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Christine Ackers
A discourse on the practice of wearing
orthotic insoles in shoes as a means if remedying poor
posture
Putting remedial arch supports in children’s
shoes as a means of correcting common postural defects,
such as flat feet or hyper-extended knees, is both inappropriate
and harmful. The inserts appear to be effective; but
meaningful orthosis is not achieved, and the price paid
for the apparent remedying of the problem has far-reaching
destructive consequences.
Body shape is organised as a whole; so when it has
become distorted - usually through bad habits of use
- it can only therefore be restored as a whole, by changing
those bad habits into good habits. Dropped arches, sore
knees or round shoulders cannot occur in isolation,
but are merely the more readily observable features
of overall poor shape and mal-coordination.
Posture as such cannot be corrected. The character
of a posture can be changed. The character of a posture
is created by the person’s manner of use - the
way the body parts are held in relation to one another,
and the muscular arrangement in which the whole self
musters force for action. Sitting is a posture. The
way you sit - whether in a collapsed over-relaxed shape;
or in a tightened down shape; or in an opened out, lengthened
and widened shape; or in an over-lengthened and narrowed
and stiffened
shape - gives the character of your sitting posture.
Good use
As two- year-old Roger Chen investigates his environment
he adopts several postures. He reaches up, leans forward
and around, reaches out, turns to look at Mum, holds
his toy in his lap - and in each posture the lengthened
out shape of his trunk is maintained as a constant.
The parts of his body not required for a particular
action remain free - his legs while he’s sitting,
his arms while his mother holds the bottle for him to
suck. His legs don’t need to be crossed over one
another to help him stay balanced in sitting; his arms
are not being held tensely while he’s not using
them. His overall shape is kept open throughout the
flow of movements, so that in whatever he does the safety
and well-being of his whole body is being taken care
of. His manner of use is good, giving good shapes or
what we perceive as "good posture".
Good shapes promote good function, that is: a gentle
action of the parts on one another; a sharing of loads
over the larger muscles and bones that are designed
for weight bearing; no excessive stressing of the joints;
and - in accordance with the principle of energy efficiency
- a state of maximum lightness achieved with minimal
effort. We see that Roger inhabits his body lightly
and comfortably. He enjoys being alive.
Some activities put greater demand on co-ordination
mechanisms
The body coordinates as a whole. The exacting degree
of individuation needed for fingers to manipulate a
dental drill in another person’s mouth is dependent
upon the integration and stability of the dentist’s
whole body, and especially on his ability to prevent
activity in parts not directly engaged in the procedure.
He needs to bring his eyes and hands close enough for
fine work at a variety of
angles, often maintaining a particular posture for some
time. His arms and head need to support hands and eyes
in a way that ensures that there is no wobbling, no
missing the mark. Part of this intricate operation of
balance and co-ordination entails preventing his legs
from jumping about while this is going on. His breathing
needs to continue throughout painstaking detailed work
without allowing the
movements of his ribcage to throw his fingers off track.
This complex of co-ordination, requiring constant miniscule
adjustment of the masses and weights of innervated body
parts, takes place automatically, outside of his awareness.
However, the quality - or character - of this process
can be
influenc ed consciously by his paying attention to his
manner of use in the situation. Clumsiness is less likely
to occur in a person who is neither too tense nor too
slack.
Coordination disadvantage
As a normal baby grows, his nervous system gets better
at individuating parts from the whole, better at moving
one part at a time, and leaving the parts that are not
being used acting minimally in support of the specific
movement so that energy is not wasted. At three months
when he smiles at you he flaps his arms and kicks his
legs at the same time. It's delightful to see. When
we see the expression of such wholesome pleasure in
a twelve-year-old we recognise at once that there is
something different going on. We do not expect a more
mature body to have difficulty in keeping some parts
still. It means that the person’s mechanisms are
not working optimally, they are energy inefficient.
For that person coordination is a struggle, hard work.
