Clearing up some misconceptions about bone leverage
Pardon me if this page is not laid out in wonderful design. It is a technical discussion I felt it expedient to post.
If what you read below seems to go against what you have learned...
Well, Alvin Toffler covered it in Future Shock written way back in the 1970s: He wrote, improvements in technologies of all sorts are now coming so fast that the illiterate of the 21st century are not those who cannot read and write but those who cannot learn, unlearn and relearn.
(How long has your school been teaching the same things?
Are you using technologies developed in the middle of last century?
It is time to unlearn and relearn so you can do even more than
your teachers even imagined you would be able to do for your patients..
I just got a question, actually from an Orthopedist asking about ABC™ relating to his patients and what can really be done Some very specific questions about theory and how it differs from what others are saying.
He was pleasantly surprised that the answers made more sense to him than the ones he gave and had thought he understood. I think you will like this — especially if you have questions or do not quite understand ABC™ and how it works.
Let me know what you think. Email me at DrJutkowitz@AdvancedBioStructuralCorrection.com
Really. Let me know if this is easily understandable or not.
Also, please forward this to any who think that "bone leverage" cannot account for the changes in bodies. Below is explained a set of misperceptions that has kept the entire field of manipulation from gaining its place as the premier form of healthcare for humans not having infections or cancer or something of that nature as their major health problems.
The question involved some x-ray analysis that just about everyone treating bodies should take a look at because what is on the x-ray is often interpreted in a way that does not quite match up with what is found on dissection of bodies when one does x-rays on cadavers and then cuts them up to see what is there.
There are several sets of films involved in the question and answers. The ones at right are the first ones (left is film, right is MRI of same). There are blow-ups of the films below with the explanations.
This is the question that was asked by a medical orthopedist interested in manipulation:
I have a question regarding your theory — he is referring to bones out of place in a direction the body cannot self-correct because it has no muscles or combinations of muscles that can pull in the direction needed to reposition the bone.
More specifically, he was referring to the fact that there are no muscles or combinations of muscles that can pull vertebrae posterior.
(They can be pulled into extension. Some think enough extension will pull them posterior but those people do not take into account that the bones below the one anterior are not stable and so provide no leverage over which the muscles can pull a vertebra posterior.)
I have a few patients that only have POSTERIOR displacements of multiple vertebrae - without any obvious anterior displacements.I am sending you a couple of recent examples.
So, do you suggest there is indeed an anteriorly displaced vertebra, so slightly that is not even visible,that caused these major posterior displacements as compensations?
This is an often asked question so I figured I would post the answer publically.
(Done with his permission though he is not named.)
Some doctors get upset when I say things like this but it is just a statement not a criticism.
This question is a usual one and shows a basic misunderstanding and misperception by those who are not engineers or engineering oriented.
The first part of your question is about your statement " - without any obvious anterior displacements."
The second part is about posterior displacements.
I will cover them in that order.
Regarding anterior displacements that you term "not obvious":
One must understand that when the body twists in can obscure the effects of some forces. What you see grossly can be something that is twisted or bent in more than one direction. It is as you see it but there are forces hidden by the bend and twist.
That will be obvious in a moment.
In this first picture the lumbosacral disc angle is about 10 degrees.
15-20 degrees is considered normal.
That means that at the base of the spine where leverage to force the entire trunk forward is greatest, this body has a forward displacement of L5 that tilts the entire body forward between 5 and 10 degrees.
Considering the weight of the entire trunk ON AN ANGULAR BASIS, this is a rather large anterior. That statement considers L5 is at the largest leverage point in the body forcing the entire trunk anterior.
Many would think it is the pelvis that would be the largest lever forcing the body forward. However, if you do a bit of an experiment on several people you will find that 1 inch heels tilt the pelvis forward but all those people will be more upright with the heels.
The heels and forward pelvic tilt brings the trunk backward. This is because the pelvis is a lever in the opposite direction holding the trunk upright.
If that is the opposite of what you have been taught see directly below to do a physical experiment to confirm or deny what I have written.
