The Living Back Cervical

Clavicle Shouldering the strain It may seem strange to

talk about the shoulder in a book about the back,
but the two are not only linked anatomically but
vertebrae Scapula
The human back has both the flexibility we need to perform through their working relationship. This means
complex and precise movements and sufficient strength to that many problems in the spine can make
The shoulder themselves felt in the shoulder and vice versa. The
anchor our limbs and enable us to stand upright. Even so, many The joints between the
shoulder joint (see left and page 88) comprises the
of us suffer from back pain, which is usually the result collarbone (clavicle),
upper arm (humerus) associated back bones, the collarbone (clavicle) and
of misuse or neglect owing to our busy lifestyles. and shoulder blade the shoulder blade (scapula), and the upper arm
(scapula) allow
movement but give bone (humerus). Most of the muscles that anchor
Humerus
Of all the elements that comprise our backs, the The spine the shoulder strength. the joint originate in the back and, in particular, in
spine is the most elegant in term of its design. It There are five groups of the scapula. Therefore the joints performance and
vertebrae: cervical, in
consists of 33 individual bones called vertebrae. the neck; thoracic, in the Each vertebra also has a number of joints not just the movements of the arm are inextricably linked
chest; lumbar, in the lower the intervertebral ones, but synovial joints (that with those of the back.
Elements of flexibilty As a whole, the spine back; sacral, between the is, lubricated by synovial fluid, which, rather like a
buttocks; and the coccyx
allows sufficient flexibility to make twisting and (tailbone). cars engine oil, helps to reduce wear and tear when A protective basin While the back and shoulders
bending possible, even though the movement Thoracic bone moves against bone). The most important are anchor the arms, the pelvis anchors the legs. In
permitted between individual vertebrae is often vertebrae the facet joints (page 16). They are bony catches Latin, pelvis means basin, which is a fitting term for
small. In fact, the sacral vertebrae and some of that prevent each vertebra from slipping off the the protective housing of so many vital organs. But
A vertebra
the coccygeal ones allow no movement at all. The A vertebra of the thoracic next one, making the spine into a bony chain that, it can also be thought of as part of the lower back,
movement of the spine also allows the ribs to spine is illustrated below. again, is flexible yet strong. But the facet joints can not just because its upper rim is part of the back,
rise and fall when we breathe in and out. But the The body of the vertebra also be vulnerable to both accidents and the strains but because of the strength and stability it provides
faces inwards towards the
flexibility does not come at the expense of strength: abdominal cavity and the caused by poor posture, making a catch slip off and as the anchoring point for the legs. These are joined
the spine is still strong enough to support the head processes face outwards. so disrupt the chain. to the pelvis at the hip sockets.
and anchor the muscles that move the lower limbs.
Lumbar
It also contains and protects the spinal cord, which vertebrae The pelvis Ilium Sacroiliac joint
The pelvis anchors
carries the nerves that connect the brain to the Taller in the Morning! the legs to the
nerves that serve the rest of the body. spine.
The centre of the cartilaginous discs between the
The most numerous of the vertebrae are those Body of
vertebra vertebrae is classically likened to the chewy centre
from the base of the neck to the middle of of a hard sweet, and is 85 per cent water. During
the chest: the thoracic vertebrae. Each the day our upright stance means that the weight Sacral vertebrae
one is separated from the vertebrae of the bones in the spinal column compresses each
above and below it by an intervertebral disc by as much as 10 per cent. But during sleep the
Sacrum
disc of cartilage that makes up about pressure is reduced and the discs reabsorb water, Hip joint
a quarter of the spines length; the with the result that you can wake up as much
discs act both as shock absorbers as 2 cm (1 in) taller than when you went to bed.
Pubic symphysis
and ball bearings, allowing the Coccyx
Spinous Transverse
spine to twist and bend. process process

14 Back to Basics The Living Back 15

The Living Back Cervical
Clavicle Shouldering the strain It may seem strange to
talk about the shoulder in a book about the back,
but the two are not only linked anatomically but
vertebrae Scapula
The human back has both the flexibility we need to perform through their working relationship. This means
complex and precise movements and sufficient strength to that many problems in the spine can make
The shoulder themselves felt in the shoulder and vice versa. The
anchor our limbs and enable us to stand upright. Even so, many The joints between the
shoulder joint (see left and page 88) comprises the
of us suffer from back pain, which is usually the result collarbone (clavicle),
upper arm (humerus) associated back bones, the collarbone (clavicle) and
of misuse or neglect owing to our busy lifestyles. and shoulder blade the shoulder blade (scapula), and the upper arm
(scapula) allow
movement but give bone (humerus). Most of the muscles that anchor
Humerus
Of all the elements that comprise our backs, the The spine the shoulder strength. the joint originate in the back and, in particular, in
spine is the most elegant in term of its design. It There are five groups of the scapula. Therefore the joints performance and
vertebrae: cervical, in
consists of 33 individual bones called vertebrae. the neck; thoracic, in the Each vertebra also has a number of joints not just the movements of the arm are inextricably linked
chest; lumbar, in the lower the intervertebral ones, but synovial joints (that with those of the back.
Elements of flexibilty As a whole, the spine back; sacral, between the is, lubricated by synovial fluid, which, rather like a
buttocks; and the coccyx
allows sufficient flexibility to make twisting and (tailbone). cars engine oil, helps to reduce wear and tear when A protective basin While the back and shoulders
bending possible, even though the movement Thoracic bone moves against bone). The most important are anchor the arms, the pelvis anchors the legs. In
permitted between individual vertebrae is often vertebrae the facet joints (page 16). They are bony catches Latin, pelvis means basin, which is a fitting term for
small. In fact, the sacral vertebrae and some of that prevent each vertebra from slipping off the the protective housing of so many vital organs. But
A vertebra
the coccygeal ones allow no movement at all. The A vertebra of the thoracic next one, making the spine into a bony chain that, it can also be thought of as part of the lower back,
movement of the spine also allows the ribs to spine is illustrated below. again, is flexible yet strong. But the facet joints can not just because its upper rim is part of the back,
rise and fall when we breathe in and out. But the The body of the vertebra also be vulnerable to both accidents and the strains but because of the strength and stability it provides
faces inwards towards the
flexibility does not come at the expense of strength: abdominal cavity and the caused by poor posture, making a catch slip off and as the anchoring point for the legs. These are joined
the spine is still strong enough to support the head processes face outwards. so disrupt the chain. to the pelvis at the hip sockets.
and anchor the muscles that move the lower limbs.
Lumbar
It also contains and protects the spinal cord, which vertebrae The pelvis Ilium Sacroiliac joint
The pelvis anchors
carries the nerves that connect the brain to the Taller in the Morning! the legs to the
nerves that serve the rest of the body. spine.
The centre of the cartilaginous discs between the
The most numerous of the vertebrae are those Body of
vertebra vertebrae is classically likened to the chewy centre
from the base of the neck to the middle of of a hard sweet, and is 85 per cent water. During
the chest: the thoracic vertebrae. Each the day our upright stance means that the weight Sacral vertebrae
one is separated from the vertebrae of the bones in the spinal column compresses each
above and below it by an intervertebral disc by as much as 10 per cent. But during sleep the
Sacrum
disc of cartilage that makes up about pressure is reduced and the discs reabsorb water, Hip joint
a quarter of the spines length; the with the result that you can wake up as much
discs act both as shock absorbers as 2 cm (1 in) taller than when you went to bed.
Pubic symphysis
and ball bearings, allowing the Coccyx
Spinous Transverse
spine to twist and bend. process process