He needs help to get the best out of his body.
Exercise can be harmful
When instead of sticking a hypodermic in someone’s
mouth you decide to go for a game of squash, you are
not caring for the other person now but it is still
important for you to ensure the safe integration of
all the parts of yourself. If every time you thwack
the ball you jam your skull down obliquely on your atlanto-occipital
joint, you are not doing yourself as much good as the
frequently recommended taking of exercise would lead
you to believe. There is more to exercising than simply
contracting as many muscles as possible as hard as possible.
You need to ensure that appropriate muscle groups are
being exercised. You need to be well co-ordinated if
the game is going to be good for you and not do you
harm. You need to know what you are doing.
Everyday activity can be harmful
A person’s musculature can be so badly organised
that each time she rises from a chair she thumps herself
in the stomach and in the lumbar spine. Every click
on a mouse may simultaneously be a violent attack on
the delicate structure of her neck. It makes sense for
her to be skilled in using an individuated finger on
the end of a well-sprung arm and shoulder, and to be
accomplished in leaving her neck out of it. She needs
to be able to respond with appropriate strength and
mechanical advantage for the economical requirements
of an action, and to return from various positions and
postures to an easy poise, relaxed and alert, ready
for the next action.
When she uses herself inefficiently there is no return
to an opened out shape after a specific movement.
A milder version of the poor shape she adopted remains
after the action is finished. Gradually the normal shape
of a person becomes moulded by her habitual patterns
of use. If every time she sits down she flexes too much
- that is: she tightens herself down in front; drags
her cervical spine forward jamming her head back on
her neck; her thigh muscles over-contract in taking
too much of the responsibility for seeing her safely
into the chair; and her knees pull together putting
extra strain on her lumbar spine; - then this particular
arrangement of body parts that she habitually employs
will determine the character of her posture. When it
occurs in children we call it "bad posture"
because its more obvious features will include flat
feet, round or raised shoulders and sway back. In adults
it will be associated with a variety of spinal and limb
injuries and ailments ranging from neck to lumbar spine,
shoulders, knees, elbows, hands, feet and tempero- mandibular
joints. Yet we fail to make the connection with her
"bad posture" because those shapes we associate
with the adult form are normal! Adult bodies look strange
to us when the character of their posture gives them
an opened out shape. Yet most of us used to have bodies
like Roger’s. I hope his father and mother will
help him to keep his good use for life.
Seeking solutions
Some parents do notice their children have bad posture
before the onset of painful knees or random neck spasm.
They may be recommended remedial shoe implants. This
appears to answer the problem initially, but the habits
of use that are cultivated by means of these prosthetics
will only supplant one set of damaging postural habits
with another.
Wholeness and complexity and special posture senses
Posture is dynamic, an activity of nerve and muscle
organised in the brain to be in constant process while
we are alive even while we hold very still for having
a photo taken or for balancing on one toe. We know that
ordinary activities like feeding and walking are organised
in specific brain centres and are carried out by multiple
reflexes and other neurological processes operating
muscle which acts on the skeleton. The information flowing
betwixt and between and to and from ourselves - ourselves
in action, ourselves at rest, our inner selves, ourselves
and our environment - is enormous. Not least of the
constantly active reflex activities are the postural
maintenance mechanisms that keep us upright. As well
as depending on a certain relationing of the parts for
the activation of some of these reflexes, the process
also involves using information from our senses. The
vestibular apparatus of the inner ear and
the specialised function of the soleus muscles, that
lie directly beneath the calf muscles, keep the brain
informed from instant to instant about our state of
balance. Toes help too as they are sensitive to weight
distribution and they are individuated, separated so
they can make tiny individual adjustments.
