soggy and solid. A few hopefully helpful tips:

    if the lower curve is too flat (not "swaybacked" enough" the sogging will be a backward movement in this region (and may hurt a bit)
    If the bottom curve is too swayed/arched, the tummy will pooch forward with compressions, and the arch will beome more pronounced (and may hurt a bit)

    If the middle curve is too flat, the subject is probably stretching the chest "up" excessively, what we euphemistically term "high-beams" or "headlights up" :-) (In horse terms, they are hollow backed and on the forehand!)

    If the middle curve is too rounded, it may be many different problems, but try to get the subject to move so that their sternum is vertical and that a bar along the sternum (breastbone) would fall vertically to the pubic bone.

    ******************************************************** end of part 1, to be con't.
    Answer to question on "riding with swayed back": I would venture to say most riders (in my area at least, I know from experience and talking to others who teach around the country & world that there are vast regional differences) do not ride in neutral spine. Many of the riders I work with need much more "bottom curve" or lordosis, which initially feels quite swaybacked. Is riding too swayed better than not enough? I'd say too swayed is probably the greater evil in terms of how soon the pain will likely start... Looking at most "elegant and classical" riders, I find they are much closer to neutral. The balance of neutral spine is the same balance of a good rider, IMO.
    Hope folks find this useful....please let me know if its clear or not....I'm a tremendously visual person, I hope the pictures come across sufficiently in language.

    Neutral Spine/Rec.Eq. version/Part 2

    by Anne Howard, Physical Therapist/Dressage & Event rider/trainer/instructor Part 1: Tissue response to poor posture, basic alignment, compression testing
    Part 2: Muscle contraction, Muscle tone, Spinal stabilization
    Part 3: hmmmm...still thinking...

    Spinal Stabilization
    (or how Joe Montana got back to football in record time!)
    Last piece I wrote focused on achieving a neutral position through the spine. Our test of correctness was to gently compress the spine to see if it supported an increase in stress as a solid structure, or if it had a "weak link." Hopefully you have found and corrected any positional (structural/architectural) weak links.

    [I'd love feedback on this BTW, were folks able to try this successfully? I'm planning an article and am not sure how well this presentation can be reduced to print/pictures.]

    The well balanced posture will remain so only if there are no external (or internal) deforming forces. The next step is to stabilize this correct foundation with muscle. Muscle is contractile tissue - its only action is to contract. There is no way for a muscle to actively extend itself. The basic types of muscle contraction are:

  • Concentric contraction: a muscle shortening as it contracts. Picture a person lifting a weight, the elbow flexor muscles are concentrically contracting as the wrist moves towards the shoulder.

  • Eccentric contraction: the muscle is getting longer during a contraction. Lowering the aforementioned weight in a controlled fashion is an example of the elbow flexor muscles acting eccentrically.

  • Isometric contraction: literally "same length", this is the type of contraction needed to hold the weight steady at any one point; the muscle is working strongly enough to keep the weight lifted, but the muscle is not shortening or lengthening.

    It is this last type of muscle use that we are after. How are muscles returned to original length? Relaxation does require energy useage, but the muscle is lengthened passively by its opposing muscle (or gravity on the limb as in our eccentric example).

    A related concept to contraction is muscle tone. Tone (in physcial therapy lingo) is different than fitness. It refers to the relative tension on a muscle at any given time, and can be assessed to a degree by feeling the muscle in question. A higher toned muscle will have a firmer "feel", low tone muscle will be relatively spongier, or softer. Tone does change with a change in fitness, but individuals are naturally also at different "resting tones."

    Extreme examples are the hypertonic limbs of a person with a brain injury of some sort (cerebral palsy, stroke) that causes the muscles (of an area) to be extremely tight often to the point of non-functioning. [Note that this hypertonicity can exist in conjuction with extreme weakness, they are not one and the same!] The other end of the tone scale is a complete loss of neural excitability: the flaccid or paralyzed muscle. A less dramatic comparison is to check out the muscle tone of men vs. women, most men [yes there *are* exceptions] have a higher resting tone than women.

    Good riders use a high degree of muscle tone to achieve the "quiet, still, relaxed" look that we term "correct." Most skilled riders are either highly muscle-toned individuals or have developed above-average compensations for low-tone areas. Compare their look to either of the "beginner" riders look: either extremely floppy or desperately rigid, and in either case being moved around *by* the horse.

