Monday, 11 December 2017

Why neutral?

 Why do Pilates teachers always talk about neutral?   What does it mean and is it important?

Well, neutral can relate to almost all of our body alignment, such as feet, head, rib-cage, pelvis and spine.   And like a car being in neutral gear, it means a position from which we can best move from.  Our muscles are neither shortened nor lengthened.   Our joints are in position for optimal movement and stability with minimal friction.

So, let's just take one part of the body - the pelvis and lumbar spine.  The image on the left shows a neutral pelvis with bony landmarks labelled.

The three pelvic images below and to the left represent neutral as well as anterior and posterior pelvic tilt.

The arrows show the direction of the pelvic tilt.  The relative position of the ASIS (Anterior Superior Iliac Spine), pubic bone (pubic joint) and the hip joint can also be seen.

So, how to know if we are in neutral here or not?   There are several ways to assess pelvic alignment, but there's no gold standard measurement and everyone's neutral will be slightly different as our bodies are unique.

One method is line up the ASIS bones and the pubic bone.    This is most easily felt when we lie on our back, with legs bent.   If the bones feel fairly level on the front of the pelvis and we have a gentle upward curve in the lumbar spine - we're in a neutral position, or working towards one.

In contrast, if, when we lie down, the lower back is flat on the floor and we can't slide fingers under the lower back, then we're in a posterior pelvic tilt.   We may also feel the pubic bone is higher than the ASIS bones.

So, is it important to be neutral?   Have a look at the five following advantages to a neutral pelvis (as compared to a posterior tilt).

1. Muscles
In neutral, our muscles are in mid-range.  Take the gluteal muscles; they are neither stretched nor contracted.  They are ready to work.  However, in a posterior tilt, glutes will be at a disadvantage.  They may well feel tight because they are gripping to hold the pelvis in this position, but they won't be strong muscles.

Similarly, studies of the deep, postural muscles in neutral alignment show higher activity levels.  In a posterior pelvic tilt, the deepest abdominals and pelvic floor are less active.  This means we're less stable in this alignment.

2. Joints
In neutral, our joints are also ready to move.  For example, the hip joint is free to move with a low likelihood of friction and therefore damage.  In contrast, in a posterior pelvic tilt, the head of the femur will be pushed forward in its socket and therefore friction and damage to the joint are more likely.  Hip movement is also likely to be restricted.

In neutral lumbar alignment, the discs, vertebrae, ligaments and muscles are all in an optimal position for movement, stability and shock absorption.   In a posterior tilt, the lumbar spine is flattened meaning the discs are more likely to be damaged because of the forward compression when combined with loading of our body weight.

3.  Bone alignment
In neutral pelvis, the pubic joint and the sitting bones are in place to take the weight of pelvic and abdominal organs.  In a posterior pelvic tilt, the bones are in a different position meaning the pelvic floor muscles and fascia have to help take the weight of the organs instead.  This is one risk factor for pelvic organ prolapse.

4.  Muscle balance
If all of the body is well aligned, muscle balance should be optimal.  This means muscles will be in mid-range, neither lengthened or shortened.   But in a posterior tilt, there is an effect above and below the pelvis on other connecting muscles.   For instance, hamstrings, which attach to the sitting bones, will be shortened.

5.  Intra-abdominal pressure
The diaphragm increases this pressure as we breathe.  With neutral rib-cage and pelvic alignment, this helps to stabilise us.  However, if the alignment isn't neutral, the effects of this pressure can change.  
A posterior tilt can create an altered and upward pressure on the abdominal organs moving the guts closer to the diaphragm and increasing the risk of a hiatal hernia.

So, these are some of the reasons that Pilates teachers encourage neutral alignment.

Body awareness is a big factor here as many of us are unaware of our alignment, Pilates teachers included!

For the posterior pelvic tilt, it tends to come from a gluteal gripping pattern.   This may have started during pregnancy as a way to stabilise or it might be a result of sport or dance training.   Alternatively, we might do it more consciously as a way of flattening the lower abdomen to feel slimmer.

Whatever the reason, it's worth releasing the hips and working on the gluteal gripping to gain the benefits of neutral!