14 Back to Basics The Living Back 15


Is It All in Your Head?
Many people believe that unless there is a verifiable physical
cause for pain, it can be dismissed as imaginary. But modern pain
specialists recognise that our mental state can have a profound
effect on how we experience pain. And since all pain is interpreted
in the brain, pain arising from psychological causes is no less real
or less painful than discomfort from a physical injury.
In practice, most pain has both a physical and a psychological
aspect. One persons minor twinge arising from a back strain is
another persons excruciating agony necessitating a different
treatment for each.
Whats more, an initial examination that doesnt reveal an
immediate physical cause for back pain doesnt mean that there
isnt a physical problem. It may be that further diagnostic tests
and examinations are needed to discover the source of the trouble.
Wheres the problem? Since nerves that serve
all areas of the body originate in the spinal cord,
damage or disease in the spine can contribute to
your pain by compressing or inflaming a peripheral
nerve as it joins the spinal cord, or the root of a
nerve as it emerges from the spinal cord and makes
its way between the vertebrae to the part of your
body that it serves.
Either way, a damaged or diseased spine can
cause symptoms that the brain interprets as coming
from an area served by that nerve. An injury to one
of the cervical (neck) vertebrae, for example, can
cause pain that appears to come from the arm. Or
compression of the lumbar (lower back) vertebrae
can cause shooting pains down the back of a leg
(sciatica). But referred pain, as this is called, can
also cause pain that
comes from elsewhere
Sources of
referred pain
in the body, to be felt
Some common causes of
referred pain in the back are in the brain as coming
listed in the table below. from the back.
The Language of Pain
Here are some simple explanations of the terms
you may hear doctors use in relation to pain:
A
 nalgesia The relief of pain. Painkilling
medications are often called analgesics.
C
 entral pain Pain that originates from
a problem in the central nervous system
(brain and spinal cord).
N
 euritis Inflammation of a nerve.
N
 eurogenic pain Pain that originates in any
part of the nervous system.
N
 europathy Disease or disturbance in the
functioning of a nerve.
P
 ain threshold The degree of pain that causes
it to be noticed by the affected person.
R
 adiculopathy Pinched nerve at the spinal
column for example, brachialgia and sciatica.

Back Pain Thats Not in the Back

Disorder Type of back pain Measuring pain pain in the arm
Heart attack or May be felt as pain in the back, Pain is not always easy Examination by a doctor
angina as well as the chest and/or arm will reveal whether the
to measure or evaluate. pain you feel in your arm
Gall bladder May be felt as pain just below the But researchers at the has its origins in your back
problems shoulder blade or elsewhere.
University of Aberdeen,
Lung infection May be felt as mid-back pain Scotland, devised a
simple questionnaire to help those with low-back
Stomach ulcer May be felt as pain between the pain assess the severity of their pain. By filling out
or cancer shoulder blades
the questionnaire at the start of treatment, and
Inflammation of May be felt as intermittent periodically during your treatment programme, you
the pancreas mid-back pain
can actually see for yourself how your symptoms
Menstrual cramps May be felt as low-back pain are improving day by day. You can download the
or inflammation
of the uterus questionnaire from the Centre for Evidence Based
Physiotherapy (www.cebp.nl).

36 Back to Basics Types of Back Pain 37


Is It All in Your Head?
Many people believe that unless there is a verifiable physical
cause for pain, it can be dismissed as imaginary. But modern pain
specialists recognise that our mental state can have a profound
effect on how we experience pain. And since all pain is interpreted
in the brain, pain arising from psychological causes is no less real
or less painful than discomfort from a physical injury.
In practice, most pain has both a physical and a psychological
aspect. One persons minor twinge arising from a back strain is
another persons excruciating agony necessitating a different
treatment for each.
Whats more, an initial examination that doesnt reveal an
immediate physical cause for back pain doesnt mean that there
isnt a physical problem. It may be that further diagnostic tests
and examinations are needed to discover the source of the trouble.
Wheres the problem? Since nerves that serve
all areas of the body originate in the spinal cord,
damage or disease in the spine can contribute to
your pain by compressing or inflaming a peripheral
nerve as it joins the spinal cord, or the root of a
nerve as it emerges from the spinal cord and makes
its way between the vertebrae to the part of your
body that it serves.
Either way, a damaged or diseased spine can
cause symptoms that the brain interprets as coming
from an area served by that nerve. An injury to one
of the cervical (neck) vertebrae, for example, can
cause pain that appears to come from the arm. Or
compression of the lumbar (lower back) vertebrae
can cause shooting pains down the back of a leg
(sciatica). But referred pain, as this is called, can
also cause pain that
comes from elsewhere
Sources of
referred pain
in the body, to be felt
Some common causes of
referred pain in the back are in the brain as coming
listed in the table below. from the back.
The Language of Pain
Here are some simple explanations of the terms
you may hear doctors use in relation to pain:
A
 nalgesia The relief of pain. Painkilling
medications are often called analgesics.
C
 entral pain Pain that originates from
a problem in the central nervous system
(brain and spinal cord).
N
 euritis Inflammation of a nerve.
N
 eurogenic pain Pain that originates in any
part of the nervous system.
N
 europathy Disease or disturbance in the
functioning of a nerve.
P
 ain threshold The degree of pain that causes
it to be noticed by the affected person.
R
 adiculopathy Pinched nerve at the spinal
column for example, brachialgia and sciatica.

Back Pain Thats Not in the Back

Disorder Type of back pain Measuring pain pain in the arm
Heart attack or May be felt as pain in the back, Pain is not always easy Examination by a doctor
angina as well as the chest and/or arm will reveal whether the
to measure or evaluate. pain you feel in your arm
Gall bladder May be felt as pain just below the But researchers at the has its origins in your back
problems shoulder blade or elsewhere.
University of Aberdeen,
Lung infection May be felt as mid-back pain Scotland, devised a
simple questionnaire to help those with low-back
Stomach ulcer May be felt as pain between the pain assess the severity of their pain. By filling out
or cancer shoulder blades
the questionnaire at the start of treatment, and
Inflammation of May be felt as intermittent periodically during your treatment programme, you
the pancreas mid-back pain
can actually see for yourself how your symptoms
Menstrual cramps May be felt as low-back pain are improving day by day. You can download the
or inflammation
of the uterus questionnaire from the Centre for Evidence Based
Physiotherapy (www.cebp.nl).