You can confirm this by having the person sit on a flat chair and noting their position, a chair tilting backward -- shoulders will round body comes forward at the upper trunk, neck and head -- and in a chair that has the back part higher than the front -- body straighter with no effort.
Therefore you must not just think leverage but think ANGULAR leverage and angular momentum rather than linear.
A simple explanation of what that means is that lever arms are multiplied by Pi. So, every time you think there is leverage forcing the body forward, multiply that leverage by 3.14 and you will be closer to what is actually occurring.
Figuring the angular momentum of the entire trunk being levered forward 5 to 10 degrees with each movement is rather large. Look at the picture here with both angles.
Now think of the body pitched forward toward the black arrow rather than the red. Keep in mind the trunk is about half your height and about half or more of your weight. (Depends on leg length but take this as a starting point.) Also keep in mind this is if the normal is 15º and not 20º.
Therefore, even a fairly short guy like me (5'6") has a trunk length of 2½ -2¾ feet of trunk leaning forward above that point.
Most practitioners know about the head being forward having huge effects from pictures like this in which a 12 lb head has the effect of 250% of its weight when just an inch or so forward.
The point of the analysis of these lumbar films is that the head analysis above does not consider the weight of the trunk being forward. That is much more than 12 pounds on even the skinniest person. Think what it is on one with a belly. 🙂
As a matter of fact the change in angle specifically accounts for those severe posterior displacements because those severe displacements posterior are needed to compensate the very large force anterior created by the L5 anterior.
However, those posterior displacements are more than what they seem to be. Posterior stairstepping means ligamentous damage. Have you ever tried to pull rare meat from a bone? That would be dead and usually cooked. Think about the force it would take to cause that damage pulling a ligament from a bone in a live subject.
Those bones have not been pulled backward. They have fallen backward because of the damage -- not any normal process. But, there is more.
Keep in mind that the measured L/S disc angle of 10 degrees is only an APPARENT disc angle. Why is it only the APPARENT angle of the anterior?
Because the angle is 10 degrees with all those posterior displacements forcing the body to tilt quite far posterior. Because it is damage allowing the body to be leaned that far posterior and the body is still upright you have to account for that force.
Using the same considerations of the angle of the sacrum forcing the body forward consider the BACKWARD ANGLE change at the posterior displacements of L3 and L2. That is a bunch of force in the backward direction.
To counter that backward force of the posterior displacements means the actual anterior at L5 must be much more than just 5º-10º difference from normal. (The actual L/S disc angle must be much lower than 10º - see below.) If the actual angle was not even less than the 10º measured, the severity of the posterior displacements would throw the person over backwards. 🙂
By the way, that analysis indicates that as you improve this person's body mechanics the L/S disc angle will go DOWN and the lordosis will reverse — the opposite of what a more simple analysis might tell you to expect. This will happen as the body is good enough mechanically to be less twisted and long before the twist is out and the body is good enough to have the L/S angle begin to rise and the body configuration move toward what the average person would consider toward normal.
Think like an engineer. You see all those severe posteriors.
If all those posteriors are there what is keeping the body from falling over backward?
You must think like that every time you see something "obvious" that does not seem to have a counterbalancing force.
The alternative to thinking like that is to think there is magic preventing the body from falling over backward.
Unfortunately, the failure to take things like this into account by practitioners of manipulation has prevented the field of manipulation from being the main form of healthcare for bodies not having infections, cancer and things of that nature. If you use the Gonstead method everything you do is based on missing this analysis. It is why bodies do not consistently and predictably pop upright with no effort from any other method besides the Brand New Body System™.
If you want to save yourself some time and effort having to think all these things through — it only took me about a decade —
just press the button below and you will be off and running before the end of a week
and be more effective as a
practitioner than you have ever been.
Analyses like these are why we get practitioners sending us notes like this:
"I've been using the ABC Brand New Body System™ for about 5 years now. Measurable, consistent and predictable
all the way.
We did not believe it ourselves at first.
With the Brand New Body System
there are no realistic health goals...
only unrealistic time lines.