    [A bit off topic but an area of interest. The concept that "equestrians are not athletes, the horse is," I believe comes from the methods of measuring physical output that use the (mass moved over distance divided by time) calculations. I have seen one study of aerobic changes but it was a short time conducted at rising trot. Anyone with other studies? I'd love to hear...Isometric exercises have been around a long time, I need to look up relative energy expenditures, etc. In my spare time! ;-) ]

    Where was I...Ah, using muscle to stabilize the architecture of neutral spine. There is a concept in physical therapy called spinal stabilization that trains folks (usually those having back pain) to use their muscles to keep their spines in a safe (i.e. neutral) position. The muscles that you have that can assist in this are in your trunk: the back muscles (the relatively "big" "ropy" ones that are on either side of the spine as well as the teeny ones that go from vertebra to vertebra), and the abdominal muscles (that actually wrap around most of your middle section). Knowing that muscles can only shorten or hold steady against a force, can we tighten any of these and stay in balanced neutral spine? Its an "all or nothing" type of deal, and if there will be other forces working to destabilize the spine, my vote goes for "all".

    Learning to activate all of your trunk muscles isn't always easy. Most women (in this country, at least) are well instilled with the "suck in the tummy, stretch up the chest" posture, which actually weakens the trunk musculature. Think about how you would hold your trunk if you invited someone to take a punch to your stomach (go with me on this one :-) if you would never dream of doing this!). Feel the firmness of your abdomen. Then suck in your tummy and compare the difference.

    Many of the good male riders (the ones I know happen to be European) have thumped their lower tummy and referred to their abdominal muscles as their "riding muscle" and despite a bit of a pudge overlying the muscle, the muscle there is like *concrete*! Clearly, solid abdominal muscle is part of trunk stabilization, in my practice I find that abs are usually weaker than back muscles. However, people with great abs also can have difficulty with spinal stabilization because of a deficit in coordination or connecting the brain to those muscles in a controlled manner...

    Stabilization is a skill as well as a strength. How many of you know how to fire your left external oblique abdominal muscle... or even knew that you had one? :-) Most folks don't, but can learn quickly, and then practice until its second nature. [If you're Joe Montana prepping for a game it goes beyond even that, to having your spouse hurl medicine balls (heavy) at you unexpectedly to challenge you as you amble thru the house.]

    Try these:

    Lying on your back with knees bent and feet on the floor, feel for the bony knobbles on the front of your hips (the ASIS). Get yourself into a neutral position with a small hollow under your low back... Lift one knee up a few inches. Did your two knobbles stay still/even? Likely the one on the side you lifted the foot dipped down a bit. Did you lose your neutral spine? Try again. Your goal is to maintain absolute stillness through your trunk/pelvis as your hip joint stays mobile (lifting the knees alternately). Play with different levels of tone in your back muscles and tummy muscles. Have someone push into your tummy with a fist (gently, please!) and then use your tummy muscles to lift their fist so your tummy isn't "deformed". Try lifting a knee with that level of tone...does it help? Did you lose the neutral spine the other direction?

    This exercise can be built upon in practically infinite ways to increase the demands on your stabilization...

    I use this exercise for riders in particular to help strengthen the "front-line" muscles (abs, psoas/iliacus) especially needed for dressage riders in collection. (Same as in the horse...hmmmm! Coincidence, I wonder! *sarcasm here*) In the same start position as before, recheck for neutral spine. Lift one knee then the other to nearly perpendicular to the floor. Keep a slight hollow in the lower back. Place your hands on your knees (harder) or lower on the thigh (easier) and push. The goal is to go nowhere - hard! Recheck your spine position frequently, do remember to breathe before someone finds you out cold! Hold this for short periods at first, building to a minute of strong pressure.
    If this is too hard, try with one knee at a time at first.

    (If you can come up with a better name, let me know...the "real" name for this one is "PNF: LTR R/S". And believe me the non-shorthand isn't better!)

    Same start position, this one requires a helper. Check for Neutral Spine. Put your hands together and point towards the ceiling as if about to shoot a target. Your goal is to hold this position in netral spine despite external forces. HELPER on your right side: kneeling beside the victim-uh, make that exerciser, gently push their knees to their left, and pull their hands to their right, and then release the pressure and reverse so that you pull their knees and push their hands. The helper's goal is to apply enough pressure to be a challenge but not so much that the exerciser fails. You need to monitor how they are doing in keeping their trunk still, both buns on the floor, no odd contortions through the middle, both shoulders on the floor. You may need to remind them to breathe, when they turn hot pink is a good cue. :-) Remember to apply and remove pressure slowly so they can decrease the hold and not be bounced around.

    These are basic starters for trunk awareness and stabilization training, there are many more, which I'll do next edition... If there are specific questions on these or topics you'd like addressed, please let me know. Otherwise I'll do a few back ex and add balance training.

    Anne "Yes, I'm available for clinics and seminars" Howard
    (still removing furox, betadine, cotton wisps, epsom salts, and other unmentionables from under my nails before heading to work... Patients should appreciate this... :-)
    Horses are all definitely in recuperation mode! Lindgren clinic was GREAT!)


    V A L L E Y P H Y S I C A L T H E R A P Y --> 408/338-4458

    Anne Howard, MPT
    American Sporthorse - "Serious training for the serious rider, with a good measure of silliness for sanity."