Johnston-Ruyer Back Therapy

The fundamentals of Johnston-Ruyer back therapy are simple and can be learned and applied by individuals without instruction courses, but some of the movements are a bit unusual and must be followed quite closely to be most effective in relieving everyday stress on the back muscles. All exercises can be applied in some form even (and expecially) while suffering from back pain, since, when properly performed, they can provide a degree of immediate relief by helping the patient to use their back muscles much less while they are performing ordinary activities. The most effective proof of the method often comes when patients in great pain find they can move, for example rising up from a chair, without pain if they follow the prescribed movements for doing so very precisely.

Evolution and our back

Evolution is usually a very gradual process but human evolution, while taking millions of years, has been very rapid on an Evolutionary scale. This quick change to an upright stance, unlike other mammals and almost all other anthropoids has health consequences because that process of evolution is incomplete - principally, hernias (tears in the abdominal wall which is now under much greater stress), fallen arches and back muscles spasms. All are direct consequences of the change to bipedal motion. Even so, we are pretty well adapted to an upright stance (just not yet perfectly adapted.) Back problems would be much rarer if we lived our lives in aboriginal conditions, being active, using our legs a great deal and not using chairs - or even if we were only a little less sedentary than modern humans have now become.

Using Other Muscles More

This rehabilitation plan assumes that a sedentary lifestyle and/or poor motion-posture is the root of most back problems, since during a period of comparative inactivity, our back muscles remain strong or at least active - even while sitting we use our back muscles to adjust ourselves, lean and reach - but the rest of our musculature, including our legs, become relatively weak. In contrast, our legs aren't doing much while we sit. Our tendency then, is to constantly overuse our back muscles, particularly lower back muscles, to substitute for other muscles, especially leg muscles. It's natural that this should happen, since we're still used to using our back muscles all the time, and these remain relatively strong. Paradoxically, back problems don't occur because of a "weak back", although it feels that way when they're hurting. According to the Johnston-Ruyer approach, back problems usually occur because the back muscles are the only muscles left that are fairly strong and which the sufferer is still used to using. Therefore, these muscles are overused, and used inappropriately to compensate for other weaker and less used muscles. Eventually the extra burden on the back causes muscle spasms, a typical sort of athletic injury for any overused muscle, which we experience as nagging back pain or as a severe episode of pain that puts us "flat on our backs."

The Basic Program

Standard sorts of leg exercises are part of the program, if possible including lots of running and walking (taking care not to employ back muscles to help swing the legs.) Maintaining a specific sort of balance while moving, especially when sitting down or getting up from a chair is the other half of the therapy. Both parts require relearning our unthinking patterns of motion, in simple but precise ways that let all our other muscles do more of the work, and our backs, less. Exercises to strengthen the back itself are regarded as inessential, since the principle of the method is to strengthen and ready for use the rest of the musculature, such as the legs. Yes, it is possible that your back muscles are not in great condition, but it's very probable that other muscles, such as the legs, are even weaker.

While this therapy can be used as an adjunct for atypical back pain resulting from unusual medical conditions, it is principally designed for the standard case, of a no longer young or no longer athletic person experiencing episodes of back pain (lower or upper.)

There was a time, only a few years ago, when physicians uniformly prescribed bed rest for backaches. Scientific studies then showed that this actually aggravated the problem by further weakening muscles, and that getting active again as quickly as possible strongly aided patient's recovery. This change of treatment has boosted Johnston-Ruyer therapy, because it helps patients get moving even while still in pain, and begin the process of recovery as soon as possible. At the same time, it's very specific changes to the way in which we move, such as when raising or lowering our body weight, form habits which relieve the back of much of the burden it has been under while at the same time strengthening other muscles so that they can resume a more normal, active role.

Believe it or not, the best time to exercise and learn how to use your muscles in ways that will cause your back less pain is when your back is hurting - because this is when even the smallest deviations from good posture-in-motion will show up. This, after all, is one of the evolutionary purposes of such pain - to illustrate and enforce the more efficient use of our muscles, and retrain us in these better habits - not to keep us wholly inactive while we slowly starve. (Remember, you've already consulted a physician and can reasonably assume that your back pain is the usual kind, not caused by an unusual injury or disease.)

Using the legs more, and the back muscles less is central to most approaches to back pain. Johnston-Ruyer holds that overuse of the back muscles occurs when we lose track of where our center of gravity is; or more particularly, *where the centers of gravity of each of our three main body segments are with relation to each other.* It holds that back muscles are usually strained or overused when they are attempting to balance us and keep us upright while the centers of gravity of these main body segments are eccentric from a straight vertical line through the body. The three segments of our body mass are held to be: 1) toes to knees ("upper body"), 2) knees to hips ("upper legs"), and 3) hips to the top of the head ("lower legs"). Even sitting up from a chair, or sitting down badly with the centers of gravity of these segments out of line, can cause very considerable strain to our back muscles.

