Hello. I'm Margaret Martin at MelioGuide, registered physiotherapist,
here to discuss with you flexion and extension of our vertebral column,
also another word for our spine. Let's look first at flexion and extension of the vertebral
column relative to the whole body. If I start to flex my body, I'm flexing all of my joints,
from the toes, knees, hips. My spine is flexed, my elbows, my wrists, and my fingers are
all in flexion. Everything's coming forward in the sagittal plane and now I am going into extension.
Now we get to specifically look at flexion and extension in different
planes of movement for our spine. As you notice, as I came into flexion of the lumbar spine,
that means I'm bending forward. My spine is flattening. Now, if I want to go into flexion of
the thoracic spine I start to bring my shoulders forward. If I want flexion of the cervical spine,
that's where I bring my neck forward. It's not a movement I do very often so I'm a bit stiff coming
down, but that is flexion of the spine. Now, I'm going to come out of this. I'm going to come out
first through the lumbar spine. I'm going to get a little arch there. I'm going to now start to
extend more through the thoracic spine or mid-back and now I'm extending through the cervical spine.
If I continue back,
I may fall on my head so I'm not going to keep going, but that's extension in its fullest
in the spine. If we look at that in sitting, in sitting the surface that we're sitting on
largely will influence whether we're in flexion or extension. With my knees a little lower than
my hips, it allows me to tilt my pelvis forward and encourages more extension through the spine.
This is bringing me into a little bit more extension in my lumbar spine. I can exaggerate
that extension through my thoracic spine and if I was looking up at something in the ceiling
I would be also extending my cervical spine. Too often, people spend a lot of time in flexion.
Flexion is now where all the vertebrae start to lean forward and
I'm in flexion in my entire spine. If I wanted to continue all the way down into flexion,
you would be reaching all the way to the floor.
It's important for people to realize that we have flexion and extension in every movement that we do
and that you're in control of that movement. Let's explore it as we go down to the ground because a
lot of people choose to sit on the floor, and if we're sitting on our heels that's a great way
to again get the knees a little lower than the hips so that that's tilting the
pelvis ever so slightly, encouraging that extension in the lumbar spine.
That little bit of extension in the lumbar spine is a really healthy thing
to help the thoracic spine be in its best alignment. Now we're talking neutral here,
but if I wanted to go all the way back I would now be going into extension of my spine,
or if I wanted to go forward, and you'll see this done in yoga poses, now I'm going into flexion.
Certain sitting postures, as you might see people sit cross-legged. Now, when we sit like this,
that will naturally tilt the pelvis in the opposite direction and encourage more flexion.
There's flexion in both the lumbar, you see I've lost that little arch, and now it's
encouraging more flexion through my thoracic spine and flexion through my cervical spine.
We can take this down one more step, which is down to the floor. When we sleep in the fetal
position we are in fluxion of the lumbar spine, the thoracic spine, and the cervical spine. Now,
you could encourage a little more extension or neutral position of your body when you're
sleeping by bringing your head back and maybe aligning your shoulder relative to your hip.
That would encourage more neutral positioning. For people that like to sleep on their stomach,
not always great for your neck but it does encourage extension through the spine.
Now, if you like to sleep with a pillow underneath the front of your body, then you're going into
extension. If you're doing any yoga poses, whether it's Sphinx or whether it's Cobra, these movements
are bringing you into extension of your spine. For individuals who like to sleep with pillows
tucked underneath their chest or their head and neck, then realize that you're putting your back
in quite a bit of extension. Not that it's a lot but it's for a long time, so your facet joints
might not always appreciate it but this is one way that you can certainly get into extension.
Now, if you do a simple yoga pose, even just hanging out on your wrist
or your forearms or if you come up to a Cobra, all these are going into extension of your spine.
Recognize that in life we do a lot of flexion and extension of our spine but we just tend to do a
lot more flexion. When it comes to extension and flexion of the spine, there's another component
that I think is really important for people to understand, and that's the difference between
passive movement and active movement. Passive flexion, I'm just letting gravity sink me down.
