sacral angle? 7 questions

by phoebe birks
(sydney)

Dear Sarah,
A few questions have come to my mind that I did not get the opportunity to ask you when I was there as you were so busy looking after your patients.
* What is the optimal sacral Angle To maintain on the back block while decompressing the lumbar area? Anterior tilt ? Flat? Or a posterior tilt?
* Should one make any effort with the lower abs to position the sacrum effectively? Or just let go?
*what role, if any, does the transversus abdominus play in spinal segment stability?
* If one has a very tight hip flexors that yank on the spine and pelvis during lumbar decompression can one keep the knees slightly flexed and still have a good result?
* Is the main aim to decompress the facet joints or the lumbar discs when doing the supine decompression of the pelvic area on the back block?
* After one has spent one minute of decompression on the back block in the lumbar area. I and others have experienced a momentary pain when we first elevate our pelvises off the block, which then disappears. As this is a common experience in my anecdotal observation. Could you please explain why this pain occurs.
* when lifting heavy loads with the spine (25kg or so) Do you recommend a neutral spine?or lumbar flexion? My understanding is that with heavy loads one has to make a stiff kinetic chain in neutral for these circumstances and move effectively from the hip and knees. Is this right?
Kind regards :-) and thanks again your guidance is invaluable.
Phoebe Birks

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Feb 20, 2013
 Question 5 on answered
by: Anonymous

Question 5 Is the main aim to decompress the facet joints or the lumbar discs when doing the supine decompression of the pelvic area on the back block? Answer: BackBlock decompresses the discs, followed by ‘knees rocking’ and ‘reverse curls’ to decompress the facet joints
Question 6 After one has spent one minute of decompression on the back block in the lumbar area. I and others have experienced a momentary pain when we first elevate our pelvises off the block, which then disappears. As this is a common experience in my anecdotal observation. Could you please explain why this pain occurs.
Answer: Yes, completely normal. You will see on my downloadable video 4 How to Decompress the Spine’ that this is normal.
Question 7 When lifting heavy loads with the spine (25kg or so) Do you recommend a neutral spine? or lumbar flexion? My understanding is that with heavy loads one has to make a stiff kinetic chain in neutral for these circumstances and move effectively from the hip and knees. Is this right?
Answer: Some researcher say ‘neutral’ spine others say ‘flexed’. None say ‘extended’ (in fact both Bogduk and Adams say this ‘is to be avoided’ despite the dictums of the current manual handling industry).
Feb 20, 2013
 Questions 1-4 answered
by: Anonymous

Question 1 What is the optimal sacral angle to maintain on the back block while decompressing the lumbar area? Anterior tilt ? Flat? Or a posterior tilt?
Answert: You shouldn’t ‘work at’ your sacrum being at any angle, rather you should just let go. However, once more initiated, people with the more flat or humped lumbar spine (a lumbar kyphosis) should tend towards putting the BackBlock higher up under the sacrum (slightly more towards the head) and this will facilitate a better lordosis returning. Conversely, an advanced lumbar lordosis will be corrected over time and gently by having the BB slightly lower, towards the coccyx. Having said that: where it’s comfortable is where it should be.
Question 2 Should one make any effort with the lower abs to position the sacrum effectively? Or just let go?
Answer Just let go.
Question 3 What role, if any, does the transversus abdominus play in spinal segment stability?
Answer: It activates a few moments before elective spinal movement in a feed-forward reflex that stabilises the spinal segments. It does this by compressing the lumbar segments together vertically. This is why I do not like TrA training ‘in isolation’ as it inflames the lumbar spine to have too much compression and makes any low back pain worse. This is also why I like through-range strengthening by working your spine naturally using ALL THREE layers of abdominal muscles, through concentrating on lower abs in the knees-to-chin exercise
Question 4 If one has a very tight hip flexors that yank on the spine and pelvis during lumbar decompression can one keep the knees slightly flexed and still have a good result?
Answer: You shouldn’t need to do this. The yank should not be a yank if you let the legs down straight one by one. Keeping the knees bent negates the benefit. If too irritable, do ‘the dart’ exercise instead.

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