“It’s not the LIFTING, it’s the LEANING”, said Anne Lenert RN. At that time she comprised twenty years’ worth of forcibly retired nursing skills. She said, “Lifting is a consciously-planned operation into which much thought and experience has been put. But leaning over beds is what you do all day long. It damaged my back, wore it out.”
She was told she would never be fit to return to work. But Anne trained as a teacher of the Alexander Technique (ATE). As such, she has become an accomplished leaner, putting more thought into this crucial aspect of her job, so that now no occupation threatens her physical well-being.
She knew intimately what her problem was in leaning over her patients. She was tilting her body forward from the hips, to reach across and down to her patients. Having lost her infant skill of redistributing her body weight efficiently in bending, she would lean across the beds and hold-on- for-dear-life, over-contracting her muscles, straining her joints, even stretching the tough protective walls of her spinal discs – all this on a daily basis as she did her normal rounds. It was the same when she got home and leaned some more over the cooker, the workbench, and the sink; and at the weekend while shampoo-ing the family’s long-haired guinea-pig in a bucket. The constant in this variety of activities was her poor balance.
We say a body is ‘in balance’ where it needs to make the least effort to hold itself upright. When it leans, it moves ‘out of balance’. Leaning is what I’m doing when I hold an arm away from my torso to reach the keyboard or the butter. Extreme leaning is taking place when Anne has to reach so far across her patients that she would fall if she weren’t constrained by the edge of the bed. If she had retained the habit of bending her knees while leaning she would have been a bit better off. There would have been better counter-balance within the shaping of her body to the task. But knee-bending is not in itself the answer. For example, football coaches have eliminated squats from their training programmes because their way of bending was damaging the players’ knees even before getting onto the pitch.
Countering the imbalance in leaning is automatic. Each time you move an arm out sideways your weight must shift a little in the opposite direction. We see that all movement produces reaction in response to action. What we also need to observe is that this response can be performed efficiently or inefficiently – that is, it can benefit the body overall, or it can damage it – depending on how it is done.
A body is leaning efficiently when it opens into a lengthened and widened shape in response to the initiation of movement. We call it poor or inefficient leaning when the body narrows and shortens into a tightened and pulled-down shape. However it is done, imbalance must be countered in order to prevent falling. Thank goodness this takes place automatically and out of our awareness. The ins and outs of the business are too many for the conscious mind to deal with in process. But what we can be aware of while we are off balance – or leaning – is whether we are lengthening or shortening to counterbalance. In Alexander Technique language, when we lengthen up we say we are using ourselves well; and when we shorten down we say our use is poor.
Lifting involves mustering strength for extraordinary short-term weight- bearing. As long as the body is kept in good working order – that is, when a person’s everyday use has rendered her musculo-skeletal structure strong and springy – this concentration of energy will be sufficient for the extra work.
It is when the parts are worn to their barest capability through habitual poor use that an out-of-the-ordinary load will cause localised breakdown. Muscle and connective tissue may be torn, and joints may suffer distortion injury; and worst of all, the ligaments holding the spinal discs in place may have been so weakened by continual over-stretching that they can no longer maintain columnar stability of the lumbar vertebrae. With so much weight concentrated on the lumbar spine, a relatively small movement can cause an already weakened disc wall to rupture, forcing its fluid contents to bulge threateningly towards nerves running through the spinal canal, poised to, in one awful moment, change the lifter’s chronic ‘bad back’ to an horrendously acute one.
Quite reasonably, when this happens, we conclude that it was the lifting that did it. But on a fuller analysis we discover that the years of poor leaning led predictably to such an outcome.
In addressing the cost of injury in the workplace by means of ergonomic appliances, there is a persistent failure to take into account that the basic action in every job, involving even the smallest movements, is leaning. There was a recent recommendation to install hotel beds that can be raised for servicing. Bad backs were causing a wasteful loss of trained staff. Why is it so difficult to see that the root of the problem lay not with the beds but rather with the workers’ inability to lean to the task of making them in a manner that would keep their bodies safe? Job entry requirements to keep the body lengthened while bending; learning the best ways of counterbalancing in leaning; and learning good head balance for stress-free mouse manipulation would make much more sense than spending an afternoon being taught simplistic one-size-fits-all manoeuvres such as to ‘bend the knees’ while lifting, or to ‘sit up straight’ at the screen.
Efficiency in body movement means using minimum effort to produce maximum effect, where strength and stamina are greatest, and where holding-on-for-dear-life is replaced by comfortable balance.
To understand what we mean by balance and good leaning we need to observe young children at play, and to venture into a jumble of concepts used to describe the relationships and functions of the material world. Below are listed Webster’s definitions of some of these properties, functions and notions:
MASS – the extent of space that an object occupies; a quantity of matter cohering together so as to make one body, usually of indefinite shape. eg a mass of dough.
VOLUME – compass, capacity, shape, defined mass.
