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The bone-thinning disease that affects so many in their older years may be helped by ensuring one is actually putting weight through the bones while standing or sitting.

Before I get into this topic, I want to let you know that I have created a
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We have probably all seen photos of what the inside of bone looks like – kind of like honeycomb with lots of tiny holes. This keeps bone light and strong, with the boney web lining itself up according to the forces put through the bone. In someone with osteoporosis the holes in the web of bone become bigger, and the bone that forms the web becomes thinner making the bone more prone to fracture.

In the upper spine where fractures are common, a vertebrae may simply crush through the weakest area of the bone web, usually changing the shape of the vertebrae to a wedge forcing more roundness in the upper back and the head to come forward. Unfortunately, when one vertebrae is crushed, it makes the others more prone due to the change in forces going through the area. These vertebrae fractures can be excruciatingly painful. The other common fracture sites are the neck of the femur (the long bone in our thigh at the top close to where it attaches to the pelvis) and the wrist.

Mechanical stress going through the bones helps the boney matrix create bone to counteract those stresses, which is why “weight-bearing exercise” is strongly suggested to keep bones strong. Exercise aside, I have noticed that many people’s natural standing posture does not actually put much weight through the bones. The pelvis is often shifted forward, the ribcage is tilted back, and the head is forward. When I stand behind a person standing this way and push slowly but forcefully down both shoulders, the body tends to buckle sending the pelvis even further forward and the ribs further back. This suggests that the weight is going through the soft tissue rather than through the bones. Maybe the first step to maintaining and building bone mass is to make sure one is standing in a way that actually loads the bones!

The goal is to stack the bricks by trying to become as tall as possible, reaching the base of the skull up. Most people will need to bring their pelvis back to find their full height, which will in turn straighten ribcage. The pelvis should be directly over the legs in such a way that the thigh and buttock muscles are not contracting. You know you've got it right when there is no buckling in the body when someone pushes slowly but forcefully down on the shoulders. I find I can actually feel the pressure going through the bones when this is done to me.

This concept is important in sitting as well. We often tend to sit behind our sit bones instead of on them, which rounds our back so the weight of our trunk and head is no longer going through the ideal load-bearing parts of the spine. So, sit tall on your sit-bones so that there is a little arch in the low back, and figure out where to keep your ribcage so that when someone pushes on your shoulders nothing buckles in the trunk. You can even have someone push slowly yet with some force on the top of your head to see if your neck is lined up correctly. Nothing should buckle anywhere if the forces are being carried by the bones instead of the soft tissue.

Because we spend the majority of our day sitting, standing and walking, it makes sense to ensure that we are loading our bones while doing these activities. Weight training in the gym will be that much more effective if one starts from a place of good posture. And spending some time regularly on all 4s can help load the arm bones in order to prevent wrist fractures.

As for the belief that calcium supplementation is the key for preventing or reversing osteoporosis, Charles Poliquin had a good analogy in his article on the topic, where he suggested that when building a building, one can keep supplying 2 by 4s to the building site, but unless you also supply all the other stuff needed to build the building including the workers to put it together, those 2 by 4s will remain on the ground. They don't magically turn into a building. We need a functioning endocrine system (the workers) to get the calcium into the bones. A dysfunctional endocrine system is probably the most important cause of osteoporosis, and is most frequently completely overlooked. I wrote about it in more detail in my other post on osteoporosis.

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Butt gripping is a common unconscious habit that may be at the root of low back, SI joint and hip pain.

Do you have chronic low back or hip pain? If you are female, did you notice that you developed your back pain during pregnancy or after giving birth? Maybe a fall or car accident triggered the back pain and now it is ongoing? Whatever the initial cause it may be worth checking yourself to see if you are a butt gripper. Butt gripping is a term coined by Diane Lee and Linda Joy Lee, used to describe a back stabilization strategy that involves squeezing the buttocks together. This habit is completely unconscious, and is a common strategy the brain uses to try and stabilize the spine if the muscles that are supposed to do the job are not functioning as they should, or if there are significant digestive issues that may be causing gas. Butt grippers are easy to recognize in other people – not only do they look like they are squeezing their butt cheeks together, but they also frequently walk like a duck with the toes pointing out.

Sometimes it is more challenging to recognize the habit in oneself. If you are not sure, have a friend help you. Lie on the floor on your back, completely relaxing your leg and buttock, and have your friend pick your leg up and hold it bent to 90 degrees, at the knee and at the ankle. Your friend can then try and move your upper leg side to side. It should swing completely freely with no movement in the pelvis at all if you are not butt gripping. If the leg moves stiffly as if one were churning butter, or if the pelvis moves with the leg, that means the buttocks are hanging onto the leg and you are indeed a butt gripper. Check both legs, because occasionally the problem can be one-sided.

Why would this habit increase low back and hip pain? Try squeezing your butt cheeks together hard, and walk across the room. Notice how your legs cannot swing freely, and how you need to rotate your spine in order to move a leg forward. This puts extra wear and tear on the vertebral joints – not good. Contracting the piriformis, a deep rotator muscle in the buttock that runs from the sacrum (triangular bone at the bottom of the spine) to the big bump on the outside of the upper leg bone (greater trochanter), puts a strangle hold on the bottom of the sacroiliac joint, compressing it and creating pain. Furthermore, because the sacrum is a triangular bone and butt gripping squeezes the bottom part of the joint, the top of the SI joint opens up making it unstable. And with the sciatic nerve being so close to the piriformis muscle in the buttock, occasionally overuse of this muscle will create sciatic pain.

Although not in the right place to mimic piriformis properly, the bungee cord in the photo simulates a butt gripping strategy, and one can clearly see how this opens the top of the SI joint. This might also destabilize the joint between the top of the sacrum and the lowest vertebrae, and possibly the lumbar spine further up. Also, the piriformis might pull the front of the lower sacrum forward, unlocking the SI joint, destabilizing it. Massaging the external hip rotator muscles will help temporarily, but until one stops using a butt gripping strategy the pain will not go away permanently.

In order to stop butt gripping permanently, one must replace the butt-gripping stabilization strategy with one that is more optimal. Ideally we want to create a ring of support around the top of the pelvis by using the deepest abdominal muscle called the transversus abdominis. Notice in this photo how the bungee cord simulating the action of transversus abdominis, closes the SI joint, and how using this muscle would stabilize the pelvis in a way that does not compromise the ability of the legs to move freely. This muscle, along with co-contraction of multifidus and the pelvic floor form the optimal way to stabilize the low back and SI joint.

Find transversus abdominis by getting onto all 4s, letting your belly hang out, pulling in the tissue just above the pubic bone, feeling a slight muscle contraction there, and holding it while breathing. The contraction should be well below the belly button. Drawing the navel to the spine activates the wrong muscle according to Real Time Ultrasound research, and therefore does not provide the needed stabilization to the spine. One should be able to hold this deep, low contraction and breathe quite easily. Once you can find this abdominal muscle, lean back so your butt cheeks open. Then try finding your connection to transversus in various positions including sitting and standing. Transversus should be on at very low intensities pretty much all the time, so build up hold times rather than contracting and relaxing it.

Frequently practice finding transversus abdominis in standing, and then practice letting go of your buttocks so your legs can swing freely. Teaching your brain to use your body differently can take a few weeks to a few months of diligent practice, so be patient. Best practice for a minute 6 times an hour rather than an hour a day, so set a timer to beep at you every 10 minutes. Over time as your brain learns a new way of stabilizing your back and pelvis your pain may very well dissipate. This is tricky stuff, so do find a good physio or CHEK practitioner to help ensure you are doing this correctly.

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