Category Archives: Feet

The chronic lower back pain conundrum – Seán Carey

Sitting posture

Much excitement over a recent article by The Guardian’s medical journalist, Dr Luisa Dillner, in which she canvasses the views of a physiotherapist, an osteopath and a ballet teacher on the vexed topic of ‘good’ and ‘bad’ posture, with a special focus on the latter’s effects on health and well-being.

There were several strands to the argument but the main theme was that so-called bad posture – ‘usually defined as slumping, leaning forwards or standing with a protruding belly’ – is not the primary reason why so many people in the UK experience chronic lower back pain.

This is not a new argument. As I explain in my book, Alexander Technique in Everyday Activity: Improve how you sit, stand, walk, work and run, the reasons why people develop chronic lower back problems are multiple and complex:

‘Although the precise cause of chronic back pain is often difficult to pinpoint, it is usually related to conditions such as herniated disc – the so-called slipped disc – and by a variety of inflammatory processes in the musculoskeletal system, as well as age-related degeneration, especially in those over 65.’

I also highlight that lower back pain is linked to anxiety and stress.

And in my book, I offer some advice to those suffering from chronic lower back pain – namely, that it is very important to obtain an accurate medical diagnosis in order to rule out any existing medically treatable pathological problem of the spine.

Interestingly, the physiotherapist and osteopath interviewed by Dr Dillner did concede that once someone has developed chronic lower back pain ‘posture may affect it’ and that ‘sitting for a long time’ is best avoided.

But what wasn’t mentioned in The Guardian article (though it is covered in my book) concerns an important discovery made in 2006 by a team of Canadian and Scottish scientists.

It is that how we sit on a chair has enormous implications for spinal health. The team, which used an innovative whole-body MRI scanner to investigate 22 adult volunteers with ‘healthy backs’, found at the start of the study that despite being asymptomatic 12 of the group exhibited a significant degree of disc degeneration or disc protrusion.

The scans then revealed that sitting on a chair with feet touching the floor in either a forward slouch or an upright 90 degrees, ‘good posture’ position, had a significant impact on the vertebral column, since the lower spinal discs in particular were already showing signs of deformity.

In fact, this effect was greatest when subjects adopted the sit up ‘straight’ position. In as little as 10 minutes fluid was leaking out of the inner core of the discs. This finding is highly significant, considering that the 23 sponge-like intervertebral discs constitute around one third of the total length of the spine, and play a critical role as shock absorbers in everyday movement, especially in bending and twisting motions.

From an Alexander Technique point of view sitting up ‘straight’, as most people in our culture understand it, is in fact over-straight. Simply put, it’s just another way of tightening the neck, raising the chest and hollowing the back. In turn, that misuse lifts the sitting bones from the chair and transfers body weight on to the thighs, creating inappropriate downward pressure along the spinal column, including the discs. The alternative of slumping isn’t much better.

Instead, in order to sit upright painlessly and efficiently we need to learn the skill of giving our weight to our ischial tuberosities – the sitting bones at the base of the spine.

Only then can our anti-gravity and non-tiring support muscles transfer the weight of our head, upper body and arms into whatever support surface is available. This could be the ground itself, or a raised surface such as a chair, tree stump or rock, or moving surface such as a horse, elephant or camel.

To make this clearer you can try this experiment. Locate your sitting bones by sitting on a flat surface, such as a wooden chair, and put the palm of each hand under each buttock. Through the skin, fatty tissue and thick muscle you will feel a bony protrusion under each hand. At this point let yourself slump so that your spine assumes a C-shaped curve. You will notice how you roll on to the back edge of your sitting bones and your weight transfers on to the rear of the pelvis and towards the tailbone (coccyx).

Now try sitting up ‘straight’. Chances are that you are now arching your back. If so, you will experience how your support contact moves on to the very front edge of your sitting bones, in such a way that much of your weight is taken by your thighs.

By contrast, see if you can find a way of sitting in balance so that your weight is taken more or less by the middle of the curved arch of your sitting bones, with your double S-shaped spine extending upwards and your head freely poised on top of it.

This is balanced sitting. It’s easier said than done, of course. But it’s the only way to sit to avoid exacerbating chronic lower back pain, while also preserving the long-term integrity of the discs of your spine.

You can read more about an Alexander approach to sitting and other movements in Seán Carey’s Alexander Technique in Everyday Activity: Improve how you sit, stand, walk, work and run

Available through Amazon with free P & P



Going up the wall – Seán Carey

FM AleWall Work102Lxander told Marjory Barlow and the other students on his first training course group that once they had qualified as teachers they would find wall work very useful to perform in the intervals between lessons, especially if there wasn’t sufficient time to lie down on the floor or table. One reason why wall work is so valuable, FM went on to explain, derives from the sensory feedback that becomes available by lightly placing the whole of one’s back against a firm surface, such as a smooth wall or door, head freely poised on top of the spine and, then, using inhibition and direction, to make one or more carefully-thought-out movements.

Going on to the toes is one such movement. With your head leading, slide your body upwards (in stages if necessary) – ‘take plenty of time,’ Marjory advised me when I performed the movement in her teaching room – so that you go on to the balls of your feet and then your toes, without pressing back against the contact surface or bracing back your knees or holding your breath. Having arrived on tiptoe, it’s a good idea to pause at this juncture and release any unnecessary holding or excess tension in the buttocks, lower back, knees and ankle joints made while moving upwards. (When first performing the activity most of us will find that there’s often quite a lot of tension to discard. But definitely one way you can help the process along is by directing your heels to release away from your sitting bones or hip joints.) To return to the floor maintain your light contact with the wall or door and allow your ankles to release very slowly so that you maintain your internal length.