WEIGHT – the force with which a body is attracted towards the earth by gravity.
CENTRE OF GRAVITY – a point along a vertical line within an object’s mass along which the earth’s gravitational pull can be considered to be acting.
BALANCE – stability produced by even distribution of weight on each side of the vertical axis of an object.
COUNTER-BALANCE – to oppose with an equal weight.
LEANING – the act of deviating from a vertical position.
LEVER – a rigid substance used to sustain a weight at one point of its length by the application of a force at a second, and turning at a third on a fulcrum. A supported or hanging position in which a gymnast’s body while extended or bent at right angles at the hips is held parallel to the floor.
FULCRUM – a prop or support about which a lever turns.
CANTILEVER – a projecting beam supported at only one end.
And as if that weren’t enough science, we also need to take into account that all these properties function in combinations:-
WEIGHT- is a function not a property. An object’s mass combines with the earth’s gravitational pull to produce it.
MASS has both weight and volume – except in space where it becomes weightless.
POINT OF BALANCE – balancing is a matter of bringing the centre of gravity directly over the base of an object – which can also be called its point of balance. Being off balance is when an object’s centre of gravity has moved too far beyond the base, so that it must fall if not restrained by other means. In other words, the POINT of BALANCE and the CENTRE OF GRAVITY need a good working relationship in mobile creatures.
Our centre of gravity is constantly on the move. And so is balance which must constantly be lost in order to be regained. These concepts are rather indeterminate and notional. Like life and leaning they are simply always going on. Only in a cadaver can that point along the vertical line of gravitational pull that we call the centre of gravity be located with any certainty. While we’re alive – even while we think we are standing perfectly still – our pumping hearts and sloshing stomach contents keep our centres of gravity and our balancing mechanisms dancing about like light on water. Thank heavens they are managed subconsciously by functions of the brain in combination with our senses, so we don’t need to know where either is from moment to moment. Yet we do benefit from maintaining a measure of conscious control over the whole carry-on by having good habits of use.
To counterbalance efficiently we need to ensure that the body’s centre of gravity doesn’t move too far beyond its point of balance without enough stretch in the extensor musculature to ensure a healthy cantilevering of torso, with the powerful muscles of the lower back acting on the fulcrum of the hip joint. If it should stray beyond this pale, we will have to either give in to gravity and fall, or we’ll have to hang-on-for-dear-life to prevent ourselves from doing so.
Our senses let us know of that moment when the less desirable response has occurred. We feel tense and awkward, off balance yet remaining upright under duress. In this case our brain has assessed that the short- term gain of preventing a fall is less costly than any potential long-term damage. Some of our brain functions are primitive. The million years old mammalian cerebellum didn’t anticipate the health care costs of the twenty-first century.
Jennifer pulls down in front to bend, hurting her neck and back and knees, but not falling over.
Imagine the guy rope that a tent pole is leaning away from, how tight and awful it might feel if it were sentient, while the opposite rope becomes horribly slack. This gives us a simple analogy for the common human experience of being floppy while feeling tense.
But the process is not so clear-cut in us. A tent pole only leans when it hasn’t been put up properly, whereas we live in a veritable flux of leaning. Leaning comprises the largest purpose-component of our lives. We are not pegged to the ground; nor are we firmly planted on the seabed like anemones who are additionally supported by water, so they can wave their tentacles around without fear of flopping over. The business of staying upright – and of keeping our centre of gravity close to the point of balance – is much more complex for persons than it is for poles or for sea creatures. We are not limited to staying in one spot with an option of either remaining erect or of falling over. So instead of having external ropes pinning us to the ground, and water to help support our weight, our guy-ropes are built-in. We take them through air with us when we run for the bus or slalom down le piste.
A principal guy-rope of the upright mammal is the Achilles tendon which extends from the heel bone, turning into contractile calf muscle further up the leg. Tendons act as steel struts that keep the trunk safe while it leans. The small human foot doesn’t give such a tall creature much of a base to sway around on. Maybe the elongated shoe – the poulaine – that was fashionable in fifteenth century Europe gave enhanced leaning capacity – although to what end, one rather wonders.
In any case, the downside of the consequent impediment to movement ensured that the fashion was short-lived.* Instead, as we generally find in extant living things, the design fits the environment, making the unadorned foot’s sway range probably about right for our height. Mountaineers who have lost toes to frostbite will tell you thatbalance is trickier without them. It’s harder maintaining one’s centre of gravity within the circumference of a diminished base.
Notice that because your heel doesn’t extend as far from your line of gravitational pull as your metatarsals and toes do, you cannot lean back as far as you can lean forward. And you cannot lean backwards at all without scrunching your toes and contracting the musculature around the front of your ankles – the whole lot responding in a fraction of a second like multiple guy-ropes.
(*It’s a shame the downside of high-heels hasn’t yet done away with that pernicious fashion too!)