If you close your eyes while standing you can feel
your soleus muscles and your toes twiddling and twitching
as you sway slightly. Swaying is a component of balance
as balance must continually be being adjusted. If it
is not being lost and regained it is not a state of
balance, it is a fixed state. If your legs are tightly
gripped you will not be able to feel so much of this
balancing process. Some of the activity will not be
going on because muscle that is held constantly too
tense loses its sensitivity. Feedback from specialised
fibres within the muscle mass falls silent when the
muscle is overcontracted. The further our use deteriorates,
the less information we receive about our state of muscular
wellness. We become less aware of the compensatory wrong
muscle activity that is engaged when there is a shortfall
of muscle tone where it is needed. If the erector spinae
- the muscles that straighten the spine - are not working
adequately, other muscle groups will be dragooned from
their proper function
into helping hold us upright. They will have to contract
harder than is appropriate to the ir design in order
to accomplish what has to be done - whether that is
to run us rapidly out of the way of a heavy moving object,
or to keep our eyes glued to a screen. When our toes
and legs are gripped, the delicate responsiveness of
the soleus muscle is diminished and the recti abdominis
muscles are improperly
deployed in helping to stop us from falling over. When
a person’s overall use has deteriorated, when
she is flexing too much and tightening down in front,
her shape is distorted and becomes harder to balance.
Her toes are bound to stiffen as part of the overall
need to stop her from toppling over. Toes are sense
organs, they are supposed to remain soft and feeling.
When they are subjected to constant excessive tension
they lose their responsiveness, so that parts normally
acting in relationship with them are deprived of important
information. Problems also develop in the feet because
gripping toes distort the natural lie of the foot. Feet
are also sense organs, equipped to interpret the texture,
cant and stability of what they are treading on. To
function well, feet and toes need gentle stimulation
from the continual performance of their sensing job.
Under well-sprung lengthened out legs and torso they
are able to respond with delicate precision to the toppling
and swaying above. They help keep the head balanced
and free.
The body’s response to orthotic devices worn in
shoes
Gripped toes twist and tilt the feet; feet that are
tilted and turned make the toes grip. This is going
on all the time as an appropriate response to our stepping
on variously angled and textured surfaces. But it is
a response to a temporary situation, and a frequent
return to standing on the whole foot on an even surface
is a normal part of that response. When an orthotic
appliance is placed in the shoe we are held off balance
permanently, forcing the toes into perpetual crisis
mode. They try to counteract the legs’ being thrust
out from under the hip sockets by putting a lock on
the feet. A state of simulated bandyleggedness is induced,
which the body tries to deal with by making corrective
adjustments all the way up through the pelvis and trunk
to the neck and head. It is an unavoidable syndrome
of compensatory tightening because the ankle joint can
only flex the foot into positions of plantar- flexion
or dorsiflexion.
It can only move the foot up and down to point the toes
or to pull the toes upwards to stretch the back of the
leg. It cannot move sideways; so when the foot is inverted
and supinated, that is when the soles are turned to
face one another by means of objects placed underneath
their inner edges, the leg bone at the top end of the
ankle joint is pushed over sideways and is forced to
rotate at the knee and in the hip joint, making adjustments
of muscle contraction imperative all the way up the
body. As the knee is flexed slightly and rotated outwards
the hamstring muscles are tugged so they stiffen. As
the hamstrings contract, they pull on the pelvis where
they are attached to the sitting bones at the bottom
of
the pelvis. This pulls the pelvis back and down which
makes the abdominal muscles which are attached to the
front of the pelvis at the pubic bone, contract also
- partly in reflex response to the movement of the pelvis
and partly in response to the need to restore overall
balance.