Aside from general exercises to strengthen the legs, the most important, and central exercise is therefore to learn to sit down and get up from a chair. We all do this constantly, and usually in a simple but awkward way that strains our back muscles with work they needn't be doing, whether we feel that or not. It isn't an exercise we were evolved to perform, and a special technique is required to sit down in or rise from a chair while keeping the centers of gravity of the three segments of our body mass precisely "stacked on top of one another". This series of movements is more complex than what we usually do when standing up, or sitting down, and more precise.

The same principle, of keeping these three separate centers of gravity all lined up vertically, perfectly, can then be extended to other activities: when raising and lowering oneself, reaching, lifting, using stairs and running. But a good place to begin is with the process of sitting in, and standing up from a chair, because most people do it so awkwardly.

In summary, one could say that the vast majority of back problems are not a hardware error - not originally a problem with disks or muscles or anything else physical. They could be characterized instead, as a software error. The way our brains tell the muscles to move, particularly if we've become used to being sedentary, causes the problems. A positive feedback cycle easily sets in - a vicious cycle of pain and behavior can easily form in which most muscles are allowed to weaken, and because they are weak, are used still less. Meanwhile the back muscles, because they remain relatively strong, are used more and more. Then one of two things happens: when an unusual stress or heavy lift occurs, the habit of overusing the back muscles may really hit home and the large back muscles will begin to spasm or seize up causing acute pain, or, poor motion-posture habits become so ingrained that nearly all movements are causing the back muscles to do too much work, resulting in constant nagging back pain from even ordinary activities, pain that just never seems to leave. It won't leave until other muscles are strengthened and our posture-in-motion changes.

Learning different ways of using the body that keep those centers of gravity on top of one another at all times, and exercising and strengthening our other muscles, breaks the cycle, and can allow a pain-free life to resume, in which we aren't straining our back.

Note that to keep the centers of gravity of our three body segments stacked exactly on top of one another, in a straight line to the ground, each section has to pivot and tilt. If you've ever seen an aboriginal dancer, dancing largely in a crouch, you've a very good idea of what that means - aboriginal dancing is strenuous and keeps going for a while. If their posture-in-motion isn't very good, the dancer will surely feel that later. So their body segments are exactly stacked and each segment tilts and pivots as necessary to maintain that rule of posture throughout the dance, setting all of us a good example.

Similarly, rising from a chair, say, we want to pivot and tilt each body-section as if it were independent, to keep those centers of gravity lined up as well as we can. (Starting by leaning far forward and tucking our feet a bit under the chair, before we begin to rise.)

As was said earlier, our bodies didn't evolve for use with chairs. So it shouldn't be surprising that chairs can force stereotyped motions that isolate and overuse just a few muscles, and that they often force us to move a bit awkwardly, with our body segments out of line. So therapy often centers on relearning this common motion, in detailed steps or stages. With luck, you'll be in at least some pain when learning the exercise, since your discomfort will punish any deviations from good practice, and be a very accurate teacher. If doing this exercise leads to substantially more pain, you are doing it accurately, or have a problem other than normal back pain from overuse and deconditioning. Stop, and consult a physician.

The Stages of Rising From a Chair:

1) Put your feet underneath your chair, well back. Sliding just one foot back before rising from a seat is helpful, but two is better.

2) Lean far forward. (Keep a straight line from the waist to the top of your head, as you do so.) Don't use your arms to help you lean or to maintain this posture. Use the muscles on the bottom of our rump and high upper back - but not the lower back. Paradoxical, or lowering, movements are more strenuous than they seem (as weight lifters know) so don't be sloppy about this motion. At first, it may be a good idea to just practice leaning your upper body segment forward and backward in the chair with no pain or strain - when moving backward, use the muscles on the bottom of your calves and thighs, and avoid using back muscles.

3) *In place*, slide your upper legs forward. That is, *without rising from the chair* and while pivoting your upper body in the direction of an upright posture - keeping it's center of gravity roughly in place - slide or scoot your behind well forward. Keep your feet where they are while you do this (likely a bit further back than they usually are when you rise from a chair now.) Both the center of gravity of your upper body and the center of gravity of your lower legs should remain precisely in place with relation to the floor as you slide your upper leg segment (behind/knees) forward, until the center of gravity of this upper leg segment is in a vertical line with the center of gravity of the other two segments..

4) Lift your behind up from the chair only very slightly, just enough to take your weight off the chair - but don't rise yet.

5) Take a moment, just a moment, to carefully align the centers three segments of your body with respect to one another so that they are in a perfectly straight line going down into the ground. Again, you should be able to avoid using your back muscles while doing this. If you leaned well forward before starting to sit up, and had your feet well underneath the seat, no great adjustment should be necessary. Probably your upper leg segment needs to move just a little further forward, and other small adjustments may also need to be made.