36 Back to Basics Types of Back Pain 37

Shoulder Exercises
These exercises help relieve pain and increase mobility in most
conditions that affect the shoulder and general aches and
pains caused by overuse and bad posture. Before doing these
exercises, read the cautions on page 10.
Elephant trunk
1 Stand and bend over
forwards, resting one
hand on a chair back or table
for support. Swing the other
hand back and forth like an
elephants trunk 10 times.
100 Neck and Shoulders
Standing rotation Hands-to-back stretch
1 Stand straight,
maintaining your
natural spinal curves,
1 Stand straight with
your feet shoulder-
Alternative If you cant
touch your fingers, hold
width apart and place a scarf (or belt) in the top
with abdominal muscles
one hand as far down hand and let it dangle down
tight, your feet shoulder-
your back as possible. your back. Grasp the scarf
width apart and your
Place the other hand with your lower hand as far
arms hanging down at
on your back as far up up it as possible. Gently pull
your side. Rotate your
as possible and try to down on the scarf and then
arms so that the palms
interlock the fingers. pull up with your upper
of your hand turn out
Hold for a count of 10 hand. Repeat 10 times and
to face sideways and
and then change sides. then swap sides.
then repeat in the other
direction. Move slowly
but rhythmically. Repeat
five times, making sure
that your shoulders stay
relaxed and down and do Pole rotation
not hunch forwards.
2 Then, with your arm
hanging loosely, swing
the arm from side to side
across the front of your body
in a relaxed way 10 times.
2 Lift the pole keeping
it horizontal over
your head.
3 Bring the pole
down behind
3 Finish with a circular
action, first clockwise and
you. Try not to bend
your elbows or let one
2 1
then counter-clockwise. Do Repeat Step 1 but Stand upright with arm lead. Reverse the
this 10 times then change hold your hands the spine in its movement to bring the
sides and repeat the whole out to the side at neutral position and pole back to the starting
sequence. shoulder height. your abdominal muscles position. Repeat 10 times.
tightened. Hold a pole, To make the exercise
stick, or broom handle, at easier, move your hands
either end in front of you, further apart, to increase
horizontally across the the stretch, bring them
front of your body. closer together.
Shoulder Exercises 101
Shoulder Exercises
These exercises help relieve pain and increase mobility in most
conditions that affect the shoulder and general aches and
pains caused by overuse and bad posture. Before doing these
exercises, read the cautions on page 10.
Elephant trunk
1 Stand and bend over
forwards, resting one
hand on a chair back or table
for support. Swing the other
hand back and forth like an
elephants trunk 10 times.
100 Neck and Shoulders
Standing rotation Hands-to-back stretch
1 Stand straight,
maintaining your
natural spinal curves,
1 Stand straight with
your feet shoulder-
Alternative If you cant
touch your fingers, hold
width apart and place a scarf (or belt) in the top
with abdominal muscles
one hand as far down hand and let it dangle down
tight, your feet shoulder-
your back as possible. your back. Grasp the scarf
width apart and your
Place the other hand with your lower hand as far
arms hanging down at
on your back as far up up it as possible. Gently pull
your side. Rotate your
as possible and try to down on the scarf and then
arms so that the palms
interlock the fingers. pull up with your upper
of your hand turn out
Hold for a count of 10 hand. Repeat 10 times and
to face sideways and
and then change sides. then swap sides.
then repeat in the other
direction. Move slowly
but rhythmically. Repeat
five times, making sure
that your shoulders stay
relaxed and down and do Pole rotation
not hunch forwards.
2 Then, with your arm
hanging loosely, swing
the arm from side to side
across the front of your body
in a relaxed way 10 times.
2 Lift the pole keeping
it horizontal over
your head.
3 Bring the pole
down behind
3 Finish with a circular
action, first clockwise and
you. Try not to bend
your elbows or let one
2 1
then counter-clockwise. Do Repeat Step 1 but Stand upright with arm lead. Reverse the
this 10 times then change hold your hands the spine in its movement to bring the
sides and repeat the whole out to the side at neutral position and pole back to the starting
sequence. shoulder height. your abdominal muscles position. Repeat 10 times.
tightened. Hold a pole, To make the exercise
stick, or broom handle, at easier, move your hands
either end in front of you, further apart, to increase
horizontally across the the stretch, bring them
front of your body. closer together.
Shoulder Exercises 101
Middle and Lower Back Challenges Move back to health
Regular exercise of the
right kind is the key to
maintaining and restoring
The middle (thoracic) and lower (lumbar) back bear the weight of the the health of your mid and
lower back.
upper body, which puts them under particular pressure. This makes these
areas of the spine particularly vulnerable to damage and injury from both
everyday movements and unusual stresses and strains.

The lumbar spines range of movement enables What can go wrong? In this section of the
you to twist. The thoracic spine has a lesser range book, were going to look at what the different
of possible movement, but it enables you to bend components of the thoracic and lumbar spine
forwards and lean backwards. should be doing and what can go wrong when
Your thoracic spine is important, too, because it disease, injury or other factors affect their ability
moves every time you take a breath. Since your ribs to perform their usual function.
are so closely linked to your spinal bones by joints Unfortunately, there are many things that can
and ligaments, every time you breathe in, your ribs go wrong soft-tissue injuries (page 110), sciatica
rise; every time you breathe out, they fall. (page 118), a slipped, or prolapsed, disc (page
116), osteoarthritis (page 58), spinal stenosis (page
116), facet joint problems (page 117), pain that has
Know the area been referred from other parts of the body (page
The thoracic spine 36), injuries (page 122), sacroiliac joint problems
runs from the
shoulders down to (page124), piriformis syndrome (page 128) and the
the vertebra to which special problems experienced during pregnancy
the lowest rib is (page 130). The list seems long, but there is
joined. The lumbar
region extends effective treatment for most of these problems.
from this point Tight muscles (page 114), whether in your back,
to the pelvis. hip, hamstrings (the muscles at the back of your
Thoracic spine
thighs) or the deep muscles that are attached to
your vertebrae are all vulnerable to strain and injury.
The risk of such injury is made more likely by the
sedentary lifestyle that many of us adopt, which
Lumbar
spine increases the risk of losing flexibility in these key
muscles (page 112).
The best way to protect your spine from injury
is to pay attention to your posture (page 148) and
exercise every day to maintain flexibility and keep
your back healthy (page 164).

