For the past 16 years or so I've had a "bad back". I originally strained something doing deadlifts and there have been repeated bouts of back spasms ever since. Sometimes they have been severe, leaving me on the floor and almost unable to move. On other occasions it is more of a continual minor ache. Sometimes I'll be OK for months on end and capable of some relatively good athletic performances - big walks in the hills, demanding met con circuits even - when I did more lifting - some heavy deadlifts.
That is context for this post. You see I'm always on the look out for thoughts about back health. I get a regular sports massage and have learned that trigger point therapy and stretching the glutes and psoas is really important for me - just to relieve the effects of sitting all day at a desk. I have learned much from Rif for example.
In addition to the physical side, I must also say that I believe that there is a big psychological element to my back spasms - when I'm stressed my back pain is always worse. In fact I have a lot of sympathy for Dr Sarno's approach to and understanding of back pain. He talks about TMS - effectively back pain being a tactic that your mind/body uses to divert your attention from the things that are really bothering you subconsciously.
While I think stress has a big role, I also think there are physical measures to employ to attack the symptoms and also simply to maintain health.
With this in view, you'll understand that I was interested to read a post on Matt's blog recently about a book he was reading. The post was called Best Back Book and was about a book by Esther Gokhale: 8 Steps to a Pain Free Back
This post is not intended to be a review of the book, but I would agree with Matt that this is a superb volume. He explains:
Judged by the title, you might think is just another back pain book. However, this book is much, much more. It is really an anthropological and evolutionary study of how the human back is supposed to work. Why do traditional cultures have low levels of back pain, yet the rate is skyrocketing in the U.S.? What is the proper way to sit, stand, and walk? These are the questions the author attempts to answer.
I am only part-way through this book, and I learning something new almost every page. For example, many fitness experts state that a "neutral" or flat pelvis is correct posture. Instead, the author makes the case that the natural alignment for the pelvis is to be "tipped forward". She supports this with pictures of babies, young children, and people in traditional cultures who all exhibit a tipped-forward pelvis and none of whom suffer from back pain.
The photographs in the book are fascinating and show just how poor the posture of the average Westerner is. The book is worth buying simply for these photographs which are an indictment of the way so many of us stand, walk, sit and lie.
It is an excellent and challenging book that I wholly recommend. Easy to read and inspiring too.
The Asian / Third World Squat
Basing so much of her argument on trying to what is "natural" I was surprised that Esther did not talk about the squat.
People in developing countries seem to squat all the time. In the absence of chairs it seems the natural way to rest / eat.....and defecate.
Surely if we are to use our backs in their natural positions, we should be squatting lots? Indeed I'd come across this recommended a couple of times as a healthy stretch. Remember Mark Sissons stretching his sprint video? Then the "latrine squat" was recommended here as a glute stretch.
T nation even had an article on this - talking of the Third World Squat
You'll notice that in third-world countries, there will be a lot of situations where people are hanging out or working, and rather than sitting or kneeling down, they squat. They can sit like this comfortably for hours. It seems like a simple thing and can be easily overlooked, but try it some time. The average North American adult can't even get into this position, let alone stay there for any length of time.
There was even the comedy video - with serious points - about the "Asian Squat"
So why did Esther not like the squat?
I emailed her and asked!
Here is her response - basically if you have not grown up squatting like this, it is probably too late to start - you bones will not be built for it. They will have settled into structures which do not easily accommodate the Asian squat.
Here are my musings on squatting.
1. At birth, many of our joints (including the ankles, knees and hips) are not ossified. Instead of bone, we have cartilage in those areas.
2. Each of the above joints has a timetable for when the cartilage ossifies. The hip joint, for example, is made of three parts - the ischeum, ileum and pubis - each pair of which ossifies at a different age (first pair at age 2; last pair at age 16).
3. Once your joints have ossified, they are relatively immutable. Bone does change shape depending on the stresses on it, but it does not change drastically and in particular, the above ossifications are irreversible.
4. If you grow up squatting (on pit toilets, eating on the floor, etc) then the joints ossify differently than if you grew up sitting on chairs and using commodes for toilets. In particular, if you grew up squatting, your joints will ossify in a way that allow you to continue to squat in adulthood. If you did not squat through the years that your ankles, knees, and hips were ossifying, you will probably not be able to do a healthy full squat in adulthood.
5. People who force squats without having he joint architecture to do them tend to round their backs (compressing their spinal discs), pronate their ankles, and stress their knees.
6. Recommendation: don't try to force a squat. In most situations you can do the job equally well with a modified squat (on foot flat on the floor, the other on the ball of the foot). The times squatting does help are childbirth and evacuating your bowels. In these situations I recommend using some extra support under your heels - this makes squatting easy on the ankles and back. For other situations like certain squatting Yoga poses, I recommend not going all the way into the pose.
There you have it! The interesting thing to me though was her recommendation:
In most situations you can do the job equally well with a modified squat (on foot flat on the floor, the other on the ball of the foot).
I'd seen this before! My friend Bryce Lane wrote a piece a few years ago about his experience with this stance of squat.
The B Squat
Bryce came up with this stance while experimenting with positions to get more stability in lifts. The leverage is better apparently. You can read his thoughts here: The B Squat
So there you are.
I like it when different people come up with the same idea from different directions. I'm going to start using the b Squat more myself - the body weight one and maybe even as a goblet squat - hopefully to keep my posture more healthy and efficient.