The Evolution of Low Back Pain by John Gorman

The Evolution of Low Back Pain by John Gorman.

I first became aware of John Gorman when he wrote an article for The Alexander Review. He was an engineer who had had a number of Alexander lessons and wanted to share his insights on how the spine worked. Afterwards, I recognised his name in connection with chairs and back supports he was marketing.

Much later, a pupil of mine said she had visited a chiropractor whose main piece of advice was that she should slump more. This confused her since I appeared to have always maintained the opposite. The chiropractor’s name was John Gorman. Then I saw an advertisement for “The Evolution of Lower Back Pain” in STATNEWS and learned that his engineer’s interest in the spine had caused him to train in McTimoney Chiropractic.

Initially, I found his ideas hard to grasp but put that down to a general disinterest in mechanics. Then I realised it wasn’t that I was being obtuse; my difficultly was in accepting a theory diametrically opposed to what I believed.

By the time I finished the book I was in much less doubt about the validity of his arguments. Now, months later, although an element of scepticism remains, I think his ideas should at least be considered by anyone interested in how the spine works and what might, or might not, be done to enable it to function better.

I came to the Alexander Technique with a bad back and have been trying to find out more about it ever since. Books, even Alexander books nowadays, give the sort of generalised advice for good use everyone is familiar with. The benefits of maintaining an upright posture, especially when sitting, are so widely recognised that the human tendency to fall short of this ideal is assumed to lie behind most back problems.

John Gorman agrees that our way of sitting is the main culprit, but he thinks the more we attempt to put it right by “sitting well”, the less good we will do ourselves. As he says, “It is when we are sitting relatively upright that the mechanical situation is worst”.

He explains how the two lowest discs of the spine are naturally wedge-shaped (the thick end of the wedge faces forwards) and how they should not be forced beyond parallel sidedness, otherwise two things may result. The first is a warning pain. The second is a tendency for muscles in other areas of the back to go into spasm, causing “clamped joints”. Undoing clamped joints forms the basis of his work.

He recommends trying to maintain the wedge shape of these discs at all times, since, as he says, “Even when the pain level is very low, (only a slight ‘feeling’), the warning pain can still turn on clamped joints”. Little mention is made of any activity other than sitting that can cause this, but the implication is we become progressively less tolerant of general misuse the more our two lowest discs are subjected to sustained, undue flexion. Much of his book is spent explaining why it is virtually impossible to sit in an ordinary way without this occurring.

The problem is due to the tendency of the pelvis, when relaxed, to tilt backwards. His engineer’s answer is to use specially designed chairs which ensure the alignment of the lower vertebrae by providing pelvic support. Similar props are also available for use in a car. Where such devices are impractical, such as at a meal table or desk, he suggests dispensing with a backrest altogether and adopting the muscular balance of what he calls “Alexander Sitting”.

The alternative solution is for us to slump. As John Gorman puts it, “When we do sit slumped all the joints of the spine will be flexed and all muscles and ligaments will tend to be stretched to a natural length.” Somewhat surprisingly, he also says, “For most people slumped sitting will actually have to be learned. We are so used to trying to ‘sit up straight’ that most people cannot easily sit slumped”.

He relates this to sitting on a conference room or dining chair. “If the pelvis is placed sufficiently far forwards to produce a complete slouch it is a satisfactory sitting position and much better than sitting up against the backrest of such a chair as we are normally told to do.”

Clearly, most forms of sitting involve positioning ourselves reasonably far back in a seat and then leaning against the available support. But unless we are prepared to stiffen muscularly in order to prevent it, our pelvis will usually tilt backwards, putting pressure on the front of our lowest vertebra and causing a levelling of the two wedge-shaped discs.

John Gorman estimates that during such sitting, with the pelvis tilted back by about 40 degrees, there will be approximately 20 degrees of flexion in the two lowest joints of the spine and little anywhere else. He compares this with slouching on a settee, where the pelvic tilt will be greater at 60 degrees, and the back will appear much more bent, but because the flexion is spread evenly over all eighteen joints, individually it will be only about 3 degrees. In this way, the wedge shape of the two lowest discs can be maintained.

Needless to say, slumping is recommended only as a natural part of sitting and not of any other activity such as standing or walking. John Gorman’s use of the word “natural” is interesting here, since he poses the question, “Why don’t more naturally living people have the same problems?” His answer is simple: uncivilised people don’t sit, they slump.

It’s difficult to know where to look for evidence of this. Slumping and slouching are hard to define, anyway; but the diagrams in his book do show an alignment of the spine similar to that of a deep squat. Squatting is incontestably natural, and a position of repose for half the human race. Perhaps we should be looking at slumping as an inferior, but easier to achieve, version of this.

Understanding a mechanical theory is one thing; accepting it as an idea is another; but translating that into practice, in order to verify it, is virtually impossible when you can neither see, nor feel with any precision, what is going on.

Certainly, my pelvis tilts backwards whenever I sit and lean against the support of anything but a very straight backed chair; this is especially so in a car; but I can’t begin to say what happens to my wedge-shaped lower discs. I do get “feelings” in my lower back from time to time, but I don’t know it these are warnings of an impending clamped joint. So whether it is better for my spine, and for me, to spend lengthy periods fully flexed in a slump, or flexed at one end only while sitting upright, is unclear. Perhaps my sensory appreciation requires more intensive re-education, or more of a suspension of traditional Alexandrian belief than I am ready for.

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