104 Middle and Lower Back

Middle and Lower Back Challenges Move back to health
Regular exercise of the
right kind is the key to
maintaining and restoring
The middle (thoracic) and lower (lumbar) back bear the weight of the the health of your mid and
lower back.
upper body, which puts them under particular pressure. This makes these
areas of the spine particularly vulnerable to damage and injury from both
everyday movements and unusual stresses and strains.

The lumbar spines range of movement enables What can go wrong? In this section of the
you to twist. The thoracic spine has a lesser range book, were going to look at what the different
of possible movement, but it enables you to bend components of the thoracic and lumbar spine
forwards and lean backwards. should be doing and what can go wrong when
Your thoracic spine is important, too, because it disease, injury or other factors affect their ability
moves every time you take a breath. Since your ribs to perform their usual function.
are so closely linked to your spinal bones by joints Unfortunately, there are many things that can
and ligaments, every time you breathe in, your ribs go wrong soft-tissue injuries (page 110), sciatica
rise; every time you breathe out, they fall. (page 118), a slipped, or prolapsed, disc (page
116), osteoarthritis (page 58), spinal stenosis (page
116), facet joint problems (page 117), pain that has
Know the area been referred from other parts of the body (page
The thoracic spine 36), injuries (page 122), sacroiliac joint problems
runs from the
shoulders down to (page124), piriformis syndrome (page 128) and the
the vertebra to which special problems experienced during pregnancy
the lowest rib is (page 130). The list seems long, but there is
joined. The lumbar
region extends effective treatment for most of these problems.
from this point Tight muscles (page 114), whether in your back,
to the pelvis. hip, hamstrings (the muscles at the back of your
Thoracic spine
thighs) or the deep muscles that are attached to
your vertebrae are all vulnerable to strain and injury.
The risk of such injury is made more likely by the
sedentary lifestyle that many of us adopt, which
Lumbar
spine increases the risk of losing flexibility in these key
muscles (page 112).
The best way to protect your spine from injury
is to pay attention to your posture (page 148) and
exercise every day to maintain flexibility and keep
your back healthy (page 164).

104 Middle and Lower Back

Thoracic Spine Exercises
Shoulder-blade squeeze Lateral twist

These exercises are useful for easing

aches and pains in the middle part of
your back, such as pain between the
1 Sit upright on the
edge of a hard chair. 1 Lie on the floor with your knees bent
and your head supported by a pillow.
Place both arms straight up behind your
shoulder blades and any pain that head. Relax and hold for 30 seconds.
may be felt when breathing deeply.
Before doing these exercises, be
sure to check with your doctor
if you have a current back problem,
and read the cautions on page 10.

Diaphragmatic breathing

1 Lie on your back with your knees

bent at right angles and a pillow
under your head to support your
neck, then relax. Rest your hands
at the bottom of your rib cage, with
2 Raise your arms so they
are in a vertical line with
your shoulders.
2 Inhale deeply through your nose,
filling your lungs you should feel

your fingers just touching below
your sternum (breastbone).
Seated twist
2
your fingers separate and your ribs Bend your elbows at
expand. Hold the breath for a few right angles, then pull
seconds, relax and exhale. Repeat three your elbows behind you,
times. Rest, and repeat twice more. squeezing your shoulder
blades together. Hold for
10 seconds.

1 Sit on a hard chair

with an upright back.
3 Stretch your right hand over towards
the left as far as possible without

2 Reach your left hand lifting your right hip off the ground. Hold
down the front right for 10 seconds and then lower your arms.
leg of the chair as far
as possible. Hold for
3 Bring your arms
forwards and wrap
them around you as
Repeat on the other side. Do the full
sequence five times.
10 seconds and then
if hugging yourself
straighten slowly.
pulling your shoulder
Repeat five times.
blades apart. Hold for
10 seconds and relax.

3 Repeat Step 2 on the

other side.
Repeat five times.

136 Middle and Lower Back Thoracic Spine Exercises 137

Thoracic Spine Exercises
Shoulder-blade squeeze Lateral twist

These exercises are useful for easing

aches and pains in the middle part of
your back, such as pain between the
1 Sit upright on the
edge of a hard chair. 1 Lie on the floor with your knees bent
and your head supported by a pillow.
Place both arms straight up behind your
shoulder blades and any pain that head. Relax and hold for 30 seconds.
may be felt when breathing deeply.
Before doing these exercises, be
sure to check with your doctor
if you have a current back problem,
and read the cautions on page 10.

Diaphragmatic breathing

1 Lie on your back with your knees

bent at right angles and a pillow
under your head to support your
neck, then relax. Rest your hands
at the bottom of your rib cage, with
2 Raise your arms so they
are in a vertical line with
your shoulders.
2 Inhale deeply through your nose,
filling your lungs you should feel

your fingers just touching below
your sternum (breastbone).
Seated twist
2
your fingers separate and your ribs Bend your elbows at
expand. Hold the breath for a few right angles, then pull
seconds, relax and exhale. Repeat three your elbows behind you,
times. Rest, and repeat twice more. squeezing your shoulder
blades together. Hold for
10 seconds.

1 Sit on a hard chair

with an upright back.
3 Stretch your right hand over towards
the left as far as possible without

2 Reach your left hand lifting your right hip off the ground. Hold
down the front right for 10 seconds and then lower your arms.
leg of the chair as far
as possible. Hold for
3 Bring your arms
forwards and wrap
them around you as
Repeat on the other side. Do the full
sequence five times.
10 seconds and then
if hugging yourself
straighten slowly.
pulling your shoulder
Repeat five times.
blades apart. Hold for
10 seconds and relax.

3 Repeat Step 2 on the

other side.
Repeat five times.

136 Middle and Lower Back Thoracic Spine Exercises 137

Chapter 5

The Healthy
Back
This amazing structure, with its complex engineering, needs
careful maintenance from an early age to give you the best
chance of lifelong back health. This chapter contains vital
advice on how to achieve good posture and how to protect
your back while undertaking everyday activities. There are also
tips on maintaining a healthy weight and on dealing with stress
in the interests of back health. And theres a series of healthy
back exercises to help you stay pain free.
Chapter 5

The Healthy
Back
This amazing structure, with its complex engineering, needs
careful maintenance from an early age to give you the best
chance of lifelong back health. This chapter contains vital
advice on how to achieve good posture and how to protect
your back while undertaking everyday activities. There are also
tips on maintaining a healthy weight and on dealing with stress
in the interests of back health. And theres a series of healthy
back exercises to help you stay pain free.

