Gluteal Amnesia Linked to Chronic Low Back Pain

“Gluteal Amnesia and Other Perils of Posterior Chain De-Activation” by David Quinlan

As I write this, I am shortening my hip flexor and hamstring muscles, weakening my spinal ligaments, inhibiting neural function in the muscles that stabilize the spine, putting the entire posterior chain (hamstrings, glutes, perispinals) in effect, to sleep, and heading down the road to disc degeneration – all of this by the simple act of sitting. It seems to be an innocent activity, but there are three major problems associated with sitting:

  1. We do too much of it
  2. We often do it with poor posture
  3. The motor patterns it creates become self-sustaining.

Most of us sit when we work at our desks, eat, drive, surf the web, relax, read, study, watch TV, go to the movies, tweet, mow the lawn, socialize, and often even during exercise (seated row, seated cable pulls, seated military press), and so on and on. The sitting position, even with good posture, shortens and stiffens the hamstrings and hip flexors, while lengthening and weakening the the gluteals and perispinals. According to spine expert Stuart McGill (“Low-Back Disorders…”2007), prolonged compression of the glut’s inhibits their ability to activate when needed as prime movers for hip extension (“gluteal amnesia”). This creates an imbalance in the body’s structure and function, which can lead to injury or impaired performance.

So it’s bad enough that we often sit for 6 to 12 hours a day, but we do additional damage by the way that we sit. Typically we slouch forward, which has been shown to weaken the ligaments on the posterior spine. The weaker these ligaments, the harder the spine-supporting muscles have to work to keep a neutral posture. The trouble is that slouching has been shown to inhibit the function of the nerves that activate those muscles. Thus the slouching becomes a self-sustaining destructive habit. In addition, research has shown that prolonged spinal flexion (bending forward) de-sensitizes the nerves that signal lower-back pain, thus making that posture feel better, even while it is damaging spinal integrity. (source: Dr Jeff Anderson, “Fundamental Mechanics Relating to Back, Hip, and Knee” -lecture 6/4/10)

So get up and take a walk! Go to the gym! Reverse the damage done by all that slouching. Sorry, but its not that simple. If you are a prolonged sitter, even one with good posture, your hip flexors (the muscles that bring your knees up or cause you to bend forward at the waist) are shorter and stronger than your glutes. So, without conscious activation of the glutes and elongation of the hip flexors, your body will simply learn to walk (or run on the treadmill, or sit on the bike) in the dysfunctional posture of a sitter – slightly bent forward at the waist, and with a short stride – keeping the hip joints and spine in their most comfortable adapted position. Once again, this can lead to diminished performance – not only in athletic pursuits, but in the crucial daily activities of life – and to injury.

Many common abdominal exercises contribute to the problem. Most variations of crunches, sit-ups, and leg-lifts tend to tilt the pelvis and shorten the hip flexors in the same way that sitting does. Most of the typical hamstring stretches simply create a more extreme version of the dysfunctional motor patterns of sitting. While these exercises are physically demanding and have some benefits, and may even feel good due to endorphin release and neural inhibition, they are accelerating many of the classic problems caused by sitting. (Anderson)

Ah, but we martial artists take part in an activity that is such a complete physical training regimen for flexibility, strength, and endurance, that we don’t have to worry about these issues. Wrong again. Simply put, do we work the back of the body as much as we work the front? Do we do some form of pull-up for every pushup we do? Do we throw a back-kick for every front-kick? Do we perform a back extension for every crunch? Do we throw a back-fist or reverse elbow back behind us for every strike we throw forward? Not even close. So not only do we sit for hours every day, but then we go to the gym or the dojo to work out and spend hours, weeks, years, strengthening the same dysfunctions that we create all day by sitting.

So why aren’t we falling apart? The truth is that we are. We are suffering a national epidemic of back pain. 85 % of adults develop degenerative disc disease by age 50, back pain is the number one cause of missed playing time for athletes, and, significantly, athletes have a higher incidence of disc degeneration and injury than the general population (Anderson). So we are all destroying our spinal health, but athletes (and, I assume, martial artists – Anderson does not specify what is meant by “athletes”, ) are doing it faster than most. Let’s hear it for us over-achievers.

If you are relatively young and in great shape, this may not seem relevant to you. But dysfunctional motor patterns may exist, though well-compensated for by your youth and physical condition. In other words, not only might you be doing lasting damage to your spine, you might also be performing, as an athlete or martial artist, at a significantly lower level than you could be. Many top-level sports trainers have stories about world-class athletes who can compensate so well for their various imbalances, that they are dominant in their sport. That is, until an injury related to the imbalance ends their career. Or, the happier ending, a qualified trainer helps re-habilitate their movement.

What can we do about it? Sit less, and with better form (your mother was right, don’t slouch!). Try to sit on your ischial tuberosities – your sit bones, and not your tailbone. Keep the lower back curved forward, away from your seat-back, with your chest high and shoulders down and back. Use a lumbar support cushion if needed, but try to develop the muscle strength and motor memory of good posture, so you don’t need the cushion. Take frequent breaks, and us them to activate the posterior chain and elongate the anterior. In simplest terms, relax and elongate the muscles on the front of the body and contract those on the back. (An exception to this is the hamstrings, which are located on the back of the legs. They should be elongated, and the opposing muscles, the quads, should be contracted). Start your workouts with some type of posterior chain activation exercise, to “wake up” the glutes and back muscles. Before a Kempo workout, doing slow back-kicks, holding the extension, with hands pulled far back in chambered position can do this.

When sitting at a desk for a long period of time, try the following routine: Start with the ‘take-a-knee’ position: rotate about 30 degrees to your left and put you right knee on or toward the floor. Tighten the glutes and press the hips forward, keeping shoulders back over hips. Do this for a minute or two and then switch sides. Then go back to sitting, but extend one leg forward, knee extended, and rest on the heel. Periodically clench the quads (front thigh muscles), which helps elongate the hamstrings. Alternate legs. This can be done discretely in a cubicle or office, and it is easy to do while typing, reading, or talking on the phone.

When driving long distances, stop and take a break when possible, and go for a walk. Posterior chain activation begins as you step out of the car: weight on the heel, drive hips forward as you stand up. Walk with head and chest up, hips forward, and take a long stride, which helps activate the glutes and stretch the hip flexors.

The practice of yoga includes many excellent exercises for this, and the kettlebell swing, if done properly, will help as well. An internet search will reveal a lot of information, much of it possibly accurate.

Any resemblance between this article and a scholarly, well-resaerched report of findings by a qualified health professional is highly unlikely. But the conventional wisdom regarding exercise, posture, and spinal health is changing. Proper motor function leads to more efficient, powerful, and safe movement. For those who have suffered back pain, it is imperative to remain as well-informed as possible, in order to try and minimize further damage, and allow for healing to occur. For those who have yet to experience back pain, consider an ounce of prevention. • Martial Way Self Defense Center

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