After reading Part 1 of this article series (see "related articles" at right), I hope you have a better understanding of assessing posture and prescribing exercise based on the assessments. It is time to delve deeper into neutral spine. There are many ways to define neutral. However, in my opinion the best way to explain it to a client is that this alignment is the best posture the body can be in at this point in time. You also need to explain to your clients that neutral alignment does not feel “natural.” It shouldn’t because most people, regardless of fitness level, are not in neutral spinal alignment all of the time. The way I define neutral spine is by its components. Starting with the head and working down to the hips, it is easiest to understand when broken into four components. Each component has unique characteristics that help to better define how to properly align that particular body part. For the purposes of this article, the four components of neutral spine are:
- Cervical Neutral
- Shoulder Neutral
- Ribcage Neutral
- Pelvic Neutral
These four components of the spine each have joints, bones and muscles that work together to provide stability of the torso or core. Increasing core stability is one of the most important training tools a personal trainer can provide. Better core stability can help an elderly person become more mobile in activities of daily life. While on the other end of the spectrum, elite athletes can improve sports performance when their core is stronger because they can direct power more efficiently to the area of the body needed for the sport without losing precious strength stabilizing the core. In addition to the health benefits of improved posture, there are the aesthetic benefits of looking younger and leaner. Think about a younger woman who has a kyphotic or "bent over" posture. Often, she looks older than her actual age because her posture is that of an older woman. Joseph Pilates was very much ahead of his time when he said that a “flexible spine is a healthy spine at any age.” This statement was true in the 1920s and remains true today.
Let’s start with the head and work our way down. This is a good way to start as it ensures you don’t miss anything. Ideally, the ear should be in line with the acromion process of the shoulder. Common language used by Pilates instructors is to “reach through the crown of the head” or “keep the head in line with the spine.” This helps to remind participants to keep the head directly on top of the spine. Many people will have a forward head posture in a relaxed state or even when they are aware and trying to realign the head. This posture is when the ear is shifted in front of the shoulder. Over time, this posture can put a strain on the muscles of the upper back and neck if it is not corrected. The health benefits of proper cervical alignment can be less frequency of headaches, relief from muscular pain and better sleep. In addition, as stated before, the aesthetic benefits are a more youthful appearance.
The shoulder girdle is probably the one area of the neutral spine that is most overlooked. In the early teaching of Pilates, most of the focus was on the area between the ribcage and pelvis. Many times in neutral alignment, you will see the cervical area lumped together with the shoulders in neutral alignment. However, the importance of the shoulder girdle position is essential to proper ribcage alignment and a strong abdominal contraction during the Pilates exercises. The shoulders can affect the core in many ways. For instance, try elevating your shoulder blades up toward your ears. Hold the blades in this position and engage your abdominal muscles. Now, try this same exercise keeping the shoulder blades down, wide on your back and your chest open. You should feel a deeper engagement of the abdominal muscles when the shoulders are in good alignment. In addition to a deeper contraction of the abdominal muscles, your core is now supported front to back. The shoulder blades are drawing down, creating support in the back while the abdominals are drawing in and up supporting the front. The reason the shoulder girdle is misunderstood is that it has so many ways in which it needs to be aligned and many variables that can affect good alignment. To better understand how to align the shoulders, it is easiest to break it down into all the different ways that the shoulder can move.
In the majority of people, the front of their shoulders are internally rotated. Due to activities of daily life, the muscles are shortened in the front of the shoulder. This shortening of the muscles draws the joint forward and the shoulders into misalignment. The best placement for the shoulder joint is when the arm is in line with the glenohumeral joint and the palm of the hand is facing the hip joint. In this neutral shoulder position, there will be equal balance of all the muscles surrounding the shoulder girdle and the scapula will be flat on the thoracic spine. To teach the proper position, cue the following in a seated or standing position:
- Place the pelvis and ribcage into neutral.
- Turn the palms to face the front of the body.
- Draw the finger tips toward the floor without over-depressing the scapulae.
- Open the front of the chest.
- Keeping the chest and upper arm still, turn both hands back from the elbows.
- Place the hands at the sides.
- This is the neutral shoulder position.
If you listen to any Pilates class, one constant refrain you will hear from the teacher is to “draw the shoulders down away from the ears.” This cue is repeated many times because it is important for achieving neutral spine. Sometimes as a person begins to be challenged or placed under stress, the shoulder blades will begin to elevate toward the head. This inhibits the body’s ability to contract the abdominals, thus limiting the stability of the torso. The proper alignment of the shoulder blades is midway between fully elevated and fully depressed. The muscles that draw the scapulae down should be engaged but not gripped to hold the blade down. This is the ideal position for the scapulae on the back and one in which the joint is most stable.
In the many upper body weight bearing positions in Pilates, it is essential for the scapulae to stay down and flat on the back. Many Pilates teachers will refer to poor alignment of the shoulder blade when weight bearing as “winging” of the blades. This is when the shoulder blades are lifted away from the back, creating a winged appearance. This is usually caused by muscle imbalance or injury. Sometimes a person’s shoulder blades will “wing” off of the back without any weight bearing on the hands. This is evidence of an unstable shoulder girdle. Therefore, weight bearing of the upper body should be limited until the musculature is balanced and the person can maintain this balance during movement. To teach the proper position, cue the following in a seated position:
- Place the pelvis and ribcage into neutral.