walking back Walking This activity eases
to health
Walking is an ideal form
muscle tension, encourages
of exercise for back health. continuous interaction between the
It promotes circulation muscles, stretches the connective
and boosts the strength
tissues, promotes healthy blood
and flexibility of the spinal
muscles. Just be careful to circulation and deepens breathing.
carry any gear you need in Concentrate on walking with good
a well-designed backpack
that spreads the load evenly
posture, relaxed shoulders and neck
over your shoulders. muscles and a loose-limbed gait.
Swimming A low-impact activity
that takes pressure off your
spinal joints and muscles, it gives you a good
cardiovascular workout, tones your stomach and
back muscles and increases flexibility. Swimming
146 The Healthy Back
is particularly good if youre pregnant. But
remember: the crawl and backstroke are the best
strokes to use because they lengthen the muscles
and increase flexibility; dont do a flip turn at the
end of each length; dont extend your neck too
far back when you breathe; and swim gently and
rhythmically to avoid straining your neck and
lower back.
Y
 oga A gentle yoga class (page 196) can
promote a healthy back by increasing flexibility,
strength, endurance, balance and posture. The
key word here is gentle: hatha yoga is the most
suitable type. More vigorous disciplines, such
as ashtanga or power yoga, can cause back
problems or make them worse. Take things at
your own pace, dont overstretch and make sure
that you choose a good teacher.
P
 ilates Method An increasingly popular exercise
technique (page 192), Pilates exercises strengthen
the deep postural muscles that support correct
alignment of the spine and helps correct any
muscle imbalances, thereby decreasing wear and
tear on the spinal joints. Pilates also improves
the strength and flexibility of the muscles and
teaches awareness of any bad movement habits.
D
 ance This excellent form of exercise improves
posture, maintains strong bones, increases muscle
strength and stamina and increases balance and
co-ordination. Its fun, too. Which dance style
is right for you depends on your age, fitness,
whether there is any existing back problem
and your inclination. Start slowly and build up
gradually until your fitness levels have improved.
The (possibly) bad It may be a bit unfair to call
all these activities bad, because their potential to
damage your back depends largely on how you do
them. But caution is certainly warranted.
Jogging An excellent way to stay fit and maintain
bone strength, but the high impact of running,
especially on hard surfaces, can place stress on
the spinal joints of the lower back. To minimise
your chances of an injury, remember that it is
vital to warm up first (page 96). Start and end
by walking, then jog slowly, building up speed.
When youve finished, give your spine a good
stretch out to open up your impacted lower spine.
If you experience back pain, you should probably
consider another aerobic activity.
G  olf Walking around a golf course can be a
wonderful way of exercising, as long as you dont
have a heavy bag of clubs to carry if you do,
swap shoulders between each hole or, better still,
use a cart. Even so, a golf swing and a stooping
posture are not good for your back. Counter them
by stretching your back after every stroke and
doing practice swings the other way around.
C  ycling This is a good general exercise to
improve fitness that strengthens your hip and
leg muscles. But stooping over the handlebars
on a racing bike is not good. The forward-flexed
position shortens your hip flexors and puts a
lot of strain on your lower back and neck. If you include the fact that they involve Digging deep
Gardening can be a great
cycle in this position, take time to stretch your twisting and bending, often under
way of getting exercise in
hip flexors and back muscles and strengthen your strain. They also develop one side the fresh air while doing
gluteal and stomach muscles. Sit-up-and-beg of the body more than the other, something useful. But be
sure to alternate spadework
bikes are far better for your back and static so putting unnatural stresses and
with rest and tasks that are
bikes that have back supports are better still. strains on the spinal column. To less back-stressful such as
avoid this, exercise the opposite pruning or dead-heading.
The ugly These activities carry a risk to your back side to achieve a balance.
if not undertaken with care. G
 ardening Gardening can put considerable stress
on your back. The secret of minimising these
T
 ennis, squash and badminton All these racket stresses is to think little and often. Alternate
sports have pluses and minuses. A plus is that heavy work that involves stooping, such as
the outcome is increased fitness and stamina digging and weeding, with light chores. And take
and the maintenance of bone strength. Minuses frequent breaks to rest and stretch your spine.
Stable, Supple and Strong 147

walking back Walking This activity eases
to health
Walking is an ideal form
muscle tension, encourages
of exercise for back health. continuous interaction between the
It promotes circulation muscles, stretches the connective
and boosts the strength
tissues, promotes healthy blood
and flexibility of the spinal
muscles. Just be careful to circulation and deepens breathing.
carry any gear you need in Concentrate on walking with good
a well-designed backpack
that spreads the load evenly
posture, relaxed shoulders and neck
over your shoulders. muscles and a loose-limbed gait.
Swimming A low-impact activity
that takes pressure off your
spinal joints and muscles, it gives you a good
cardiovascular workout, tones your stomach and
back muscles and increases flexibility. Swimming
146 The Healthy Back
is particularly good if youre pregnant. But
remember: the crawl and backstroke are the best
strokes to use because they lengthen the muscles
and increase flexibility; dont do a flip turn at the
end of each length; dont extend your neck too
far back when you breathe; and swim gently and
rhythmically to avoid straining your neck and
lower back.
Y
 oga A gentle yoga class (page 196) can
promote a healthy back by increasing flexibility,
strength, endurance, balance and posture. The
key word here is gentle: hatha yoga is the most
suitable type. More vigorous disciplines, such
as ashtanga or power yoga, can cause back
problems or make them worse. Take things at
your own pace, dont overstretch and make sure
that you choose a good teacher.
P
 ilates Method An increasingly popular exercise
technique (page 192), Pilates exercises strengthen
the deep postural muscles that support correct
alignment of the spine and helps correct any
muscle imbalances, thereby decreasing wear and
tear on the spinal joints. Pilates also improves
the strength and flexibility of the muscles and
teaches awareness of any bad movement habits.
D
 ance This excellent form of exercise improves
posture, maintains strong bones, increases muscle
strength and stamina and increases balance and
co-ordination. Its fun, too. Which dance style
is right for you depends on your age, fitness,
whether there is any existing back problem
and your inclination. Start slowly and build up
gradually until your fitness levels have improved.
The (possibly) bad It may be a bit unfair to call
all these activities bad, because their potential to
damage your back depends largely on how you do
them. But caution is certainly warranted.
Jogging An excellent way to stay fit and maintain
bone strength, but the high impact of running,
especially on hard surfaces, can place stress on
the spinal joints of the lower back. To minimise
your chances of an injury, remember that it is
vital to warm up first (page 96). Start and end
by walking, then jog slowly, building up speed.
When youve finished, give your spine a good
stretch out to open up your impacted lower spine.
If you experience back pain, you should probably
consider another aerobic activity.
G  olf Walking around a golf course can be a
wonderful way of exercising, as long as you dont
have a heavy bag of clubs to carry if you do,
swap shoulders between each hole or, better still,
use a cart. Even so, a golf swing and a stooping
posture are not good for your back. Counter them
by stretching your back after every stroke and
doing practice swings the other way around.
C  ycling This is a good general exercise to
improve fitness that strengthens your hip and
leg muscles. But stooping over the handlebars
on a racing bike is not good. The forward-flexed
position shortens your hip flexors and puts a
lot of strain on your lower back and neck. If you include the fact that they involve Digging deep
Gardening can be a great
cycle in this position, take time to stretch your twisting and bending, often under
way of getting exercise in
hip flexors and back muscles and strengthen your strain. They also develop one side the fresh air while doing
gluteal and stomach muscles. Sit-up-and-beg of the body more than the other, something useful. But be
sure to alternate spadework
bikes are far better for your back and static so putting unnatural stresses and
with rest and tasks that are
bikes that have back supports are better still. strains on the spinal column. To less back-stressful such as
avoid this, exercise the opposite pruning or dead-heading.
The ugly These activities carry a risk to your back side to achieve a balance.
if not undertaken with care. G
 ardening Gardening can put considerable stress
on your back. The secret of minimising these
T
 ennis, squash and badminton All these racket stresses is to think little and often. Alternate
sports have pluses and minuses. A plus is that heavy work that involves stooping, such as
the outcome is increased fitness and stamina digging and weeding, with light chores. And take
and the maintenance of bone strength. Minuses frequent breaks to rest and stretch your spine.
Stable, Supple and Strong 147
Take the Right Posture Postural muscles
The main groups of postural
muscles muscles that work
Trapezius Head In the same plane as your
pelvis, neither jutting forwards
nor back; a vertical line drawn
through the crown of your head
all the time to keep the should pass through the middle
Adopting a standing, sitting or walking posture that places minimum body in its correct position of your pelvis when viewed from
are shown here. the front. From the side, the head
stress on your spine and other supporting structures is one of the key should be in line with the sacrum.