Structural, sensory and functional requirements for
good use
Try supinating your feet (standing on their outer
edges) and leaving your stomach muscles relaxed. It’s
hard to balance. As the pelvis is drawn back and down,
the lumbar spine flattens which subdues the responsiveness
of the multifidus muscles. The tiny multifidus muscles
straddle the vertebral joints obliquely so that as they
contract they pull each vertebra into line, straightening
out the spinal curves a bit. They form part of the erector
spinae group, and their job is to maintain posture,
keep us upright. They need constant gentle stimulation
to retain their responsiveness. The spinal curves need
to be maintained through good use at degrees of intensity
that are somewhere in the middle of too little or too
much. "Somewhere-in-the- middle" is a place
that is difficult for the laboratory technician to get
a hold of but it is easily recognisable by an Alexander
Technique teacher by the feel of the whole body he has
his hands on because, when the multifidus muscles are
doing their job, the whole body responds with an increase
in stature. It visibly and palpably lengthens and widens.
When there is either too much or too little curvature
in the lumbar spine this opening out and enlarging will
not be happening. The person will be slumped down and
will have a lifeless feel, a lack of springing, a lack
of muscle tone; or, - as is the case when her feet are
supinated - she will be fixed and not springy, from
making too much muscle contraction. Within the same
scenario, the shortened recti abdominis also pull the
front of the chest down, diminishing the breathing capacity
and increasing the curvature of the thoracic spine;
the cervical spine is drawn forward so that balance
of the head on the neck is made impossible.
Quadrupeds and bipeds
A four- legged creature is more stable than we bipeds
but he still needs to hold himself off the ground. He
has shorter legs positioned under four corners of his
trunk giving him a broader base than ours is, relative
to height, making balance easier. But he still needs
to hold himself up to move along the ground. Living
in air requires this, unless you pull along the ground
by contracting along one side and then the other as
snakes do, or you invest in mechanisms that make leaping
or jumping the energy efficient option. Fish don’t
have a problem with holding themselves up as they are
supported by their medium. We have special problems
because we stand particularly tall on our narrow base,
precariously balanced on only two of our limbs. Long
and thin, we must hold ourselves erect without becoming
exhausted in the process. Fortunately we are designed
so that this holding upright takes place with least
expenditure of energy - provided that we don’t
spoil the delicate mechanisms that subtly effect it
for us.
Relaxation is an oversimplification of our needs
Although the holding upright does itself, is automatic,
it nevertheless requires a great deal of muscle contraction.
An unconscious person lying on the ground is arbitrarily
shaped, just prevented from falling apart by the ligament
and connective tissue and muscle wrapped around her
bones. When she wakes and begins to get up she’ll
need to gather some tension, perhaps by stretching out.
She doesn’t need to know which muscles to contract
because that’s taken care of by co-ordination
programming centres in her brain. As she gets to her
feet, it doesn’t make sense to exhort her at this
moment to "Relax!" It would be more helpful
to suggest she draw herself up to her fullest stature.
We can also urge her to guard against fixing down into
her hips, locking herself down. We can help her to stand
up and ensure that only the postural maintenance musculature
is engaged, the least and best that she needs for standing.
She hasn’t decided yet what she’s going
to do. She’s in a state of suspended action, she’s
remaining free, inhibiting unnecessary muscle contraction
while remaining ready to move quickly once she’s
decided where to go.
But making too much tension is not quite it either
Try getting up from the floor without contracting
muscle. You’ll discover it’s not possible.
Once you are upright, grip yourself tightly, make too
much tension, make your legs rigid and try to take a
step.
You’ll notice that you have to release something
to move. You won’t know exactly what you had to
release; that will be taken care of by your brain. Our
nervous system operates a rippling mix of contraction
and release. Sometimes there’s a less than optimal
balance of ingredients in the mixture: we
may be contracting or releasing some parts too much,
or other parts may be contracting and releasing too
little. We can help the organising centres produce the
best mix by consciously intervening, by inhibiting our
harmful habits of use so the centres are free to arrange
best co-ordination for us.
Prevention of the wrong thing from happening is fundamental
to the process of learning how to use
ourselves well.
Education in use of the self is needed
Prevention is the sine qua non of postural re-education.