6) Now rise, straight up, pivoting and tilting each section of the body, all simultaneously, to keep that perfect line - that is, to continuously keep the three centers of gravity of your body segments in a straight vertical line down through the floor. You may well feel an unusual strain in your leg muscles as you do this, particularly the large muscles on the top of your upper legs. That's not a bad thing - it means that they are finally doing the hard work, and your back isn't. If your back hurts, the chances are awfully good that your legs haven't been doing their fair share, are deconditioned, and will complain when they are asked to take on a normal load.

6) Repeat this exercise, at intervals, frequently and carefully - not too fast.

Do this exercise very slowly at first, then faster. Practice and repeat! If you can get just this one complex motion down pat, that alone may be sufficient to change the rest of your habits and get you into a pain-free motion.

Now the chances are awfully good, especially if you're experiencing back pain, that this way of rising up out of a chair is a lot more complex, and more precise, than what you're doing currently. It could be said to use "isolations", that is, different parts of the body are moving in different ways, and in different directions, at the same time. This is one of the harder things to master when you learn how to be a professional figure skater, and it's also tough for the rest of us to get just right. But chairs are so strange to our bodies that we must rise and sit very correctly in order to avoid overburdening our back muscles. So the proper, staged method of rising from (and sitting down in) chairs has to be learned with real precision.

Doing this exercise while your back hurts will teach you that even the smallest deviation from the most proper motion can put more strain on your back muscles than is necessary.

Remember, though, that the purpose of this exercise is less to strengthen muscles and more to strengthen habits. It's your attention that makes it valuable. Mindlessly or sloppily practicing won't be helpful. Large number of repetitions at one time aren't needed so much as your frequently revisiting the exercise, at different times, with real attention. You're trying to change your everyday, unconscious habits, not just your muscle tone.

Sitting down is a very similar exercise, pretty much just reversing the order of the five stages, as if filmed in reverse. However different muscles are used, so sitting down means learning some things you didn't learn standing up. Note that while sitting down isn't discussed here in the same detail because the steps are so similar, sitting down, a "paradoxical motion", is actually *more* strenuous than standing up from a chair, and should be practiced at least as much, and at least as carefully. Don't take it for granted.

Some chairs make the Johnston-Ruyer stages of rising from (or sitting down in) a chair easier than others, of course. It can help considerably to use a chair with wheels or casters so that you can tuck your feet well under before rising, and let your legs simply push the chair back as you rise. Using office chairs with casters doesn't help your back much if you don't use the proper procedure to rise from them, but with the right motions, the mobility of the chair does help. It would be wonderful for our backs if our chairs were designed so that the seat could easily slide forward while the rest of the chair remained in place, as if the chair's seat were a drawer, but chairs aren't made that way... yet. Meanwhile, you may find that a chair with a smooth, relatively flat or frictionless seat is easier to rise from properly. (Note that some surfaces that seem smooth, such as vinyl, often have very high standing friction, that keep your seat glued where it is. Leather will vary according to the factory treatment - so test it out.) Another way of easing motion three, that of sliding your behind forward without rising, is to put one of those mats of wooden beads on your favorite chair. Because the beads are slippery and can roll, motion two will be easier. If the chairs you are using don't allow a smooth, easy step three motion of sliding your bottom forward, get rid of them. they'll cost you much more in the long run by tending to force you to rise up from the chair improperly. Junk it - don't recycle: the poor have enough problems. Surprisingly frequently, the chairs you think "are uncomfortable" or "have a lousy shape" are actually just hard to rise from, often precisely because the friction of movement along the seat cushion is so large that it forces you to sit and rise in very unbalanced ways that heavily punish a few muscles that must take the whole load up, while other muscles that could otherwise help out are left idle.

Note that if you adopt this sort of motion throughout the day, keeping your three centers of gravity aligned as you move, and strictly so every time you sit down or rise up from a chair, you may discover that your "back problem" is really a leg or knee problem - that you've been overusing your back and deviating from proper posture because of a pre-existing injury or weakness. If so, don't ignore this discovery, or just press forward: take it back to your doctor - you don't want to solve your back problems and at the same time aggravate any other previously existing problems.

With this and the other recommended exercises, developing an awareness, or "felt sense" of what muscles are being used for every motion is very important, and exercising while experiencing discomfort is an important tool for doing this.

Other Exercises

2) Squat down to the floor keeping the centers of gravity of each of the three sections of your body exactly in line with your overall center of gravity, and back up. This should produce a very characteristic, active, swinging motion as you go down and back up. If you notice that your rear spends a lot more time jutting out when you're doing this than you expected, you're probably doing the exercise the right way. Make sure that your head stays still in relation to the rest of your upper body, maintaining a straight line. It may be best to start with much smaller movement, popping up and down only slightly, to begin with, in order to move accurately, keeping the center of gravity of all three segments in line as you move. Make sure you are using the muscles at the back of your legs.

