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Pain Free for Women: The Revolutionary Program for Ending Chronic Painby Pete Egoscue
Structure and Stricture
Look at the drawing of the human skeleton in Figure 1-1, and tell me whether it is male or female.
Take your time.
It would require a lucky guess or specialized training to know you're looking at a female skeleton. Likewise, the drawing of the human musculature, in Figure 1-2, is also difficult to identify as female. I'll spare you a third illustration that makes the same point about the central nervous system.
What is my point? Muscles, bones, and nerves--the three major components of the musculoskeletal system--and the way they are assembled, are nearly identical for both men and women. The word nearly here isn't a loophole: it means we are roughly 99.99999999999 percent the same. Out of all our many bones, muscles, tendons, ligaments, joints, and neural axons, only two bones are slightly different in men and women: the pelvis and the femur.
The female pelvis is broader than the male's, with wider and deeper inlets and outlets, and it has relatively less overall bone mass. (Technically the pelvis comprises four bones, but I'm considering it as a single entity since these bones are fused in adults.) As for the femur (thighbone), its head end--the one that fits snugly into the socket of the hip joint to form the body's strongest joint--forms the connection at a more pronounced angle, giving the pelvis more leeway to tip into the birthing position. Because of the broader female pelvis, the female femur also has a slightly greater angle of incline as it descends to the knee.
Anything else that you've heard or read about differences in joints, ligaments, and such is pure unproved conjecture. I won't even call it theory. I'm not knocking conjecture; I resort to it myself. But solid, undisputed evidence exists only for these two structural differences.
As for the skeletal muscles, they have no gender-specific shapes, composition, or locomotor functions. An artist illustrating a medical text would probably have to include genitals or a profile to clue readers to whether they were examining a male or a female.
Gray's Anatomy, first published in the mid-nineteenth century, recognizes that the human musculoskeletal system is the same for both males and females. Most of the illustrations in the 1901 edition, for example, are genderless. Intricate black-and-white line drawings powerfully convey the ruggedness of the human biomechanical structures that are common to both sexes. Looking at them, you could be reading a blueprint for an immense and revolutionary machine possessing the sheer might and ingenuity to change the face of the world--and, in fact, you are.
Unfortunately, the Gray's example is not widely followed these days. The latest edition of a classic kinesiology handbook has only five or six illustrations using female models, compared with dozens showing men as examples of strength and overall function. The same is true of a thick human anatomy and physiology text that describes itself as intended for students in health, medicine, and biology programs. Perhaps those authors and publishers were chary about displaying the unclothed female torso; if so, we need to start growing up. I'd like to think that when Brandi Chastain exuberantly doffed her jersey to celebrate her team's 1999 World Cup soccer championship playoff victory, the gesture made the pages of anatomy texts safe for sports bras.
Farewell to Tarzan
The suggestion that men are the gold standard of musculoskeletal fitness and function does triple-barreled mischief. For starters, it helps mislead women to believe that no matter what they do, they'll never achieve strength and functional parity with men--or even come reasonably close. This leads to a "Boys are strong, girls are weak" mentality that reinforces stereotypes that help deny women access to their aspirations.
Second, the notion that a woman's body is substandard or abnormal invites pharmaceutical and technological means to come to her aid and to correct these shortcomings.
One orthopedic clinic I know runs a newspaper ad that features an eye-catching illustration of a shapely, sexy leg--with the knee surrounded by construction scaffolding. The product is--what else?--reconstructive knee surgery for women. The ad even hints that beautiful knees are the work of a surgeon's scalpel. Inevitably, with more than 50 percent of the population as potential customers, the medical marketplace tries to provide a stream of new products to remedy the ever-widening circle of women's health problems and supposed design defects, like the "accident-prone" female knee.
The notion of female design defects leads to a self-fulfilling prophecy. If a woman is persuaded that her knees and muscles and bones are not designed to be strong and functional, the positive health benefits of having such strength and function will be lost to her. She will be frail, sick, and accident prone. No medical product ever devised can take the place of a healthy musculoskeletal system. But without a healthy system, there can only be a downward spiral of breakdown-intervention-breakdown-intervention. On that prediction, my crystal ball is absolutely clear.