contributions you can make to the health of your back. On these pages
well show you what good posture is and how to improve and maintain Erector spinae

it in your daily life. Shoulders Held back, but not

The U.S. Southern California Orthopedic Institute
defines what the word posture means extremely
well: it is the bodys alignment and positioning with
respect to the ever-present force of gravity. Whether
we are standing, sitting, or lying down, gravity exerts
a force on our joints, ligaments, and muscles. Good
posture entails distributing the force through our
body so no one structure is overstressed.
We are all familiar with the image of a soldier
standing to attention: eyes front, shoulders back,
stomach and backside in. But does it demonstrate
good posture? The answer is no. The soldier may
look great, and the various parts of his or her body
are certainly in their correct positions. But the body
is rigid and taut, which breaks one of the prime
rules of good posture: your body must always be
loose and flexible, held in what physiotherapists call
a neutral position.
Good posture means holding your body in such a
rigidly so. They should also
be level with each other and
Sternocleido- relaxed downwards, with no
mastoid muscle Pectoral suggestion of hunching or
Why posture matters The reason why pressure muscles rounding forwards.
over joints should be even and natural and muscles
should be relaxed, not tense or stretched, has to do
with the fact that there are two types of muscle:
phasic and postural. Phasic muscles contain a high
proportion of fast-twitch fibres that is, the muscle
Gluteals
fibres that act and react the most quickly and are
Hamstrings
the muscles you use to make a deliberate action.
Postural muscles, with a high proportion of slow- Buttocks Tucked in, so
that the lower spine can
twitch fibres, are at work all the time, keeping the follow its natural curve.
Do not exaggerate this;
body upright and in its correct position. doing so puts strain on
the lower spine.
If your posture is poor, and the various parts
of your body are not positioned correctly relative
to each other, one group of postural muscles
will be taut and the opposing muscles will be
overstretched. As a result, neither group works Abdominals
efficiently, and with time the stretched muscles
Knees Straight,
become weaker, leading to postural misalignment but not braced
and an increased risk of back problems. For Quadriceps back rigidly.

way that pressures over joints are even and natural, example, if your lumbar spine is too arched, your
and muscles are not stretched or tensed. Anything abdominal muscles will be overstretched and their
else causes muscle tension, and puts strain on opposing muscles will shorten and become tense. Tibialis anterior

the joints. So your spine should be straight, when

looked at from the back. But when looked at from Be posture aware A key part of any strategy for Good posture
the side it should be showing its natural curves. Any preventing or recovering from back problems is to Check the illustrations Weight
and pointers on this and distribution
deviation from this suggests increased and perhaps know what good posture looks and feels like. The Evenly over the
the following page for heel and ball of
uneven pressure on individual areas, stretched information and illustrations on the following pages hints on the best posture the foot.
ligaments and tense or stretched muscles. will help you do that. for back health.

148 The Healthy Back Take the Right Posture 149

Take the Right Posture Postural muscles
The main groups of postural
muscles muscles that work
Trapezius Head In the same plane as your
pelvis, neither jutting forwards
nor back; a vertical line drawn
through the crown of your head
all the time to keep the should pass through the middle
Adopting a standing, sitting or walking posture that places minimum body in its correct position of your pelvis when viewed from
are shown here. the front. From the side, the head
stress on your spine and other supporting structures is one of the key should be in line with the sacrum.

contributions you can make to the health of your back. On these pages
well show you what good posture is and how to improve and maintain Erector spinae

it in your daily life. Shoulders Held back, but not

The U.S. Southern California Orthopedic Institute
defines what the word posture means extremely
well: it is the bodys alignment and positioning with
respect to the ever-present force of gravity. Whether
we are standing, sitting, or lying down, gravity exerts
a force on our joints, ligaments, and muscles. Good
posture entails distributing the force through our
body so no one structure is overstressed.
We are all familiar with the image of a soldier
standing to attention: eyes front, shoulders back,
stomach and backside in. But does it demonstrate
good posture? The answer is no. The soldier may
look great, and the various parts of his or her body
are certainly in their correct positions. But the body
is rigid and taut, which breaks one of the prime
rules of good posture: your body must always be
loose and flexible, held in what physiotherapists call
a neutral position.
Good posture means holding your body in such a
rigidly so. They should also
be level with each other and
Sternocleido- relaxed downwards, with no
mastoid muscle Pectoral suggestion of hunching or
Why posture matters The reason why pressure muscles rounding forwards.
over joints should be even and natural and muscles
should be relaxed, not tense or stretched, has to do
with the fact that there are two types of muscle:
phasic and postural. Phasic muscles contain a high
proportion of fast-twitch fibres that is, the muscle
Gluteals
fibres that act and react the most quickly and are
Hamstrings
the muscles you use to make a deliberate action.
Postural muscles, with a high proportion of slow- Buttocks Tucked in, so
that the lower spine can
twitch fibres, are at work all the time, keeping the follow its natural curve.
Do not exaggerate this;
body upright and in its correct position. doing so puts strain on
the lower spine.
If your posture is poor, and the various parts
of your body are not positioned correctly relative
to each other, one group of postural muscles
will be taut and the opposing muscles will be
overstretched. As a result, neither group works Abdominals
efficiently, and with time the stretched muscles
Knees Straight,
become weaker, leading to postural misalignment but not braced
and an increased risk of back problems. For Quadriceps back rigidly.

