The Spine 103small co-contraction of the abdominal muscles can
be used to bring the torso forward (so that it is more
directly over the pelvis) and into alignment along
the plumb line. This repositioning of the torso will
also lessen the forces (extensor moment) tending to
cause the hip hyperextension and posterior tilting
of the pelvis associated with the fatigue posture.
Cueing to “lift the upper back up and forward,” as
though there was a string attached to the spine (at
a level between the shoulder blades) that is being
pulled up on a slight forward diagonal, can often
be used to find correct positioning. If slight hip
hyperextension is still present, slight activation of the
hip flexors (iliopsoas) by cueing to bring the front
of the pelvis slightly forward toward the thigh can
be used to establish the desired neutral position of
the pelvis and hip joint (figure 3.27B).
Cervical Lordosis and Forward Head
An increased curve in the upper back (often associ-
ated with kyphosis) can bring the head forward and
the eye level down. To reach a horizontal eye level,
the upper neck is then brought into extension,
resulting in cervical lordosis and an undesired
forward positioning of the chin termed forward
head (Palmer and Epler, 1990) as seen in figure
3.29A. This forward position also moves the center
of gravity of the head in front of the line of grav-
ity of the body; and Caillet (1996) estimates that
when the head is 3 inches (7.6 centimeters) for-
ward, the weight of the head (approximately 10
pounds or 4.5 kilograms) exerts about 30 pounds
(13.6 kilograms) of torque on the cervical spine.
This places excessive demands upon the spinal
extensors and facet joints.
Over time, this position tends to create a short-
ening of the cervical extensors; and neck presses
(figure 3.29B), in which the chin is brought down
and the head is gently pressed back against the
hand for 5 seconds, are often recommended for
relief. The neck extensors can also be stretched
using the hand to gently lengthen the neck by
bringing the head “out and forward” on a slight
diagonal (figure 3.29C). However, when kyphosis
is involved, correcting the kyphosis is essential
for correct head positioning. Use of images such
as bringing the chin slightly back and imagining
“being suspended from just behind the ears” can
sometimes help get the desired length in the neck
and avoid the tendency for the chin to jut forward
(figure 3.29D). However, care must be taken not to
excessively stretch or straighten the neck. When X
rays are taken, many dancers find that they have lost
the natural curve (lordosis) in their cervical spines,
and so working with a qualified physical therapist is
advisable if this condition is marked.Flat Back
Flat back posture involves a decreased lumbar curve
such that the low back looks flat as seen in figure
3.23C. The flat back posture reduces the normal
shock absorbency of the spine and is hypothesized
to contribute to disc degeneration. Interestingly,
having decreased curvatures of the spine is thought
to increase the risk for low back injury (Klausen,
Nielsen, and Madsen, 1981; McMeeken et al., 2002),
just as having excessive curvatures can increase
injury risk. The flat back posture is sometimes seen
in dancers who have worked so hard to decrease
their excessive lumbar lordosis that they have actu-
ally overcorrected and taken out the desired curve
in their lumbar spines. It is also likely that the
cueing and alignment encouraged in many forms
of dance, focusing on “lengthening the spine,“
tend to decrease the cervical, thoracic, and lumbar
curvatures. Whether the extent of curve reductionFIGURE 3.29 Improving forward head. (A) Forward head posture;
(B) strengthening neck flexors with neck press; (C) stretching neck
extensors; (D) technique: chin back with neck lifting up.