This is passive flexion. An active flexion would be a sit-up. If I'm looking at passive extension,
if I just prop myself here, my back is in extension but it's passively there,
my back doesn't have to do anything. My shoulders and arms are supporting the position so that makes
it passive for my spine or the spinal muscles. Whereas if I go down and then lift myself up
with my spinal muscles, this is active extension of the spine, and this is all so very important
to understand when looking for ways to keep our spine safe. We need both the passive,
but even more important, we need the active extension. That's what's making all the
muscles work around the spine, so that holding a neutral position feels a lot more comfortable.
What I've found with my clients is that they're so used to being in flexion that if I encourage
them to go into extension they're just getting to neutral and they think they're in extension.
They already feel like, "Oh, I'm so open, I feel so different than I usually do." This is where it
becomes important that people spend a bit of time every day on their stomach. At the very least,
with elbows under chin and then going into a bit of a spinal stretch or what we call a Cobra
so that you have some point of reference to what is the opposite spectrum to flexion
since we spend so much time, 95% or more of our day in flexion but hardly any time in extension.
We need to spend time in extension so that neutral feels comfortable.
If neutral doesn't feel comfortable, then you're just going to naturally go into flexion. That
position in flexion when you're reaching things, when you're throwing a ball, all of that is going
to compromise your shoulder, it's going to compromise your neck, it's going to compromise
your back, and that's where pain starts. I've done several blogs that mention shoulder plane
and posture, Dowager's hump and posture so if you want more information, just check on those.
Mostly what I want you to get from this blog is that it's so very important that you find
mindful moments of movement in your day. When you're coming out of doing a transition in
your life, so you wake up and if you're a side sleeper then make sure that you
be like your cat and you stretch and you just extend your limbs laying flat on your back. If you
just came out of a Zoom call and even on Zoom calls we tend to be attentive to the
person in front of us so just take a moment and extend your body. Just these momentary
position changes is so very wonderful and so very important to keep you pain-free.
Another so important thing is when we're actually making time to exercise.
We make time to exercise to do the things we love to do, whether it's gardening or whether
it's sports. When we do sports, if you think about how someone goes to throw a ball, well that
beautiful rotation that happens through the body doesn't happen very well when we're in in flexion,
we don't get enough rotation. Rotation is opened up by the movement of the spine in extension,
and so you want to ensure that you get that motion pattern any time you're going to go to the gym.
You don't want to go to the gym and keep doing what you're doing all day,
which is all forward movement, but rather focus on really opening through the body, making the
resistance be for the back body and not so much for the front body. A lot of people don't realize
that when they spend time in flexion the muscles in the front of the body, mainly your pectoralis
muscles and the muscles that attach to the front of the arms, your latissimus dorsi,
these muscles get tight, and when they get tight they start to limit your extension.
The other thing that's happening is that the muscles of your back, especially of your upper
back and neck, they are being stretched all day. When they're being stretched,
any muscle that's under prolonged stretch is going to be weaker.
Then when you try to sit up tall and stand tall you're like, "Ooh, it feels like it takes a lot
of work." It takes a lot of work because you've been in flexion for a long time.
Again, going back to these mindful moments of movement where you maybe extend that to going,
"I'm just going to sit upright just a little bit longer," and so that your body starts to get
more accustomed to being held in a more neutral position so that you could not just look your best
but be your best in terms of voice projection, in terms of functional
movements of all of your body parts, as well as keeping your organs happy, and
your spine happy, and your disks happy. A lot of individuals in their thirties and forties
and fifties have disk herniations and this is because we spend too much time in flexion.
A lot of people as they get older and their bones get weaker, which is called osteoporosis,
they spend too much time in flexion and that causes wedge fractures or compressions at the
front of the vertebral bodies, and so bringing yourself back to neutral as much as possible,
finding that sweet spot between flexion and extension of your spine so that you can keep your
spine happy and healthy your whole life through. I'm Margaret at MelioGuide, have a lovely day.