TCM: I've Got Your Back (Protecting Your Posture)
When a patient comes into my clinic and tells me they have lower back pain, there’s a good chance I am going to look for other Kidney Deficiency signs and symptoms. When another practitioner of acupuncture and Chinese medicine comes into my clinic and tells me they have lower back pain, I’m going to ask them how their posture is while performing cupping, Gua Sha and acupuncture.
During our teenage years we are told to, '“Stand up straight!” and “Pull your shoulders back!” Sometimes I feel like yelling something similar to bodyworkers. Well, perhaps a little more specific for them, but the core of the message is the same: protect your spine.
Tai Chi and Qigong are great martial art disciplines. After 25 years of training and teaching Kung-Fu, I truly believe Tai Chi teaches two important concepts: posture and how to use our limbs correctly. Let’s start with posture which is exactly what is taught while learning to ride a horse. The ears are to be in line with the shoulders, which are to be in line with the hips and then the ankles. The shoulder blades are pulled back and down, and the elbows are to remain close to the ribs pointing downwards. There is a slight tucking in of the tailbone which can be facilitated by a slight contraction of the perineum and buttocks.
All of these characteristics of Tai Chi posture keep the spine in alignment and cause a human being to use their serratus anterior and latissimus dorsi as the primary muscles for pushing and pulling (remembering to keep the elbow down). The difference can easily be seen in opening up a jam or pickle jar. It is common for people to bring their shoulder up towards their ears and point their elbows out to the side. However, more strength can be obtained by dropping the shoulders (and elbows).
Tai Chi, because of the downward pointing elbow concept, teaches through movement how to link the hips and elbows to generate power by moving the entire body. Tai Chi posture can easily be carried into the treatment room.
Learning how to squat and deadlift with weight are just as important as learning Tai Chi. Learning how to properly squat and properly deadlift improves posture. Also, these essential movements teach us how to lift things again. Toddlers are smart. They all squat down to reach for their toys. They hip-hinge (deadlift) if the object is a little higher than the ground. Toddlers also know how to properly elongate their spines to catch something over their head. It’s the adults that fail, get lazy and start rounding their backs. Toddlers and weightlifters have lots of good body mechanics in common.
A squat and deadlift are essentially the same thing - the only thing that changes is that during a squat the knees completely bend, whereas during a deadlift the knees only bend slightly. Both movements require the hips to move back and out out of the way. In order to return to a normal standing position, the hips have to drive back underneath the torso and head. The spine remains straight and the perineum and buttocks are slightly tightened to allow for a slight pelvic tuck. There is one difference between Tai Chi and lifting: where the head is.
In Tai Chi, the hips remain underneath the head at all times, therefore the head stays centred over the shoulders and the eyes look forward. When lifting heavy objects, and due to the weight of the head, it’s recommended that the head lead the upward motion of the lift. If the head (and eyes) look down the body will follow and serious injury can occur when lifting heavy. A good example of this is found in The Snake set (Eight Pieces of Silk Qigong) where the head leads the movement.
Application in Clinic
The first thing to do after purchasing a new massage table, or if one is sharing a room with another practitioner, is to make sure the table is set up for one’s height. This will vary from practitioner to practitioner. If one feels that the table is too high for their patients, a step stool is a good thing to have tucked underneath. The table must be set up for the practitioner, not the patient, so the acupuncturist can practice pain-free for many years to come. To measure for proper table height is easy. The table should reach the fingertips.
Some acupoints, like GB31, are at hip level when needling. In these instances, squatting is a good alternative than contorting oneself in a semi-upside-down position. The same goes for cupping and Gua Sha.
There are many times when a practitioner cannot walk around a massage table (when it is placed against a wall) or when there is an element of reaching across the table regardless of where the table is in a room. Needling inner leg acupoints such as SP9 and SP6, or outer Back-Shu points such as UB47 and UB52 warrant a hip hinge. It is extremely important to guard oneself from any rounding of the back. If the back rounds to reach an acupoint it is recommended to place the thighs against the table for stability and to hinge the hips backwards for counterweight. This will ensure the spine stays straight.
Of course, there can be a combination of the two. Reaching for GB21 is a good example of a squat and a hip hinge at the same time.
Practice doesn’t end in the kwoon or gym. Just like mediation techniques are meant to exist in the real world, one can take Tai Chi and weightlifting posture into the clinic. Protect your posture your whole career through.