Our entire muscular wrapping has to contract more as we lean than when we are vertical and behaving like a well-positioned tent pole. But our lives are about leaning – moving ourselves around . Therefore we should be doing it in a way that doesn’t end up delivering us to the physiotherapist. Our marvellous flexibility can be precarious. On the other hand, being contractile and jointed allows for a beautifully balanced shaping, contracting just enough where necessary, while leaving relaxed the muscles that aren’t required for a particular movement; so that when things are operating at their best, a feeling of ease pervades the person. We aim for balance in our diets and in our emotional states. How come harmonious leaning is placed so low down on our list of priorities?
We can lean easily if we make sure we don’t pull ourselves out of shape. We don’t even need to know which muscle does what, as the cerebellum handles the myriad details of organisation required for co-ordinated movement. We need only to cobble our fabulous consciousness with a measure of desire and will to get the best safe perfor mance out of our cerebellum’s efforts to keep us afloat. See how lightly infant Christopher cantilevers his extended trunk, his natural early way of moving ensuring the safety and best use of the agglomeration of parts he was born with.
Sadly, by the time we are adult we are leaning so badly that if it weren’t for our saving ability to counterbalance by tightening down we would topple into the wash basin as we struggle to apply mascara at the bathroom mirror.
In a symmetrical object – a cube, a plank – the earth’s gravity is considered to be pulling on it from the middle towards the ground. A human’s centre of gravity is roughly in the middle of her body while standing. Of course, if she has been playing the violin a lot and has grown larger pectoral muscles on her bowing arm side, they will have some effect on the precise placement of that imaginary vertical line and therefore on her exact centre from where gravity is pulling. But we don’t need to look so closely, only to be aware that as she plays her instrument that line will be buzzing around with her arm movements like a blow-fly at her face. Her entire musculature will be fizzing with tiny counterbalancing adjustments.
Counter-balance, as the phrase describes, is needed when we have come off balance, that is, whenever we move. Each time I lift a foot to take a step, my entire body weight is magically transferred to the other leg which takes over the job of safely manoeuvring my torso with its head wobbling and arms flailing above it. If this automatic transference of weight – or counter-balancing – didn’t take place, we surely would have evolved closer to ground level, to be heaving and tumbling our way through life more like a bunch of land-lubber sea lions. Consider how much counter- balancing is going on when a dog has lost a limb. You wouldn’t see your dining-room table coping so well with the loss of one of its legs.
Counter-balance is effected in an amazingly refined equation of contracting and relaxing elastic guy ropes whose precise co-ordination can keep a gangly human body poised above ground while it hip-hops on one hand.
We gasp at such a sight because it’s out of the ordinary. But it is equally stunning that I can whack my boyfriend across the head without either of us falling over. Our balancing mechanisms keep us both muscularly organised so that we stay upright throughout a spat of domestic violence. The one who comes off best will be s/he who didn’t pull down during the exercise. As my grand old teacher Walter Carrington advised, when you’re in a fight, you want to damage the other person, not yourself.
And Anne, in administering care to the damaged, needs to avoid adding her injuries to theirs. The really nasty experience for we tall creatures is that recognisable instant when our centre of gravity has wandered too far beyond our base, making us tighten down as an alternative to falling over. Try leaning too far forward from the ankles without bending your knees. You’ll notice your toes grip, and general exhaustion sets in quick-smart. Phew! What an uncomfortable over-expenditure of energy. Then slacken your torso and discover how it becomes impossible to stop yourself from falling.
But there is a third way of occupying our environment more propitiously. We cancounter-balance by flexing at the ankles, knees and hips to redistribute our weight. By allowing the torso to lie like a see-saw across the fulcrum of the feet, we have already improved the situation. Yet even that simple alternative won’t quite give us best leaning. Unless we also ensure that the torso is fully opening out across that fulcrum, the loads will bear down at wrong angles on our joints leading to further varieties of ‘bad back’, and threatening our knees with wear, our hips with breakage, and our feet with collapsed arches into the bargain.
The body is only carried on the dedicated weight-bearing spots of its joints when the torso is fully opened out. When we tighten down, our shape is distorted causing misalignment of the parts. Just as Benjamin Franklin’s kingdom was lost for want of a nail in his horse’s shoe, the human torso cannot open out unless its head is in a forward-and-up relation to the neck. Efficient leaning cannot be achieved in bits. We must look beyond the parts to the whole. It’s a long story and altogether too much to think about. Luckily for us F M Alexander did the fine observation and devised the educational practice he called his Technique of Good Use of the Self. We have lessons in the Alexander Technique to restore our leaning skills, so we can feel pleasurably tired instead of exhausted after work. And we can add valuable qualifications to our CVs as Anne did who is now: Registered Nurse, Alexander Technique Teacher and Good Leaner.
Anne Lenert RN ATE GL
Drawings by Jing Sheng Wang
Editorial assistance from Jean Fischer.
For a comprehensive description of good leaning see The Monkey Procedure by Dilys Carrington circa 1980.