way that pressures over joints are even and natural, example, if your lumbar spine is too arched, your
and muscles are not stretched or tensed. Anything abdominal muscles will be overstretched and their
else causes muscle tension, and puts strain on opposing muscles will shorten and become tense. Tibialis anterior

the joints. So your spine should be straight, when

looked at from the back. But when looked at from Be posture aware A key part of any strategy for Good posture
the side it should be showing its natural curves. Any preventing or recovering from back problems is to Check the illustrations Weight
and pointers on this and distribution
deviation from this suggests increased and perhaps know what good posture looks and feels like. The Evenly over the
the following page for heel and ball of
uneven pressure on individual areas, stretched information and illustrations on the following pages hints on the best posture the foot.
ligaments and tense or stretched muscles. will help you do that. for back health.

148 The Healthy Back Take the Right Posture 149

How to Avoid Strain
If you make an effort, its not too difficult to keep posture in
mind when youre walking from place to place or moving from
task to task. The difficulty comes when youre stuck in one
position for some time or when you are carrying out a task
that has unusual physical demands.
pick it up
Picking up any object from
the ground even a light
one can strain your back
if you dont do it correctly.
Always bend your knees and
keep your back straight.
Lifting safely
Incorrect ways of lifting can be bad for your back,
because youre using the back muscles to do work
for which theyre not designed. So when lifting:
Keep your back straight and use the muscles
of your legs.
Place one hand underneath the object, if
possible, and pull it close to your body. Its worth
remembering that a weight held at arms length
increases the stress on your spine by up to 10
times that of the weight itself.
Heavy objects Its a great temptation to just stoop
down and grasp a heavy object in order to lift it. But
if you do this youre putting yourself at considerable
risk of damaging your back.
Instead, stand with one foot slightly in front of
the other as close as possible to the object to be
lifted. If you can, keep both feet flat on the floor.
Bend your knees and hips until you are low enough,
keeping your back straight. Straighten up in one
smooth movement, using your hip and leg muscles
and keeping your back straight. Only start to move
once youre standing erect.

Keep your
back straight

Bend your
knees

back strain At work From heavy manual work to desk

Many types of work involve work and everyday tasks in the home,
the possibility of back
strain, but jobs involving most activities have areas of potential
lifting and carrying are risk for your back. But most hazards
among the highest risk in your work or home life can be
occupations for back injury.
controlled if you keep in mind these
three basic rules: choose the correct equipment;
use the correct technique; and take regular breaks.
The following pages have general tips that you can
Bending down When loading a washing machine,
putting a dish in the oven or just picking up a toy
from the floor, make sure that you bend your knees
Rights and wrongs of lifting
The photograph above shows a lifting
position that carries a high risk of back
strain: the person has reached down with
a bent back and straight legs. A much safer
position is shown right: he has lowered
himself by bending the knees and has kept
his back straight. Far right, he carries the
heavy object close to his body to reduce
the amount of strain.

use in many situations. rather than your back.

152 The Healthy Back How to Avoid Strain 153

How to Avoid Strain
If you make an effort, its not too difficult to keep posture in
mind when youre walking from place to place or moving from
task to task. The difficulty comes when youre stuck in one
position for some time or when you are carrying out a task
that has unusual physical demands.
pick it up
Picking up any object from
the ground even a light
one can strain your back
if you dont do it correctly.
Always bend your knees and
keep your back straight.
Lifting safely
Incorrect ways of lifting can be bad for your back,
because youre using the back muscles to do work
for which theyre not designed. So when lifting:
Keep your back straight and use the muscles
of your legs.
Place one hand underneath the object, if
possible, and pull it close to your body. Its worth
remembering that a weight held at arms length
increases the stress on your spine by up to 10
times that of the weight itself.
Heavy objects Its a great temptation to just stoop
down and grasp a heavy object in order to lift it. But
if you do this youre putting yourself at considerable
risk of damaging your back.
Instead, stand with one foot slightly in front of
the other as close as possible to the object to be
lifted. If you can, keep both feet flat on the floor.
Bend your knees and hips until you are low enough,
keeping your back straight. Straighten up in one
smooth movement, using your hip and leg muscles
and keeping your back straight. Only start to move
once youre standing erect.

Keep your
back straight

Bend your
knees

back strain At work From heavy manual work to desk

Many types of work involve work and everyday tasks in the home,
the possibility of back
strain, but jobs involving most activities have areas of potential
lifting and carrying are risk for your back. But most hazards
among the highest risk in your work or home life can be
occupations for back injury.
controlled if you keep in mind these
three basic rules: choose the correct equipment;
use the correct technique; and take regular breaks.
The following pages have general tips that you can
Bending down When loading a washing machine,
putting a dish in the oven or just picking up a toy
from the floor, make sure that you bend your knees
Rights and wrongs of lifting
The photograph above shows a lifting
position that carries a high risk of back
strain: the person has reached down with
a bent back and straight legs. A much safer
position is shown right: he has lowered
himself by bending the knees and has kept
his back straight. Far right, he carries the
heavy object close to his body to reduce
the amount of strain.

use in many situations. rather than your back.

152 The Healthy Back How to Avoid Strain 153

What Might Work?
In this chapter youll find descriptions of the main treatment
options, and this table will give you a broad idea of what might
be appropriate in your case. But your treatment will depend on
many variables, so follow your doctors advice, which is based
on in-depth knowledge of you and your health needs.

Key
lll Common primary treatment or therapy
ll Possible back-up treatment or therapy
l Treatment or therapy that may provide
benefit or may relieve symptoms

Treatment/therapy u Physiotherapy Osteopathy Chiropractic Massage Alexander Pilates Method Yoga Acupuncture Shiatsu TENS Medication Surgery
Type of Problem q therapy Technique

Posture problems lll ll lll lll lll

Spinal curvatures ll ll ll ll ll l l lll
Osteoarthritis lll ll ll ll lll ll
Rheumatoid arthritis ll ll l l lll ll
Anklyosing spondylitis lll l ll ll lll ll
Osteoporosis lll ll ll lll
Soft-tissue injuries of the neck and upper back lll lll ll lll ll l l l l l lll
Nerve root problems of the neck or back lll ll ll l l l lll l
Thoracic outlet syndrome lll ll ll ll l lll
Shoulder muscle injuries and inflammation lll ll ll ll l l l l l lll
Ligament sprains and tears lll ll ll lll lll l
Rehabilitation from injuries (including fractures) lll ll ll l lll lll
Soft-tissue injuries of the middle and lower back lll lll lll lll lll ll ll ll l ll lll
Disc degeneration lll ll ll l lll ll
Spinal stenosis lll lll lll
Sciatica lll ll ll l l l lll ll
Sacroiliac joint problems lll lll lll l ll ll ll l ll lll
Piriformis syndrome lll lll ll l l l l l l ll
Pregnancy lll lll l ll ll ll l l l

176 Glossary of Treatments What Might Work? 177

What Might Work?
In this chapter youll find descriptions of the main treatment
options, and this table will give you a broad idea of what might
be appropriate in your case. But your treatment will depend on
many variables, so follow your doctors advice, which is based
on in-depth knowledge of you and your health needs.