The third piece of mischief is the supposition that men are stronger, fitter, and more functional than women. The male models in anatomy texts may seem that way, but their standard is a false one, because the vast majority of men have no material advantage. On average, men are somewhat larger (about 10 percent taller--big deal!), have less fat tissue (15 percent--how thrilling!), and more muscle mass (an underwhelming 15 percent) than women. These few small distinctions do not add up to significant differences.
A Curve That Keeps Us Straight
In Chapter 4 I'll explore more fully the differences--real and mythical--between men and women. In the meantime, we need to know more about the body's response to a force of nature that all humans must cope with: gravity. We tend to think of splitting the atom and landing on the moon as great feats of human genius. But they are nothing compared with our first conquest that took place about three million years ago, when Lucy knocked gravity on its butt.
Lucy is the name given to the fossil remains of our earliest known hominid ancestor to walk upright. She probably wasn't really the first, but with her demonstrated staying power, she can keep the gravity buster trophy until someone with a better claim comes along.
Gravity is a useful service: it keeps animate and inanimate objects from whirling off into space. But it also creates a problem for the animate objects, which have to animate themselves. To accomplish the job, they have evolved intriguing skills such as crawling on the belly, swimming through the sea, and taking wing to fly. The one that most fascinates me, though, is the one that involves hoisting a heavy three-foot-long pod containing a couple of buckets of blood and gurgling tissue up onto a pair of jointed stilts that are secured to two small platforms that any novice engineer would see are too tiny to balance the weight. Performing this feat of animation would be quite a challenge in its own right. But contriving to lift and swing those platforms forward one at a time with a roundish eight- or nine-pound canister, the skull, riding precariously on top is truly astounding. Yet not only does this antigravity package stay upright and moving, it will shake its bootie and dance the Watusi (if it's old enough to remember 1960s dance crazes).
Truly, just standing up and walking is a biomechanical marvel that we take totally for granted. Try it. Stand up, walk across the room, and come back.
Savor the experience.
You've just used a vehicle that makes a Boeing 757 seem as primitive as a skateboard. The 757 can only taxi down a runway and fly. You can run, jump, stretch, bend over at the waist, punch with your left, jab with your right, tap a keyboard, throw a fastball, paint water lilies, or play a Chopin étude. You have these myriad abilities because you were born with the necessary equipment as well as the potential for using it.
The soul of this machine--its core--is the spine. Its characteristic S-curve is what defeats gravity. A backbone that was absolutely straight and rigid would likely have kept us on all fours, or left us stiffly upright, able to move forward but not back or to the sides; once we were knocked off our feet, it would be nearly impossible to rise. As you can see in Figure 1-3, the S-curve creates a center of gravity that runs on a straight line from the head through the rib cage to the hips and down to the knees and ankles. It brings all the skeleton's heaviest components into balance and links them together in a way that yields vertical stability and horizontal flexibility on three cardinal planes of motion.
The spine and the pelvis are the musculoskeletal system's dream team. The spine rides on a pedestal formed by the pelvis's V-shaped sacrum, just above and around the bend from the hip-joint sockets. A head-to-toe connection is created. Working together, the pelvis and the spine allow us a range of motion that is unequaled by any other living creature. Without the spine we'd win the Olympic frog jump, but that's about it. Sans pelvis, we'd be second cousin to the rattlesnake.
The spine's S-curve configuration is produced by the shape and placement of the individual vertebral bones. Each is sized and molded to bring about the necessary overall angle to allow for a gentle flowing curve that's thicker and heavier at the base and lighter, tapered, and more flexible at the top. The vertebrae are stacked like poker chips, each separated by a small spongy pad, or disk, that acts as a cushion between them.
Although the bones of the spine hook together, after a fashion, what really keeps them united and able to hold the line of the S-curve is muscle power. The back has as many as five layers of muscles; the deepest are the spinal erectors, whose assignment is to keep us standing tall. But this assignment isn't easy to fulfill, given the persistence and power of gravity. The spine and its musculature need help from the rest of the musculoskeletal system.