3) Lift one leg at a time up while standing, with careful attention to using the muscles at the top of the upper leg going up, and bottom of the uppermost portion of the leg going down. An exercise to build awareness.

4) Getting upright when you're leaned way back in a sitting position - lift one leg and "close the scissors" to get forward.

5) Walking. Even more that other exercises, this is a double-edged sword. Doing more walking, but with old movement habits intact may stress the back unnecessarily, because it's quite possible, although quite unnecessary, to overuse lower back muscles when walking. For instance, people with two artificial legs are able to walk because they can use their lower back muscles to swing first one leg, and then the other, forward. Obviously this works those back muscles thoroughly. Sometimes one of the first symptoms of Multiple Sclerosis is lower back pain, because MS attacks the longest neurons first, particularly neurons going to the legs. This weakens the leg muscles, in effect, and the patient's lower back muscles will automatically begin to compensate, taking over more and more of the work of shifting the legs forward while walking, until finally this overuse brings the patient into the doctor's office with complaints about back pain, even though the back muscles aren't yet directly affected by MS. A very similar process can easily occur in modern, deconditioned individuals. Because we still use our back muscles at least a little while sitting, our back muscles are usually in better shape than our legs, even when we are thoroughly deconditioned, say by a sedentary office lifestyle. Therefore, when we walk, our back automatically begins to do more of the work of moving our legs forward, as our leg muscles begin to complain from their unaccustomed exertions, continuing a cycle of overuse of those lower back muscles. It's very important then, when undertaking walking as an exercise for back relief, not to use the lower back muscles, but to employ the leg muscles only to drive the legs forward. Watch to be sure that your pelvis isn't swinging (and therefore isn't being used to swing the legs) so that your hips stay in place as you walk. Exaggerate your muscle movements, pretend to be Schwartzenneger as you move. (These tricks can be largely dropped after your muscle habits have changed.) Incidentally, one of the reasons women are more prone to back pain than men is that their wider stance, increasing the distance between their legs, makes it easier for them to use back muscles to swing their legs when they are deconditioned. And of course, do the other exercises, especially conscious sitting and standing up by the appropriate stages in order to develop an acute awareness of when your back muscles are in play, and when they aren't being used. Be sure to walk on uneven surfaces, particularly up, down, and along gentle slopes and hills, to get away from stereotyped, repetitive, and identical motions on perfectly flat surfaces. Walking may be the most important exercise, in truth, but it's listed last because our bad habits will be thoroughly ingrained in the way we walk, and the previous exercises can develop the muscle-use awareness that will help us to overcome these exercises and begin to walk in a healthy way.

6) Stairs. One more thing evolution hasn't prepared us for. It's very common for highly fit athletes to injure themselves doing exercises in stairs. Climbing up stairs usually isn't the problem, although their shape enforces stereotyped and repetitive motions, unlike irregular natural slopes, and the standard size of stairs is based on the average height of people one-hundred to two-hundred years ago. But the paradoxical motion, that of going down stairs, can cause athletic injuries very easily, particularly from the impact of every step down. There is, however, a much less harmful way of traveling stairs. Again, attention to the motion of our center of gravity, in this case the center of gravity of the body as a whole, reduces strain. Take the effort of making the movement of your center of gravity as smooth and constant as possible when going either up or down stairs - rather than jogging it up and down, or constantly slowing and speeding the bulk of your body mass as you travel. Such motion is much more like what happens when we climb or descend a hill, and it's the constant rapid accelerations and decelerations of our whole body weight that cause such strain. The only solution is to keep our legs at work more constantly, as we move, keeping our body a bit closer to the stairs, and let the mass of our body move in a very straight line up or down stairs, rather than accelerating and decelerating it suddenly, again and again. This takes a lot of impact strain off joints, such as the knee, but also saves a lot of muscle work - in which you may be involving your back muscles more than is strictly necessary. Once you've figured out how to make a constant ascent or descent, or as you do, start paying attention to what muscles you're using, and shift the effort to leg muscles, top or bottom. Climbing up stairs (or even down them, if done smoothly precisely) can be good and convenient exercise, but only if done carefully, in just the right manner, since no animal has evolved to handle stairs. Walks over uneven natural slopes are better, but of course not every workplace provides these.

In summary, Johnston-Ruyer therapy for back pain tries to restore natural modes and patterns of muscles use in a somewhat un-natural modern world, not by strengthening the back, but by shifting more work to other muscles - which can only be done if the patient pays strict attention to keeping the masses of their three main body segments aligned with great precision, directly above one another. Otherwise, the back muscles, and the lower back muscles in particular must come into play. Avoid overuse of the lower back muscles, and you will also avoid spasms, the cause of back pain.