You now have the task of coming away from the wall without using some sort of leverage – for instance, by not succumbing to the desire to push with one or both of your buttocks or employing a quick flick of your shoulder blade. That, of course, is easier said than done – a true test of inhibition and direction.

You can read more about Marjory Barlow’s Alexander teaching techniques in Seán Carey’s new book, ‘Think More, Do Less: Improving your teaching and learning of the Alexander Technique with Marjory Barlow’, which has been written for Alexander teachers, trainees and advanced students. It is now available through Amazon or HITE.

Marjory Barlow’s ‘Dimple Test’ – Seán Carey

Alexander told the students on his first training course that one very effective way to encourage the musculature of their back to work was to come back as an integrated unit in small movements from the pivot point of their ankle joints.TMDLpage83


The big problem for most of us attempting the activity on our own is that before initiating the movement back from the ankles it’s necessary to be reasonably well-coordinated – your head needs to be going forward and up, your back lengthening and widening, and your knees releasing forward from your free hip joints and slightly away from each other while maintaining a good connection to your feet. That’s often not the case, of course. Many of us obtain an upright stance not by lengthening the stature but by shortening it – specifically, pushing the pelvis forward, pulling the tailbone (sacrum-coccyx) and buttocks upwards towards the lower back, and also locking the knees, hips and ankles. One major result of this tangled malcoordination is that the pelvis is pulled down on to the legs instead of it being an integral part of the torso. As FM Alexander’s niece and first-generation Alexander teacher Marjory Barlow observed if someone is standing in this very common pattern of misuse and then attempts to come back from the ankles this will only serve to amplify or increase the degree of their stiffening.

The dimple test

Marjory suggested that if you have a habit of displacing your pelvis forward and hollowing your back, it’s useful to get a measure of that misuse, ideally with the aid of a mirror, by using what she called ‘the dimple test’. It’s very simple and straightforward. While standing, without raising your shoulders or pulling your head down to your neck, place the palms of your hands, with your lengthening fingers extending downwards along the outside of your thighs so that you can feel the dimple or hollow on the outside of your buttocks. With the heels of your hands you are now aware of the bony prominence of the greater trochanter of your thigh bone (femur) of each leg on the outside of your hip joints. (Note, the greater trochanter, a lever, acts as an attachment for two of your three gluteal muscles that stabilise your hip joint and enables you to extend, rotate or lift your leg sideways.)

Marjory then suggested investigating what happens when you keep your hands on your dimples and then deliberately stiffen your knees so that they turn inwards and backwards. ‘My husband, Bill, used to call this inward-rotating knee movement “squinting”,’ she recalled. ‘But what’s interesting is that a relatively small movement of the knees has a very big effect on the hip joints, which you can feel very easily with your hands.’ If you try this out you will also notice that as you brace back your knees your tail and buttocks are pulled upwards towards your torso (in other words, you are pulling


your back in) and you stiffen your rib cage. In addition, your ankles and the arches of your feet compress and stiffen. Furthermore such a simple experiment concerned with feeling how the hip joints work are not just food for thought for Alexander teachers or trainees – they can be a revelation to students who mistakenly believe that their hip joints are positioned just below the waist.

You can read more about Marjory Barlow’s Alexander teaching techniques in Seán Carey’s new book, ‘Think More, Do Less: Improving your teaching and learning of the Alexander Technique with Marjory Barlow’, which has been written for Alexander teachers, trainees and advanced students. It is now available on HITE and through Amazon.

We know about the head but what about the feet? by Seán Carey

Standing male postureFM Alexander famously said that improved coordination comes ‘from the head downwards’. Does that mean that he neglected other parts of the body, including the feet? Definitely not. He knew from observing himself using a three-way mirror arrangement that while standing (and in motion) that as well as interfering with the balance of his head on his neck he was also making unnecessary muscular tension in his feet. In fact, he was contracting and bending his toes downwards in such a way that he was throwing his weight onto the outside of his feet, creating an arching effect, which in turn interfered with his overall balance.

Many of us will be able to identify with that or a similar type of misuse. For that reason we need to keep in mind that we do not possess the flat, extremely elastic and prehensile feet of ot
her primate species, such as apes and monkeys, which are so useful in tree climbing. In fact, one very important function of your parallel aligned toes is for balancing and feeling the ground. You can explore this by standing on one foot and then flexing your toes upwards so that none of them are in contact with the floor. It’s difficult to maintain balance, isn’t it? Your toes also play a vitally important role in locomotion. So you can also experiment with walking forward or backward with similarly upwardly-flexed toes on both feet. You will discover that this results in a tightening of your leg joints and torso and a pattern of movement which is very stiff and awkward.

The big problem is that most of us stand with too much weight on the front of the feet. However, this often goes with a pattern of general postural collapse – pulling the head down on to the neck, pulling the lower back in and stiffening the ankles, knees and hips. So if that’s what you’re doing in everyday life then you need to find a way of coming back from the pivot point of your ankle joints in such a way that the three contact points of the feet – areas around your heels, big toes and little toes – are equalised. But this is not just a matter of thinking of your feet in isolation; instead, it is a function of your general coordination. Put another way, balancing on your two feet is achieved not by ‘doing’ anything specific with your feet but by giving directions for your head, neck and back and then adding on suitable orders for your ankles, knees and hips joints and making a movement, such as walking forward, backward or sideways, so that as you move all your body’s joint surfaces are opening away from each other and your feet are releasing into the ground. As Alexander told those on his first teacher training course: ‘Everything in the body should be moving away from its nearest joint starting from the head.’

For more information read Seán Carey’s Alexander Technique in Everyday Activity: Improve how you sit, stand, walk, work and run

Available through Amazon with free P&P