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Where is neutral spine and why does it matter?

Updated: Aug 19, 2019

neutral spine, physical therapy, Fairfield, CT, CFMT

The concept of neutral spine varies in different practices such as yoga, Pilates or even the way it is taught by different physical therapists. Generally, it is accepted as the natural curve of your spine. The most common definition I can find is a slight curve in the low back. Well that’s not very specific.

I propose that neutral spine is where the spine is the most stable. From another perspective the position that allows the most deep core muscles to fire will be the strongest, most stable and most efficient leading to the least likelihood of injury. So how do we find this position?

Yoga or Pilates practitioners may place a bowl on your stomach and have you tilt forward or backward to find the center of the extremes of motion but how do we know you are in a neutral spine. It is a good guess but may not work for everyone.

In Pilates there is often a debate between flat back (imprinted) and neutral spine though neutral spine is becoming more accepted. In Pilates laying on your back having the ASIS (front outside of hip bone) and pubic symphysis (pubic bone) level is another method. Anchoring the tailbone and having L2 touch the mat is another method. In standing the ASIS (front outside of hip bone) and PSIS (bone where the dimples are in your low back) are level. We are on the right track as there is some specificity.

Relax the back says neutral posture is one in which you maintain a 128-degree angle between your torso and thigh and a 133-degree angle between your hamstrings and calves. Well there are some numbers but nobody is going to carry around a protractor to measure that angle.

Enough about everyone else, lets hear what I have found to work on hundreds and hundreds of patients. I will make a few assumptions:

1. In neutral your spine stabilizer muscles are at the best length to produce the most force i.e. they work the best in that position and have less likelihood of injury (straining a muscle).

2. In neutral you facet joints will be able to take up a lot of load as they are in the “middle” position and that will unload the discs optimally. (you are less likely to herniate a disc).

3. The system is in balance, move too far out of this position and you will either injure the muscle, joint or disc.

What I use is a percentage of pelvic tilt and perform a muscle test to find your individual “number” for how much tilt puts you in the most stable position. So instead of trying 4 different ways we have a definitive way that can identify your individual neutral and how to repeatably find it. The average person will be in the 40-60% range and your chronic over-tilters may need 20-30%. A weak and older person with stenosis (narrowing of the space where nerves exit) may need 60-70%. So there you have it a fool proof way of finding pelvic neutral. We can use this same method to find out where neck neutral is and ribcage/thoracic neutral.

I find that often women or men that have pain with yoga or Pilates are simply trying too hard to force a position that they shouldn’t be in and we have to teach them where their true neutral is. We teach a relaxed and stacked form of posture not forced posture. As with forced posture you will get tired eventually and fall into worse posture.

Another important part of neutral spine is ribcage position, you can be in pelvic neutral but not thoracic neutral. We will cover this and review breathing mechanics in a future article.

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