Neutral spine posture is a key piece of the puzzle when working to rehabilitate pelvic floor dysfunction. It is one of the three key components of a successful rehabilitation program and probably the hardest to comply with. Why is it so hard to follow through on neutral spine posture? For those of you who work hard to find and hold optimal posture throughout your day, you are well aware that neutral spine posture is a dynamic position. It is a position of free movement and balance between full extension and flexion of all of our joints. It requires muscular control versus the locking of joints or the tension of ligaments or tendons. This begins at our knees where we don’t want our femoral condyles locked in full extension on our tibial plateau, but rather just out of full extension in a position of free movement. This dynamic position requires coordinated firing of our quadriceps, hamstrings, and calves, to provide stability to our knee joints. This position is not as easy as locking our knees, but it is so much better for the health of our knee joints as well as our posture up the chain.
Next, we can look at our pelvis. It is easiest to either allow our pelvis and lumbar spine to lock back in full extension (anterior pelvic tilt) or to rock forward, resting on the tension of our hip flexors and ligaments (posterior pelvic tilt). Either of these two positions will set us up for injury through excessive compression of our lumbar vertebrae or pelvic/hip dysfunction. Rather than locking joints, positioning of the pelvis just out of the fully extended position allows free movement of the multiple joints of our pelvis, hips, and spine. Finding your neutral spine is key to maximizing blood flow and muscular control, setting the base for your thoracic and cervical spinal building blocks. This position of free movement of your pelvis and lumbar spine is not easy. Just like our knees, it requires a coordinated effort of muscles on the front and back side to hold this dynamic position. It is the co-contraction of our multifidi muscles, our transversus abdominus, and our pelvic floor muscles that help to stabilize our lumbo-pelvic girdle, setting the base upon which the rest of our spine is stacked.
Much like everything in life – if it seems too easy, it’s probably not right. Posture certainly follows this rule. It takes an awareness of your body and consistent reminders to hold neutral spine posture. You can refer to http://www.youtube.com/user/PTPartners#p/u to see and hear the cues that will help you find your own neutral spine. Let your posture be a focus by keeping your muscles “on,” and your body in a position of free movement. It’s not easy but the benefits are worth it!
Thank you so much for all of this wonderful information.
I have read through a lot of your blog, and have a question about neutral spine. I recently saw a PT for biofeedback due to postpartum incontinence and a grade 1-1 1/2 cystocele. When holding neutral spine, am I supposed to contract/tighten my pelvic floor muscles? I feel like I do have a tightening of my pelvic floor when I contract the TA and multifidi. What I am confused about, is that the PT I saw told me that I should have my pelvic floor in a relaxed state throughout my day and only contract and tighten my TA when lifting, or doing anything that causes increased abdominal pressure. I am confused about this as I do not feel like I can hold neutral spine while keeping my pelvic floor completely relaxed.
I was told that if I tighten my pelvic floor constantly, I am setting myself up for potential problems with pelvic pain, etc. She also said this would fatigue these muscles so they would not be as strong when I needed them (coughing, sneezing, running ,etc)
Could you offer any insight on this? Is it possible to hold neutral spine while keeping my pelvic floor relaxed?
Thanks so much. (I have also been using the hab-it DVD and your advanced program–they have been so helpful!)
Your PT has a valid point…you don’t want to keep your pelvic floor contracted throughout your day or you can initiate spasms. However, when you are holding neutral spine and engaging your multifidi and TA, your pelvic floor is “engaged”. It is “turned on” but not actively contracted. Your pelvic floor is built for this endurance, postural muscle tone, so no worries. What you are doing and feeling sounds perfect. Your pelvic floor is supposed to respond with a slight increase in muscle tone when you hold neutral spine. With this increased tone, it is primed and ready to react when called upon with any sudden increase in intra-abdominal pressure.