Getting our bodies to do this thing or that from commonplace
exhortations to "sit up straight", "push
your shoulders back", "tuck your tail down",
or "pull your tummy in", to the more insidious
inducements by means of harnesses, braces, orthotics
and ergono mic furniture only damages the apparatus
further, making the restoration of poise ever more elusive.
Illusory benefits of wearing orthotics
Orthotics induce a tightened down holding pattern
on the body which appears to improve posture. A person
who has developed bad habits of use, shows a postural
syndrome of pulling or collapsing down which will include
pushing the knees too far back and flattening the arches
of the feet. We see that what is required is that the
knees must not be hyper-extended because this means
the weight they are carrying will be falling on the
wrong part of the joint; and Nature lets us know this
is not satisfactory because they start to hurt. The
foot has spread out, it is no longer forming a springy
arch to help distribute weight and protect bones and
joints from stress. So it would seem logical to recreate
an arch by raising the collapsed part with a prosthesis.
We observe that muscle contracts when the orthotic is
in place, and since we know that one of the features
a foot with dropped arches lacks is tone in the muscle
and strength in the ligaments, it would seem to be a
good thing to induce the foot to use more muscle contraction.
At the same time we observe that the tug on the pelvis
from the hamstrings flexing the knees, gets rid of the
sway back and the slack tummy all in one.
A short view is unsatisfactory
But we do not see far enough. The design of the human
body is not as straightforward as that. The apparent
improvements will have been arrived at by forcing and
fixing, and in the process one of the vital features
of our structure will have been sacrificed, that is,
its springing. We will have cancelled out components
of lightness and balance, and find ourselves even further
from the attainment of true poise. Springing is energy
saving, it lends lightness and moveability. When we
tighten ourselves down we lose it. The ecology of the
operation has not been brought into the equation.
The actual result of wearing orthotics
When remedial appliances are worn in shoes the body
weight is no longer distributed on the proper six points
of the feet but is thrown onto the fleshy sides of the
feet and onto the heels at an angle.
Recreation of the arches is achieved by inverting and
supinating the feet, forcing the heels to tilt and twist
away from one another, and making the toes hold on tight.
The knees are put under even greater strain by being
rotated and adducted too far as they are drawn into
the conflict of over-contracting musculature.
Learning takes time
If body shaping is to be improved the long axis of
the body must remain free to respond economically and
ecologically to the requirements of movement and balance.
It must not be fixed, but must be capable of safely
deploying strength, speed, and agility when called on.
Piecemeal intervention without reference to the relationing
of the parts and their co-ordinating functions damages
the whole. Once you stand a child on a permanently distorted
surface, habits of gripping and pulling down will become
entrenched. Further deterioration of her sensory and
proprioceptive apparatus will follow.
The solution to common aches, pains and malfunctions
such as the inability to sit upright or stand without
hurting, lies in re-education of the person’s
manner of use. We must take the time that learning takes
to address this problem of epidemic proportions.
The need for lessons in the Alexander Technique
The study of structure and function in human movement
demands more than the skilful assemblage of esoteric
nomenclature and the regurgitation of established views
and procedures for the purpose of passing exams. The
larger part of knowledge derives from familiarity with
the material gained through plenty of hands-on work.
The more-or-less, somewhere-in-the- middle nature of
ourselves does not lend
itself to the kind of experiment that is readily set
up in a lab. But as our findings are repeated through
experience, our resource of knowledge grows significantly
and should not be discounted.
The assessment of a person’s use is made by
a teacher of the Alexander Technique largely with his
hands, in the same way as a judgement of musicality
in a pianist is made with a musician’s ear. Hands
and ears are instruments of our sensory apparatus whose
potentiality can be developed by training.
Acknowledgements:
These comments are made from my
35 years experience as a teacher of the Alexander Technique.
Thanks to David Garlick for editorial
advice, and to Bradley Newman who wore orthotics for
a week as an aid to our research.
Drawings by Jing Sheng Wang (02)
9872-7958
© Christine Ackers 1999
www.ate.org.au
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