That help comes mainly in the form of a superstructure that surrounds the spine on all four sides, like scaffolding. Stand up, and I will show you what I mean. Make sure that your feet are pointing straight ahead, parallel with each other, about twelve inches apart. Imagine a horizontal line running through your left shoulder joint and on through your right shoulder.
Imagine another horizontal line running through your left hip and on through your right hip. Imagine still another horizontal line running through your left knee on through your right knee.
Finally, imagine a fourth horizontal line running through your left ankle and on through your right ankle.
Okay? Now imagine a vertical line coming straight up from your left ankle through your left knee and left hip, then passing to the inside of your left shoulder so that it bisects your left ear. Imagine the same thing on the right side.
What have you got?
You've got a grid composed of horizontal and vertical lines that intersect at your principal load-bearing joints (Figure 1-4). The only ones that are slightly asymmetrical are the shoulders, because of the way we grow and how our shoulders work. Most people assume that the shoulder is the point where the clavicle attaches to the humerus (the upper-arm bone). And it is. But the shoulder is actually three points of articulation that constitute a joint complex spread out over enough real estate that the vertical lines of the grid cross it, even though not as obviously.
I'm running on about this because understanding the grid's role is fundamental to gaining an appreciation of how the musculoskeletal system moves smoothly and powerfully while staying erect. A grid consisting of exactly parallel horizontal and vertical lines is perfect for withstanding gravity's downward force. In the case of the musculoskeletal system, it uses the points of interaction--the ankles, knees, hips, and shoulders--to support, assist, and give the spine the structural integrity it needs without sacrificing flexibility.
This alignment of the joints allows us to shift our weight from side to side and front to back, so as to provide sequential four-point support when we walk and run--left front/right rear, right front/left rear, and so on. The hips and shoulders simultaneously rotate, rise, and fall in coordination. Meanwhile, the head, with its precious cargo of brains and eyes, stays level to look for danger and assess opportunities.
In the mechanical process that we call walking, roughly three and a half times your full body weight is projected downward onto one foot via the four load-bearing joints directly above, as the other foot is lifted off the ground and swung forward. The weight then transfers to the other side to repeat the loading of the foot, ankle, knee, hip, and shoulder. Individually, the joints aren't strong enough to handle that kind of a load. Not even the huge hip joint can take such a beating. But working together, it's a piece of cake.
The problem is that most of us ask our joints to go it alone. Our sedentary lifestyles have robbed us of our load-bearing alignment. The horizontal and vertical lines that I asked you to imagine are not parallel. The grid is askew; the scaffolding is tipped every which way. It's hardly an exaggeration to say that we are not walking so much as executing a controlled collapse. With each step, the scaffolding shudders and shakes forward, is caught just on the brink of falling, is steadied, and then is heaved forward again to bend and buckle. And away we go toward fatigue, stiffness, chronic pain, and increasing immobility.
Checking for Misalignment
The E-cises in this book are designed to correct and prevent musculoskeletal system misalignment. They are surprisingly effective and easy to do, because even though the body has undergone years of dysfunctional stress and strain, it never irretrievably loses its design.
When I first started out as an anatomical functionalist primarily helping people with back pain, I realized that every case--no matter how different the circumstances or the age of the individual--involved two things: observable skeletal misalignment and muscular weakness. What I developed was a method for strengthening key muscles and using them to restore and maintain alignment.
Over the years I've received many compliments and kind words about my work. But I don't deserve much credit--the human body is the real hero. If we pay attention, the body shows us what it needs in order to function properly. Once I realized that the starting point was always alignment--the grid, with its vertical and horizontal parallel lines--held in place by sufficient muscular strength to counteract the effects of gravity, I was able to see the misalignment and corresponding muscular weakness. When the grid is askew, there is dysfunction. Downward gravitational force guarantees it. The slumping structure stresses the joints and causes the spine to lose its S-curve. I can see it happening--and so can you.
From the Hardcover edition.
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