What I am able to do
for my patients is
"magic" in their minds.
Dr. Pete Hilgartner - Leesburg, VA
Do you know the saying, "This is not rocket science." Well, this is like rocket science. Here is why:
In the beginning of launching rockets the scientists would send up a rocket only to have it tilt sideways and crash.
The rocket usually blew up on impact so they could not look at the rocket to see what was wrong.
What they had to do was look at the film and plot the course of the rocket's flight mathematically. Analysis of that flight path would let them know what forces MUST have been present to make the rocket go in those undesired directions.
From that force analysis the engineers and scientists would look for factors that could make the rocket go in those directions. If they were right about what caused it the rocket would fly better next time.
Unfortunately, there were many more factors than they initially thought so it took many flights and analyses to figure it out enough to make rockets go where they wanted them to go.
That is very much the process I had to go through to come up with these analyses of bodies. Then I had to figure out what to fix.
Had I not one day wondered why the body did not just correct that the spinal bones going forward — and done a force analysis as well as a couple of x-rays putting a few bodies, including my own, into extension in an effort to correct some anteriors I would have never come upon the realization that the extensor muscles did not pull vertebrae posterior because there was no stable base from which they could pull.
That is short story of how I discovered the key to fixing bodies was knowing 'bones go out of place in a direction the body cannot self-correct because there are no muscles pulling in the direction needed to pull them back into proper position.
That is a bunch regarding that film but there is more about this film that no one will understand until they look at the film below and read the analysis of that one compared to the one above.
One point is that if you draw lines on the posterior aspect of the vertebrae you will see that L2 is quite an anterior displacement. Yes, I know the vertebra is in extension generally and there is stairstepping posterior.
A line at the posterior aspect of L3, L2 and L1 shows significant flexion of L2 compared to both L3 and L1 though it looks like it is in extension. Then, if you consider that T11 should be tilting posterior relative to T12 you have an anterior there too. Might not be obvious to those who do not understand the leverage and not draw the lines. See this below:
If that leaves you in a bit of a mystery watch this video:
See below for another film that explains how you can determine that the one above is actually worse than the measured 10 degree L/S disc angle seems to indicate.
So, the start of this page stated: "...without any obvious anterior displacements."
Hopefully that has been debunked for you but there is more below.
In this film the LS disc angle is approximately 3 degrees. Remember, the normal angle of the disc between L5 and S1 is 15 to 20 degrees. This is only 3 degrees.
That is 12 to 17 degrees anterior leverage at L5.
Again, a huge anterior displacement with very large leverage forcing the entire trunk anterior.
Look at the spondylosis of the anterior-superior vertebral bodies. Those are created in the sitting position because the body is so far anterior the pressures there are huge.
However, if you consider the spondylosis here versus the extreme displacements posterior in the above film without the spondylosis you should begin to wonder how that makes sense.
Well, the posterior stairstepping in that film indicates severe ligamentous damage. With no posterior stairstepping here you can get the idea this one is not quite as badly forced anterior as the person above.
YES, even though the disc angle here is 3º as opposed to what is measured at 10º above.
This is why I noted that the 10º measurement of the lumbosacral disc angle was an APPARENT measurement, not necessarily indicative of how much forward leverage there really was is on that spine at that spot.
Back to this film:
The 3 degree L/S disc angle indicates much anterior leverage. However, there is more. Note how little change there is in the AP tilt of L2 on L3 and the posterior stairstepping at L1-2.
Give this person some time and you will have something like the film above.
If this is new to you think of it like this:
It is like those Funniest Home videos where a person stands on an empty garbage can and then tries to jump forward.
The can can hold him against gravity (vertical force). The assumption is that because the can is stable in one direction (vertical) it will be so in all directions
However, the can is not stabilized sideways. Because he weighs much more than the can, his moment of inertia is so large compared to the can that when he pushes his legs to jump horizontally the can goes flying in the opposite direction while he moves very slightly..
That seems to be what happens with these analyses.
Practitioners assume that because the body is upright the leverage is in a straight line.
Very much not so.
Let me know what you think please.