- Extend both arms straight out from the shoulder joint.
- Place the palms flat against an imaginary wall with the fingers pointing to the ceiling.
- Draw the shoulder blades down into neutral.
- Widen the shoulder blades apart from one another without rounding the thoracic spine (protraction).
- Squeeze the shoulder blades together without elevating the ribcage (retraction).
- Find the midpoint between protraction and retraction.
- This midpoint is the neutral shoulder blade position.
Alignment of the ribcage is probably one of the hardest things for many people to accomplish in a Pilates class. The proper alignment seems relatively easy. You want to bring the bottom ribs in line with top of the pelvis (ASIS). This can usually be achieved by most participants when sitting or standing. However, when many participants lie supine, they cannot bring their ribs in alignment with the pelvis. This is when it is important to look for thoracic imprinting (i.e., when the last two posterior ribs are on the mat). If someone's anterior ribcage is elevated in the supine position, but he can place his last two ribs in his back on the mat, then you know his spine is protected for any exercise. However, monitoring of the thoracic imprinting is extremely important. If your client is moving his arms and legs away from his center and the posterior ribcage lifts off of the mat, you may cause him to over compress or strain his back. So, what do you do if your client has an elevated anterior ribcage and cannot get the posterior ribcage imprinted? You will need to assist him by either tilting his pelvis slightly into a posterior tilt or lifting his head onto a small, folded towel. Usually, one or the other is sufficient. However, you may need to do both in order to bring the ribcage down into a safe position. Initially, it will be your responsibility as the trainer to check for this alignment, although over time, your client will begin to develop more body awareness, and he will feel when his back ribs are lifting away from the mat. This is when you know you have truly been successful as a trainer!
Pelvic alignment can be tricky to explain because many of our clients are not very aware of their own bodies. In fact, some of your clients may not even know what their pubic bone is or where it is located. The easiest way to teach pelvic neutral is in a standing position because your client can see and feel their bodies. It also helps to teach when standing because they can see you and where you are pointing on your own body. Once the clients are standing, place the heel of both hands on top of your anterior superior iliac spine (ASIS) and your finger tips toward your pubic bone to form a triangle. This is called the anterior pelvic triangle. These bony landmarks are the best for your clients to use to check their alignment because they are in the front of the body and easily felt in most any body position. There are also two other pelvic triangles, the posterior and the bike seat. The posterior triangle is comprised of the posterior superior iliac spine (PSIS) and the coccyx. When your client is in a prone position, you can view those bones to see if the pelvis is in good alignment. The cue you give your client to get into neutral pelvis when in a prone position is to press his pubic bone against the mat. This will automatically bring the pelvis into a good position and ensure his spine is in a lengthened position before spinal extension exercises. The third triangle of the pelvis is the bike seat. This is used when in a seated position to bring the pelvis into alignment. This triangle is comprised of the ischial tuberosities (sits bones) and the pubic bone. To bring your client into good alignment in a seated position, give the cue to sit evenly and straight on the sits bones (“bones beneath the buttocks”). In this position, he will not feel the pubic bone touching, although you do want him to visualize that the pubic bone is in the same plane as the sits bones in order for the pelvis to be in the best possible alignment.
Supine pelvic alignment in the teaching of Pilates has become very confusing, leaving instructors and trainers unsure of how to proceed. Some instructors teach an imprinted pelvis when in supine with all clients regardless of their ability while other instructors teach neutral alignment. So, as a newbie to Pilates, what should you do? Well, it is very simple: you should teach both. Pelvic imprinting and neutral pelvis are not mutually exclusive. In fact, you may have clients who can perform some supine exercises in neutral while they must imprint others. By universally applying an imprinted or neutral pelvis to all clients without regard to their needs or abilities, it is like giving all clients the same weight training routine to follow. Neutral spine in all body positions is always the goal because it promotes a healthy, pain free posture. However, achieving neutral is not an overnight process. It must be accomplished in a steps and stages. If a client is in supine and he begins to lose stability in the pelvis, then placing the pelvis into a slight posterior tilt (imprinting) would be the best solution to help him. An imprinted pelvis would also be used if your client complained of low back pain during supine exercises. However, if a client has severe back pain or if the pain does not stop after imprinting the pelvis, then you should discontinue your training session and have him see his physician.
Application of Neutral
Now that you have learned how to properly align the body into neutral spine, you should try to apply this alignment to your clients in all training sessions. Good postural alignment is something that needs constant reinforcement. Think about the mother who is constantly reminding her kids to “stand up straight and stop slouching.” That reinforcement reminds them to stand tall, and over time, it enables them to replicate it without that verbal or visual reminder. As a personal trainer, you are teaching your clients the same way. If you align all of your clients into neutral spine for all workouts, you are helping them to learn better body awareness during many different activities. This is crucial for them to be able to eventually “catch themselves” slouching or in poor alignment. As stated before, good posture is essential for all types of clients since it is the foundation for a strong core. A stronger core can lead to better overall health by increasing respiration, limiting pain and improving balance. Even subtle readjustments can help the body become stronger at holding neutral spine. So, no matter what a client’s goals are for a training session, your goal should always be to help improve posture and core strength in order to lead to better overall function in life.
Photos courtesy of Mad Dogg Athletics, Inc