Key
lll Common primary treatment or therapy
ll Possible back-up treatment or therapy
l Treatment or therapy that may provide
benefit or may relieve symptoms

Treatment/therapy u Physiotherapy Osteopathy Chiropractic Massage Alexander Pilates Method Yoga Acupuncture Shiatsu TENS Medication Surgery
Type of Problem q therapy Technique

Posture problems lll ll lll lll lll

Spinal curvatures ll ll ll ll ll l l lll
Osteoarthritis lll ll ll ll lll ll
Rheumatoid arthritis ll ll l l lll ll
Anklyosing spondylitis lll l ll ll lll ll
Osteoporosis lll ll ll lll
Soft-tissue injuries of the neck and upper back lll lll ll lll ll l l l l l lll
Nerve root problems of the neck or back lll ll ll l l l lll l
Thoracic outlet syndrome lll ll ll ll l lll
Shoulder muscle injuries and inflammation lll ll ll ll l l l l l lll
Ligament sprains and tears lll ll ll lll lll l
Rehabilitation from injuries (including fractures) lll ll ll l lll lll
Soft-tissue injuries of the middle and lower back lll lll lll lll lll ll ll ll l ll lll
Disc degeneration lll ll ll l lll ll
Spinal stenosis lll lll lll
Sciatica lll ll ll l l l lll ll
Sacroiliac joint problems lll lll lll l ll ll ll l ll lll
Piriformis syndrome lll lll ll l l l l l l ll
Pregnancy lll lll l ll ll ll l l l

176 Glossary of Treatments What Might Work? 177

The Alexander Technique
The Alexander Technique aims to undo poor, ingrained habits and replace
them with the correct, natural movement of early childhood. Young
children stand and move with ease and poise, but adults often lose the
ability to do this as a result of prolonged sitting, bad lifting techniques,
poor posture, pain and stress.
Frederick Matthias Alexander, who invented The
Alexander Technique, believed that the relationship
of the head with the neck and back governs the
way the rest of the body functions. He called this
relationship the primary control. If it is balanced
and free, the postural muscles (page 149) the
muscles that hold us upright against gravity work
without effort and tension, allowing the phasic
muscles the ones that are activated to make a
specific movement to move the joints freely. If the
relationship is faulty, the postural muscles become
tense and the phasic muscles have to work harder
The Benefits
The Alexander Technique does not aim to treat specific problems,
rather to teach you how to release tension held in muscles caused
by habitual poor posture and unnecessary movements and how to
relearn correct use.
The benefits claimed include:
More freedom of movement.
Improved coordination and balance.
An increase in energy levels.
Improved relaxation.
188 Glossary of Treatments
careful adjustment
An Alexander teacher will
carefully and repeatedly
adjust your posture so that
good posture will eventually
feel right.
to achieve a movement. The result is that, over
time, the body loses its grace and suppleness. Bad
postural habits known to Alexander teachers as
patterns of misuse become ingrained with time,
so that the incorrect posture or movement feels
right and the loss of flexibility and aches and pains
are assumed to have another cause.
Teachers of the technique aim to restore the
length, coordination and flexibility of the spine and
head the primary control and re-establish the
correct relative position of the two, whether still or
in motion.
From the neck down The reason why the head
and neck are so easily moved out of their correct
position is anatomical. The head rests on a simple,
small pivot joint at the top of the spine, but its
centre of gravity is not in line with the spine. It is
much further forwards: approximately in the middle
of a line drawn between the top of your ear and
your cheekbone. Apart from when lying down,
our neck muscles are always slightly contracted to
pull against the weight and maintain the sensitive
balance that keeps the head in its correct position.
The problem is that the neck muscles often
become too tense, either for psychological or
postural reasons. The result is that the neck muscles
pull the head back and down.
The Alexander Technique
The Alexander Technique aims to undo poor, ingrained habits and replace
them with the correct, natural movement of early childhood. Young
children stand and move with ease and poise, but adults often lose the
ability to do this as a result of prolonged sitting, bad lifting techniques,
poor posture, pain and stress.
Frederick Matthias Alexander, who invented The
Alexander Technique, believed that the relationship
of the head with the neck and back governs the
way the rest of the body functions. He called this
relationship the primary control. If it is balanced
and free, the postural muscles (page 149) the
muscles that hold us upright against gravity work
without effort and tension, allowing the phasic
muscles the ones that are activated to make a
specific movement to move the joints freely. If the
relationship is faulty, the postural muscles become
tense and the phasic muscles have to work harder
The Benefits
The Alexander Technique does not aim to treat specific problems,
rather to teach you how to release tension held in muscles caused
by habitual poor posture and unnecessary movements and how to
relearn correct use.
The benefits claimed include:
More freedom of movement.
Improved coordination and balance.
An increase in energy levels.
Improved relaxation.
188 Glossary of Treatments
careful adjustment
An Alexander teacher will
carefully and repeatedly
adjust your posture so that
good posture will eventually
feel right.
to achieve a movement. The result is that, over
time, the body loses its grace and suppleness. Bad
postural habits known to Alexander teachers as
patterns of misuse become ingrained with time,
so that the incorrect posture or movement feels
right and the loss of flexibility and aches and pains
are assumed to have another cause.
Teachers of the technique aim to restore the
length, coordination and flexibility of the spine and
head the primary control and re-establish the
correct relative position of the two, whether still or
in motion.
From the neck down The reason why the head
and neck are so easily moved out of their correct
position is anatomical. The head rests on a simple,
small pivot joint at the top of the spine, but its
centre of gravity is not in line with the spine. It is
much further forwards: approximately in the middle
of a line drawn between the top of your ear and
your cheekbone. Apart from when lying down,
our neck muscles are always slightly contracted to
pull against the weight and maintain the sensitive
balance that keeps the head in its correct position.
The problem is that the neck muscles often
become too tense, either for psychological or
postural reasons. The result is that the neck muscles
pull the head back and down.
A MUST-HAVE FAMILY REFERENCE PACKED WITH PROVEN,
PRACTICAL APPROACHES TO CARING FOR YOUR BACK

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